Sections

Treatment

Approach Considerations

Individual intensive interventions, including behavioral, educational, and psychological components, are the most effective treatments of ASD. Beginning the treatment early in infancy increases the likelihood of a favorable outcome. Thus, regular screening of infants and toddlers for symptoms and signs of ASD is crucial because it allows for early identification of these patients. The American Academy of Pediatrics recommends referral for specialized diagnostic and therapeutic interventions as soon as symptoms or signs of ASD appear.^{[157, 1]}

Individuals with ASD typically benefit from behaviorally oriented therapeutic programs developed specifically for this population. Children with ASD should be placed in these specialized programs as soon as the diagnosis is entertained.

Parents, teachers, pediatricians, and other health care providers are advised to seek the assistance of people who are familiar with early intervention programs for children with ASD. The Autism Society can help parents to obtain appropriate referrals for optimal interventions.

Parents understandably become exhausted by the relentless performance of challenging behaviors by their child with ASD. A specially trained educator or behavioral psychologist can help to teach them effective ways to modify these challenging behaviors. Parents also frequently benefit from temporary respite from the child.

The possible benefits from pharmacotherapy must be balanced against the likely adverse effects on a case-by-case basis. In particular, venlafaxine may increase high-intensity aggression in some adolescents with ASD.^[10]

Limited, largely anecdotal evidence suggests that dietary measures may be helpful in some children with ASD. Avoidance of certain foods, notably those containing gluten or casein, and supplementation with specific vitamins and minerals have reportedly proved helpful in select cases.

The National Autism Center has initiated the National Standards Project, which has the goal of establishing a set of evidence-based standards for educational and behavioral interventions for children with ASD. The project has identified established, emerging, and unestablished treatments. Early identification of children with ASD followed by prompt institution of intensive interventions^[158]facilitates optimal outcomes.^[159]

Inpatient Psychiatric Care

In December 2015, an expert panel released 11 consensus statements on best practices for inpatient care of children with ASD. The panel recommends that children with ASD or intellectual disability (ID) can be treated in general inpatient psychiatric units, with specific accommodations. The recommendations also set out the information that should be obtained from children on admission, including the child's preferences, means of communication, reinforcement items, and sensory sensitivities. Also emphasized is the importance of screening for co-occurring medical and psychiatric conditions.^[160]

Special Education

Special education is central to the treatment of ASD. Although parents may choose to use various experimental treatments, including medication, they should concurrently use intensive individual special education by an educator familiar with instructing children who have ASD or a related condition. Intensive behavioral interventions, instituted as early as possible, are indicated for every child in whom ASD is suspected.^{[161, 162]}

The Education for All Handicapped Children Act of 1975 requires free and appropriate public education for all children, regardless of the extent and severity of their handicaps. Amendments to the Education of the Handicapped Act of 1986 extended the requirement for free and appropriate education to children aged 3–5 years.

Pediatricians and parents cannot assume, however, that their community’s school will provide satisfactory education for a child with ASD or a related condition. The Individuals with Disabilities Education Act authorized states to determine how to provide educational services to children younger than 3 years. Pediatricians and parents need to determine the best way to proceed with local agencies.

Legal assistance may be necessary to influence a board of education to fund appropriate education for a child with ASD or a related condition. The Autism Society maintains a Web site and offers a toll-free hotline (1-800-3-AUTISM/1-800-328-8476). This resource provides information and referral services to the public.

Speech, Behavioral, Occupational, and Physical Therapies

Therapies that are reported to help some individuals with autism spectrum disorder include the following:

Assisted communication - Using keyboards, letter boards, word boards, and other devices (eg, the Picture Exchange Communication System^[163]), with the assistance of a therapist
Auditory integration training - A procedure in which the individual listens to specially prepared sounds through headphones
Sensory integration therapy - A treatment for motor and sensory motor problems typically administered by occupational therapists
Exercise and physical therapy - Exercise is often therapeutic for individuals with autistic disorder; a regular program of activity prescribed by a physical therapist may be helpful

In addition, social skills training helps some children with ASD, including those with comorbid anxiety disorders.^[8]

In a 2-year randomized, controlled trial, children who received the Early Start Denver Model (ESDM), a comprehensive developmental behavioral intervention for improving outcomes of toddlers diagnosed with ASD, showed significant improvements in IQ, adaptive behavior, and autism diagnosis compared with children who received intervention commonly available in the community.^[164]A follow-up electroencephalographic study showed normalized patterns of brain activity in the ESDM group.151 Starting intervention at an earlier age and providing a greater number of intervention hours both related to the degree of improvement in children's behavior.^[165]

Cognitive behavior therapy (CBT)

Cognitive behavior therapy (CBT) is a technique that has been valuable for people with anxiety disorders, including social anxiety disorder. Individuals with ASD and social anxiety underwent CBT to address negative thoughts and social situations provoking anxiety to develop effective behavioral techniques. CBT represents a promising psychological treatment for people with ASD and social anxiety.^[166]

Family therapy

Living with a person with ASD can be stressful for family members. Talking therapy to ameliorate conflicts among people with ASD and other family members has been reported to be beneficial to people with ASD and to family members. Research is needed to assess family therapy for people with ASD.^[167]

Mind-body exercise

Practices such as Qigong benefit children with ASD by reducing the severity of sensory, behavioral, and language dysfunction.^{[168, 169]}

Diet

When compared with their typically developing (TD) peers, children with ASD are significantly more likely to experience GI problems and food allergies. According to one study, children with ASD were 6 to 8 times more likely to report frequent gas/bloating, constipation, diarrhea, and sensitivity to foods than TD children. Researchers also discovered a link between GI symptoms and maladaptive behavior in children with ASD. When these children had frequent GI symptoms, they showed worse irritability, social withdrawal, stereotypy, and hyperactivity compared with those without frequent symptoms.^{[170, 171]}

Individuals with or without ASD need 3 well-balanced meals daily. Dietary consultation may be useful to evaluate the benefits of special diets, including those lacking gluten and casein. Vitamin B-6 and magnesium are among the vitamins and minerals hypothesized to help some patients.^[172]

In a randomized, double-blind, placebo-controlled trial, 3 months of treatment with a vitamin/mineral supplement produced statistically significant improvement in the nutritional and metabolic status of children with ASD. In addition, the supplement group had significantly greater improvements than did the placebo group in its Parental Global Impressions-Revised (PGI-R) Average Change scores.^[173]

Additionally, preclinical and clinical studies indicate that dietary phenols alleviate symptoms of ASD.^[174]

Pharmacologic Treatment

Although 70% of children with ASD receive medications, only limited evidence exists that the beneficial effects outweigh the adverse effects.^[175]No pharmacologic agent is effective in the treatment of the core behavioral manifestations of ASD, but drugs may be effective in treating associated behavioral problems and comorbid disorders.^{[176, 177]}

The second-generation antipsychotic agents risperidone and aripiprazole provide beneficial effects on challenging and repetitive behaviors in children with ASD, although these patients may experience significant adverse effects.^[178]Risperidone and aripiprazole have been approved by the US Food and Drug Administration (FDA) for irritability associated with ASD. The second-generation antipsychotic agent ziprasidone may help to control aggression, irritability, and agitation.^[179]

Serotonergic drugs are reportedly beneficial for improving behavior in ASD. Hyperactivity often improves with methylphenidate therapy.

Additionally, treatments may be indicated for an underlying condition. For example, children with biotin-responsive infantile encephalopathy improve with the addition of biotin.

SSRIs

Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed for children with ASD and related conditions. Beneficial effects on children and adolescents with ASD have been reported with fluoxetine,^[180]escitalopram,^[181]and citalopram.^{[182, 183]}

On the other hand, a multicenter, randomized, controlled trial by King and colleagues in 149 children with ASD found no difference between citalopram and placebo among children rated as much improved or very much improved. Participants in the treatment arm received liquid citalopram daily for 12 weeks at a mean maximum daily dose of 16.5 mg (maximum 20 mg). Nearly all the citalopram recipients reported adverse effects (eg, impulsiveness, hyperactivity, diarrhea).^[184]

Serotonin syndrome

Children with ASD are at risk of developing a serotonin syndrome when treated with serotonergic agents. Therefore, children who are treated with serotonergic agents should be evaluated at baseline before beginning treatment and then regularly evaluated for symptoms of a serotonin syndrome using the serotonin syndrome checklist. See the image below for a printable version.

Serotonin syndrome checklist.

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Adverse effects and treatment efficacy

Children with ASD appear sensitive to medication and may experience serious adverse effects that outweigh any beneficial effects. For example, children may develop catatonia when treated with haloperidol and other traditional neuroleptics.^{[185, 186]}Additionally, Kem et al noted priapism in an adolescent with ASD who was treated with trazodone.^[187]

Practice guidelines from the American Academy of Pediatrics stress the importance of having some quantifiable means of assessing the efficacy of medication used for the treatment of children with ASD. Validated, treatment-sensitive rating scales that have been used in clinical practice to measure the effects of treatment on maladaptive behavior include the Clinical Global Impression Scale, the Aberrant Behavior Checklist, and the Nisonger Child Behavior Rating Form.^[188]

Experimental Approaches

Various interventions, including chiropractic manipulations, are reported to help with ASD. The results of individual case reports, however, cannot be generalized to the overall population; scientific research is needed to investigate whether treatments truly are generally helpful.

