Considerations Recommendations
1. Head, eyes, ears, nose, throat
  • Children: Hearing:  Recurrent otitis media is common
  • Nasal:  Nasal allergies are common
  • Both of these conditions may be undertreated due to communication difficulties that interfere with the child expressing pain or discomfort.
  • Children and Adults: Greater risk of significant hearing loss
  • Hyperacusis is common
  • Vision: Sensitivity to light is common
  • Strabismus and refractive errors may be more prevalent
  • Visualize tympanic membranes at each visit.
  • Consider referral to otolaryngologist if otitis media persists.
  • Screen hearing and vision regularly
  • Screen for nasal allergies


2. Dental
  • Children and Adults: Dental caries are common. Individuals with sensory sensitivities may not be thorough in toothbrushing, and restricted diets may predispose some to dental caries.
  • Bruxism may lead to excessive tooth surface wear/damage and predispose to decay.
  • Refer to a dentist for semi-annual exams, or more frequently if indicated.
  • Consider treatment for bruxism, if present
3. Sleep
  • Children and Adults: Difficulty initiating or maintaining sleep is common (50%-80%).
  • Ascertain a sleep history, including whether habits are in place to promote sleep (e.g., adequate physical exercise , minimizing caffeine and, in the case of adults, alcohol, and limiting use of electronic devices close to bedtime).
  • Evaluate for causes of night wakings, including obstructive sleep apnea, restless legs syndrome/periodic leg movements of sleep (which may be more common in this population due to low iron from restricted diets), nocturnal  seizures, and parasomnias (sleepwalking, sleep terrors, confusional arousals).
  • Implement simple behavioral strategies to improve sleep habits.
  • Refer to a sleep specialist and/or for a sleep study as appropriate.
4. Gastrointestinal
  • Children and Adults: Constipation, diarrhea, gastroesophageal reflux disease (GERD), and food adversions/preferences are common.
  • Some individuals may be on specialized diets, e.g., gluten-free, casein-free diet.
  • Food allergies are also common.
  • Refer to a gastroenterologist, nutritionist, or dietician, as appropriate. Depending on the nature and severity of the gastrointestinal problems, treatments can include dietary interventions, behavioral interventions focused on feeding and diet, nutritional supplements, and medications that address gastrointestinal disorders.
  • Ascertain whether the individual is on a specialized diet and if so, whether nutritional needs are being met since these individuals may be at risk for nutritional deficiencies.
5. Sexual Function
  • Adults: Males and females are fertile.
  • Consider discussion of recurrence risk and reproductive options, with possible referral to gynecologist
  • Consider birth control when girls begin menstruation to avoid unwanted pregnancy
  • Consider evaluation by geneticist if patient and/or family is interested in determining whether a genetic etiology can be identified
6. Musculoskeletal (MSK)
  • Children: Hypotonia is common (~ 50%)
  • Hypotonia gradually improves over time.
  • Consider evaluation by neurologist.
  • Physical therapy can improve gross motor control and overall body strength.  Occupational and speech-language therapy can help with fine motor control, speech, and feeding difficulties
7. Neurology
  • Children and Adults: Seizures are relatively common (6%-30%).
  • Some individuals may experience onset of seizures during puberty. These seizures may be subtle and not readily observable.
  • Motor dysfunction is common (gross and fine motor delays, apraxia, and difficulty with walking and coordination).
  • Motor apraxia improves over time.
  • Tic disorders are more common (Tourette syndrome or chronic motor tic).
  • Ascertain a history of staring spells, loss of consciousness or awareness, and convulsive activity. Refer to a neurologist and/or for an EEG as appropriate.
  • Consider evaluation with neurologist if adolescent begins to exhibit significant behavior problems, e.g., aggression or self-injury, or if academic progress is affected.
  • Ascertain a history of motor difficulties. Refer to a physical therapist or an occupational therapist as needed for evaluation and/or treatment
8. Behavioral/mental health
  • Children and Adults: Individuals may have impaired social relationships. Some may not show an interest in social interactions while others seek interaction but are not skilled in how to proceed.
  • Individuals often have restricted patterns of interests or repetitive behaviors. Young children may rock, stare, or twirl strings.
  • Elopement/wandering is common, particularly in children.
  • Individuals of all ages may express a need for sameness in daily routines.
  • Up to 90% may be undersensitive or oversensitive to sensory input (sound, visual stimuli, taste, smell, or touch).
  • Tantrums, self-injurious or aggressive behaviors are common.
  • Co-morbid psychiatric problems are common. Individuals may have more than one condition, with a high prevalence of psychotropic medication treatment in this population. Conditions include depression, anxiety, obsessive-compulsive disorder, and attention deficit hyperactivity disorder.
  • Regular surveillance for behavioral issues is important. Refer for behavioral therapy and psychiatric intervention as appropriate.
9. Infectious disease/Immune Deficiency
  • Children and Adults: ~ 25% have immune deficiency and dysfunction. This may manifest as frequent infections (e.g., ear, sinus, upper respiratory).
  • Consider referral to infectious disease specialist if infections occur frequently
10. Etiology
  • Autism is a behaviorally defined entity. While most individuals with ASD have a “multifactorial etiology,” some have identifiable etiologies, such as Fragile X or tuberous sclerosis, which may help guide treatment.
  • Consider evaluation by geneticist if patient and/or family is interested in determining whether a genetic etiology can be identified.
11. Other
  • Up to 50% of individuals with ASD may have an intellectual disability.
  • It is important to have an accurate measure of underlying cognitive potential determined by a psychologist or other qualified examiner, including nonverbal measures. Such psychological assessments may need to be repeated periodically through childhood.

Original tool: © 2014 Vanderbilt Kennedy Center
Developed by Malow BA, and Shouse J.

This tool was reviewed by physicians on the Toolkit’s Advisory Committee; for list, view here.

Four published autism spectrum disorder health care guidelines were reviewed and compared.


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