Based on strong research evidence (Level A), the prevalence of autism spectrum disorder (ASD) in the United States has increased in recent years. (1) • Based on strong research evidence (Level A), girls, minority children, and children from non–English-speaking households are more likely to have missed or delayed ASD diagnoses; particular attention should be given to screening in these populations. (1)(13)(15)(16)(17) • Based on some research evidence as well as consensus (Level B), the American Academy of Pediatrics recommends use of an ASD-specific screening tool at the 18- and 24-month health supervision visits because structured screeners have been shown to increase the likelihood of early identification of both ASD and other developmental delays. Due to concerns about low sensitivity, clinicians should refer for specialist ASD evaluation based on clinician and parent concerns and not solely based on screening results. (2)(33)(34) • Based primarily on consensus due to lack of relevant clinical studies (Level C), children who screen positive on ASD-specific instruments should be referred for both school/early intervention evaluation and a specialist ASD diagnostic evaluation. • Based on some research evidence as well as consensus (Level B), the gold standard for diagnosis of ASD is a multidisciplinary evaluation, but not all elements are necessary for the initial diagnosis and initiation of early intervention services. Pediatricians may want to consider provisional in-office diagnoses to help children access specialized services earlier in development, when the potential therapeutic benefits may be greater. (44) • Based on some research evidence as well as consensus (Level B), the behavioral intervention with the strongest evidence base is applied behavior analysis therapy, with several studies showing high-intensity treatment leading to the largest gains especially for children younger than 3 years. (58)(59)(60) • Based on some research evidence as well as consensus (Level B), youth with ASD are at increased risk for certain medical comorbidities, most psychiatric diagnoses, and intentional/ unintentional injury. Pediatricians should routinely screen for and counsel families about these conditions. (89)(90)(91)(92)(93)(94)(95)(96)(97) © 2021 American Academy of Pediatrics. All rights reserved.