Transcranial magnetic stimulation

Repetitive transcranial magnetic stimulation has been reported to alleviate repetitive behaviors and improve social functioning in ASD.^[189]

Secretin therapy

Several anecdotal reports suggested that secretin, a gastrointestinal hormone that may function as a neurotransmitter, was an effective intervention for the symptoms of ASD. This led to several scientific studies of secretin for children with ASD.^{[190, 191, 192]}However, 2 reviews of these trials failed to demonstrate that secretin had a beneficial effect on these children.^{[193, 194]}

Hyperbaric oxygen therapy

Beneficial effects from hyperbaric oxygen therapy have been reported in 6 patients with ASD. The risks of this procedure must be weighed against the benefits for individual patients. Controlled clinical trials and other studies are needed to confirm the potential value of this intervention.

Intranasal oxytocin

Research suggests that administration of a single intranasal dose of the hormone oxytocin increases activity in brain regions associated with reward, social perception, and emotional awareness and temporarily improves social information processing in children with ASD.^{[195, 196]}

In the study of 17 high-functioning children and adolescents with ASD, brain centers associated with reward and emotion recognition responded more during social tasks when children received oxytocin instead of a placebo.

Although behavioral studies in children and adults suggest that a single dose of intranasal oxytocin improves social interaction and comprehension of affective speech, results from clinical trials examining the effect of daily administration of the drug have been mixed.

Specialist Resources

Children with ASD and related conditions typically benefit from intensive, thorough evaluation performed by experienced professionals. Intensive diagnostic evaluation and treatment are accomplished quickly and effectively by well-trained clinicians at well-staffed centers. Valuable resources are listed below.

Division of Developmental and Behavioral Pediatrics

University of Maryland Medical Center

737 West Lombard Street, First Floor

Baltimore, MD 21201

Phone: 410-706-2300

Fax: 410-706-5770

URL: http://www.medschool.umaryland.edu/pediatrics/Divisions/Division-of-Behavioral--Developmental-Pediatrics/

Yale Developmental Disabilities Clinic

Yale Child Study Center

Yale University School of Medicine

350 George Street, 2nd Floor

New Haven, CT 06511

Phone: 203-785-3420

URL: www.autism.fm

Seaver Autism Center for Research and Treatment

Icahn School of Medicine at Mount Sinai

Department of Psychiatry

Mount Sinai School of Medicine, Box 1230

One Gustave L Levy Place

New York, NY 10029

Phone: 212-241-0961

Email: theseavercenter@mssm.edu

URL: https://icahn.mssm.edu/research/seaver

Center for Autism and Related Disorders

Kennedy Krieger Institute

Creamer Family Building

3901 Greenspring Avenue

Baltimore, MD 21211

URL: https://www.kennedykrieger.org/patient-care/centers-and-programs/center-for-autism-and-related-disorders

Division of Child and Adolescent Psychiatry

Neuropsychiatric Hospital

University of California at Los Angeles

760 Westwood Plaza, Room 48-240

Los Angeles, CA 90024-1759

Phone: 310-825-9989 (800-825-9989 from outside 310)

URL: https://people.healthsciences.ucla.edu/institution/groups-detail?group_id=12516

Medical Investigation of Neurodevelopmental Disorders (MIND) Institute

University of California Davis Medical Center

2825 50th Street

Sacramento, CA 95817

Phone: 916-703-0280

URL: https://health.ucdavis.edu/mindinstitute/contactus/index.html

Strong Center for Developmental Disabilities

Department of Pediatrics

Children's Hospital at Strong

University of Rochester Medical Center

601 Elmwood Ave, Box 671

Rochester, NY 14642

URL: https://www.urmc.rochester.edu/strong-center-developmental-disabilities/contact-us.aspx

Consultations

Neuropsychological consultation can be helpful to assess intelligence. Deficits in simple and complex problem-solving tasks (verbal and nonverbal), are likely to be demonstrated on the following tests:

Wisconsin Card Sorting Test
Trail Making Test
Stanford-Binet Intelligence Test

Other consultations include the following:

Ophthalmologic consultation - May be indicated to rule out a treatable visual deficit; special lenses are reported to help some individuals with ASD.
Neurologic consultation with a movement disorder specialist - Indicated to evaluate tics and other movement disorders when present
Infectious disease consultation - May be helpful to rule out bacterial or fungal infections
Metabolic consultation - May help to identify any deficiencies
Immunologic consultation - May be useful to rule out immune abnormalities. The possible benefits of experimental treatments, such as intravenous (IV) immunoglobulin therapy, must be weighed against the risks of experimental treatments
Otolaryngologic consultation - May be indicated to rule out deficits in the auditory apparatus; additionally, audiography is indicated to rule out hearing deficits

