Saturday, July 07, 2007

Autism Can Be Diagnosed at 14 Months

By closely monitoring the social and communication development in very young children, researchers at the Kennedy Krieger Institute in Baltimore reported that they could diagnose autism at 14 months of age in half of the cases they studied, and by three years of age in the other half.

The research study is in the July 2007 issue of the Archives of General Psychiatry. A very brief description of the study is here (the full study is available to the medical journal's subscribers). A press release describing the results is here, via the Autism Speaks website.

Early diagnosis is a key issue for families of kids with autism spectrum disorders (ASD). Early diagnosis can lead more quickly to the start of early intervention services. If such services go well, it can mean not only better outcomes for the kids, but it means less costly service burdens later on.

The most recent statistics released by the Centers for Disease Control found that in the 14 states studied, the median age for a diagnosis in most of the states was four years old or later. (See background information here.)

The researchers released a list of four "signs of developmental disruptions" which parents and pediatricians should be watching. Here's the list:

1. Abnormalities in initiating communication with others.
Rather than requesting help to open a jar of bubbles through gestures and vocalizations paired with eye contact, a child with ASD may struggle to open it themselves or fuss, often without looking at the nearby person.

2. Compromised ability to initiate and respond to opportunities to share experiences with others.
Children with ASD infrequently monitor other people's focus of attention. Therefore, a child with ASD will miss cues that are important for shared engagement with others, and miss opportunities for learning as well as for initiating communication about a shared topic of interest. For example, if a parent looks at a stuffed animal across the room, the child with ASD often does not follow the gaze and also look at the stuffed animal. Nor does this child often initiate communication with others. In contrast, children with typical development would observe the parent's shift in gaze, look at the same object, and share in an exchange with the parent about the object of mutual focus. During engagement, children have many prolonged opportunities to learn new words and new ways to play with toys while having an emotionally satisfying experience with their parent.

3. Irregularities when playing with toys.
Instead of using a toy as it is meant to be used, such as picking up a toy fork and pretending to eat with it, children with ASD may repeatedly pick the fork up and drop it down, tap it on the table, or perform another unusual act with the toy.

4. Significantly reduced variety of sounds, words and gestures used to communicate.

Compared to typically developing children, children with ASD have a much smaller inventory of sounds, words and gestures that they use to communicate with others.

"For a toddler with autism, only a limited set of circumstances – like when they see a favorite toy, or when they are tossed in the air – will lead to fleeting social engagement," said Dr. Rebecca Landa, the director of the Kennedy Krieger's Center for Autism and Related Disorders, and lead study author. "The fact that we can identify this at such a young age is extremely exciting, because it gives us an opportunity to diagnose children with ASD very early on when intervention may have a great impact on development."

Landa's research group hopes to establish a standardized criteria for diagnosing autism spectrum disorders among very young children.

This is a tricky task, for the researchers also found that "autism often involves a progression, with the disorder claiming or presenting itself between 14 and 24 months of age. Some children with only mild delays at 14 months of age could go on to be diagnosed with ASD. ... While some children developed very slowly and displayed social and communication abnormalities associated with ASD at 14 months of age, others showed only mild delays with a gradual onset of autism symptoms, culminating in the diagnosis of ASD by 36 months."

The bottom line for families comes at the end of the press release:

If parents suspect something is wrong with their child's development, or that their child is losing skills during their first few years of life, they should talk to their pediatrician or another developmental expert. This and other autism studies suggest that the "wait and see" method, which is often recommended to concerned parents, could lead to missed opportunities for early intervention during this time period.

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