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Screening for Autism Should Occur Twice Before Age Two
< Oct. 31, 2007 > -- The American Academy of Pediatrics (AAP) released a new report that recommends all children should be screened for autism at 18 and 24 months. Screening should be done whether parents or physicians suspect the disorder is present or not.
In an effort to make it easier for pediatricians to recognize and start early treatment for children with autism spectrum disorders (ASDs), the AAP also released recommendations in two reports for identifying and managing these conditions.
"Pediatricians are the front line" in identifying autism spectrum disorders, says Dr. Melissa Nishawala, clinical director of the Autism Spectrum Disorders Service at the New York University Child Study Center. "And, the earlier we find out, the swifter we can intervene when the brain is more immature, and we can help to model it in different directions."
"The tendency has been to understand that child development varies widely and to reassure the parents that some children speak late or even if they seem to be off track developmentally, that most children catch up," Dr. Nishawala adds. "So, if there's a parental concern, they may get a referral, or it may take several months of waiting to see if the child gets back on track developmentally."
The result can be that it may take a year or more before a child is officially diagnosed with autism, and a critical window in treatment time has been lost.
Two reports are published in this month's issue of Pediatrics. They were released this week during the American Academy of Pediatrics annual meeting.
The first report, which details ways to detect autism spectrum disorders, highlights some of the earlier signs that might suggest an ASD. They may include a lack of joyful expression, no babbling by five months of age, and a lack of recognition. Failure to make eye contact is another symptom of ASD.
Repetitive movements with objects may also occur, such as not waving or pointing. The delayed onset of babbling past 9 months of age is another early sign of autism.
Later, as speech develops and these disorders become more apparent, some important red flags are: no single words by 16 months of age; no two-word phrases by 24 months; and loss of language skills or social skills at any age.
The second report focuses on what to do after autism has been diagnosed and stresses that early intervention is critical. The report recommends that intervention should begin as soon as autism is suspected, rather than waiting until the diagnosis is confirmed.
Early intervention can make a huge impact in the child's prognosis. "Autism doesn't go away, but therapy can help the child cope in regular environments," says Dr. Chris Plauche Johnson, co-author of the reports. "It helps children want to learn and communicate."
Children with ASDs should be involved in year round intervention therapies for at least 25 hours a week, according to the report. Uninterrupted therapy is vital for helping to keep up the progress made with interventions.
The report also suggests that pediatricians familiarize themselves with some of the complementary and alternative therapies available for children.
For example, some parents feel that when their child is on a casein/glutein-free diet, their symptoms improve. However, such a diet needs to be carefully planned, because nutritional inadequacies can develop. If a pediatrician is aware that the child is on such a diet, he or she can give the parent a referral to a nutritionist to ensure that the child is getting the right nutrients, the report says.
"Pediatricians need to be aware of the alternatives and listen to parents who may want to go down those avenues, and they need to know where to send those families for additional help," says Dr. Johnson, director of the Autism Center at Children's Hospital of Pittsburgh at the University of Pittsburgh Medical Center. "If families feel dismissed by their doctor, they may not disclose all the treatments they're trying."
Behavior management strategies may also be effective in dealing with the tantrums, aggressive behavior, and self-injury that are common in children with ASDs.
The management report also notes that some medical issues, such as sleep and gastrointestinal disturbances, are common in children with autism spectrum disorders.
Dr. Johnson says both reports are very well done and comprehensive. Dr. Nishawala also states the new recommendations were comprehensive, but says it might be helpful in the future to include additional information about which therapies have been debunked in autism treatment.
Always consult your child's physician for more information.
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Autism is just one of five disorders that falls under the general category, Pervasive Developmental Disorders (PDD). These are neurological disorders that are usually found in the early years of a child's life.
Children with PDD have difficulty in areas of development or use of functional skills such as language, communication, social skills, and motor behaviors.
The five disorders under the PDD umbrella are:
Autism is the most common of these disorders, occurring in one of every 150 live births in the US. While autism cannot be cured, there are treatment approaches that can reduce symptoms. However, an approach that may be effective with one child may not work for another, so individualized plans are important.
Most experts agree that the earlier intervention is started, the more effective it is.
The Autism Society of America describes potential intervention programs for children with autism. Children under three years are eligible for "early intervention" (EI) assistance from the federal government.
Education assistance for these youngsters can be school or home-based. Early intervention teams may come to the child's home to train parents or caregivers about how to teach and work with their child.
Whether in-home or at school, these programs are designed to provide guidance by professionals who have experience working with children with disabilities, especially autism.
Other services, such as speech, physical therapy, or occupational therapy, may be part of a child's rehabilitation program. These are used as necessary to meet the specific child's needs.
All school-aged children (through age 21) are guaranteed education supplied by a local public school. This program should also be based on the student's unique needs which are documented in the child's Individualized Education Program (IEP).
Education at this developmental level is focused on academics, language, behavioral issues, and social, leisure, and self-help skills.
Programs appropriate for your child may be found through either the medical or educational community.
There are also state agencies that may provide resources, including protection and advocacy agencies; developmental disabilities councils; vocational rehabilitation centers; parent training centers; and educational resources.
Always consult your child's physician for more information.
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