The Executive Suite: Autism spectrum disorder at the intersection of pediatrics and primary care

Autism Spectrum Disorder (ASD) continues to be the fastest-growing serious developmental disability in the United States, impacting one in 36 children. Families on this journey often encounter formidable challenges as they seek the right resources for accurate diagnosis and treatment for their children. They often question if their primary care physician or pediatrician is the most qualified to make recommendations and if they need a referral to a developmental-behavioral pediatrician. An overview of these disciplines demonstrates the overlap in their roles and capabilities for addressing ASD.

Understanding ASD

The U.S. Centers for Disease Control & Prevention (CDC) defines ASD as a developmental disability caused by differences in the brain. Experts describe people with ASD as having problems with social communication and interaction, and restricted or repetitive behaviors or interests. They may also have different ways of learning, moving or paying attention.

The World Health Organization (WHO) reports that about one in 100 children has autism, and while characteristics may be detected in early childhood, autism is often not diagnosed until much later.

The American Academy of Family Physicians (AAFP) advises the earliest sign of autism in children is the delayed attainment of social skill milestones, including joint attention, social orienting and pretend play. They characterize language impairment as a common, but less specific, sign of autism, pointing to repetitive behaviors and restricted interests that may not be noted until after social skill and communication impairments are exhibited.

Diagnosis and referrals

Referrals for diagnostic evaluations are crucial. Pediatricians should perform developmental surveillance, administer autism-specific screenings at 18- and 24-month visits and refer for comprehensive evaluations when concerns arise. Simultaneous referrals to relevant specialists prevent delays in diagnosis and treatment.

Overlap in pediatric and family physician roles

Pediatricians, focused on infants, children and adolescents, often address ASD due to their emphasis on managing physical, behavioral and mental health. While pediatricians typically see patients under 18, family physicians, central to primary care, provide comprehensive health care for all ages. Both play vital roles in identifying and managing autism.Primary care's role

Primary care providers must understand ASD diagnostic criteria, differential diagnoses and available supports and services. Familiarity with co-occurring medical conditions ensures a holistic approach to care. While medications can address certain aspects, there's no single medical therapy effective for all ASD symptoms.
Pediatricians' contribution
Pediatricians should perform developmental surveillance, administer autism-specific screenings and provide referrals for diagnostic evaluations. The American Academy of Pediatrics (AAP) counsels physicians to perform developmental surveillance at all well-child visits, and also recommends administering an autism-specific screening tool at the 18- and 24-month. Understanding diagnostic criteria, differential diagnoses, available supports and managing co-occurring conditions are essential components of pediatric care.
Developmental-behavioral pediatricians
These specialists, with an additional three years of training in developmental and behavioral problems, provide in-depth evaluations, consider medical and psychosocial factors and offer counsel. They play a pivotal role in diagnosing autism and coordinating interventions, often collaborating with other specialists.

Early intervention matters

Research underscores the significance of early diagnosis and intervention, especially before the age of 2. Early interventions enhance long-term positive outcomes, with some children progressing to a point where they no longer fall within the autism spectrum.

Early interventions not only give children the best start possible, but also the best chance of developing to their full potential. The sooner a child gets help, the greater the chance for learning and progress. In fact, recent guidelines suggest starting an integrated developmental and behavioral intervention as soon as ASD is diagnosed or seriously suspected. Some children with autism make so much progress that they are no longer on the autism spectrum when they are older.

In the intersection of pediatrics and primary care, collaboration and understanding across disciplines are crucial. By leveraging the strengths of pediatricians, family physicians and developmental-behavioral pediatricians, we can create a comprehensive support network for individuals and families affected by ASD. This collaborative approach ensures that every child receives timely interventions, maximizing their potential for a fulfilling life.