Saturday, February 8, 2014

Standards of Practice for autism guide

Fred Volkmar, Matthew Siegel, Marc Woodbury-Smith, Bryan King, James McCracken, and Matthew State, the doctors who compose the American Academy of Child and Adolescent Psychology Committee on Quality Issues, created a new edition of the Practice Parameter for the Assessment and Treatment of Children and Adolescents with Autism Spectrum Disorder in The Journal of the American Academy of Child and Adolescent Psychiatry in February 2014. Two of the major reasons for the revision is the new diagnostic criteria of the DSM- IV-TR and the copious quantity of research undertaken within the field.

They examined the etiology of the disorder, particularly the neurobiological and familial/genetic factors. They found a high rate of epilepsy  and some support for neurological issues, including limbic system abnormalities and neurotransmitter elevations. They confirmed a lack of support for vaccine related causes, but leave the door open for immune system concerns in some cases. They highlight risk factors of close spacing of pregnancies, advanced maternal and paternal age, and extreme prematurity. They also confirmed the evidence for multiple genes to be involved in the disorder.

Under the section related to differential diagnosis, the authors identify many assessment tools. they then go on to identify common comorbid conditions such as intellectual disabilities in 80% of all cases, behavior difficulties (ex. hyperactivity, OCD, self-injury, tics, anxiety and depression), often defined by age, and attentional difficulties.

From there they make seven recommendations:
  1. early screening of all children
  2. diagnostic evaluations on children who are identified in the screenings
  3. multidisciplinary assessments
  4. support for families to obtain appropriate, evidence-based, structured educational and behavioral interventions
  5. pharmacotherapy targeting specific symptoms
  6. long-term support for the family and individual for treatment
  7. specific inquiries regarding alternative treatments, especially in light of the limited evidence supporting many of them

They offer an extensive listing of social-pragmatic programs and medications that have evidence to support their use. A teacher might be well served to have access to the medications listing to better understand the intention of the medications and side effects. I was pleased that sleep disturbances were identified as a concern. Many individuals and their families endure chronic sleep deprivation that must be addressed in order to improve their quality of life. Further there is support for combining medicine and parent training.

Of particular note is the multiple places where support for the family is indicated. Since autism is a disorder that has significant impact on the family especially stress levels which have been compared to soldiers in combat, professional support for families to thrive is essential. Providing wrap around services to families seems the gist.

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