Published online April 1, 2008
PEDIATRICS Vol. 121 No. 4 April 2008, pp. 828-830 (doi:10.1542/peds.2007-3833)

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COMMENTARY

Guidelines for Early Identification, Screening, and Clinical Management of Children With Autism Spectrum Disorders

Stanley I. Greenspan, MD^a, T. Berry Brazelton, MD^b, José Cordero, MD, MPH^c, Richard Solomon, MD, MPH, FAAP^d, Margaret L. Bauman, MD, FAANP^e, Ricki Robinson, MD, MPH, FAAP^f, Stuart Shanker, DPhil^g, Cecilia Breinbauer, MD, MPH^h

^a Department of Psychiatry, Behavioral Sciences, and Pediatrics, George Washington University, Washington, DC; Departments of
^b Pediatrics (Emeritus)
^e Neurology, Harvard Medical School and Departments of Neurology and Pediatrics and Learning and Developmental Disabilities Evaluation and Rehabilitation Services (LADDERS), Massachusetts General Hospital, Boston, Massachusetts
^c School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
^d Ann Arbor Center for Developmental and Behavioral Pediatrics, Ann Arbor, Michigan
^f Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
^g Department of Philosophy and Psychology and the Milton and Ethel Harris Research Initiative, York University, Toronto, Ontario, Canada
^h Interdisciplinary Council on Developmental and Learning Disorders, ICDL Graduate School, Kentfield, California

Abbreviations: AAP, American Academy of Pediatrics • ASD, autism spectrum disorder

The first 20% of the full text of this article appears below.

Congratulations to the American Academy of Pediatrics (AAP). Two of their recent clinical reports published in Pediatrics, "Identification and Evaluation of Children With Autism Spectrum Disorders"¹ and "Management of Children With Autism Spectrum Disorders,"² will enable pediatricians to address parent concerns sooner, facilitating the early identification of children with autism spectrum disorders (ASDs). As physicians and developmentalists with decades of accumulated experience in working with children with developmental challenges, we applaud and welcome these publications. However, we would like to expand on these reports. In this commentary we (1) describe a broader functional/developmental framework for screening for ASDs, (2) provide a critique of the current trend toward behavioral treatments as primary intervention strategies, and (3) present research evidence for functional/developmental approaches.

A broader and more refined "functional" developmental framework³ looks for compromises in the child's healthy milestones and helps parents and other caregivers work with the child to improve that area of functioning and overall healthy progression.^* This approach helps families identify challenges early in the first and second years of life and to begin to help their children before the 18- and 24-month screenings recommended by the AAP.⁴ An overfocus on specific problem behaviors without a framework for promoting healthy development may prove to be counterproductive.⁵

Screening that focuses on specific behaviors or symptoms (eg, whether a child responds to his or her name toward the end of the first year) may identify a percentage of . . . [Full Text of this Article]

Address correspondence to Stanley I. Greenspan, MD, 7201 Glenbrook Road, Bethesda, MD 20814. E-mail: stanleygreenspan@gmail.com

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