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Paeds Topicsgrowth-development-and-behaviour

Paeds · growth-development-and-behaviour

Autism spectrum disorder

Also known as ASD · Autism · Autistic spectrum disorder · Asperger syndrome · Pervasive developmental disorder · PDD-NOS

Fellowship assessment and management of autism spectrum disorder: DSM-5-TR diagnosis, multimodal evaluation, early supports, comorbidity care, irritability pharmacotherapy with monitoring, crisis care, education interfaces and regional pathways.

high25 referencesUpdated 11 July 202613 min readVerification in progress

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Target exams

RACP General PaediatricsRACP DWERACP DCERCPCH Progress+MRCPCH TheoryMRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics

Red flags

  • Toddler with no name response, limited joint attention or pointing, language delay or regression, and restricted/repetitive behaviours — start supports and diagnostic pathway now, not watchful waiting
  • Developmental regression outside the early toddler window, or with seizures or focal neurology — exclude alternative encephalopathies
  • Severe self-injury, aggression with injury risk, or catastrophic meltdowns — functional analysis, medical pain screen, least-restrictive safety plan before antipsychotics
  • Autistic adolescent with new depression, suicidal ideation or self-harm — elevated suicide risk; do not dismiss as 'just autism'
  • Suspected catatonia (mutism, posturing, food or fluid refusal) — medical-psychiatric emergency pathway
  • New fixed delusions or hallucinations with functional break — assess for psychosis; do not diagnostic-overshadow

Life stages

infanttoddlerpreschoolschool-ageadolescentyoung-adult-transition

Care settings

preventive-medical-homecommunity-schooloutpatientwarded-acutetelehealthrural-remote

Clinical exam formats

written-onlyracp-dce-long-caseracp-dce-short-casemrcpch-short-clinicalmrcpch-developmentmrcpch-history-managementmrcpch-communicationmrcpch-videorcpsc-structured-oral

Board mappings

  • General and Community Paediatrics
  • Growth, development and behaviour
  • Autism spectrum disorder assessment and management
  • Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
  • Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
  • Neurodevelopmental disability and behavioural paediatrics competencies
  • Clinical Applications
  • Development, behaviour and neurodisability
  • Long Cases
  • Short Cases
  • 4. Professional skills and knowledge: Patient management
  • 5. Professional skills and knowledge: Health promotion and illness prevention
  • General Paediatrics: Assesses development and initiates appropriate management for neurodevelopmental conditions
  • Foundation of Practice (FOP)
  • Applied Knowledge in Practice (AKP)
  • Growth, development and neurodisability
  • Clinical
  • History
  • Communication
  • Development
  • General Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child Care
  • General Pediatrics Content Outline — Domain 9: Mental and Behavioral Health
  • General Pediatrics Content Outline — Domain 10: Neurology (as applicable to neurodevelopment)
  • Patient Care 4: Clinical Reasoning
  • Medical Knowledge 1: Clinical Knowledge
  • Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
  • Medical Expert
  • Communicator
  • Pediatrics: Foundations EPA — Assessing growth and development
  • Pediatrics: Core EPA — Managing common developmental and behavioural conditions
On this page
Study tools

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Practise this topic

  • Short-answer question1
  • Viva station1
  • Clinical case1

Target exams

RACP General PaediatricsRACP DWERACP DCERCPCH Progress+MRCPCH TheoryMRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics

Red flags

  • Toddler with no name response, limited joint attention or pointing, language delay or regression, and restricted/repetitive behaviours — start supports and diagnostic pathway now, not watchful waiting
  • Developmental regression outside the early toddler window, or with seizures or focal neurology — exclude alternative encephalopathies
  • Severe self-injury, aggression with injury risk, or catastrophic meltdowns — functional analysis, medical pain screen, least-restrictive safety plan before antipsychotics
  • Autistic adolescent with new depression, suicidal ideation or self-harm — elevated suicide risk; do not dismiss as 'just autism'
  • Suspected catatonia (mutism, posturing, food or fluid refusal) — medical-psychiatric emergency pathway
  • New fixed delusions or hallucinations with functional break — assess for psychosis; do not diagnostic-overshadow

Life stages

infanttoddlerpreschoolschool-ageadolescentyoung-adult-transition

Care settings

preventive-medical-homecommunity-schooloutpatientwarded-acutetelehealthrural-remote

Clinical exam formats

written-onlyracp-dce-long-caseracp-dce-short-casemrcpch-short-clinicalmrcpch-developmentmrcpch-history-managementmrcpch-communicationmrcpch-videorcpsc-structured-oral

Board mappings

  • General and Community Paediatrics
  • Growth, development and behaviour
  • Autism spectrum disorder assessment and management
  • Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
  • Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
  • Neurodevelopmental disability and behavioural paediatrics competencies
  • Clinical Applications
  • Development, behaviour and neurodisability
  • Long Cases
  • Short Cases
  • 4. Professional skills and knowledge: Patient management
  • 5. Professional skills and knowledge: Health promotion and illness prevention
  • General Paediatrics: Assesses development and initiates appropriate management for neurodevelopmental conditions
  • Foundation of Practice (FOP)
  • Applied Knowledge in Practice (AKP)
  • Growth, development and neurodisability
  • Clinical
  • History
  • Communication
  • Development
  • General Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child Care
  • General Pediatrics Content Outline — Domain 9: Mental and Behavioral Health
  • General Pediatrics Content Outline — Domain 10: Neurology (as applicable to neurodevelopment)
  • Patient Care 4: Clinical Reasoning
  • Medical Knowledge 1: Clinical Knowledge
  • Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
  • Medical Expert
  • Communicator
  • Pediatrics: Foundations EPA — Assessing growth and development
  • Pediatrics: Core EPA — Managing common developmental and behavioural conditions
The fellowship answer

