Stanley I. Greenspan, MD, T. Berry Brazelton, MD, José Cordero, MD, MPH, Richard Solomon, MD, MPH, FAAP, Margaret L. Bauman, MD, FAANP, Ricki Robinson, MD, MPH, FAAP, Stuart Shanker, DPhil and Cecilia Breinbauer, MD, MPH
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.
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} - click link "Full Text PDF" to the right of the page to access full article
Address correspondence to Stanley I. Greenspan, MD, 7201 Glenbrook Road, Bethesda, MD 20814. E-mail: stanleygreenspan@gmail.com
