Findings of a new study published in the journal JAMA Pediatrics suggest that autism screenings can be done for children as early as 14 months of age, instead of the regular testing done between 18 to 24 months old.
The study looked into 1,269 toddlers who had gotten their first evaluation between the ages of 12 and 36 months, which was followed by another assessment later. Four hundred forty-one of the children had autism spectrum disorder (ASD) while 828 did not. The diagnoses of the children included ASD, features of ASD, developmental and language delay, and other types of developmental issues.
The researchers focused on the accuracy and stability of the diagnoses the toddlers received as time passed. They found that 84% of the children who participated in the study and who had been diagnosed with autism at their first evaluation retained the same diagnosis when they reached the ages of 3 or 4.
The study determined that 2% of the children who were initially considered to have ASD were later found to have typical development and that the diagnostic stability of ASD was strongest compared to other diagnoses and when children were evaluated at 14 months old and above, instead of at 12 to 13 months.
“Our findings suggest that as ASD diagnosis becomes stable starting at 14 months, and overall is more stable than other diagnoses, such as language or developmental delay,” Karen Pierce, PhD, a professor of neurosciences and co-director of the University of California, San Diego Autism Center of Excellence, who served as first author of the study, stated in a press release.
The National Institute of Mental Health (NIMH) describes autism spectrum disorder as a developmental disorder which impacts a person’s behavior and communication. Because there are multiple variations in the types and severity of symptoms that people may experience, autism is called a “spectrum” disorder.
As cited by the NIMH according to data from the Diagnostic and Statistical Manual of Mental Disorders, which was created by the American Psychiatric Association (APA) to help diagnose mental disorders, symptoms of ASD include difficulty in communicating and interacting with others, restricted interests and repetitive behaviors, and among others.
Difficulties in social interaction and communication involve, according to the NIMH:
Little or unstable eye contact
A tendency not to listen to or look at other people
Inability or being slow to respond to verbal attempts made by others to get their attention
Being unable to understand other people’s point of view or actions
A tendency to keep talking about their own subject of interest, without noticing that others are not expressing interest or allowing others to respond
Making facial expressions, movements, and gestures that do not complement what they are saying
Repetitive behaviors and restricted interests include:
Unusual behaviors such as repeating specific words or phrases
Lasting intense interests in different subjects
Overly-focused interests (e.g., the moving parts of specific objects)
Being more or less sensitive to stimuli such as light or noise
The NIMH also states that people with ASD may experience irritability and issues with sleep.
The diagnosis of ASD typically takes place in two stages. The first stage involves general developmental screenings done during regular check-ups when a child is 9, 18, and 24 or 30 months old. During these screenings, doctors will not only consider their own observations of the child and information they gather from ASD screening tools, but also anecdotes and concerns from the child’s parents and/or guardians.
If a child manifests developmental problems, she might be recommended to take an additional evaluation or the second stage of diagnosing ASD. This evaluation may be done by a team of doctors and other professionals who are experienced in diagnosing ASD. This team may include a developmental pediatrician, a child psychologist and/or a child psychiatrist, a neuropsychologist, and a speech-language pathologist.
During the second stage, the team of professionals may pay particular attention to factors such as the child’s cognitive level, language abilities, and skills that are necessary to accomplish everyday activities like eating and putting on clothes. The evaluation may also include blood and hearing tests since ASD sometimes takes place with other illnesses or disorders. The diagnosis will then be given as an outcome of the evaluation.
Currently, the American Academy of Pediatrics (AAP) recommends children be screened for ASD during visits to the doctor between the ages of 18 to 24 months old. These tests are on top of screenings for developmental delays and disabilities conducted when the child is 9 months old, 18 months old, and 24 or 30 months old, especially if she is determined to be at high risk for developmental problems. Through these screenings, professionals will then be able to provide a final diagnosis by the time the child is 2 years old, along with recommendations for treatment.
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However, according to Pierce, delaying the evaluation of a child who displays signs of ASD is a “missed opportunity,” mainly because it is during the first few years of a child’s life when his brain develops very rapidly.
“The brain is very plastic during early development and can be impacted by input from the environment,” Pierce told CNN. “The frontal cortex in particular — the part of the brain essential for the development of social skills — is making a large number of connections between brain cells across the first two years of life.”
The earlier a child is diagnosed, the earlier she can receive the treatments and interventions she needs.
“It’s conceivable that outcomes for children with autism could be improved if treatment occurred during this period of rapid brain growth, rather than after, which is more commonly the case,” Pierce stated in the press release issued by UC San Diego.
Michael Morrier, an assistant professor and program director of screening and assessment at the Emory Autism Center at Emory University School of Medicine who was not involved in the study, pointed out more benefits of earlier ASD diagnosis to CNN.
“The biggest benefit to diagnosis young is really two-fold. One would be preventing challenging behaviors,” Morrier said. These behaviors, which develop gradually over time, can include banging the child’s head repeatedly against a table or separating himself from others.
According to Morrier, through an earlier diagnosis of ASD, “we’re going to probably prevent a lot of those types of behaviors from starting.”
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He continued that earlier diagnosis from autism screening before the child is between 18 to 24 months old can also “give [families] the skills and give the child the skills needed so that they can feel supported in going out into the community and having real social experiences that all young kids should have.”