Guidelines

[Guideline] Landa R. Bringing the early signs of autism spectrum disorder into focus. Youtube. Available at https://www.youtube.com/watch?v=YtvP5A5OHpU. 2013; Accessed: January 5, 2020.
Lord C, Elsabbagh M, Baird G, Veenstra-Vanderweele J. Autism spectrum disorder. Lancet. 2018 Aug 11. 392 (10146):508-520. [QxMD MEDLINE Link].
[Guideline] Filipek PA, et al. Practice parameter: screening and diagnosis of autism: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology 2000 Aug;55(4):468-79. Reaffirmed July 2010. [Full Text].
Courchesne E, Carper R, Akshoomoff N. Evidence of brain overgrowth in the first year of life in autism. JAMA. 2003 Jul 16. 290(3):337-44. [QxMD MEDLINE Link].
Aylward EH, Minshew NJ, Field K, Sparks BF, Singh N. Effects of age on brain volume and head circumference in autism. Neurology. 2002 Jul 23. 59(2):175-83. [QxMD MEDLINE Link].
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-V). 5th Edition. Washington, DC: American Psychiatric Association; 2013:
Johnson CP, Myers SM, American Academy of Pediatrics Council on Children With Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007 Nov. 120 (5):1183-215. [QxMD MEDLINE Link].
Antshel KM, Polacek C, McMahon M, Dygert K, Spenceley L, Dygert L, et al. Comorbid ADHD and anxiety affect social skills group intervention treatment efficacy in children with autism spectrum disorders. J Dev Behav Pediatr. 2011 Jul-Aug. 32(6):439-46. [QxMD MEDLINE Link].
Gates JA, Kang E, Lerner MD. Efficacy of group social skills interventions for youth with autism spectrum disorder: A systematic review and meta-analysis. Clin Psychol Rev. 2017 Mar. 52:164-181. [QxMD MEDLINE Link].
Marshall BL, Napolitano DA, McAdam DB, Dunleavy III JJ, Tessing JL, Varrell J. Venlafaxine and increased aggression in a female with autism. J Am Acad Child Adolesc Psychiatry. 2003 Apr. 42(4):383-4. [QxMD MEDLINE Link].
Sharma SR, Gonda X, Tarazi FI. Autism Spectrum Disorder: Classification, diagnosis and therapy. Pharmacol Ther. 2018 Oct. 190:91-104. [QxMD MEDLINE Link].
Teitelbaum P, Teitelbaum O, Nye J, Fryman J, Maurer RG. Movement analysis in infancy may be useful for early diagnosis of autism. Proc Natl Acad Sci U S A. 1998 Nov 10. 95(23):13982-7. [QxMD MEDLINE Link]. [Full Text].
Brasic JR, Holland JA. Reliable classification of case-control studies of autistic disorder and obstetric complications. Journal of Developmental and Physical Disabilities. 2006;18:355-381:
Brasic JR, Holland JA. A qualitative and quantitative review of obstetric complications and autistic disorder. Journal of Developmental and Physical Disabilities. 2007;19:337-364:
Brasic JR, Holland JA, Alexander M. The increased likelihood of obstetric complications in autistic disorder [abstract]. Southern Medical Journal. 2003;96 (10 supplement):S34:
Fatemi SH, Earle J, Kanodia R, Kist D, Emamian ES, Patterson PH, et al. Prenatal viral infection leads to pyramidal cell atrophy and macrocephaly in adulthood: implications for genesis of autism and schizophrenia. Cell Mol Neurobiol. 2002 Feb. 22(1):25-33. [QxMD MEDLINE Link].
Tick B, Bolton P, Happé F, Rutter M, Rijsdijk F. Heritability of autism spectrum disorders: a meta-analysis of twin studies. J Child Psychol Psychiatry. 2016 May. 57 (5):585-95. [QxMD MEDLINE Link].
Ronemus M, Iossifov I, Levy D, Wigler M. The role of de novo mutations in the genetics of autism spectrum disorders. Nat Rev Genet. 2014 Feb. 15 (2):133-41. [QxMD MEDLINE Link].
Lyall K, Croen L, Daniels J, Fallin MD, Ladd-Acosta C, Lee BK, et al. The Changing Epidemiology of Autism Spectrum Disorders. Annu Rev Public Health. 2017 Mar 20. 38:81-102. [QxMD MEDLINE Link].
Zerbo O, Yoshida C, Gunderson EP, Dorward K, Croen LA. Interpregnancy Interval and Risk of Autism Spectrum Disorders. Pediatrics. 2015 Oct. 136 (4):651-7. [QxMD MEDLINE Link].
Gutierrez GC, Smalley SL, Tanguay PE. Autism in tuberous sclerosis complex. J Autism Dev Disord. 1998 Apr. 28(2):97-103. [QxMD MEDLINE Link].
Court finds no Vaccines-autism link. Hum Vaccin. 2010 May 14. 6(5):[QxMD MEDLINE Link].
Brauser D. No Evidence Multiple Vaccines Raise Autism Risk, CDC Says. Medscape Medical News. Available at http://www.medscape.com/viewarticle/781670. Accessed: April 3, 2013.
DeStefano F, Price CS, Weintraub ES. Increasing Exposure to Antibody-Stimulating Proteins and Polysaccharides in Vaccines Is Not Associated with Risk of Autism. J Peds. March 2013.
Hammer LD, Curry ES, Harlor AD, Laughlin JJ, Leeds AJ, Lessin HR, et al. Increasing immunization coverage. Pediatrics. 2010 Jun. 125(6):1295-304. [QxMD MEDLINE Link].
Filipek PA, Accardo PJ, Ashwal S, Baranek GT, Cook EH Jr, Dawson G, et al. Practice parameter: screening and diagnosis of autism: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology. 2000 Aug 22. 55(4):468-79. [QxMD MEDLINE Link].
Courchesne E, Mouton PR, Calhoun ME, Semendeferi K, Ahrens-Barbeau C, Hallet MJ, et al. Neuron number and size in prefrontal cortex of children with autism. JAMA. 2011 Nov 9. 306(18):2001-10. [QxMD MEDLINE Link].
Davenport L. Measuring thoughts' accurately detects autism. Medscape Medical News. December 3, 2014. [Full Text].
Just MA, Cherkassky VL, Buchweitz A, Keller TA, Mitchell TM. Identifying autism from neural representations of social interactions: neurocognitive markers of autism. PLoS One. 2014. 9(12):e113879. [QxMD MEDLINE Link]. [Full Text].
Hughes JR. Autism: the first firm finding = underconnectivity?. Epilepsy Behav. 2007 Aug. 11(1):20-4. [QxMD MEDLINE Link].
Ecker C, Suckling J, Deoni SC, Lombardo MV, Bullmore ET, Baron-Cohen S, et al. Brain anatomy and its relationship to behavior in adults with autism spectrum disorder: a multicenter magnetic resonance imaging study. Arch Gen Psychiatry. 2012 Feb. 69(2):195-209. [QxMD MEDLINE Link].
Brasic JR, Mohamed M. Human brain imaging of autism spectrum disorders. In: Seeman P, Madras B, Eds. Imaging of the Human Brain in Health and Disease. Neuroscience-Net, LLC, 2012. [Full Text].
NIH press release. Disorganized cortical patches suggest prenatal origin of autism. Available at http://www.nih.gov/news/health/mar2014/nimh-27.htm. Accessed: April 1, 2014.
Stoner R, Chow ML, Boyle MP, Sunkin SM, Mouton PR, Roy S, et al. Patches of disorganization in the neocortex of children with autism. N Engl J Med. 2014 Mar 27. 370(13):1209-19. [QxMD MEDLINE Link].
Carmody DP, Lewis M. Regional white matter development in children with autism spectrum disorders. Dev Psychobiol. 2010 Dec. 52(8):755-63. [QxMD MEDLINE Link].
Cauda F, Geda E, Sacco K, D'Agata F, Duca S, Geminiani G, et al. Grey matter abnormality in autism spectrum disorder: an activation likelihood estimation meta-analysis study. J Neurol Neurosurg Psychiatry. 2011 Dec. 82(12):1304-13. [QxMD MEDLINE Link].
Hwang BJ, Mohamed MA, Brašić JR. Molecular imaging of autism spectrum disorder. Int Rev Psychiatry. 2017 Dec. 29 (6):530-554. [QxMD MEDLINE Link].
Puts NAJ, Wodka EL, Harris AD, Crocetti D, Tommerdahl M, Mostofsky SH, et al. Reduced GABA and altered somatosensory function in children with autism spectrum disorder. Autism Res. 2017 Apr. 10 (4):608-619. [QxMD MEDLINE Link].
Robertson CE, Ratai EM, Kanwisher N. Reduced GABAergic Action in the Autistic Brain. Curr Biol. 2016 Jan 11. 26 (1):80-5. [QxMD MEDLINE Link].
Brix MK, Ersland L, Hugdahl K, Grüner R, Posserud MB, Hammar Å, et al. "Brain MR spectroscopy in autism spectrum disorder-the GABA excitatory/inhibitory imbalance theory revisited". Front Hum Neurosci. 2015. 9:365. [QxMD MEDLINE Link].
Ehlers S, Gillberg C, Wing L. A screening questionnaire for Asperger syndrome and other high-functioning autism spectrum disorders in school age children. J Autism Dev Disord. 1999 Apr. 29 (2):129-41. [QxMD MEDLINE Link].
Oblak AL, Gibbs TT, Blatt GJ. Decreased GABA(B) receptors in the cingulate cortex and fusiform gyrus in autism. J Neurochem. 2010 Sep 1. 114(5):1414-23. [QxMD MEDLINE Link]. [Full Text].
Endres D, Tebartz van Elst L, Meyer SA, Feige B, Nickel K, Bubl A, et al. Glutathione metabolism in the prefrontal brain of adults with high-functioning autism spectrum disorder: an MRS study. Mol Autism. 2017. 8:10. [QxMD MEDLINE Link].
Aoki Y, Kasai K, Yamasue H. Age-related change in brain metabolite abnormalities in autism: a meta-analysis of proton magnetic resonance spectroscopy studies. Transl Psychiatry. 2012 Jan 17. 2:e69. [QxMD MEDLINE Link].
Corrigan NM, Shaw DW, Estes AM, Richards TL, Munson J, Friedman SD, et al. Atypical developmental patterns of brain chemistry in children with autism spectrum disorder. JAMA Psychiatry. 2013 Sep. 70 (9):964-74. [QxMD MEDLINE Link].
Hardan AY, Fung LK, Frazier T, Berquist SW, Minshew NJ, Keshavan MS, et al. A proton spectroscopy study of white matter in children with autism. Prog Neuropsychopharmacol Biol Psychiatry. 2016 Apr 3. 66:48-53. [QxMD MEDLINE Link].
