Thursday, September 23, 2010

Autism: recognition and management

The September 15th edition of AFP Journal Club reviews an analysis of evidence behind the persistent but scientifically discredited hypothesis that the measles, mumps, and rubella (MMR) vaccine causes children to develop autism. Since a 1998 case series published in The Lancet first suggested this hypothesis, 13 large ecologic and observational studies performed worldwide have shown no association between the receipt of MMR vaccine and autism. Nonetheless, many parents continue to believe that delaying or refusing MMR vaccine and other immunizations will protect their children from harm. Dr. Andrea Darby-Stewart notes that this is a critical educational opportunity:

A national survey conducted in 2003 to 2004 indicated that more than one fourth of all U.S. parents were either unsure of vaccine safety or refused or delayed vaccination of their children because of safety concerns. However, the most important take-home point from that survey was that the parents who changed their minds and immunized their children did so because of information and assurance provided by their health care professional. Indeed, we do make a difference!

An AFP article published earlier this year reviews guidance for family physicians on how to coordinate medical and behavioral care for children who have been diagnosed with an autism spectrum disorder. More controversial is a 2007 practice guideline from the American Academy of Pediatrics that recommends that primary care clinicians routinely screen children at nine, 18, 24, and 30 months of age using an autism-specific screening tool. In light of the uncertain evidence for improved outcomes in children identified by screening, the American Academy of Family Physicians recently nominated "Screening for Autism in Children" as a new topic for review by the U.S. Preventive Services Task Force.

Given the steadily rising prevalence of autism spectrum disorders (approaching 1 in 100 U.S. children) and that autism can present with subtle symptoms in its early stages, what approach do you take to identify this condition in practice, if any?

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