Autism: Early Screening by Pediatricians

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Medical Author: David Perlstein, MD, MBA, 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. A recent report from the CDC funded Autism and Developmental Disabilities Monitoring (ADDM) Network 2012 report published that the prevalence of 8 year old children diagnosed with ASDs had increased from 6.5 per 1,000 children (1 in every 150 children) in 2002 to 11.3 per 1,000 children (1 in every 88 children) in 2008. Many believe that there is an "autism epidemic." However, as with many diseases and disorders, there are many reasons for this high prevalence. Moreover, researchers continue to explore the many factors that cause autism.

Fortunately, significant media coverage and increased research have resulted in a better-educated public and more vigilant health care professionals. We are much better at screening and identifying children and infants at risk, better at documenting the diagnoses, and better at intervening earlier. It has been clearly shown that early diagnosis and intervention are usually associated with better outcomes. A recent study from Columbia University and published in the medical journal Pediatrics noted that there was even a subgroup of severely affected infants with ASD who, with an appropriate intervention, “experience rapid gains, moving from the severely affected to high functioning.” They named this group “bloomers.” This alone justifies universal screening, early identification, and intervention.

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 two 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 health care professionals were already screening, the process has been formalized and I expect that even more children will be referred, resulting in earlier diagnosis and intervention.

In our practices we use the Modified Checklist for Autism in Toddlers (M-CHAT) screening tool. 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 they are 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, and 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 health care professionals will be more capable of achieving optimal care for those with autism.

REFERENCES:

Centers for Disease Control (CDC). "Community Report From the Autism and Developmental Disabilities Monitoring (ADDM) Network. Prevalence of Autism Spectrum Disorders (ASDs) Among Multiple Areas of the United States in 2008." Autism and Developmental Disabilities Monitoring Network 2012. <http://www.cdc.gov/ncbddd/autism/documents/ADDM-2012-Community-Report.pdf>.

Fountain, Christine, et al. "Six Developmental Trajectories Characterize Children With Autism." Pediatrics published online April 2, 2012. <http://pediatrics.aappublications.org/content/early/2012/03/28/peds.2011-1601>.

Robins, Diana, et al. "Modified Checklist for Autism in Toddlers (M-CHAT)." Copyright 1999. <http://www2.gsu.edu/~psydlr/DianaLRobins/Official_M-CHAT_Website_files/M-CHAT.pdf>.