What are the guideline sources, guidelines and references for Autism spectrum disorder ?
Guideline sources The following summarized guidelines for the evaluation and management of autism spectrum disorder (ASD) are prepared by our editorial team based on guidelines from the British Association for Psychopharmacology (BAP 2018), the U.S. Preventive Services Task Force (USPSTF 2016), and the American Academy of Child and Adolescent Psychiatry (AACAP 2014). 1 2 3 4 4 5 5 6 7 Definition ASD comprises a heterogeneous group of neurodevelopmental disorders characterized by early- onset deficits in social communication as well as restricted and repetitive interests and behaviors. 4 Epidemiology ASD is associated with alterations in brain connectivity resulting from a complex interaction of genetic, epigenetic and environmental factors. 5 Pathophysiology The prevalence of ASD in the United States is estimated at 1250-2410 persons per 100,000 population. 4 https://web.pathway.md/diseases/receYTB3zBBB9w2tb 1/4 6/23/23, 3:16 AM Autism spectrum disorder Pathway Disease course Clinical manifestations include developmental delay, deficits in social interaction, communication, and repetitive/restricted behaviors. Approximately 75% of patients with ASD have comorbid psychiatric conditions including anxiety, depression, attention-deficit hyperactivity disorder, bipolar disorder, and Tourette syndrome. 5 6 Prognosis and risk of recurrence Individuals with ASD have an estimated excess mortality rate ratio of 5.6. Associated medical disorders (including epilepsy with cognitive impairment) and accidents account for most of the deaths. 7 Calculator DSM 5 diagnostic criteria for aut Guidelines 1. Screening and diagnosis Indications for screening: as per USPSTF 2016 guidelines, insufficient evidence to assess the balance of benefits and harms of screening for ASD in young children for whom no concerns of ASD have been raised by their parents or a clinician. I Diagnostic process: Employ a multidisciplinary approach for the diagnosis of ASD. B Perform direct clinical assessment of the individual, and, wherever possible, obtain a detailed interview with the caregiver or other informants, reports from school and employment, and assessment of cognitive and language skills, and a medical examination. B Diagnostic criteria: Obtain a developmental history to support the diagnosis of ASD. B Use established diagnostic criteria, such as the DSM-5 criteria, for diagnosis of ASD. B 2. Diagnostic investigations Clinical assessment: include questions about ASD symptomatology in the developmental assessment of young children and in the psychiatric assessment of all children. B 3. Medical management https://web.pathway.md/diseases/receYTB3zBBB9w2tb 2/4 6/23/23, 3:16 AM Autism spectrum disorder Pathway Pharmacotherapy: As per BAP 2018 guidelines: Insufficient evidence to recommend any pharmacological agent for the routine management of ASD. I Avoid risperidone and aripiprazole in the management of repetitive behaviors in view of potential adverse effects. If used, clinicians should weigh up the risks and benefits and reevaluate these regularly. D As per AACAP 2014 guidelines, consider pharmacotherapy in children with ASD when there is a specific target symptom or comorbid condition. C 4. Nonpharmacologic interventions Alternative medicine: inquire about the use of alternative or complementary treatments and discuss their risk and potential benefits. B Behavioural interventions: assist families in obtaining appropriate, evidence-based, and structured educational and behavioral interventions for children with ASD. B 5. Specific circumstances Patients with depression: Individualize the approach to treatment of depression in pediatric patients with ASD. Follow established guidelines to treat depression. B Individualize the approach to treatment of depression in adult patients with ASD. Follow established guidelines to treat depression. B Patients with anxiety: consider a cautious trial of SSRIs in children with ASD and anxiety, followed by risperidone in patients in whom SSRIs are poorly efficacious. Monitor for worsening of anxiety in some children. C Patients with sleep disorders: Use melatonin, if possible, in combination with a behavioral intervention in children with sleep disorders occurring in the context of ASD. A Use melatonin, if possible, in combination with a behavioral intervention in adults with sleep disorders occurring in the context of ASD. B Patients with irritability: Consider risperidone or aripiprazole for the treatment of irritability in children with ASD only when behavioral or educational approaches have failed. B Consider aripiprazole, risperidone, or a SSRI for the treatment of of irritability in adults with ASD on a case-by-case basis, and only after considering alternatives. C Patients with ADHD: use methylphenidate as first-line therapy, and atomoxetine or alpha2a receptor agonists as second-line therapy, for the management of attention deficit hyperactivity https://web.pathway.md/diseases/receYTB3zBBB9w2tb 3/4 6/23/23, 3:16 AM Autism spectrum disorder Pathway disorder in patients with autism. A Patients with tic disorders and Tourette's syndrome: individualize treatment decisions in patients with ASD and tic disorders or Tourette's syndrome. B 6. Follow-up and surveillance Long-term support: maintain an active role in long-term treatment planning and in the support of the individual and the individual's family. B References 1. Howes OD, Rogdaki M, Findon JL et al. Autism spectrum disorder: Consensus guidelines on assessment, treatment and research from the British Association for Psychopharmacology. J Psychopharmacol. 2018 Jan;32 1 3 29. Open 2. Volkmar F, Siegel M, Woodbury-Smith M et al. Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2014 Feb;53 2 237 57. Open 3. Siu AL, US Preventive Services Task Force USPSTF , Bibbins-Domingo K et al. Screening USPSTF for Autism Spectrum Disorder in Young Children: US Preventive Services Task Force Recommendation Statement. JAMA. 2016 Feb 16;315 7 691 6. Open 4. Myers SM, Voigt RG, Colligan RC et al. Autism Spectrum Disorder: Incidence and Time Trends Over Two Decades in a Population-Based Birth Cohort. J Autism Dev Disord. 2019 Apr;49 4 1455 1474. Open 5. Sharma SR, Gonda X, Tarazi FI. Autism Spectrum Disorder: Classification, diagnosis and therapy. Pharmacol Ther. 2018 Oct;190 91 104. Open 6. Yenkoyan K, Grigoryan A, Fereshetyan K et al. Advances in understanding the pathophysiology of autism spectrum disorders. Behav Brain Res. 2017 Jul 28;331 92 101. Open 7. Bilder D, Botts EL, Smith KR et al. Excess mortality and causes of death in autism spectrum disorders: a follow up of the 1980s Utah/UCLA autism epidemiologic study. J Autism Dev Disord. 2013 May;43 5 1196 204. Open 8. Schaefer GB, Mendelsohn NJ, Professional Practice and Guidelines Committee. Clinical genetics evaluation in identifying the etiology of autism spectrum disorders: 2013 guideline revisions. Genet Med. 2013 May;15 5 399 407. Open 9. Anne Masi, Marilena M DeMayo, Nicholas Glozier et al. An Overview of Autism Spectrum Disorder, Heterogeneity and Treatment Options. Neurosci Bull. 2017 Apr;33 2 183 193. Open https://web.pathway.md/diseases/receYTB3zBBB9w2tb 4/4