Autism spectrum disorders (ASDs) are neurobehavioral disorders characterized by abnormalities in three behavioral domains including social interaction, impaired communication, and repetitive stereotypic behaviors. ASD affects approximately 1% of children and is on the rise with significant genetic mechanisms underlying these disorders. We review the current understanding of the role of genetic and metabolic factors contributing to ASD with the use of new genetic technology. Fifty percent is diagnosed with chromosomal abnormalities, small DNA deletions/duplications, single-gene conditions, or metabolic disturbances. Genetic evaluation is discussed along with psychiatric treatment and approaches for selection of medication to treat associated challenging behaviors or comorbidities seen in ASD. We emphasize the importance of prioritizing treatment based on target symptom clusters and in what order for individuals with ASD, as the treatment may vary from patient to patient. 1. Introduction Classical autism which was first described in 1943 [1] belongs to a group of heterogeneous disorders known as autism spectrum disorders (ASD). These neurobehavioral disorders are characterized by abnormalities in three behavioral domains including disturbances in social interaction, impaired communication skills, and repetitive stereotypic behaviors with an onset recognized prior to 3 years of age [2]. ASD includes not only classical autism (autistic disorder) but also asperger disorder (high functioning) and pervasive developmental disorder not otherwise specified (PDD-NOS) [2–6]. The American Academy of Pediatrics recommends autism screening of all infants and toddlers for early identification and intervention by at least 12 months of age and again at 24 months. Several validated rating scales are helpful in establishing the diagnosis, including Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS), in combination with clinical presentation [7–9]. Specialist assessments and work-ups are available usually at university hospitals and university-affiliated programs and ideally should include regular visits at least annually depending on the chief complaint with a psychologist specializing in ASD, a psychiatrist to examine for treatable symptom presentations such as inattention, a neurologist for seizure assessment and brain imaging to exclude anatomical abnormalities, and a clinical geneticist to identify a known genetic syndrome causing autism, genetic counseling issues, and appropriate genetic testing for family members (now or
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