ASD is a lifelong neurodevelopmental diagnosis. You need persistent social-communication differences across all three DSM-5-TR domains plus restricted/repetitive behaviours in at least two of four domains, with early developmental onset and real-world impairment. No medicine treats core social-communication deficits. Start developmental, educational and parent-mediated supports early — often while assessment is still running. Treat comorbidities. Reserve risperidone or aripiprazole for severe irritability after behavioural formulation, with full metabolic monitoring. [1] [8] [9] [11]

A caregiver brings a three-year-old who “lives in his own world.” He lines up cars, panics when the route home changes, and does not look when his name is called at childcare. Your job is not only to label or not label. You must decide what is unsafe today, what supports start this week, and how diagnosis will change the plan. Early red-flag surveillance and screening tools live on the sister page Social communication concerns and autism recognition. This page owns assessment, confirmation, medical work-up, intervention ladder and irritability pharmacology. [1] [2] [18]

Overview & Definition

ASD is a neurodevelopmental condition. It is not progressive neurodegeneration and not a personality style. Core features are (1) persistent deficits in social communication and social interaction across contexts, and (2) restricted, repetitive patterns of behaviour, interests or activities. Features are present in the early developmental period. They may not fully show until social demands exceed capacity. They cause clinically significant impairment. They are not better explained by intellectual developmental disorder alone. When both occur, social communication must sit below that expected for the child’s general developmental level. [1] [3]

DSM-5 collapsed older labels (autistic disorder, Asperger disorder, PDD-NOS) into one spectrum with severity levels and clinical specifiers. ICD-11 uses the same broad clinical construct for multi-board candidates. Use the current operational criteria in your exam answer; do not spend viva time defending historical taxonomy. [2] [3]

Definition you can say aloud

“This child meets criteria for autism spectrum disorder: multi-setting social-communication differences across all three domains plus restricted/repetitive behaviours, with developmental onset and functional impairment. That is a clinical diagnosis supported by tools, not a lab test.” [1] [2]

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References25ShowHide
  1. [1]Hyman SL Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics, 2020.PMID 31843864
  2. [2]Volkmar F Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 2014.PMID 24472258
  3. [3]Lai MC Autism. Lancet, 2014.PMID 24074734
  4. [4]Maenner MJ Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MMWR. Surveillance summaries, 2023.PMID 36952288
  5. [5]Zeidan J Global prevalence of autism: A systematic review update. Autism research, 2022.PMID 35238171
  6. [6]Sandin S The Heritability of Autism Spectrum Disorder. JAMA, 2017.PMID 28973605
  7. [7]Bai D Association of Genetic and Environmental Factors With Autism in a 5-Country Cohort. JAMA psychiatry, 2019.PMID 31314057
  8. [8]McCracken JT Risperidone in children with autism and serious behavioral problems. The New England journal of medicine, 2002.PMID 12151468
  9. [9]Owen R Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder. Pediatrics, 2009.PMID 19948625
  10. [10]Marcus RN Aripiprazole in the treatment of irritability in pediatric patients (aged 6-17 years) with autistic disorder: results from a 52-week, open-label study. Journal of child and adolescent psychopharmacology, 2011.PMID 21663425
  11. [11]Dawson G Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics, 2010.PMID 19948568
  12. [12]Green J Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial. Lancet, 2010.PMID 20494434
  13. [13]Pickles A Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial. Lancet, 2016.PMID 27793431
  14. [14]Bearss K Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: a randomized clinical trial. JAMA, 2015.PMID 25898050
  15. [15]King BH Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism. Archives of general psychiatry, 2009.PMID 19487623
  16. [16]Fung LK Pharmacologic Treatment of Severe Irritability and Problem Behaviors in Autism: A Systematic Review and Meta-analysis. Pediatrics, 2016.PMID 26908468
  17. [17]Simonoff E Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 2008.PMID 18645422
  18. [18]Robins DL Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics, 2014.PMID 24366990
  19. [19]Schaefer GB Clinical genetics evaluation in identifying the etiology of autism spectrum disorders: 2013 guideline revisions. Genetics in medicine, 2013.PMID 23519317
  20. [20]Lord C The Lancet Commission on the future of care and clinical research in autism. Lancet, 2022.PMID 34883054
  21. [21]Hirvikoski T Premature mortality in autism spectrum disorder. The British journal of psychiatry, 2016.PMID 26541693
  22. [22]Cassidy S Understanding and prevention of suicide in autism. The Lancet. Psychiatry, 2017.PMID 28551299
  23. [23]Reichow B Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). The Cochrane database of systematic reviews, 2018.PMID 29742275
  24. [24]Scahill L Extended-Release Guanfacine for Hyperactivity in Children With Autism Spectrum Disorder. The American journal of psychiatry, 2015.PMID 26315981
  25. [25]Gringras P Melatonin for sleep problems in children with neurodevelopmental disorders: randomised double masked placebo controlled trial. BMJ, 2012.PMID 23129488

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