Intervention for autistic spectrum disorders

Abstract

Summary:A comprehensive approach to the assessment of any child with autism must be matched specifically to each individual child and family. This premise holds for medical therapies and special education services as well as psychopharmacologic interventions. Behavioral, as opposed to pharmacologic, treatment is the hallmark of effective intervention for autism. Physicians involved in the care of children with autism need to become familiar with educational law and intervention recommendations. Goals should include improved functional verbal and nonverbal communication and social skills, increased engagement in developmentally appropriate activities, improved fine and gross motor skills, and the development of independent academic and organizations skills, as well as replacement of problem behaviors with developmentally appropriate behaviors.. Medicating children with autism is difficult, but is often necessary for chronic behavioral difficulties. In the absence of clear and present guidelines, we have attempted to use evidence and clinical experience to suggest an algorithm based on symptom clusters. Although children with autism may be responsive to medications at lower doses and more susceptible to side effects than other children, medical intervention can produce a significant improvement in the quality of life for the child and family. Careful thought leading to correct identification of target behaviors can appropriately direct better alternatives for medication. Although these approaches are costly and time-consuming endeavors, the expenditure of such efforts is the only available pathway to improve the potential outcomes for individuals with autism as well as decrease the lifetime societal costs for each individual.

Change in Autism Symptoms and Maladaptive Behaviors in Adolescents and Adults with an Autism Spectrum Disorder

“…However, the ADI-R is not a self-administered instrument but rather is scored by trained interviewers based on parent responses to structured probes. It is currently recognized as the "gold standard" measure for evaluating autism symptoms (Filipek et al, 1999), and prior research has established strong agreement between ADI-R ratings based on parent report and expert ratings based on direct clinical assessment (Lord et al, 1994(Lord et al, , 1997. Likewise, the SIB-R has been extensively validated in large samples and correspondence between parent and clinician ratings is strong (Bruininks et al, 1996).…”

Sensory Sensitivities and Performance on Sensory Perceptual Tasks in High-functioning Individuals with Autism

“…The diagnosis of autism was established through two structured research diagnostic instruments, the Autism Diagnostic Interview-Revised (ADI-R: Lord, Rutter, & LeCouteur, 1994) and the Autism Diagnostic Observation Schedule-General (ADOS-G: Lord, Rutter, Dilavore, & Risi, 1999) and confirmed by expert clinical opinion in accordance with accepted clinical descriptions of high functioning autistic individuals (Minshew, 1996;Filipek et al, 1999). All subjects in the autism group met criteria for autism on all three domains of the ADI and the age cut off, and both the social and communication cut offs and the total cut off on the ADOS.…”

Language outcomes of toddlers with autism spectrum disorders: a two year follow‐up

“…Until recently children with ASDs were rarely diagnosed before the age of 3-4 years, [Chakrabarti & Fombonne, 2001;Charman & Baird, 2002;Fombonne, 2005;Filipek et al, 1999]. But a major thrust of current research has been to lower the age of identification, due in part to evidence supporting the effectiveness of early intervention [Rogers, 2006;Stahmer, Ingersoll, & Koegel, 2004].…”