Primary Care for Children with Autism

University of Utah, Salt Lake City, UT 84108, USA.
American family physician (Impact Factor: 2.18). 02/2010; 81(4):453-60.
Source: PubMed


The earliest sign of autism in children is the delayed attainment of social skill milestones, including joint attention, social orienting, and pretend play. Language impairment is a common, but less specific, sign of autism. Repetitive behaviors and restricted interests may not be noted until after social skill and communication impairments are exhibited. Physicians should perform developmental surveillance at all well-child visits, and the American Academy of Pediatrics recommends administering an autism-specific screening tool at the 18- and 24-month visits. A referral for comprehensive diagnostic evaluation is appropriate if concerns arise from surveillance, screening, or parental observations. The goals of long-term management are to maximize functional independence and community engagement, minimize maladaptive behaviors, and provide family and caregiver support. Physicians play an important role in coordinating care through an interdisciplinary team; referring families for specialized services; and treating children's associated conditions, including sleep disturbances, gastrointestinal problems, anxiety, and hyperactivity. Autism is a lifelong condition, but early recognition, diagnosis, and treatment can improve the prognosis, whereas associated medical conditions, psychiatric conditions, and intellectual disability can worsen the prognosis.

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Available from: Paul S Carbone
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    • "Compared to children without ASD, children with ASD have higher healthcare use, including physician visits; physical, occupational, or speech therapy; and treatment for emotional, developmental, or behavioral problems (Gurney et al., 2006). Treatment for ASD is multidisciplinary and includes applied behavioral analysis, speech therapy , occupational therapy, physical therapy, and medications to address symptoms of autism (Carbone et al., 2010; Myers, 2007; Myers and Johnson, 2007). "
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    ABSTRACT: The objectives of this study are to evaluate the employee benefits parents of children with autism spectrum disorders have, how benefits are used, work change, and job satisfaction. We conducted a cross-sectional mailed survey study of 435 families with children with autism spectrum disorders residing in the United States. We received 161 surveys for a response rate of 37%. Families reported using the following benefits: 39% paid family leave, 19% unpaid family leave, 91% flexible work arrangements, and 86% telecommuting. Of respondents, 43% reported stopping work, cutting down on hours worked, or changing jobs because of their child's condition. Having paid family leave was a positive predictor for job satisfaction. Parents of children with autism spectrum disorders have an interest and need for alternative work arrangements. © The Author(s) 2015.
    Full-text · Article · Sep 2015 · Autism
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    • "The clinical management of ASD aims to maximize the affected individual's functional independence and quality of life, and to mitigate carers' distress and burden [Carbone, Farley, & Do, 2010; Myers et al., 2007] by minimizing core symptoms, lowering the impact of associated mental health symptoms, and reducing maladaptive behaviors [Cadman et al., 2012]. A comprehensive treatment approach includes educational and behavioral programs and pharmacological treatment as an adjunct in the management of ASD [Myers et al., 2007]. "
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    ABSTRACT: There is significant variation in prescriptions among countries in clinical practice for the treatment of comorbidities associated with autism spectrum disorder (ASD). It has been suggested that many people with mental health disorders in low-/middle-income countries do not receive adequate treatment. Hence, this study investigated psychopharmacological treatment patterns for ASD comorbidities in 30 countries and the association between country's income and prescription rates.The IMS Prescribing Insights database was used to investigate prescription patterns for ASD comorbidity treatment from 2007 to 2012. Data were obtained from 30 countries in continents of Europe, Asia, Oceania, Central America, South America, and Africa. The gross domestic product (GDP) per capita was used as a proxy for each country's income. Spearman correlation was used to examine the association between prescription rate and GDP per capita.The highest prescription rates were found in Western Europe (3.89–36.36/10,000) while the lowest prescription rates were found in Asian countries, such as Turkey, Indonesia, Saudi Arabia, and Pakistan (0.04–0.82/10,000). The most commonly prescribed drug for ASD comorbidity treatment in most of the countries was risperidone, but antidepressants and antiepileptic drugs were also frequently prescribed. There was a significant positive correlation between GDP per capita and prescription rate (Spearman ρ = 0.60; P = 0.0011; 95% confidence interval 0.27–0.81), that is, the higher the GDP per capita, the higher the prescription rate.There are marked international differences in prescription rates, and this is partially accounted by economic factors. Future research should combine more data for ASD comorbidity treatment to explore the disparity of psychopharmacological treatment between countries. Autism Res 2014, ●●: ●●–●●. © 2014 International Society for Autism Research, Wiley Periodicals, Inc.
    Full-text · Article · Oct 2014 · Autism Research
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    • "The goals of ASD management are to maximize the affected person's functional independence and quality of life, and to alleviate family distress/carer burden by e-mail: minimizing core ASD symptoms, decreasing maladaptive behaviours (Myers et al. 2007; Carbone et al. 2010) and reducing the impact of associated mental health symptoms/ disorders such as anxiety and depression (Cadman et al. 2012). There are a number of educational and behavioural programmes that are routinely used to improve communication , social skills, academic achievement and decreasing maladaptive behaviours in patients with ASD, and pharmacological treatment may be considered an adjunct to these interventions for ASD management (Myers et al. 2007). "
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    ABSTRACT: Previous studies on psychotropic drugs prescribing in autism spectrum disorder (ASD) were from the USA or the UK. However, these studies may not be generalizable to other countries. There is a need to understand the extent of psychopharmacological prescribing for ASD treatment at a multinational level to identify areas of prescribing which lack evidence. We used the IMS Prescribing Insights database to investigate psychotropic drugs prescribing patterns for ASD treatment in children and adults in 2010-2012. Data were obtained from Europe (France, Germany, Italy, Spain and UK), South America (Mexico and Brazil), North America (Canada and USA) and Asia (Japan). North American countries have the highest prescription rates, followed by the European and South American countries. Prescribing rates were higher in children compared to adults in individual countries. The most commonly prescribed drug for ASD was risperidone in young people (except in UK and Japan). In the UK, methylphenidate (34 %) was the most commonly prescribed for young people and haloperidol (44.1 %) in Japan. In adults, the most commonly prescribed drug class was antipsychotics and particularly risperidone (thioridazine and ziprasidone were the most prescribed antipsychotics in Brazil and USA, respectively). There is variation in medication prescription for people with ASD among countries, which may be attributable to diagnostic criteria, clinical guidelines or health care systems. However, there is a lack of evidence of efficacy and safety for many psychotropic drugs prescribed for people with ASD. Research is needed to bridge the evidence gaps in prescribing.
    Full-text · Article · Sep 2013 · Psychopharmacology
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