American Speech-Language-Hearing Association

EBP Compendium: Summary of Clinical Practice Guideline

American Academy of Pediatrics; Council on Children with Disabilities
Identification and Evaluation of Children with Autism Spectrum Disorders

Johnson, C. P., & Myers, S. M. (2007).
Pediatrics, 120(5), 1183–215.

AGREE Rating: Recommended with Provisos

Description:

This guideline provides recommendations for diagnosis, screening and assessment of children with autism spectrum disorder (ASD). The primary audience intended for this guideline is pediatricians.

Recommendations:

  • Assessment/Diagnosis
    • Assessment Areas 
      • Cognition/Language - Clinicians must differentiate typical from autistic echolalia and often refer for a formal speech-language evaluation by a speech-language pathologist (p. 1192).
      • Hearing - An audiologic evaluation is recommended for all children with language delays including children with suspected ASD regardless of the result of the neonatal screening. If behavioral audiometry is unsuccessful, auditory brainstem or brainstem auditory evoked-response tests can be used. Sedation will likely be necessary (p. 1203).
    • Assessment Instruments
      • Screening
        • General developmental screening tools may be used with unselected primary care populations. These tools are likely to detect developmental disorders, including ASDs; however, they do not differentiate children with ASD from children with developmental disorders. Data are not available on the sensitivity of ASD detection (p. 1199).
        • There are several tools currently being developed to screen children “at risk” for autism who are younger than 18 months; however, no tools are currently available for clinical use (p. 1199).
        • While many level 2 screening tools (i.e., tools that are used in developmental clinics and early intervention programs as opposed to primary care facilities) have been marketed for identification of older at-risk children, these tools require further comparative research before one can be recommended over another (p. 1199).
        • “Among the tools designed for screening the elementary school-aged population, only the Childhood Asperger Syndrome Test (CAST) has been assessed in a large, unselected population as a level 1 (i.e., general population) screening tool. The authors concluded that the CAST is useful as a screening test for ASDs in epidemiologic research but that there is not enough evidence to recommend it for routine screening in the general population as part of a public health program” (pp. 1201-1202).
        • Several tools are available for screening at-risk children who are 18 months or older. “Some measures, such as the Checklist for Autism in Toddlers (CHAT), Modified Checklist for Autism in Toddlers (M-CHAT), and Pervasive Developmental Disorders Screening Test-II Primary Care Screener were designed specifically for early detection of ASDs in young children” (p. 1199).
  • Treatment
    • Cognition/Language
      • General Findings - "Factors associated with better outcomes include early identification resulting in early enrollment in appropriate intervention programs and successful inclusion in regular educational and community settings with typically developing peers” (p. 1206).
  • Service Delivery
    • Provider
      • “Other professionals, such as child psychologists, SLPs, pediatric occupational therapists, and social workers with expertise in ASDs, can be helpful by performing independent evaluations, often using standardized tools that can assist in the diagnostic process, especially when no team or pediatric ‘expert’ is available… the American Speech-Language-Hearing Association published guidelines that stated that an SLP with expertise in ASDs can make the diagnosis independently when other resources are not available” (p. 1202).

Keywords: Autism Spectrum Disorders

Access the Guideline

Added to Compendium: November 2010

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