Chugani DC. Neuroimaging and neurochemistry of autism. Pediatr Clin North Am. 2012 Feb. 59(1):63-73, x. [QxMD MEDLINE Link].
Pennesi CM, Klein LC. Effectiveness of the gluten-free, casein-free diet for children diagnosed with autism spectrum disorder: based on parental report. Nutr Neurosci. 2012 Mar. 15(2):85-91. [QxMD MEDLINE Link].
Alberti A, Pirrone P, Elia M, Waring RH, Romano C. Sulphation deficit in "low-functioning" autistic children: a pilot study. Biol Psychiatry. 1999 Aug 1. 46(3):420-4. [QxMD MEDLINE Link].
James SJ, Melnyk S, Jernigan S, Cleves MA, Halsted CH, Wong DH, et al. Metabolic endophenotype and related genotypes are associated with oxidative stress in children with autism. Am J Med Genet B Neuropsychiatr Genet. 2006 Dec 5. 141B(8):947-56. [QxMD MEDLINE Link]. [Full Text].
Oliveira G, Diogo L, Grazina M, Garcia P, Ataíde A, Marques C, et al. Mitochondrial dysfunction in autism spectrum disorders: a population-based study. Dev Med Child Neurol. 2005 Mar. 47(3):185-9. [QxMD MEDLINE Link].
Filipek PA, Juranek J, Nguyen MT, Cummings C, Gargus JJ. Relative carnitine deficiency in autism. J Autism Dev Disord. 2004 Dec. 34(6):615-23. [QxMD MEDLINE Link].
Giulivi C, Zhang YF, Omanska-Klusek A, Ross-Inta C, Wong S, Hertz-Picciotto I, et al. Mitochondrial dysfunction in autism. JAMA. 2010 Dec 1. 304 (21):2389-96. [QxMD MEDLINE Link].
Celestino-Soper PB, Violante S, Crawford EL, Luo R, Lionel AC, et al. A common X-linked inborn error of carnitine biosynthesis may be a risk factor for nondysmorphic autism. Proc Natl Acad Sci U S A. 2012 May 22. 109 (21):7974-81. [QxMD MEDLINE Link].
Saghazadeh A, Ataeinia B, Keynejad K, Abdolalizadeh A, Hirbod-Mobarakeh A, Rezaei N. Anti-inflammatory cytokines in autism spectrum disorders: A systematic review and meta-analysis. Cytokine. 2019 Nov. 123:154740. [QxMD MEDLINE Link].
Dipasquale V, Cutrupi MC, Colavita L, Manti S, Cuppari C, Salpietro C. Neuroinflammation in Autism Spectrum Disorders: Role of High Mobility Group Box 1 Protein. IJMCM. Summer 2017. 6:148-155. [Full Text].
Larsson HJ, Eaton WW, Madsen KM, Vestergaard M, Olesen AV, Agerbo E, et al. Risk factors for autism: perinatal factors, parental psychiatric history, and socioeconomic status. Am J Epidemiol. 2005 May 15. 161(10):916-25; discussion 926-8. [QxMD MEDLINE Link].
Lawler CP, Croen LA, Grether JK, Van de Water J. Identifying environmental contributions to autism: provocative clues and false leads. Ment Retard Dev Disabil Res Rev. 2004. 10(4):292-302. [QxMD MEDLINE Link].
Constantino JN, Zhang Y, Frazier T, Abbacchi AM, Law P. Sibling recurrence and the genetic epidemiology of autism. Am J Psychiatry. 2010 Nov. 167(11):1349-56. [QxMD MEDLINE Link]. [Full Text].
Wang C, Geng H, Liu W, Zhang G. Prenatal, perinatal, and postnatal factors associated with autism: A meta-analysis. Medicine (Baltimore). 2017 May. 96 (18):e6696. [QxMD MEDLINE Link].
Glasson EJ, Bower C, Petterson B, de Klerk N, Chaney G, Hallmayer JF. Perinatal factors and the development of autism: a population study. Arch Gen Psychiatry. 2004 Jun. 61(6):618-27. [QxMD MEDLINE Link].
Hughes S. Prenatal Valproate Exposure Linked to Autism. Medscape Medical News. Available at http://www.medscape.com/viewarticle/803034. Accessed: May 2, 2013.
Christensen J, Grønborg TK, Sørensen MJ, Schendel D, Parner ET, Pedersen LH, et al. Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. JAMA. 2013 Apr 24. 309(16):1696-703. [QxMD MEDLINE Link].
Croen LA, Grether JK, Yoshida CK, Odouli R, Hendrick V. Antidepressant use during pregnancy and childhood autism spectrum disorders. Arch Gen Psychiatry. 2011 Nov. 68(11):1104-12. [QxMD MEDLINE Link].
Andrade C. Antidepressant Exposure During Pregnancy and Risk of Autism in the Offspring, 1: Meta-Review of Meta-Analyses. J Clin Psychiatry. 2017 Sep/Oct. 78 (8):e1047-e1051. [QxMD MEDLINE Link].
Brooks M. Autism Risk Linked to Maternal Thyroid Dysfunction. Available at http://www.medscape.com/viewarticle/809718. Accessed: August 27, 2013.
Román GC, Ghassabian A, Bongers-Schokking JJ, Jaddoe VW, Hofman A, de Rijke YB, et al. Association of gestational maternal hypothyroxinemia and increased autism risk. Ann Neurol. 2013 Aug 13. [QxMD MEDLINE Link].
Ozonoff S, Young GS, Carter A, Messinger D, Yirmiya N, Zwaigenbaum L, et al. Recurrence risk for autism spectrum disorders: a Baby Siblings Research Consortium study. Pediatrics. 2011 Sep. 128(3):e488-95. [QxMD MEDLINE Link]. [Full Text].
Abrahams BS, Geschwind DH. Connecting genes to brain in the autism spectrum disorders. Arch Neurol. 2010 Apr. 67(4):395-9. [QxMD MEDLINE Link].
Abrahams BS, Geschwind DH. Advances in autism genetics: on the threshold of a new neurobiology. Nat Rev Genet. 2008 May. 9(5):341-55. [QxMD MEDLINE Link]. [Full Text].
Hallmayer J, Cleveland S, Torres A, Phillips J, Cohen B, Torigoe T, et al. Genetic heritability and shared environmental factors among twin pairs with autism. Arch Gen Psychiatry. 2011 Nov. 68(11):1095-102. [QxMD MEDLINE Link].
Gillberg C, Cederlund M. Asperger syndrome: familial and pre- and perinatal factors. J Autism Dev Disord. 2005 Apr. 35(2):159-66. [QxMD MEDLINE Link].
Merritt JL 2nd, Jalal SM, Barbaresi WJ, Babovic-Vuksanovic D. 14q32.3 deletion syndrome with autism. Am J Med Genet A. 2005 Feb 15. 133A(1):99-100. [QxMD MEDLINE Link].
Liu XQ, Georgiades S, Duku E, Thompson A, Devlin B, Cook EH, et al. Identification of genetic loci underlying the phenotypic constructs of autism spectrum disorders. J Am Acad Child Adolesc Psychiatry. 2011 Jul. 50(7):687-696.e13. [QxMD MEDLINE Link].
Jorde LB, Hasstedt SJ, Ritvo ER, Mason-Brothers A, Freeman BJ, Pingree C, et al. Complex segregation analysis of autism. Am J Hum Genet. 1991 Nov. 49(5):932-8. [QxMD MEDLINE Link]. [Full Text].
Schaefer GB, Lutz RE. Diagnostic yield in the clinical genetic evaluation of autism spectrum disorders. Genet Med. 2006 Sep. 8(9):549-56. [QxMD MEDLINE Link].
Durand CM, Betancur C, Boeckers TM, Bockmann J, Chaste P, Fauchereau F, et al. Mutations in the gene encoding the synaptic scaffolding protein SHANK3 are associated with autism spectrum disorders. Nat Genet. 2007 Jan. 39(1):25-7. [QxMD MEDLINE Link]. [Full Text].
Monteiro P, Feng G. SHANK proteins: roles at the synapse and in autism spectrum disorder. Nat Rev Neurosci. 2017 Mar. 18 (3):147-157. [QxMD MEDLINE Link].
Garber KB, Visootsak J, Warren ST. Fragile X syndrome. Eur J Hum Genet. 2008 Jun. 16(6):666-72. [QxMD MEDLINE Link].
Nakamoto M, Nalavadi V, Epstein MP, Narayanan U, Bassell GJ, Warren ST. Fragile X mental retardation protein deficiency leads to excessive mGluR5-dependent internalization of AMPA receptors. Proc Natl Acad Sci U S A. 2007 Sep 25. 104(39):15537-42. [QxMD MEDLINE Link]. [Full Text].
Curatolo P, Porfirio MC, Benedetti S, Giana G, Manzi B. [Autismo.]. Minerva Pediatr. 2008/10;60(5):846-848:
Curatolo P, Bombardieri R, Jozwiak S. Tuberous sclerosis. Lancet. 2008 Aug 23. 372(9639):657-68. [QxMD MEDLINE Link].
Roberts EM, English PB, Grether JK, Windham GC, Somberg L, Wolff C. Maternal residence near agricultural pesticide applications and autism spectrum disorders among children in the California Central Valley. Environ Health Perspect. 2007 Oct. 115(10):1482-9. [QxMD MEDLINE Link]. [Full Text].
Samson K. CDC-backed study suggests possible link between autistic disorders, maternal perticide exposure in California. Neurology Today. September 2007;7:7:
Hackethal V. More Evidence Links Autism to Air Pollution. Medscape Medical News. Available at http://www.medscape.com/viewarticle/833653. Accessed: October 24, 2014.
Evelyn Talbott, Lynne Marshall, Judith Rager, Vincent Arena, Ravi Sharma. The Association of National Air Toxics Assessment Exposures and the Risk of Childhood Autism Spectrum Disorder: A Case Control Study. American Association for Aerosol Research. Available at http://aaarabstracts.com/2014/viewabstract.php?pid=599. Accessed: October 24, 2014.
Modabbernia A, Velthorst E, Reichenberg A. Environmental risk factors for autism: an evidence-based review of systematic reviews and meta-analyses. Mol Autism. 2017. 8:13. [QxMD MEDLINE Link].
Sandin S, Hultman CM, Kolevzon A, Gross R, MacCabe JH, Reichenberg A. Advancing maternal age is associated with increasing risk for autism: a review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 2012 May. 51(5):477-486.e1. [QxMD MEDLINE Link].
Hultman CM, Sandin S, Levine SZ, Lichtenstein P, Reichenberg A. Advancing paternal age and risk of autism: new evidence from a population-based study and a meta-analysis of epidemiological studies. Mol Psychiatry. 2011 Dec. 16(12):1203-12. [QxMD MEDLINE Link].
Rapin I, Tuchman RF. What is new in autism?. Curr Opin Neurol. 2008 Apr. 21(2):143-9. [QxMD MEDLINE Link].
Honda H, Shimizu Y, Rutter M. No effect of MMR withdrawal on the incidence of autism: a total population study. J Child Psychol Psychiatry. 2005 Jun. 46(6):572-9. [QxMD MEDLINE Link].
