Office-Based Medical Care

  • Yamini Jagannath HoweEmail author
  • Phil Bartel
  • Robert E. Accordino
Part of the Current Clinical Psychiatry book series (CCPSY)


Autism spectrum disorder (ASD) is an increasingly prevalent condition that can affect the way an individual interacts with others across the life span. Due to social communication impairments, sensory difficulties, and comorbid emotional or behavioral problems, individuals with ASD may have difficulty accessing high-quality outpatient medical care. Medical providers often feel unprepared to meet the needs of individuals with ASD in a busy, outpatient clinic. In this chapter, we address these concerns by outlining specific strategies that can be employed to prepare the patient for an outpatient medical visit, discussing specific practice accommodations that can be made as well as the general approach to the history and physical examination of patients with ASD. Topics relevant to the care of pediatric, adolescent, and adult patients with ASD are presented, including clinical case examples.


Autism spectrum disorder Outpatient care Delivery of healthcare/methods 


  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, D.C: American Psychiatric Association; 2013.CrossRefGoogle Scholar
  2. 2.
    Baio J, Wiggins L, Christensen DL, Maenner MJ, Daniels J, Warren Z, et al. Prevalence of autism spectrum disorder among children aged 8 years –autism and developmental disabilities monitoring network, 11 sites, United States, 2014. MMWR Surveill Summ. 2018;67:1–23.CrossRefGoogle Scholar
  3. 3.
    Howlin P, Moss P, Savage S, Rutter M. Social outcomes in mid- to later adulthood among individuals diagnosed with autism and average nonverbal IQ as children. J Am Acad Child Adolesc Psychiatry. 2013;52(6):572–81. e1.CrossRefGoogle Scholar
  4. 4.
    McDougle CJ. Sounding a wake-up call: improving the lives of adults with autism. J Am Acad Child Adolesc Psychiatry. 2013;52(6):566–8.CrossRefGoogle Scholar
  5. 5.
    Allely CS. Pain sensitivity and observer perception of pain in individuals with autistic spectrum disorder. Sci World J. 2013;2013:916178.CrossRefGoogle Scholar
  6. 6.
    Bultas MW, McMillin SE, Zand DH. Reducing barriers to care in the office-based health care setting for children with autism. J Pediatr Health Care. 2016;30(1):5–14.CrossRefGoogle Scholar
  7. 7.
    Raymaker DM, McDonald KE, Ashkenazy E, Gerrity M, Baggs AM, Kripke C, et al. Barriers to healthcare: instrument development and comparison between autistic adults and adults with and without other disabilities. Autism. 2016;21:972–84.CrossRefGoogle Scholar
  8. 8.
    Zuckerman KE, Lindly OJ, Bethell CD, Kuhlthau K. Family impacts among children with autism spectrum disorder: the role of health care quality. Acad Pediatr. 2014;14(4):398–407.CrossRefGoogle Scholar
  9. 9.
    Kogan MD, Strickland BB, Blumberg SJ, Singh GK, Perrin JM, van Dyck PC. A national profile of the health care experiences and family impact of autism spectrum disorder among children in the United States, 2005–2006. Pediatrics. 2008;122(6):e1149–58.CrossRefGoogle Scholar
  10. 10.
    Golnik A, Ireland M, Borowsky IW. Medical homes for children with autism: a physician survey. Pediatrics. 2009;123(3):966–71.CrossRefGoogle Scholar
  11. 11.
    Davignon MN, Friedlaender E, Cronholm PF, Paciotti B, Levy SE. Parent and provider perspectives on procedural care for children with autism spectrum disorders. J Dev Behav Pediatr. 2014;35(3):207–15.CrossRefGoogle Scholar
  12. 12.
    Browning A. My hospital passport: the National Autistic Society; 2016. Available from:
  13. 13.
    Massachusetts General Hospital Lurie Center Autism Care Questionnaire. Available from:
  14. 14.
    Broder-Fingert S, Shui A, Ferrone C, Iannuzzi D, Cheng ER, Giauque A, et al. A pilot study of autism-specific care plans during hospital admission. Pediatrics. 2016;137(Supplement 2):S196–204.CrossRefGoogle Scholar
  15. 15.
    McGuire K, Fung LK, Hagopian L, Vasa RA, Mahajan R, Bernal P, et al. Irritability and problem behavior in autism spectrum disorder: a practice pathway for pediatric primary care. Pediatrics. 2016;137(Suppl 2):S136–48.CrossRefGoogle Scholar
  16. 16.
