CAN Consensus Statement

Autism and related disorders occur in as many as one in 500 children. Recognizing the need for uniform recommendations to help guide the initial diagnostic evaluation and referrals in this area, an initial working group of the Cure Autism Now Foundation promulgated the following consensus guidelines for autism screening and diagnostic referral. Although these recommendations were formulated using the best information currently available, they are likely to be modified as the results of additional studies become available; however, they provide a useful tool for clinicians involved in the management of children with autism and related developmental abnormalities. INTRODUCTION Autism is a neuropsychiatric syndrome characterized by onset prior to age 3 of severe abnormalities of reciprocal social relatedness; communication deficits (including deficits in language); and restricted, stereotyped patterns of interest and behaviors. Although autism has a wide spectrum of clinical presentations, it is distinct from other childhood neuropsychiatric disorders and primary forms of mental retardation. Autism presents a clinical challenge. Children with autism and related disorders, pervasive developmental disorders (PDDs), are often not diagnosed until several years after initially presenting for medical or behavioral evaluation. This is due in part to the lack of uniform guidelines for surveillance, diagnostic evaluation, and follow-up of children with autism and related disorders. Early diagnosis, however, may be essential to successful intervention in children with autism or other developmental language delay. Advances in developmental neurobiology and psychology suggest that the first few years of life represent a critical period for the development of many perceptual and higher-order processing systems in the human brain. Recent evidence also indicates that early identification and subsequent treatment may portend a better prognosis. Recognizing the need for early diagnosis and treatment, Cure Autism Now (CAN) convened this initial working group to produce the following consensus outline for screening, workup, and referral. Because few controlled trials have been conducted, in many areas this consensus is based on clinical experience and judgment. Therefore, these recommendations are likely to be modified as new data becomes available. Nevertheless, they represent the consensus of a group of neurologists, pediatricians, psychologists, and psychiatrists who are experienced in the diagnosis, evaluation, and treatment of children with autism, using the best information currently available. This consensus statement is intended as a brief outline and not a comprehensive guide. Detailed practice guidelines for children with PDD are forthcoming from the American Academy of Child and Adolescent Psychiatry (personal communication, F Volkmar and D. Cohen, January, 1998). General detailed guidelines for the workup of infants and toddlers with psychiatric disorders are available from that same organization. INITIAL SCREENING Autism and related disorders occur in between one and 500 and one in 1,000 children. Many pediatricians are uncertain how to proceed with the workup of the 1 to 2-year-old child who looks normal, but in whom the parents complain of delayed language or social behavior relative to other children. Parents may even report subtle regression. Because timely identification may lead to early intervention and better outcomes, a standard screening device that can help distinguish between potentially autistic and nonautistic behaviors, and identify most children at risk, would prove beneficial. The Checklist for Autism in Toddlers (CHAT) successfully identifies autism or PDD in may • Discuss the usefulness of a simple screening tool for autism and pervasive developmental disorders. • Identify appropriate neurodevelopmental evaluations in children with language delay or other indicia of autism. • Discuss appropriate laboratory studies for children with suspected autism. EDUCATIONAL OBJECTIVES *Cure Autism Now (CAN) Consensus Group: The following individuals participated in the conference, or through their reviews of the initial draft, made substantive contributions to this preliminary consensus. Dr. Daniel Geschwind is assistant professor of neurology and director of the neurogenetics program in the Department of Neurology at the UCLA School of Medicine. Dr. Jeffrey L. Cummings is professor of neurology and psychiatry at the UCLA School of Medicine. Dr. Eric Hollander is professor of psychiatry and clinical director of the Seaver Autism Research Center at The Mount Sinai School of Medicine in New York and the editor of the CNS Spectrums Journal. Feature Article CNS Spectrums Journal March 1998