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Thursday, April 28, 2011

Early Screening

Previous posts have examined early diagnosis and intervention.

The Los Angeles Times reports:

Autism treatment works best the earlier a child is diagnosed and begins therapy. A new screening test for babies at their 1-year-old check-up may be reliable enough to be used in pediatricians' offices around the world, said the authors of a review of the method.

The screening test was performed on 10,479 1-year-olds in San Diego. The babies were the patients of 137 different pediatricians. Parents or guardians gave their permission for the babies to be screened.


The study, published online Thursday in the Journal of Pediatrics, did not determine how many of the children who passed the screening test went on to receive a diagnosis of autism or developmental delay. Moreover, some of the parents of babies who failed the initial screening test did not choose to proceed with additional screening. Finally, the screening test would not be expected to identify the approximately 25% of children who are diagnosed with a different pattern of autism in which they develop normally in the first year but begin to regress some time after their first birthday.

USA Today interview Geraldine Dawson of Autism Speaks:

Q: How common is early screening for autism today?

A: The current recommendation from the American Academy of Pediatrics is that all children be screened for autism at the 18- and 24-months-old well-baby checkups. However, there are still many pediatricians who are not systematically screening for autism as part of routine well-baby checkups.

Q: At what age are most kids seen for initial suspicions of autism? At what age are they diagnosed?

A: Unfortunately, although it is possible to screen for autism in toddlers and diagnose reliably by 18 to 24 months, the average age of diagnosis in the USA is close to 5 years. Similarly, although interventions now exist for toddlers as young as 12 months, often children don't begin intervention until much later in the preschool period. The fact that the kids in this study began intervention, on average, by 17 months was very positive.

Q: Does age of diagnosis vary by region, race or income?

A: Yes. Studies have shown that children from ethnic minority backgrounds and lower socioeconomic status often receive their autism diagnosis at a much later age and require more visits to the doctor to receive a diagnosis.

Q: Could doctors begin using the new screening checklist right now?

A: Keep in mind that the pediatricians using this screening tool were working closely with a university-based center that specializes in autism. The center staff offered training in its use and were able to evaluate and provide recommendations for children who screened positive on the questionnaire. With appropriate training and support from professionals with expertise in autism, pediatricians could certainly use the questionnaire.

Q: Are enough services available for the babies who will need them?

A: All infants who demonstrate developmental delays are eligible for "Birth to Three" services paid for by the state. Some states offer generic intervention, others autism-specific services. Some autism treatment centers offer interventions for infants as young as 12 months, but this is still a relatively new area of research. There are still only a few published studies on interventions for infants with autism.

Q: About one in 110 kids have an autism-like condition. Will better screening increase the prevalence?

A: The CDC is tracking changes of autism prevalence over time. They study children who are 8 because most children are diagnosed by that age. So, detecting autism very early should not increase the prevalence. If providing intervention at a very young age is very effective in reducing symptoms of autism, it is possible that it could actually decrease prevalence of autism by age 8.