Case challenges in autism spectrum disorder: the role of the pediatrician.

Pediatricians play a crucial role in the evaluation and management of autism spectrum disorders. This role has grown in importance as the prevalence of autism has increased by 78% since 2002, according to the Centers for Disease Control and Prevention.1 Pediatricians are charged with developmental screening and thus with the detection of cases of autism by using tools such as the Modified Checklist for Autism in Toddlers at 18 and 24 months. Algorithms exist to direct pediatricians to refer suspected cases for full multidisciplinary evaluation and treatment.2 To help with when the diagnosis and severity of the condition is not so clear, we have chosen case challenges that reflect important guide posts for the pediatrician treating children with autism spectrum disorders (ASD). These cases focus on higherfunctioning autism to provide help to the practicing clinician who may find little information on how to manage these patients situated at the boundary between disease and typical development. Often, fewer clinical services are available for children with ASD who may not qualify for educational services through the school system unless comorbid conditions such as attention-deficit/hyperactivity (ADHD) disorder exist. In autism treatment centers, in an effort to minimize lifelong disability, priority is rightly placed on delivering intense levels of services to those patients with critical deficits in speech and occupational functioning. It can be challenging to find speech and language pathologists experienced and willing to work with children who have intact speech basics but have deficits in the “pragmatic nature” and social interactive elements of speech. Children with milder levels of autistic symptoms also generally do not qualify for intense waiver-based state services, which allow for case management and focused behavioral therapies. Pediatricians should remain aware of grass roots efforts and parent organizations such as Families for Early Autism Treatment (FEAT) and Autism Speaks, which offer important support and directions for parents exhausted by the needs presented by these children. The outpatient diagnosis of higher-functioning ASD can be difficult because the deficits of social interaction are milder and harder to identify. The case challenge addressing this question (see page 411) offers information on common clinical symptoms and clinical scales to help make a diagnosis.