Taylor B, Miller E, Farrington CP, Petropoulos MC, Favot-Mayaud I, Li J, et al. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet. 1999 Jun 12. 353(9169):2026-9. [QxMD MEDLINE Link].
Thompson WW, Price C, Goodson B, Shay DK, Benson P, Hinrichsen VL, et al. Early thimerosal exposure and neuropsychological outcomes at 7 to 10 years. N Engl J Med. 2007 Sep 27. 357(13):1281-92. [QxMD MEDLINE Link].
Retraction--Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 2010 Feb 6. 375(9713):445. [QxMD MEDLINE Link].
Dobbs M. What the autism studies show isn't reflected in what the candidates say. The Washington Post. April 22, 2008;A: A8:
Blaxill MF. What's going on? The question of time trends in autism. Public Health Rep. 2004 Nov-Dec. 119(6):536-51. [QxMD MEDLINE Link]. [Full Text].
Newschaffer CJ, Falb MD, Gurney JG. National autism prevalence trends from United States special education data. Pediatrics. 2005 Mar. 115(3):e277-82. [QxMD MEDLINE Link].
Maenner MJ, Shaw KA, Bakian AV, et al. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018. MMWR Surveill Summ. 2021 Dec 3. 70 (11):1-16. [QxMD MEDLINE Link].
Baio J, Wiggins L, Christensen DL, et al. Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. MMWR Surveill Summ. 2018 Apr 27. 67 (6):1-23. [QxMD MEDLINE Link].
Kogan M, Vladutiu C, Schieve L, et al. The Prevalence of Parent-Reported Autism Spectrum Disorder Among US Children. Pediatrics. Nov 2018.
Blumberg SJ, Bramlett MD, Kogan MD, Schieve LA, Jones JR, Lu MC. Changes in prevalence of parent-reported autism spectrum disorder in school-aged U.S. children: 2007 to 2011-2012. Natl Health Stat Report. 2013 Mar 20. 1-11, 1 p following 11. [QxMD MEDLINE Link].
Baxter AJ, Brugha TS, Erskine HE, Scheurer RW, Vos T, Scott JG. The epidemiology and global burden of autism spectrum disorders. Psychol Med. 2015 Feb. 45 (3):601-13. [QxMD MEDLINE Link].
Kim YS, Leventhal BL, Koh YJ, Fombonne E, Laska E, Lim EC, et al. Prevalence of autism spectrum disorders in a total population sample. Am J Psychiatry. 2011 Sep. 168(9):904-12. [QxMD MEDLINE Link].
Kurita H. [Current status of autism studies]. Seishin Shinkeigaku Zasshi. 2001. 103(1):64-75. [QxMD MEDLINE Link].
Bailey A, Bolton P, Butler L, Le Couteur A, Murphy M, Scott S, et al. Prevalence of the fragile X anomaly amongst autistic twins and singletons. J Child Psychol Psychiatry. 1993 Jul. 34(5):673-88. [QxMD MEDLINE Link].
Chudley AE, Hagerman RJ. Fragile X syndrome. J Pediatr. 1987 Jun. 110(6):821-31. [QxMD MEDLINE Link].
Cohen IL, Sudhalter V, Pfadt A, Jenkins EC, Brown WT, Vietze PM. Why are autism and the fragile-X syndrome associated? Conceptual and methodological issues. Am J Hum Genet. 1991 Feb. 48(2):195-202. [QxMD MEDLINE Link]. [Full Text].
Einfeld SL. Autism and the fragile X syndrome. Am J Med Genet. 1988 May-Jun. 30(1-2):237-8. [QxMD MEDLINE Link].
Fisch GS, Cohen IL, Jenkins EC, Brown WT. Screening developmentally disabled male populations for fragile X: the effect of sample size. Am J Med Genet. 1988 May-Jun. 30(1-2):655-63. [QxMD MEDLINE Link].
Reiss AL, Freund L. Fragile X syndrome, DSM-III-R, and autism. J Am Acad Child Adolesc Psychiatry. 1990 Nov. 29(6):885-91. [QxMD MEDLINE Link].
Wang LW, Tancredi DJ, Thomas DW. The prevalence of gastrointestinal problems in children across the United States with autism spectrum disorders from families with multiple affected members. J Dev Behav Pediatr. 2011 Jun. 32(5):351-60. [QxMD MEDLINE Link].
Crawley JN, Heyer WD, LaSalle JM. Autism and Cancer Share Risk Genes, Pathways, and Drug Targets. Trends Genet. 2016 Mar. 32 (3):139-146. [QxMD MEDLINE Link].
Craig F, Savino R, Trabacca A. A systematic review of comorbidity between cerebral palsy, autism spectrum disorders and Attention Deficit Hyperactivity Disorder. Eur J Paediatr Neurol. 2019 Jan. 23 (1):31-42. [QxMD MEDLINE Link].
Miano S, Ferri R. Epidemiology and management of insomnia in children with autistic spectrum disorders. Paediatr Drugs. 2010 Apr 1. 12 (2):75-84. [QxMD MEDLINE Link].
Lukmanji S, Manji SA, Kadhim S, Sauro KM, Wirrell EC, Kwon CS, et al. The co-occurrence of epilepsy and autism: A systematic review. Epilepsy Behav. 2019 Sep. 98 (Pt A):238-248. [QxMD MEDLINE Link].
Larson FV, Wagner AP, Jones PB, Tantam D, Lai MC, Baron-Cohen S, et al. Psychosis in autism: comparison of the features of both conditions in a dually affected cohort. Br J Psychiatry. 2017 Apr. 210 (4):269-275. [QxMD MEDLINE Link].
Magnuson KM, Constantino JN. Characterization of depression in children with autism spectrum disorders. J Dev Behav Pediatr. 2011 May. 32 (4):332-40. [QxMD MEDLINE Link].
Vasa RA, Mazurek MO, Mahajan R, Bennett AE, Bernal MP, Nozzolillo AA, et al. Assessment and Treatment of Anxiety in Youth With Autism Spectrum Disorders. Pediatrics. 2016 Feb. 137 Suppl 2:S115-23. [QxMD MEDLINE Link].
Vasa RA, Mazurek MO. An update on anxiety in youth with autism spectrum disorders. Curr Opin Psychiatry. 2015 Mar. 28 (2):83-90. [QxMD MEDLINE Link].
Vasa RA, Carroll LM, Nozzolillo AA, Mahajan R, Mazurek MO, Bennett AE, et al. A systematic review of treatments for anxiety in youth with autism spectrum disorders. J Autism Dev Disord. 2014 Dec. 44 (12):3215-29. [QxMD MEDLINE Link].
Mahoney A, Poling A. Sexual Abuse Prevention for People with Severe Developmental Disabilities. J of Developmental and Physical Disabilities. May 2011;23(4):369-76:
Anderson C, Law JK, Daniels A, Rice C, Mandell DS, Hagopian L, et al. Occurrence and family impact of elopement in children with autism spectrum disorders. Pediatrics. 2012 Nov. 130(5):870-7. [QxMD MEDLINE Link].
Baron-Cohen S, Allen J, Gillberg C. Can autism be detected at 18 months? The needle, the haystack, and the CHAT. Br J Psychiatry. Dec 1992;161:839-43:[QxMD MEDLINE Link].
Baron-Cohen S, Cox A, Baird G, Swettenham J, Nightingale N, Morgan K, et al. Psychological markers in the detection of autism in infancy in a large population. Br J Psychiatry. 1996 Feb. 168(2):158-63. [QxMD MEDLINE Link].
Lord C, Rutter M, Le Couteur A. Autism Diagnostic Interview-Revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. J Autism Dev Disord. 1994 Oct. 24(5):659-85. [QxMD MEDLINE Link].
Liptak GS, Kennedy JA, Dosa NP. Social Participation in a Nationally Representative Sample of Older Youth and Young Adults With Autism. J Dev Behav Pediatr. 2011 Apr 15. [QxMD MEDLINE Link].
[Guideline] Landa R. Early signs of autism spectrum disorder. YouTube. Available at https://www.youtube.com/watch?v=YtvP5A5OHpU. 2013; Accessed: December 14, 2019.
Allison C, Auyeung B, Baron-Cohen S. Toward brief "Red Flags" for autism screening: The Short Autism Spectrum Quotient and the Short Quantitative Checklist for Autism in toddlers in 1,000 cases and 3,000 controls [corrected]. J Am Acad Child Adolesc Psychiatry. 2012 Feb. 51(2):202-212.e7. [QxMD MEDLINE Link].
Allison C, Baron-Cohen S, Wheelwright S, Charman T, Richler J, Pasco G, et al. The Q-CHAT (Quantitative CHecklist for Autism in Toddlers): a normally distributed quantitative measure of autistic traits at 18-24 months of age: preliminary report. J Autism Dev Disord. 2008 Sep. 38(8):1414-25. [QxMD MEDLINE Link].
Auyeung B, Baron-Cohen S, Wheelwright S, Allison C. The Autism Spectrum Quotient: Children's Version (AQ-Child). J Autism Dev Disord. 2008 Aug. 38(7):1230-40. [QxMD MEDLINE Link].
Baron-Cohen S, Hoekstra RA, Knickmeyer R, Wheelwright S. The Autism-Spectrum Quotient (AQ)--adolescent version. J Autism Dev Disord. 2006 Apr. 36(3):343-50. [QxMD MEDLINE Link].
Baron-Cohen S, Wheelwright S, Skinner R, Martin J, Clubley E. The autism-spectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism Dev Disord. 2001 Feb. 31(1):5-17. [QxMD MEDLINE Link].
Demetriou EA, Lampit A, Quintana DS, Naismith SL, Song YJC, Pye JE, et al. Autism spectrum disorders: a meta-analysis of executive function. Mol Psychiatry. 2018 May. 23 (5):1198-1204. [QxMD MEDLINE Link].
Fombonne E, Rogé B, Claverie J, Courty S, Frémolle J. Microcephaly and macrocephaly in autism. J Autism Dev Disord. 1999 Apr. 29(2):113-9. [QxMD MEDLINE Link].
Schaefer GB, Mendelsohn NJ, Professional Practice and Guidelines Committee. Clinical genetics evaluation in identifying the etiology of autism spectrum disorders: 2013 guideline revisions. Genet Med. 2013 May. 15 (5):399-407. [QxMD MEDLINE Link].
[Guideline] World Health Organization. International Statistical Classification of Diseases and Related Health Problems 10th Revision. 10. Geneva, Switzerland: World Heatlh Organization; 2016. [Full Text].
Canal-Bedia R, García-Primo P, Martín-Cilleros MV, Santos-Borbujo J, Guisuraga-Fernández Z, Herráez-García L, et al. Modified checklist for autism in toddlers: cross-cultural adaptation and validation in Spain. J Autism Dev Disord. 2011 Oct. 41(10):1342-51. [QxMD MEDLINE Link].
