Clinical Review

Diagnosis and management of autism in childhood

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d6238 (Published 21 October 2011) Cite this as: BMJ 2011;343:d6238
  1. Stephanie Blenner, assistant professor of pediatrics1,
  2. Arathi Reddy, developmental behavioral pediatrician2,
  3. Marilyn Augustyn, associate professor of pediatrics, division director1
  1. 1Division of Developmental Behavioral Pediatrics, Boston University School of Medicine, Boston, MA 02118, USA
  2. 2Boston Medical Center, Boston, MA, USA
  1. Correspondence to: S Blenner stephanie.blenner{at}bmc.org

Summary points

  • Autism spectrum disorders are neurodevelopmental conditions that share core impairments in social reciprocity, communication, and behaviour but have a range of presentations

  • The prevalence of autism has increased over the past 15 years, partly because the definition now includes milder forms of the disorder

  • Genetic factors and potential environmental causes are being studied; vaccines have been shown not to be associated with autism in multiple studies

  • Surveillance and screening by the general clinician allow affected children to be identified early and to gain access to crucial early interventions

  • Most management strategies aim to improve communication, cognitive abilities, and social and daily living skills, while decreasing maladaptive behaviour

  • Involvement of general clinicians and paediatricians in ongoing care helps families access services and prioritise and plan for future needs

Autism spectrum disorder is a commonly used umbrella term for a class of neurodevelopmental disorders characterised by a triad of deficits in social reciprocity, impaired communication, and repetitive restricted patterns of behaviour or interests. Symptoms are evident in early childhood, often before age 3 years, and result in functional impairment. Autism was first described in the 1940s; it was originally thought to be relatively rare because only the most severely affected people were identified. However, epidemiological studies have documented an increasing prevalence over the past 15 years, with one UK cohort study from 2006 reporting a prevalence rate of about one in 110 children compared with four to five cases per 10 000 before the 1990s.1 This reflects, in part, recognition of a broader phenotype of affected individuals who share impairments within the three core areas.2

It is crucial that general clinicians are familiar with the diagnosis and management of autism because the importance of early identification and intervention, and the benefit of supporting families in navigating the myriad of decisions once …

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