Cognition, Language, and Learning Disabilities Case

A 3-year-old boy was recently diagnosed with ASD.

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A 3-year-old boy was recently diagnosed with ASD. He presents with delays in the areas of learning, communication, fine motor skills, and social interactions. He is engaging in aggression and self-injurious behavior and is experiencing sleep difficulties. His parents request guidance regarding appropriate intervention services.

What do you recommend?

A. Speech and language therapy. 

B. Occupational therapy. 

C. Applied behavior analysis.

D. Educational interventions. 

E. All of the above. 

The correct answer is “E.” Similar to this child, children with ASD often present with multiple areas of concern and treatment must be tailored to individual need. There is no “one size fits all” approach that is effective in working with all children with ASD. It is common for children with ASD to receive intervention through a combination of school programming and private, community-based services. Although a cure for autism does not exist, evidence-based interventions have been identified that, in many cases, can lead to improvements in overall functioning. Applied behavioral analysis (ABA) is an intervention that focuses on changing behaviors by understanding the relationship between behavior and the environment. It has been shown to improve cognitive functioning, social skills, communication, and play skills, though not all children demonstrate equal success. Early intensive ABA programming, typically defined as 25 to 40 hours per week of evidence-based services prior to age 4 years and parental involvement can be instrumental in targeting core difficulties associated with ASD. Medical care is an important treatment component, and referral to subspecialists may be indicated based on specific concerns. Several genetic and neurodevelopmental syndromes are associated with ASD at a much higher rate than in the general pediatric population. There include Angelman, CHARGE (coloboma, heart defect, choanal atresia, retarded growth and development, genital abnormality, and ear abnormality), Cornelia DeLange, Klinefelter, and Sotos syndromes; fragile X; trisomy 21; neurofibromatosis; and tuberous sclerosis. Children with ASD are more likely than the general pediatric population to experience difficulties with feeding, sleep, gastrointestinal disorders (including constipation), seizures, and psychiatric conditions. Several alternative treatments for ASD exist. Many lack scientific support and, in some cases, they may be costly and result in physical harm.

Sources:

Question & Explanation: Peterson AR, Wood KE. Pediatrics Examination and Board Review. New York, NY: McGraw-Hill Education; 2017.

Photo: Chapter 173 Genetic Evaluation of Intellectual Disability and Autism, Kline MW. Rudolph's Pediatrics, 23e; 2018

Leah Carton

Associate Editor - Pediatrics, Dermatology, Geriatrics , McGraw Hill