Autism: Early Screening by Pediatricians

Medical Author: David Perlstein, MD FAAP
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

It is commonplace to have a family member or close friend with a child diagnosed with one of the autism spectrum disorders (ASDs, including Autistic Disorder, Asperger Disorder, Pervasive Developmental Disorder). These are a set of neurodevelopmental disabilities affecting young children and adults, which are currently not considered "curable." The goals of management include minimizing the symptoms and maximizing both independent function and quality of life. These are not uncommon disorders. Their prevalence has been estimated as approximately 6.5 per 1000 children, or 1 in every 150 children. Many believe that there is an "Autism Epidemic." However, as with many diseases and disorders, there are many reasons for this high prevalence.

Fortunately, significant media coverage and increased research have resulted in a better educated public and more vigilant healthcare practitioners. It is clear that early diagnosis and intervention are associated with better outcomes.

Recently the American Academy of Pediatrics (AAP) published an updated guide for the "Management of Children with Autism Spectrum Disorders." In this publication, both background information and management choices are reviewed. In addition the AAP's approved "Surveillance and Screening Algorithm: Autism Spectrum Disorders (ASDs)" is introduced. Currently this translates into the following: All children should be screened for autism at 18 months and again at 2 years of age, and at any time a parent raises a concern about autism spectrum disorders (even if they have no signs of developmental delay). Although many healthcare practitioners were already screening, the process has been formalized and I expect that even more children will be referred, resulting in earlier diagnosis and intervention.

I am a community pediatrician. In my practice I have decided to adopt the CHAT Screening Tool (Checklist for Autism in Toddlers). Because early intervention has been shown to improve outcomes, we also try to educate our parents as early as possible to be aware of the warning signs of autism spectrum disorders, and encourage them to speak to our staff whenever concerned.

We focus on the following simple symptom screens recommended by the CDC:

1. Does the child babble or coo by 12 months?

2. Does the child gesture by 12 months (pointing, waving, grasping)?

3. Does the child say single words by 16 months?

4. Does the child say two-word phrases independently by 24 months?

5. Has the child lost any social or language skills?

The CHAT Screening Tool in part focuses on the following:

At 18 months does your child:

1. Look at you and point when he/she wants to show you something?

2. Look when you point to something?

3. Use imagination to pretend play?

There are many other symptoms associated with autism spectrum disorders, including social and communication deficits, bizarre or repetitive behaviors, sensory abnormalities and self injurious behaviors.

Most importantly, my advice for parents is that if they are concerned about their child's behavior, they should talk with their doctor. With a working parent-doctor partnership healthcare practitioners will be more capable of achieving optimal care for those with autism.

References: Pediatrics. November 2007; Vol 120, Number 5. Centers for Disease Control and Prevention.