Medical Management of Autism Spectrum Disorders
When autism was first described in the 1940's as a unique condition, it was thought to be caused by poor parenting -- specifically poor parenting on the part of mothers who did not engage their child emotionally.
We've come a long way since that time in our understanding of autism and related conditions. Today, researchers describe ASD as a neurological disorder. For reasons that are not well understood, the brain develops differently in individuals who experience ASD. Although still diagnosed by observing its behavioral symptoms (as opposed to using a medical marker such as a blood test), ASD is now understood to be a medical condition that requires a specific type of medical management.
Once a diagnosis of ASD is clearly established, the medical issues related to ASD can be divided into three categories:
- Those related to the treatment of the core symptoms of ASD: These issues include prescribing occupational, speech, physical, and/or behavioral therapy; managing medications for symptom management; and coordinating referral to specialty healthcare providers as needed. In order to secure insurance coverage, primary care physicians are increasingly being called upon to authorize the overall treatment plan for young children receiving intensive interventions.
- Those related to other medical conditions that appear to be more common in individuals with ASD: Seizure disorders, allergies, gastrointestinal issues, and psychiatric conditions such as depression are among the health issues that researchers are investigating in relation to ASD. The findings vary in how clearly associated the link is between any of these conditions and ASD. However, evidence is strong enough to merit that patient and family concerns be taken seriously. Because of their communication challenges, individuals with ASD may be especially poor at reporting symptoms. It is not unusual for children and even adults with ASD to suffer from untreated pain that has been dismissed as "part of their autism".
- Those related to routine healthcare: Both acute and preventative care can be more challenging to provide to individuals who experience ASD. For example, because of the sensory differences that may accompany ASD, routine hygiene, procedures like dental fillings, blood draws, and weight management may present unique challenges for healthcare providers who see patients with ASD.
The primary care provider -- usually a pediatrician, family doctor, or general internist (for adults) -- plays an important role in managing these complex health concerns. For children with ASD, it is strongly recommended that primary care be provided by a practice that uses a "medical home" approach. Additionally, the American Academy of Pediatrics (AAP) has established care management guidelines for ASD which can assist parents in asking appropriate questions when working with their child's doctor.
What They Do
- Conducts routine screening for developmental delays at well child check ups; screens for ASD at 18 and 24 months.
- Helps to interpret an ASD diagnosis.
- Coordinates referral to medical specialists as needed.
- May assist in securing insurance coverage for therapies such as speech, occupational therapy, and behavior-based therapy (ABA).
- Advises when special accommodations are needed for routine procedures such a blood draw.
- Follows AAP Guidelines for the management of children with ASD.
Who's Who: A Family Guide to Providers
Primary Care Provider
Specialty Medical Provider
Psychologist, Social Worker,
Mental Health Counselor
- Helps with complex referrals for evaluation or specialty medical care.
- May help access insurance coverage.
- May facilitate communication with other services providers such as your child's special education team or providers of therapeutic services.
- Evaluation & treatment for co-occurring conditions that are thought to be or known to be more common in individuals with ASD -- e.g. gastrointestinal distress, seizures, and allergies.
- Ongoing evaluation if new symptoms emerge.
- Medication management for co-occurring conditions and/or behavioral symptoms such as depression, obsessive-compulsive disorder, and Tourettes Syndrome.
- Counseling, especially with regard to social skills development.
- Family counseling to assist in parenting and other issues.
- Accommodations as needed: Some children with ASD require gradual acclimation to routine dental procedures. Some children with ASD have routine dental work performed under full anesthesia.
- Assistance with sensory-related eating concerns or nutritional status of individuals with co-occurring gastrointestinal issues.
- Accommodations as needed.
Systems of Care, Medical Care
The NH Council on Autism Spectrum Disorders
21 S. Fruit Street
Concord, NH 03301
Copyright (c) 2012 NH Council on ASD, all right reserved
New Hampshire Council on Autism Spectrum Disorders
Putting the Pieces Together in the Granite State