Psych · Child and adolescent psychiatry — neurodevelopmental
Autism spectrum disorder
Also known as ASD · Autism · Autistic spectrum disorder · Asperger syndrome · Pervasive developmental disorder · PDD-NOS · Neurodevelopmental autism
Exam-exhaustive fellowship reference on autism spectrum disorder — DSM-5-TR criteria and levels, ICD-11 mapping, epidemiology and genetics, differentials (ADHD, intellectual disability, social anxiety, SCD, psychosis), multimodal assessment, behavioural and parent-mediated interventions, psychopharmacology for co-occurring irritability (risperidone and aripiprazole with monitoring), capacity, safeguarding and transition to adult care. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Toddler with no response to name, limited joint attention or pointing, language delay or regression, and restricted/repetitive behaviours — urgent developmental pathway, not watchful waiting
- Developmental regression outside the typical early toddler window, or with seizures or focal neurology — exclude alternative neurodevelopmental and epileptic encephalopathies
- Severe self-injury, aggression with injury risk, or catastrophic meltdowns — functional analysis, medical pain screen, least-restrictive safety plan; do not start antipsychotics without formulation
- Autistic adolescent or adult with new depression, suicidal ideation, or self-harm — suicide risk is elevated; do not dismiss as 'just autism'
- Suspected catatonia (mutism, posturing, refusal to eat or drink) in ASD — medical-psychiatric emergency pathway
- New fixed delusions or hallucinations with functional break — do not diagnostic-overshadow as 'autistic oddity'; assess for psychosis and organic causes
Meet the patient
A 7-year-old is referred because he "won't cooperate". He lines up his pencils before he can start, melts down when the fire alarm tests on Thursdays, has one friend and forty facts about trains, and has started hitting himself on the head at school. His mother has been asking about assessment since he was three.[1][15]
The referral asks for medication. The examiner will ask something else: "what is the behaviour achieving, and what have you already changed about the environment?" Answer that before you answer anything about risperidone.[12][14]
References20ShowHide
- [1]Hyman SL, Levy SE, Myers SM Identification, Evaluation, and Management of Children With Autism Spectrum Disorder Pediatrics, 2020.PMID 31843864
- [2]Lai MC, Lombardo MV, Baron-Cohen S Autism Lancet, 2014.PMID 24074734
- [3]Maenner MJ, Warren Z, Williams AR, et al. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020 MMWR Surveill Summ, 2023.PMID 36952288
- [4]Zeidan J, Fombonne E, Scorah J, et al. Global prevalence of autism: A systematic review update Autism Res, 2022.PMID 35238171
- [5]Sandin S, Lichtenstein P, Kuja-Halkola R, Hultman C, Larsson H, Reichenberg A The Heritability of Autism Spectrum Disorder JAMA, 2017.PMID 28973605
- [6]Bai D, Yip BHK, Windham GC, et al. Association of Genetic and Environmental Factors With Autism in a 5-Country Cohort JAMA Psychiatry, 2019.PMID 31314057
- [7]McCracken JT, McGough J, Shah B, et al. Risperidone in children with autism and serious behavioral problems N Engl J Med, 2002.PMID 12151468
- [8]Owen R, Sikich L, Marcus RN, et al. Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder Pediatrics, 2009.PMID 19948625
- [9]Dawson G, Rogers S, Munson J, et al. Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model Pediatrics, 2010.PMID 19948568
- [10]Green J, Charman T, McConachie H, et al. Parent-mediated communication-focused treatment in children with autism (PACT): a randomised controlled trial Lancet, 2010.PMID 20494434
- [11]Pickles A, Le Couteur A, Leadbitter K, et al. Parent-mediated social communication therapy for young children with autism (PACT): long-term follow-up of a randomised controlled trial Lancet, 2016.PMID 27793431
- [12]Bearss K, Johnson C, Smith T, et al. Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: a randomized clinical trial JAMA, 2015.PMID 25898050
- [13]King BH, Hollander E, Sikich L, et al. Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: citalopram ineffective in children with autism Arch Gen Psychiatry, 2009.PMID 19487623
- [14]Fung LK, Mahajan R, Nozzolillo A, et al. Pharmacologic Treatment of Severe Irritability and Problem Behaviors in Autism: A Systematic Review and Meta-analysis Pediatrics, 2016.PMID 26908468
- [15]Simonoff E, Pickles A, Charman T, Chandler S, Loucas T, Baird G Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample J Am Acad Child Adolesc Psychiatry, 2008.PMID 18645422
- [16]Volkmar F, Siegel M, Woodbury-Smith M, King B, McCracken J, State M; American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI) Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder J Am Acad Child Adolesc Psychiatry, 2014.PMID 24472258
- [17]Lord C, Charman T, Havdahl A, et al. The Lancet Commission on the future of care and clinical research in autism Lancet, 2022.PMID 34883054
- [18]Robins DL, Casagrande K, Barton M, Chen CM, Dumont-Mathieu T, Fein D Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F) Pediatrics, 2014.PMID 24366990
- [19]Hirvikoski T, Mittendorfer-Rutz E, Boman M, Larsson H, Lichtenstein P, Bölte S Premature mortality in autism spectrum disorder Br J Psychiatry, 2016.PMID 26541693
- [20]Cassidy S, Rodgers J Understanding and prevention of suicide in autism Lancet Psychiatry, 2017.PMID 28551299