From the Guidelines
For an 11-year-old with behavioral concerns and possible Autism Spectrum Disorder (ASD), the best initial referral would be to a developmental-behavioral pediatrician or child psychiatrist specializing in neurodevelopmental disorders. These specialists can conduct comprehensive evaluations including standardized assessments like the Autism Diagnostic Observation Schedule (ADOS-2) and the Autism Diagnostic Interview-Revised (ADI-R) 1. A child psychologist with expertise in ASD is also appropriate, particularly for cognitive and behavioral assessments. The evaluation process typically involves multiple appointments and may include questionnaires for parents and teachers, direct observation, cognitive testing, and speech-language assessment.
While waiting for specialist appointments, which often have long wait times of 3-6 months, parents should contact their school district to request educational evaluations and consider connecting with local autism support organizations. Early intervention is crucial as proper diagnosis allows access to appropriate therapies like Applied Behavior Analysis (ABA), speech therapy, occupational therapy, and social skills training 1. Additionally, addressing co-occurring conditions such as ADHD, anxiety, or learning disabilities is essential for comprehensive treatment planning.
Some key considerations in the evaluation and treatment of ASD include:
- Comprehensive multidisciplinary assessment, including medical, psychological, and communication assessments 1
- Active involvement of families and/or caregivers as part of the intervention, which can have a positive impact on developmental outcomes 1
- Developmentally appropriate interventions that combine developmental and behavioral approaches, beginning as early as possible 1
- The use of standardized assessments and evidence-based interventions to ensure the best possible outcomes for the child.
It is also important to note that the evaluation and treatment of ASD should be individualized to the child's specific needs and circumstances, taking into account their unique strengths, challenges, and developmental profile 1. By prioritizing early intervention, comprehensive assessment, and evidence-based treatment, children with ASD can receive the support they need to thrive and reach their full potential.
From the FDA Drug Label
The efficacy of RISPERIDONE in the treatment of irritability associated with autistic disorder was established in two 8-week, placebo-controlled trials in children and adolescents (aged 5 to 16 years) who met the DSM-IV criteria for autistic disorder.
The 11-year-old with behavioral concerns and possible Autism Spectrum Disorder (ASD) should be referred to a child psychiatrist or a pediatric neurologist for a comprehensive evaluation and diagnosis.
- A multidisciplinary team including psychologists, therapists, and social workers may also be involved in the assessment and treatment plan.
- The patient may be evaluated using assessment scales such as the Aberrant Behavior Checklist (ABC) and the Clinical Global Impression - Change (CGI-C) scale to measure the emotional and behavioral symptoms of autism. 2
From the Research
Referral Options for an 11-year-old with Behavioral Concerns and Possible Autism Spectrum Disorder (ASD)
- The first point of contact for referral should be the child's pediatrician, as they play an important role in early recognition of autism spectrum disorders 3.
- Pediatricians can perform developmental surveillance and use autism-specific screening tools to identify potential signs of ASD 4.
- If concerns arise, a referral for a comprehensive diagnostic evaluation is appropriate, which may involve a coordinated Developmental-Behavioral Pediatrics and Pediatric Neurology diagnostic pathway 5.
- This pathway can help improve access to autism diagnostic services and reduce wait times for evaluation 5.
- The diagnostic evaluation may also involve genetic and metabolic testing, as up to 40% of individuals with ASD have genetic syndromes or chromosomal abnormalities 6.
Specialized Services and Support
- Once a diagnosis is made, referral to specialized services such as speech-language pathologists, psychologists, and occupational therapists may be necessary to support the child's developmental and behavioral needs 4, 5.
- Physicians can also play a role in coordinating care and referring families to community resources, such as support groups and educational programs 4.
- Treatment approaches may include behavioral interventions, pharmacological interventions, and psychiatric treatment approaches, which should be tailored to the individual child's needs and symptoms 7, 6.