WSJ: How Young is Too Young? - autism

[Guest guest]

How young is too young?

Early diagnosis could give children a head start in therapy, but some

infants outgrow behaviors.

*By Suein Hwang*

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THE WALL STREET JOURNAL

When Pam Lyle's daughter Hailey was 13 months old, she suddenly lost

her ability to speak and began retreating into her own world. Two

months later, Lyle brought her to Yale University's Child Studies

Center in Connecticut, where she got a diagnosis that is unusual for

a child that young: autism.

* Kleiner,* 4, diagnosed with autism, plays with a toy at The

Therapy Place in Bloomington, Minn., in 2003. Many children with

autism aren't diagnosed until age 3 or later, but that may change as

specialists examine whether earlier diagnosis could lead to better

response to treatment.

ASSOCIATED PRESS FILE PHOTO

* *of Odessa, Del., kisses his 11-year-old son Ian while

his wife Annette watches during an interview in 2003. Ian is one of

as many as 500,000 children in the U.S. with autism, a developmental

disorder.

MONIQUE BRUNSBERG / THE (WILMINGTON, DEL.) NEWS JO

Now, after 2 1/2 years of intensive in-home treatment, Hailey makes

eye contact and recently has learned to use pictures to communicate —

an outcome the Orange, Conn., family attributes to her early

diagnosis.

Many specialists say autism isn't identifiable in most children

until at least 18 months of age, when the behaviors that are the

common hallmarks of the disorder are more apparent. While there are

no statistics on average age of diagnosis, many children aren't

diagnosed until age 3 or later. But thanks to studies showing that

preschoolers often respond better to treatment than do children

diagnosed at earlier ages — as measured by gains in language and IQ

scores — specialists are exploring whether children diagnosed at even

younger ages might fare even better.

Several studies, including research in Canada and at the University

of California, San Diego, have tied the eventual diagnosis of autism

to attributes observed in infants as young as 6 months of age. Autism

specialists around the country say parents are increasingly bringing

in toddlers and infants — some as young as 4 months — for evaluation.

At the Center for Autism and Related Disorders at the Kennedy

Krieger Institute in Baltimore, director Landa says it once

was rare to see even a toddler, but now the clinic sees " a minimum of

one baby a week. "

Yale University's center is seeing a child younger than 18 months

every few weeks, says director Fred Volkmar. And researchers are

eager to see these youngest patients. Whereas many families must wait

a couple of years for an appointment at Yale, children younger than 2

can get in to see a specialist in the time span of a few weeks to a

couple of months.

*ON THE RISE*

Autism, a little-understood condition marked by social withdrawal,

repetitive behaviors and poor communication skills, is believed to be

the fastest-growing developmental disability.

There are varying theories as to why autism is on the rise, from the

use of mercury preservatives in childhood vaccines to increased

awareness driving more diagnoses. The Centers for Disease Control and

Prevention in Atlanta estimates about 24,000 children are diagnosed

annually, and that as many as 500,000 children in the U.S. have the

condition.

Some experts are skeptical of efforts to diagnose autism in infants

and toddlers in clinical practice. Autism typically is diagnosed once

a child exhibits a certain number of behavioral symptoms, such as not

making eye contact. With very young children there is a wide range of

behaviors that could be considered normal. It can be hard to tell

whether a behavior such as a lack of sociability in an infant is

truly a symptom or just means the child hasn't yet reached a certain

developmental level.

" I don't know how you diagnose autism in a 12-month-old, " says Sally

J. , psychiatry professor at the University of

California-'s M.I.N.D. Institute.

Even assuming autism can be identified in such young children, there

is little research on what treatments might be appropriate. For

children roughly 3 years of age and older, the main treatment for

autism is intensive structured teaching of skills for many hours a

week. Specialists who see infants and toddlers must experiment with

adapting therapies for younger patients.

Only a few specialists are willing to diagnose infants and toddlers,

and they typically offer a " provisional " diagnosis, acknowledging that

the situation may change.

The hope is that by identifying autistic symptoms in children when

their minds are the most pliable, doctors could find something

tantamount to a cure.

" The brain systems responsible for social engagement and speech

perception are really developing between birth and age 2 very

rapidly, " says Geraldine Dawson, director of the Autism Center at the

University of Washington in Seattle, who says she has worked with a

7-month-old child who exhibited autistic symptoms.

*TREATMENT*

The drive to diagnose children in infancy is unrelated to the theory

that vaccines later in childhood are to blame for autism. The

immunization theory, Dawson says, focuses on children who develop

normally initially but then lose their skills, which she estimates is

about 25 percent of autistic children.

This new research is focused on identifying the remaining 75 percent

who demonstrate symptoms very early on.

Specialists who evaluate infants point to a number of symptoms that

could suggest trouble down the road. Even as early as a year, they

say, most infants should be able to gesture, babble and interact with

their parents. Parents of children diagnosed with autism often say

they noticed differences even in infancy, when their babies showed

little interest in engaging them or wouldn't look up when called.

Shulman, a specialist in infant/toddler autism at the Albert

Einstein College of Medicine's Children's Evaluation and

Rehabilitation Center in Bronx, N.Y., points to one family whose only

son was diagnosed at a year. The boy ignored his parents even when

yelled at, didn't want to be touched, and was very focused on playing

with spinning items like wheels.

Five months of treatment later, the child has improved so

dramatically his parents are reducing his therapy and enrolling him

in a mainstream preschool, says Shulman.

In cases of very young children and dramatic recoveries, some

experts raise questions about whether the children were ever

suffering from autism to begin with. And some researchers say they

have observed children who appear to have autistic symptoms early on

but later seem to grow out of them. n Sigman, a child-psychiatry

professor at UCLA, co-authored a study looking at a group of

14-month-old siblings of autistic children who also had significant

language delays (siblings are frequently studied, as they have a

higher likelihood of developing autism themselves). The study found

that most of these children were normally developing by 54 months.

*SIGNS*

Many specialists exploring early intervention point to research that

links infants to autism. In late April, a study published by Canadian

researchers found that kids later diagnosed with autism shared

certain behaviors when they were younger — such as decreased activity

levels at the age of 6 months and using fewer phrases and gestures at

12 months.

Another study published a couple of years ago by the University of

California, San Diego, associated autism with small head

circumference at birth followed by a sudden growth spurt before the

end of the first year.

In a 2000 study, University of Washington researchers examined

videotapes of babies ranging from 8 to 10 months of age and were able

to distinguish those who would later develop autism in 11 out of 15

cases. The two symptoms that the babies tended to demonstrate the

most frequently was a failure to respond to their names and lack of

eye contact.

For her part, Lyle is grateful for the early diagnosis. If Hailey,

now almost 4, hadn't been treated so soon, her mother says, she would

have " become one of these children who sits in a corner rocking and

banging her head on a wall. "

*

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