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Saturday, August 6, 2016

Earlier Diagnosis Means Better Treatment

In The Politics of Autism, I discuss evaluation and diagnosis of young children.

A release from the American Psychiatric Association:
Diagnosis of autism spectrum disorder before the age of 4 means that a child is more likely to get effective, evidence-based treatment, such as behavioral therapy. When children are diagnosed at after that threshold, they are less likely to receive such treatment, but they are more likely to be treated with medication, according to research published online today in Psychiatric Services in Advance.
In addition, delays of more than two years between when parents first discuss concerns with a provider and receiving an autism diagnosis were associated with higher use of complementary and alternative medicine, which is considered more controversial.
The strongest evidence for effective treatment for autism is for behavioral intervention therapy directed at core autism symptoms, such as social skills and inflexible behaviors. Early intensive treatments may have long-term benefits for children’s functioning. Other therapies, including complementary and alternative medicine and medication treatments for autism, are more controversial and are not as strongly supported by scientific studies.
Researchers, led by Katharine Zuckerman, M.D., M.P.H., with Oregon Health and Science University, in Portland, assessed the experiences of 722 children ages 6 to 11 with autism spectrum disorder. They looked at use of health services, including behavioral intervention therapy, school-based therapy (including social skills training, occupational therapy, physical therapy, or speech and language therapy), complementary and alternative medicine (such as nutritional supplements), and psychotropic medications (such as antidepressants and medications for attention-deficit/hyperactivity disorder (ADHD)).
On average, parents first discussed developmental concerns with a provider when the child was just over 2 years old, and the average age at autism diagnosis was more than 4 years. Use of complementary and alternative medicine was nearly twice as common among children with longer versus shorter delays (21 percent and 11 percent, respectively). The American Academy of Pediatrics recommends that all children be screened for autism at 18 months and at 24 months, yet only about half of primary care practitioners screen for autism. A diagnosis of autism can typically be made by age 2. The average age at diagnosis in the United States is more than 4 years old.
Researchers concluded that efforts to increase early autism diagnosis may result in greater use of effective autism-related therapy and improved functional outcomes for children with autism spectrum disorder.