The general pediatrician's role in managing an adolescent with an autism spectrum disorder depends largely on his or her comfort with doing counseling, testing, and medication management.
Most adolescents with an autism spectrum disorder already have a pretty thick chart from a history of pediatrician and pediatric subspecialist consultations, but the etiology question may remain. If a child's intelligence is within the normal range, a lot of elaborate medical testing generally is not necessary. If the child has cognitive dysfunction, such as an IQ below 70, there is a greater probability of finding an underlying cause for the disorder.
Consider separate counseling and procedural visits. Like many pediatric patients, one with an autism spectrum disorder can be anxious about vaccinations, needles, or any other unpleasant procedure. So if they know a particular visit is limited to a discussion of concerns, they are more likely to relax and be more communicative.
Counseling will depend on the cognitive and language abilities of the patient. Discussions will have to be tailored to the level of understanding of the teen with autism spectrum disorder.
Counseling can include addressing sexuality issues. Discuss physical and emotional changes associated with adolescence and the effects they can have on the patient and the family. Teenagers in general are often confused about these changes, and those with autism spectrum disorder are no exception.
Discussions of the sort of sexual interest the patient has or does not have will depend on the patient's expressive capacity. Ask open-ended questions about any situations that may have arisen or about any concerns the patient may have about the future.
Also, educate the teen about the prevention of unwanted pregnancy and sexually transmitted infections.
Medication management is important in this population. Many adolescents on the autism spectrum already take psychopharmacologic agents. There is a wide range of comfort levels among pediatricians regarding prescription of psychopharmacologic agents and management of behavioral challenges. Refer the patient to a specialist if you are not at ease in these situations.
Similarly, some pediatricians will be more comfortable than others in ordering and evaluating genetic testing.
Technology has advanced from general karyotype testing a decade ago to more accurate molecular fragile X assays and chromosome microarray analyses that are available today.
If you feel up to date based on your training and experience, go ahead and order initial testing or updated testing as indicated.
General pediatricians are well equipped to manage any underlying medical issues. For example, if a patient has spells that might suggest seizures, an EEG might be in order, especially in this higher-risk population.
Start a transition plan once the adolescent is in high school. Pediatricians are integral in creating this plan, along with family physicians, internists, and/or other adult care providers.
Also work with school personnel to ensure an optimal outcome. Specific goals can include preparing the patient for postsecondary education or having the patient get necessary vocational skills as he or she becomes more independent and joins the workforce.
Work with parents to clarify goals for future living arrangements. Also suggest that parents establish a special needs trust to protect assets designated for the adolescent while still maintaining eligibility for government benefit programs.