    Coury DL, Ashwood P, Fasano A, Fuchs G, Geraghty M, Kaul A, et al. Gastrointestinal conditions in children with autism spectrum disorder: developing a research agenda. Pediatrics. 2012;130(Suppl 2. United States):S160–8.CrossRefGoogle Scholar
  17. 17.
    Buie T, Fuchs GJ 3rd, Furuta GT, Kooros K, Levy J, Lewis JD, et al. Recommendations for evaluation and treatment of common gastrointestinal problems in children with ASDs. Pediatrics. 2010;125(Suppl 1):S19–29.CrossRefGoogle Scholar
  18. 18.
    Elrod MG, Hood BS. Sleep differences among children with autism spectrum disorders and typically developing peers: a meta-analysis. J Dev Behav Pediatr. 2015;36(3):166–77.CrossRefGoogle Scholar
  19. 19.
    Mandell DS, Walrath CM, Manteuffel B, Sgro G, Pinto-Martin JA. The prevalence and correlates of abuse among children with autism served in comprehensive community-based mental health settings. Child Abuse Negl. 2005;29(12):1359–72.CrossRefGoogle Scholar
  20. 20.
    Cheak-Zamora NC, Farmer JE, Mayfield WA, Clark MJ, Marvin AR, Kiely Law J, Law PA. Health care transition services for youth with autism spectrum disorders. Rehabil Psychol. 2014;59(3):340–8.CrossRefGoogle Scholar
  21. 21.
    Billstedt E, Gillberg C, Gillberg C. Autism after adolescence: population-based 13- to 22-year follow-up study of 120 individuals with autism diagnosed in childhood. J Autism Dev Disord. 2005;35:351–60.CrossRefGoogle Scholar
  22. 22.
    Child and Adolescent Health Measurement Initiative. National profile of children with special health care needs and autism spectrum disorder: Key findings from the 2009/10 NS-CSHCN & 2007 NSCH. 2012. Retrieved from
  23. 23.
    Holtz K, Owings N, Ziegert A. Life journey through autism: a guide for transition to adulthood. 2006. Retrieved from:
  24. 24.
    Lotstein DS, Ghandour R, Cash A, McGuire E, Strickland B, Newacheck P. Planning for health care transitions: results from the 2005–2006 national survey of children with special health care needs. Pediatrics. 2009;123:e145–52.CrossRefGoogle Scholar
  25. 25.
    Raymaker DM, McDonald KE, Ashkenazy E, Gerrity M, Baggs AM, Kripke C, et al. Barriers to healthcare: instrument development and comparison between autistic adults and adults with and without other disabilities. Autism. 2017;21:972–84.CrossRefGoogle Scholar
  26. 26.
    Dern S, Sappok T. Barriers to healthcare for people on the autism spectrum. Adv Autism. 2016;2:2–11.CrossRefGoogle Scholar
  27. 27.
    Nicolaidis C, Kripke CC, Raymaker D. Primary care for adults on the autism spectrum. Med Clin N Am. 2014;98:1169–91.CrossRefGoogle Scholar
  28. 28.
    Kirchner J, Appelmann S, Chiewkowsky C, Dern S, Dohle R, Elias R, Gotz E, Gottschlich R, Grambert CN, Kliemann D, Melzow F, Speer O, Purwins S, Dziobek I. Wissen und Unwissen uber Autismus. Poster presented at the 3rd Scientific Meeting for Autism Spectrum Conditions (WTAS) February 18–19th 2010, Frankfurt am Main.Google Scholar
  29. 29.
    Zerbo O, Massolo ML, Qian Y, Croen LA. A study of physician knowledge and experience with autism in adults in a large integrated healthcare system. J Autism Dev Disord. 2015;45:4002–14.CrossRefGoogle Scholar
  30. 30.
    Nicolaidis C, Raymaker D, McDonald K, Dern S, Boisclair WC, Ashkenazy E, et al. Comparison of healthcare experiences in autistic and non-autistic adults: a cross-sectional online survey facilitated by an academic-community partnership. J Gen Intern Med. 2013;28:761–9.CrossRefGoogle Scholar
  31. 31.
    Nicolaidis C, Raymaker DM, Ashkenazy E, McDonald KE, Dern S, Baggs AE, et al. “Respect the way I need to communicate with you”: healthcare experiences of adults on the autism spectrum. Autism. 2015;19:824–31.CrossRefGoogle Scholar
  32. 32.
    Kuhaneck HM, Chisholm EC. Improving dental visits for individuals with autism spectrum disorders through an understanding of sensory processing. Spec Care Dentist. 2012;32:229–33.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Yamini Jagannath Howe
    • 1
    Email author
  • Phil Bartel
    • 2
  • Robert E. Accordino
    • 3
  1. 1.Developmental-Behavioral PediatricsMassachusetts General Hospital, Lurie Center for AutismLexingtonUSA
  2. 2.University of Pittsburgh School of MedicinePittsburghUSA
  3. 3.Child and Adolescent PsychiatryMassachusetts General HospitalBostonUSA

Personalised recommendations