[Guideline] Cincinnati Children's Hospital Medical Center. Best evidence statement (BESt). Use of motor and self-care assessment tools for children with autism spectrum disorder (ASD). 2009 Jul. [Full Text].
Cincinnati Children's Hospital Medical Center. Best evidence statement (BESt). Use of sensory assessment tools with children diagnosed with autism spectrum disorder (ASD). 2009 Mar. [Full Text].
[Guideline] New York State Department of Health, Division of Family Health, Bureau of Early Intervention. Clinical Practice Guideline: Quick Reference Guide. Autism/Pervasive Developmental Disorders, Assessment and Intervention for Young Children (Age 0-3 Years). Reprinted 2009. [Full Text].
Lord C, Petkova E, Hus V, Gan W, Lu F, Martin DM, et al. A multisite study of the clinical diagnosis of different autism spectrum disorders. Arch Gen Psychiatry. 2012 Mar. 69(3):306-13. [QxMD MEDLINE Link].
Sahota PK, Miles JH, Wang CH. Sleep disorders in children with autism. Neurology. 1997;48 (3):A258:
Hashimoto T, Tayama M, Miyazaki M, Murakawa K, Shimakawa S, Yoneda Y, et al. Brainstem involvement in high functioning autistic children. Acta Neurol Scand. 1993 Aug. 88(2):123-8. [QxMD MEDLINE Link].
Hashimoto T, Tayama M, Murakawa K, Yoshimoto T, Miyazaki M, Harada M, et al. Development of the brainstem and cerebellum in autistic patients. J Autism Dev Disord. 1995 Feb. 25(1):1-18. [QxMD MEDLINE Link].
Filipek PA. Quantitative magnetic resonance imaging in autism: the cerebellar vermis. Curr Opin Neurol. 1995 Apr. 8(2):134-8. [QxMD MEDLINE Link].
Via E, Radua J, Cardoner N, Happé F, Mataix-Cols D. Meta-analysis of gray matter abnormalities in autism spectrum disorder: should Asperger disorder be subsumed under a broader umbrella of autistic spectrum disorder?. Arch Gen Psychiatry. 2011 Apr. 68(4):409-18. [QxMD MEDLINE Link].
Eyler LT, Pierce K, Courchesne E. A failure of left temporal cortex to specialize for language is an early emerging and fundamental property of autism. Brain. 2012 Mar. 135:949-60. [QxMD MEDLINE Link]. [Full Text].
Sundaram SK, Kumar A, Makki MI, Behen ME, Chugani HT, Chugani DC. Diffusion tensor imaging of frontal lobe in autism spectrum disorder. Cereb Cortex. 2008 Nov. 18(11):2659-65. [QxMD MEDLINE Link]. [Full Text].
Barnea-Goraly N, Lotspeich LJ, Reiss AL. Similar white matter aberrations in children with autism and their unaffected siblings: a diffusion tensor imaging study using tract-based spatial statistics. Arch Gen Psychiatry. 2010 Oct. 67(10):1052-60. [QxMD MEDLINE Link].
Jou RJ, Mateljevic N, Kaiser MD, Sugrue DR, Volkmar FR, Pelphrey KA. Structural neural phenotype of autism: preliminary evidence from a diffusion tensor imaging study using tract-based spatial statistics. AJNR Am J Neuroradiol. 2011 Oct. 32(9):1607-13. [QxMD MEDLINE Link].
Zürcher NR, Bhanot A, McDougle CJ, Hooker JM. A systematic review of molecular imaging (PET and SPECT) in autism spectrum disorder: current state and future research opportunities. Neurosci Biobehav Rev. 2015 May. 52:56-73. [QxMD MEDLINE Link].
Heh CW, Smith R, Wu J, Hazlett E, Russell A, Asarnow R, et al. Positron emission tomography of the cerebellum in autism. Am J Psychiatry. 1989 Feb. 146(2):242-5. [QxMD MEDLINE Link].
Syed AB, Brasic JR. Nuclear neurotransmitter molecular imaging of autism spectrum disorder. AIMS Molecular Science. 2019. 6:87-106. [Full Text].
Fatemi SH, Wong DF, Brašić JR, Kuwabara H, Mathur A, Folsom TD, et al. Metabotropic glutamate receptor 5 tracer [¹⁸F]-FPEB displays increased binding potential in postcentral gyrus and cerebellum of male individuals with autism: a pilot PET study. Cerebellum Ataxias. 2018. 5:3. [QxMD MEDLINE Link].
Chiron C, Leboyer M, Leon F, Jambaqué I, Nuttin C, Syrota A. SPECT of the brain in childhood autism: evidence for a lack of normal hemispheric asymmetry. Dev Med Child Neurol. 1995 Oct. 37(10):849-60. [QxMD MEDLINE Link].
Malow BA. Sleep deprivation and epilepsy. Epilepsy Curr. 2004 Sep-Oct. 4(5):193-5. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Hyman SL, Levy SE, Myers SM, et al. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics. 2019. e20193447. [Full Text].
French L, Kennedy EMM. Annual Research Review: Early intervention for infants and young children with, or at-risk of, autism spectrum disorder: a systematic review. J Child Psychol Psychiatry. 2018 Apr. 59 (4):444-456. [QxMD MEDLINE Link].
Zwaigenbaum L, Penner M. Autism spectrum disorder: advances in diagnosis and evaluation. BMJ. 2018 May 21. 361:k1674. [QxMD MEDLINE Link].
McGuire K, Erickson C, Gabriels RL, Kaplan D, Mazefsky C, McGonigle J, et al. Psychiatric Hospitalization of Children With Autism or Intellectual Disability: Consensus Statements on Best Practices. J Am Acad Child Adolesc Psychiatry. 2015 Dec. 54 (12):969-71. [QxMD MEDLINE Link].
[Guideline] Luiselli JK, Bass JD, Whitcomb SA. Teaching applied behavior analysis knowledge competencies to direct-care service providers: outcome assessment and social validation of a training program. Behav Modif. 2010 Sep. 34(5):403-14. [QxMD MEDLINE Link].
[Guideline] Carr JE, Fox EJ. Using video technology to disseminate behavioral procedures: a review of Functional Analysis: a Guide for Understanding Challenging Behavior (DVD). J Appl Behav Anal. 2009 Winter. 42(4):919-23. [QxMD MEDLINE Link]. [Full Text].
Ganz JB, Davis JL, Lund EM, Goodwyn FD, Simpson RL. Meta-analysis of PECS with individuals with ASD: investigation of targeted versus non-targeted outcomes, participant characteristics, and implementation phase. Res Dev Disabil. 2012 Mar-Apr. 33(2):406-18. [QxMD MEDLINE Link].
Dawson G, Rogers S, Munson J, Smith M, Winter J, Greenson J, et al. Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics. 2010 Jan. 125(1):e17-23. [QxMD MEDLINE Link].
Rogers SJ, Estes A, Lord C, Vismara L, Winter J, Fitzpatrick A, et al. Effects of a Brief Early Start Denver Model (ESDM)-Based Parent Intervention on Toddlers at Risk for Autism Spectrum Disorders: A Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry. 2012 Oct. 51(10):1052-65. [QxMD MEDLINE Link]. [Full Text].
Spain, D., Sin, J., Harwood, L., et al. Cognitive behaviour therapy for social anxiety in autism spectrum disorder: a systematic review. Advances in Autism. Jan 3 2017. 3(1):34-46.
Spain D, Sin J, Paliokosta E, Furuta M, Prunty JE, Chalder T, et al. Family therapy for autism spectrum disorders. Cochrane Database Syst Rev. 2017 May 16. 5:CD011894. [QxMD MEDLINE Link].
Rodrigues JM, Mestre M, Fredes LI. Qigong in the treatment of children with autism spectrum disorder: A systematic review. J Integr Med. 2019 Jul. 17 (4):250-260. [QxMD MEDLINE Link].
Rodrigues JMSM, Mestre MICP, Matos LC, Machado JP. Effects of taijiquan and qigong practice over behavioural disorders in school-age children: A pilot study. J Bodyw Mov Ther. 2019 Jan. 23 (1):11-15. [QxMD MEDLINE Link].
Brooks M. GI Troubles Common, Linked to Negative Behaviors in Autism. Medscape Medical News. Available at http://www.medscape.com/viewarticle/814364.. Accessed: November 26, 2013.
Chaidez V, Hansen RL, Hertz-Picciotto I. Gastrointestinal Problems in Children with Autism, Developmental Delays or Typical Development. J Autism Dev Disord. 2013 Nov 6. [QxMD MEDLINE Link].
Mousain-Bosc M, Roche M, Polge A, Pradal-Prat D, Rapin J, Bali JP. Improvement of neurobehavioral disorders in children supplemented with magnesium-vitamin B6. II. Pervasive developmental disorder-autism. Magnes Res. 2006 Mar. 19(1):53-62. [QxMD MEDLINE Link].
Adams JB, Audhya T, McDonough-Means S, Rubin RA, Quig D, Geis E, et al. Effect of a vitamin/mineral supplement on children and adults with autism. BMC Pediatr. 2011 Dec 12. 11:111. [QxMD MEDLINE Link]. [Full Text].
Serra D, Almeida LM, Dinis TCP. Polyphenols as food bioactive compounds in the context of Autism Spectrum Disorders: A critical mini-review. Neurosci Biobehav Rev. 2019 Jul. 102:290-298. [QxMD MEDLINE Link].
Oswald DP, Sonenklar NA. Medication use among children with autism spectrum disorders. J Child Adolesc Psychopharmacol. 2007 Jun. 17(3):348-55. [QxMD MEDLINE Link].
Spencer D, Marshall J, Post B, Kulakodlu M, Newschaffer C, Dennen T, et al. Psychotropic medication use and polypharmacy in children with autism spectrum disorders. Pediatrics. 2013 Nov. 132(5):833-40. [QxMD MEDLINE Link].
Brauser D. Psychotropics Still Commonly Prescribed for Autism. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/812982. Accessed: November 2, 2013.
McPheeters ML, Warren Z, Sathe N, Bruzek JL, Krishnaswami S, Jerome RN, et al. A systematic review of medical treatments for children with autism spectrum disorders. Pediatrics. 2011 May. 127(5):e1312-21. [QxMD MEDLINE Link].
McDougle CJ, Kem DL, Posey DJ. Case series: use of ziprasidone for maladaptive symptoms in youths with autism. J Am Acad Child Adolesc Psychiatry. 2002 Aug. 41(8):921-7. [QxMD MEDLINE Link].
