Developmental screening should be part of each well-child examination. The Denver Developmental Screening tools have often been used for this purpose but they lack sensitivity and specificity for autism. The AAP provides a thorough examination of screening instruments for autism (Johnson and Myers, 2007). A variety of screening tools aimed specifically at autism are available but also lack sensitivity (Bryson et al., 2003). Therefore, physicians should take parental concerns about delayed speech and language development seriously, especially beyond 18 months of age, even in the context of normal screening. In addition to delayed speech development, the other common presenting symptom is challenging behavior. The behaviors may include a violent reaction to minor changes in the environment or routine, stereotypic movements such as clapping or rocking, and preoccupation with narrow interests or inanimate objects.

When autism is suspected, a thorough evaluation should be performed, including appropriate intellectual testing, speech-language assessment, Autism Diagnostic Interview-Revised (ADI-R) (Western Psychological Services [WPS], 2003) and the Autism Diagnostic Observation Schedule (ADOS) (WPS, 2001). Because hearing loss can mimic autism, the evaluation should also include formal audiologic testing. Common comorbidities include anxiety, depression, and obsessional behavior (Prater and Zylstra, 2002). Many autistic patients develop infantile spasms in the first year of life, a severe seizure disorder.



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