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:
- Does the child babble or coo by 12 months?
- Does the child gesture by 12 months (pointing, waving, grasping)?
- Does the child say single words by 16 months?
- Does the child say two-word phrases independently by 24 months?
- 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:
- Look at you and point when he/she wants to show you something?
- Look when you point to something?
- 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.
Last Editorial Review: 11/16/2007