Hollander E, Phillips A, Chaplin W, Zagursky K, Novotny S, Wasserman S, et al. A placebo controlled crossover trial of liquid fluoxetine on repetitive behaviors in childhood and adolescent autism. Neuropsychopharmacology. 2005 Mar. 30(3):582-9. [QxMD MEDLINE Link].
Owley T, Walton L, Salt J, Guter SJ Jr, Winnega M, Leventhal BL, et al. An open-label trial of escitalopram in pervasive developmental disorders. J Am Acad Child Adolesc Psychiatry. 2005 Apr. 44(4):343-8. [QxMD MEDLINE Link].
Namerow LB, Thomas P, Bostic JQ, Prince J, Monuteaux MC. Use of citalopram in pervasive developmental disorders. J Dev Behav Pediatr. 2003 Apr. 24(2):104-8. [QxMD MEDLINE Link].
Couturier JL, Nicolson R. A retrospective assessment of citalopram in children and adolescents with pervasive developmental disorders. J Child Adolesc Psychopharmacol. 2002 Fall. 12(3):243-8. [QxMD MEDLINE Link].
King BH, Hollander E, Sikich L, McCracken JT, Scahill L, Bregman JD, 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 Jun. 66(6):583-90. [QxMD MEDLINE Link].
Brasic JR, Zagzag D, Kowalik S, Prichep L, John ER, Barnett JY, et al. Clinical manifestations of progressive catatonia. Ger J Psychiatr. 2000. 3 (2):13-24. [Full Text].
Brasic JR, Zagzag D, Kowalik S, Prichep L, John ER, Liang HG, et al. Progressive catatonia. Psychol Rep. 1999. 84 (1):239-46.
Kem DL, Posey DJ, McDougle CJ. Priapism associated with trazodone in an adolescent with autism. J Am Acad Child Adolesc Psychiatry. 2002 Jul. 41(7):758. [QxMD MEDLINE Link].
[Guideline] American Academy of Pediatrics. Management of Children With Autism Spectrum Disorder. Pediatrics. 2007 Nov;120(5):1183-1215. Available at http://pediatrics.aappublications.org/content/120/5/1162.full.
Barahona-Corrêa JB, Velosa A, Chainho A, Lopes R, Oliveira-Maia AJ. Repetitive Transcranial Magnetic Stimulation for Treatment of Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Front Integr Neurosci. 2018. 12:27. [QxMD MEDLINE Link].
Rossignol DA. Hyperbaric oxygen therapy might improve certain pathophysiological findings in autism. Med Hypotheses. 2007. 68(6):1208-27. [QxMD MEDLINE Link].
Rossignol DA, Rossignol LW. Hyperbaric oxygen therapy may improve symptoms in autistic children. Med Hypotheses. 2006. 67(2):216-28. [QxMD MEDLINE Link].
Rossignol DA, Rossignol LW, James SJ, Melnyk S, Mumper E. The effects of hyperbaric oxygen therapy on oxidative stress, inflammation, and symptoms in children with autism: an open-label pilot study. BMC Pediatr. 2007 Nov 16. 7:36. [QxMD MEDLINE Link]. [Full Text].
Krishnaswami S, McPheeters ML, Veenstra-Vanderweele J. A systematic review of secretin for children with autism spectrum disorders. Pediatrics. 2011 May. 127(5):e1322-5. [QxMD MEDLINE Link]. [Full Text].
Williams K, Wray JA, Wheeler DM. Intravenous secretin for autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2012 Apr 18. 4:CD003495. [QxMD MEDLINE Link].
Cassels C. Oxytocin 'Normalizes' Social Deficits in Kids With Autism. Medscape Medical News. Available at http://www.medscape.com/viewarticle/817552. Accessed: December 16, 2013.
Gordon I, Vander Wyk BC, Bennett RH, Cordeaux C, Lucas MV, Eilbott JA, et al. Oxytocin enhances brain function in children with autism. Proc Natl Acad Sci U S A. 2013 Dec 2. [QxMD MEDLINE Link].
Brauser D. New Practice Guidelines for Autism. Medscape Medical News. Available at http://www.medscape.com/viewarticle/819935. Accessed: February 4, 2014.
Volkmar F, Siegel M, Woodbury-Smith M, King B, McCracken J, State M. Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2014 Feb. 53(2):237-57. [QxMD MEDLINE Link].
Wink LK, Pedapati EV, Horn PS, McDougle CJ, Erickson CA. Multiple Antipsychotic Medication Use in Autism Spectrum Disorder. J Child Adolesc Psychopharmacol. 2017 Feb. 27 (1):91-94. [QxMD MEDLINE Link].
Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Jacobsen SJ. The incidence of autism in Olmsted County, Minnesota, 1976-1997: results from a population-based study. Arch Pediatr Adolesc Med. 2005 Jan. 159(1):37-44. [QxMD MEDLINE Link].
Rutter M. Aetiology of autism: findings and questions. J Intellect Disabil Res. 2005 Apr. 49:231-8. [QxMD MEDLINE Link].
Rutter M. Incidence of autism spectrum disorders: changes over time and their meaning. Acta Paediatr. 2005 Jan. 94(1):2-15. [QxMD MEDLINE Link].
Lee MS, Kim JI, Ernst E. Massage therapy for children with autism spectrum disorders: a systematic review. J Clin Psychiatry. 2011 Mar. 72(3):406-11. [QxMD MEDLINE Link].
Dawson G, Jones EJ, Merkle K, Venema K, Lowy R, Faja S, et al. Early behavioral intervention is associated with normalized brain activity in young children with autism. J Am Acad Child Adolesc Psychiatry. 2012 Nov. 51(11):1150-9. [QxMD MEDLINE Link].
Celexa (citalopram hydrobromide) [package insert]. St. Louis, Missouri: Forest Pharmaceuticals, Inc; August, 2011. [Full Text].
US Food and Drug Administration. Celexa (citalopram hydrobromide): Drug safety communication – abnormal heart rhythms associated with high doses. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm269481.htm. Accessed: October 24, 2012.
A Message From APA President Dilip Jeste, M.D., on DSM-5. Available at http://www.psychnews.org/files/DSM-message.pdf. Accessed: December 1, 2012.
American Psychiatric Association. DSM-5 Development, Autism Spectrum Disorder. Proposed Revision. Available at http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94. Accessed: December 22, 2011.
APA. Autism Spectrum Disorder. Available at http://www.dsm5.org/Documents/Autism%20Spectrum%20Disorder%20Fact%20Sheet.pdf.. Accessed: July 1, 2013.
Brauser D. Abnormal Placentas May Signal Autism Risk. Medscape Medical News. Available at http://www.medscape.com/viewarticle/803331. Accessed: May 14, 2013.
Brauser D. Developmental Delays Detectable in High-risk 1-Year-Olds. Medscape Medical News. Available at http://www.medscape.com/viewarticle/821851. Accessed: March 17, 2014.
Brauser D. Routine Ultrasound Scans May Detect Autism in Utero. Medscape Medical News. Available at http://www.medscape.com/viewarticle/827333. Accessed: July 2, 2014.
Brauser D. Some kids 'age out' of autism. Medscape Medical News. January 23, 2013. Available at http://www.medscape.com/viewarticle/778061. Accessed: January 29, 2013.
Corrigan NM, Shaw DW, Estes AM, Richards TL, Munson J, Friedman SD, et al. Atypical Developmental Patterns of Brain Chemistry in Children With Autism Spectrum Disorder. JAMA Psychiatry. 2013 Jul 31. [QxMD MEDLINE Link].
Fein D, Barton M, Eigsti IM, Kelley E, Naigles L et al. Optimal outcome in individuals with a history of autism. J Child Psychol Psychiatry. 2013 Feb. 54(2):195-205. [QxMD MEDLINE Link]. [Full Text].
Frazier TW, Youngstrom EA, Speer L, Embacher R, Law P, Constantino J, et al. Validation of proposed DSM-5 criteria for autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2012 Jan. 51(1):28-40.e3. [QxMD MEDLINE Link]. [Full Text].
Harrison P. Novel Drug Modifies Core Autism Symptoms in Adults. Medscape Medical News. May 27 2014. [Full Text].
Huerta M, Bishop SL, Duncan A, Hus V, Lord C. Application of DSM-5 Criteria for Autism Spectrum Disorder to Three Samples of Children With DSM-IV Diagnoses of Pervasive Developmental Disorders. . Am J Psychiatry 2012;169:1056-1064. [Full Text].
Mandy WP, Charman T, Skuse DH. Testing the construct validity of proposed criteria for DSM-5 autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2012 Jan. 51(1):41-50. [QxMD MEDLINE Link].
Marcus RN, Owen R, Kamen L, Manos G, McQuade RD, Carson WH, et al. A placebo-controlled, fixed-dose study of aripiprazole in children and adolescents with irritability associated with autistic disorder. J Am Acad Child Adolesc Psychiatry. 2009 Nov. 48(11):1110-9. [QxMD MEDLINE Link].
McCracken JT, McGough J, Shah B, Cronin P, Hong D, Aman MG, et al. Risperidone in children with autism and serious behavioral problems. N Engl J Med. 2002 Aug 1. 347(5):314-21. [QxMD MEDLINE Link].
Owen R, Sikich L, Marcus RN, Corey-Lisle P, Manos G, McQuade RD, et al. Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder. Pediatrics. 2009 Dec. 124(6):1533-40. [QxMD MEDLINE Link].
Ozonoff S, Young GS, Belding A, et al. The Broader Autism Phenotype in Infancy: When Does It Emerge?. J American Academy Child Adolesc Psychiatry. 2014 Jan 23. [Epub ahead of print].
Stetka B, Correll, C. A Guide to DSM-5: Autism Spectrum Disorders. Medscape Medical News. Available at http://www.medscape.com/viewarticle/803884_4. Accessed: July 1, 2013.
Walker CK, Anderson KW, Milano KM, Ye S, Tancredi DJ, Pessah IN, et al. Trophoblast Inclusions Are Significantly Increased in the Placentas of Children in Families at Risk for Autism. Biol Psychiatry. 2013 Apr 22. [QxMD MEDLINE Link].
[Guideline] Brasic JR. Treatment of movement disorders in autism spectrum disorders. Hollander E. Autism Spectrum Disorders. 1. New York: Marcel Dekker; 2003. 273-346.

