Optimizing Outcome in Autism Spectrum Disorders

Autism spectrum disorders (ASDs) are usually lifelong with wide ranging functional outcomes. Intensive behavioral intervention, implemented early, can improve outcome significantly. Some individuals, often with milder symptoms, if treated early, can attain social, cognitive, educational, and vocational functioning in the typical range. To qualify, children must be detected and diagnosed as early as possible. Without universal screening, many children from all backgrounds are not detected until past early childhood; children from economically disadvantaged and ethnic minority families are diagnosed and treated, on average, 2 years later than others. Primary care physician surveillance should incorporate parental concerns and be supplemented by universal ASD screening at 18 and 24 months. ASD screening in other community settings could detect risk in children who may not have primary or consistent medical care. Effective ASD diagnostic systems should encompass mildly affected children. Although universal screening can reduce inequities in identification, outcome disparities will persist while intervention funding remains local.