A new CDC report that about 1% of 8-year-olds have symptoms of autism spectrum disorder carries an important message for pediatricians, says Susan Hyman, MD, autism and developmental issues specialist for the American Academy of Pediatrics.
"What this report is telling us is that ASD is not a rare disease. And that developmental surveillance and screening is an incredibly important part of well-child care," says Hyman, division chief of Neurodevelopmental and behavioral pediatrics at Golisano Children's Hospital at the University of Rochester Medical Center.
While screening is already being done in most physician practices, Hyman says it has sometimes not been addressed.
"One of the reasons that physicians in the past have been reticent [to put a name on the disorder or diagnose the child] was the belief that there was nothing you could do.
"But though we may not be able to cure ASD, we can improve symptoms. Just last week, for example, there was an exciting paper published in the journal Pediatrics that looked at a model of early intervention that enhanced language and cognitive outcomes in very young children."
Physicians may also want to keep in mind the prevalence of autism in dealing with their office populations. "There are important research projects designed to, on a day-to-day basis, help doctors [with these patients]. For example, how do you keep children from running down the hall screaming when you say 'hello?'
"When you have people with developmental disabilities. Make them more comfortable in the office visit," Hyman says.
The CDC study relied on reviews of clinical and educational records rather than on parental interviews, which are believed to allow a more accurate capture of ASD incidence.
The ASD incidence report was published Friday in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report Surveillance Summary. The authors defined ASD as autistic disorder or autism, Asperger's disorder, and pervasive developmental disorder not otherwise specified.
"These results indicate an increased prevalence of identified ASDs among U.S. children aged 8 years and underscore the need to regard ASDs as an urgent public health concern," the MMWR report said.
Nine of the 10 study sites—Florida, Alabama, Wisconsin, Pennsylvania, South Carolina, Maryland, Georgia, North Carolina, Missouri, and Arizona—reported an increase in ASD prevalence in 8-year-olds. Only Colorado was an exception.
"Identified ASD prevalence increased across all sex, racial, ethnic, and cognitive functioning subgroups," said Catherine Rice, lead author in a press briefing Friday. "For all sites, the most consistent pattern was the increase among boys," where it was four to five times higher than for girls, with one in 70 boys and 1 in 315 girls diagnosed with ASD.
The CDC study did not look at what might be causing the increased prevalence of ASD, and Rice did not rule out the possibility that better diagnosis, and improved record-keeping, may be identifying more children with these symptoms.
"Really, there's a multi-prong approach going on; we know there's no single cause for autism," but it may be a combination of environmental factors and genetics, some of which are inheritable and some which are not, says Rice.
Rice expressed similar views as Hyman about the report's take-home message for pediatricians.
"So at this point, what pediatricians should be doing is: one, listening to parents if they have a concern about their child's development, but also proactively following the screening guidelines; And if they have a concern, referring that child on for further evaluation, whether it's diagnostic or potential intervention."