Media Gallery

The significance of answers to individual Autism Screening Checklist items is as follows: Item 1- A "yes" occurs in healthy children and children with some pervasive developmental disorders; a "no" occurs in children with autism, Rett syndrome, and other developmental disorders. Item 2 - A "yes" occurs in healthy children, not children with autism. Item 3 - A "yes" occurs in healthy children and children with Asperger syndrome (ie, high-functioning autism); a "no" occurs in children with Rett syndrome; children with autism may elicit a "yes" or a "no"; some children with autism never speak; some children with autism may develop speech normally and then experience a regression with the loss of speech. Item 4 - A "yes" occurs in healthy children and children with Asperger syndrome and some other pervasive developmental disorders; a "no" occurs in children with developmental disorders; children with autism may elicit a "yes" or a "no." Items 5-10 - Scores of "yes" occur in some children with autism and in children with other disorders. Item 11 – A "yes" occurs in healthy children; a "no" occurs in some children with autism and in children with other disorders. Items 12, 13 - Scores of "yes" occur in some children with autism and in children with other disorders. Items 14-19 - Scores of "yes" occur in children with schizophrenia and other disorders, not in children with autism, Asperger syndrome, or other autism spectrum disorders. The higher the total score for items 5-10, 12, and 13 on the Autism Screening Checklist, the more likely the presence of an autism spectrum disorder.
Serotonin syndrome checklist.

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Author

James Robert Brasic, MD, MPH, MS, MA Assistant Professor, Russell H Morgan Department of Radiology and Radiological Science and Neurology, Division of Nuclear Medicine and Molecular Imaging, Assistant Professor, Department of Neurology, Johns Hopkins University School of Medicine

James Robert Brasic, MD, MPH, MS, MA is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Neurology, International Parkinson and Movement Disorder Society, Society for Neuroscience, Society of Nuclear Medicine and Molecular Imaging

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Johns Hopkins University School of Medicine; New York City Health and Hospitals/Bellevue, New York University Langone Health<br/>Serve(d) as a speaker or a member of a speakers bureau for: Society of Nuclear Medicine and Molecular Imaging, Maryland Regional Council of Child and Adolescent Psychiatry<br/>Received research grant from: National Institutes of Health, Johns Hopkins University School of Medicine, Intellectual & Developmental Disabilities Research Center (U54 HD079123) at the Kennedy Krieger Institute<br/>Received income in an amount equal to or greater than $250 from: Gerson Lehrman Group; Guidepost<br/>Received royalty from Medscape for other.

Coauthor(s)

Ashley B Durbin, BS, BA

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Farzaneh Farhadi, MD Postdoctoral Research Fellow, Johns Hopkins Hospital

Disclosure: Nothing to disclose.

Tarek Elshourbagy, MBBCh Intern, Kasr Alainy Medical School, Cairo University, Egypt; Research Physician, Department of Radiology, Johns Hopkins University School of Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Acknowledgments

This publication was made possible by the Johns Hopkins Institute for Clinical and Translational Research (ICTR) which is funded in part by Grant Number UL1 TR003098 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS or NIH. This research is also supported by the Radiology Bridge Funding Initiative to Stimulate and Advance Research (RAD BriteStar Bridge) Award of the Johns Hopkins University School of Medicine and the Intellectual and Developmental Disabilities Research Center (U54 HD079123) at the Kennedy Krieger Institute of Johns Hopkins Medical Institutions in Baltimore, Maryland.