New Study finds that autism can be diagnosed at 12 months in 1/2 of cases

[Guest guest]

http://www.eurekalert.org/pub_releases/2007-07/kki-nss070207.php

Public release date: 3-Jul-2007

[ Print Article | E-mail Article | Close Window ]

Contact:

ebutler@...

Kennedy Krieger Institute

New study shows half of children with autism can be accurately

diagnosed at close to 1 year of age Researchers at the Kennedy

Krieger Institute recognize children with autism earlier than ever

before, paving the way for earlier intervention and improved outcomes

(Baltimore, MD) — In a study published today in the Archives of

General Psychiatry, researchers from the Kennedy Krieger Institute in

Baltimore, land found that autism can be diagnosed at close to

one year of age, which is the earliest the disorder has ever been

diagnosed. The study, which evaluated social and communication

development in autism spectrum disorders (ASD) from 14 to 36 months

of age, revealed that approximately half of all children with autism

can be diagnosed around the first birthday. The remaining half will

be diagnosed later, and their development may unfold very differently

than children whose ASD is diagnosable around the first birthday.

Early diagnosis of the disorder allows for early intervention, which

can make a major difference in helping children with autism reach

their full potential.

Researchers examined social and communication development in infants

at high and low risk for ASD starting at 14 months of age and ending

at 30 or 36 months (a small minority of the children exited the study

at 30 months). Half of the children with a final diagnosis of ASD

made at 30 or 36 months of age had been diagnosed with the disorder

at 14 months, and the other half were diagnosed after 14 months.

Through repeated observation and the use of standardized tests of

development, researchers identified, for the first time, disruptions

in social, communication and play development that were indicative of

ASD in 14-month olds. Multiple signs indicating these developmental

disruptions appear simultaneously in children with the disorder.

Dr. Landa, lead study author and director of Kennedy

Krieger's Center for Autism and Related Disorders, and her colleagues

identified the following signs of developmental disruptions for which

parents and pediatricians should be watching:

Abnormalities in initiating communication with others: Rather than

requesting help to open a jar of bubbles through gestures and

vocalizations paired with eye contact, a child with ASD may struggle

to open it themselves or fuss, often without looking at the nearby

person.

Compromised ability to initiate and respond to opportunities to share

experiences with others: Children with ASD infrequently monitor other

people's focus of attention. Therefore, a child with ASD will miss

cues that are important for shared engagement with others, and miss

opportunities for learning as well as for initiating communication

about a shared topic of interest. For example, if a parent looks at a

stuffed animal across the room, the child with ASD often does not

follow the gaze and also look at the stuffed animal. Nor does this

child often initiate communication with others. In contrast, children

with typical development would observe the parent's shift in gaze,

look at the same object, and share in an exchange with the parent

about the object of mutual focus. During engagement, children have

many prolonged opportunities to learn new words and new ways to play

with toys while having an emotionally satisfying experience with

their parent.

Irregularities when playing with toys: Instead of using a toy as it

is meant to be used, such as picking up a toy fork and pretending to

eat with it, children with ASD may repeatedly pick the fork up and

drop it down, tap it on the table, or perform another unusual act

with the toy.

Significantly reduced variety of sounds, words and gestures used to

communicate: Compared to typically developing children, children with

ASD have a much smaller inventory of sounds, words and gestures that

they use to communicate with others.

" For a toddler with autism, only a limited set of circumstances –

like when they see a favorite toy, or when they are tossed in the

air – will lead to fleeting social engagement, " said Landa. " The fact

that we can identify this at such a young age is extremely exciting,

because it gives us an opportunity to diagnose children with ASD very

early on when intervention may have a great impact on development. "

The current study reveals that autism often involves a progression,

with the disorder claiming or presenting itself between 14 and 24

months of age. Some children with only mild delays at 14 months of

age could go on to be diagnosed with ASD. Landa and her colleagues

observed distinct differences in the developmental paths, or

trajectories, of children with early versus later diagnosis of ASD.

While some children developed very slowly and displayed social and

communication abnormalities associated with ASD at 14 months of age,

others showed only mild delays with a gradual onset of autism

symptoms, culminating in the diagnosis of ASD by 36 months.

If parents suspect something is wrong with their child's development,

or that their child is losing skills during their first few years of

life, they should talk to their pediatrician or another developmental

expert. This and other autism studies suggest that the " wait and see "

method, which is often recommended to concerned parents, could lead

to missed opportunities for early intervention during this time

period.

" What's most exciting about these important advancements in autism

diagnosis is that ongoing intervention research leads us to believe

it is most effective and least costly when provided to younger

children, " said Dr. Goldstein, President and CEO of the Kennedy

Krieger Institute. " When a child goes undiagnosed until five or six

years old, there is a tremendous loss of potential for intervention

that can make a marked difference in that child's outcome. "

While there are currently no standardized, published criteria for

diagnosing children with autism at or around one year of age, Landa's

goal is to develop these criteria based on this and other autism

studies currently underway at the Kennedy Krieger Institute. Landa

and her colleagues at the Institute plan on releasing preliminary

diagnostic criteria for very young children with autism in an

upcoming report.

Participants in the current study included infants at high risk for

ASD (siblings of children with autism, n=107) and low risk for ASD

(no family history of autism, n=18). Standardized tests of

development and play-based assessment tools were used to evaluate

social interaction, communication and play behaviors in both groups

at 14, 18 and 24 months of age. Researchers assigned diagnostic

impressions at every age, indicating whether there were clinically

significant signs of delay or impairment. After their last evaluation

at 30 or 36 months, each participant was then given a final

diagnostic classification of ASD, non-ASD impairment, or no

impairment. The ASD group was further divided into an Early ASD

diagnosis group and a Later ASD diagnosis group based on whether they

were given a diagnosis of ASD at 14 or 24 months.

###

About Autism

Autism spectrum disorders (ASD) is the nation's fastest growing

developmental disorder, with current incidence rates estimated at 1

in 150 children. This year more children will be diagnosed with

autism than AIDS, diabetes and cancer combined, yet profound gaps

remain in our understanding of both the causes and cures of the

disorder. Continued research and education about developmental

disruptions in individuals with ASD is crucial, as early detection

and intervention can lead to improved outcomes in individuals with

ASD.

About the Kennedy Krieger Institute

Internationally recognized for improving the lives of children and

adolescents with disorders and injuries of the brain and spinal cord,

the Kennedy Krieger Institute in Baltimore, MD serves more than

13,000 individuals each year through inpatient and outpatient

clinics, home and community services and school-based programs.

Kennedy Krieger provides a wide range of services for children with

developmental concerns mild to severe, and is home to a team of

investigators who are contributing to the understanding of how

disorders develop while pioneering new interventions and earlier

diagnosis. For more information on Kennedy Krieger Institute, visit

www.kennedykrieger.org.

Dorothy