Lets Talk About Autism (Part III)

What is the screening process for autism?

Approximately half (1/2) of the parents of children with ASD notice their child's unusual behavior(s) by age eighteen (18) months and approximately fourth-fifths (4/5) report noticing it by the age of twenty-four (24) months. According to an article in the Journal of Autism and Developmental Disorders , failure to meet any of the following milestones "is an absolute indication to proceed with further evaluations. Delay in referral for such testing may delay early diagnosis and treatment and affect the long-term outcome." Those criteria include: 1) No babbling by twelve (12) months; 2) No gesturing (pointing, waving, etc.) by twelve (12) months; 3) No single words by sixteen (16) months; 4) No two-word spontaneous (not just echolalic) phrases by twenty-four (24) months; and 5) Any loss of any language or social skills at any age.

Both the United States and Japan screen children for ASD at age eighteen (18) months and age twenty-four (24) months utilizing autism-specific formal screening tests. In contrast, in the UK, children whose families or doctor(s) recognize possible signs of autism are screened. Screening tools include the Modified Checklist for Autism in Toddlers (M-CHAT ) the Early Screening of Autistic Traits Questionnaire , and the First Year Inventory ; initial data on M-CHAT and its predecessor CHAT on children eighteen (18) to thirty (30) months suggests that it is best used in a clinical setting and that it has a low sensitivity (meaning many false- negatives) but good specificity (few false-positives). Additionally, it has been determined that accuracy may be improved by following these tests with a broadband screening that does not distinguish ASD from other developmental disorders.

How is autism diagnosed?

Diagnosis is based on behavior, rather than cause or mechanism. It is defined in the DSM-IV-TR as exhibiting at least six (6) symptoms total, including at least two (2) symptoms of qualitative impairment in social interaction, and at least one (1) symptom of qualitative impairment in communication as well as at least one (1) symptom associated with restricted and repetitive behavior. Examples of symptoms include: lack of social or emotional reciprocity, stereotyped and repetitive use of language (or language that is idiosyncratic), and persistent pre-occupation with parts of objects. To be classified as autism, onset must be prior to three (3) years-old with delays or abnormal functioning in either social interaction, language as it applies to social communication, symbolic and/or imaginative play. Additionally, the disturbance must not be better accounted for by either Rett syndrome¹ or childhood disintegrative disorder.

Two tests are commonly used in autism research: the Autism Diagnostic Interview-Revised (ADI-R ) is semi-structured parent interview, and the Autism Diagnostic Observation Schedule (ADOS ) used observation as well as interaction with the child. Additionally, the Childhood Autism Rating Scale (CARS ) is widely used in clinical environments to assess severity of autism based on observation of the child.

The child's pediatrician can perform a preliminary investigation by taking a developmental history as well as performing a physical exam. These can also be done with the help of an ASD specialist if the pediatrician feels that it's warranted. The ASD specialist takes into consideration cognitive, communications, family and other factors using standardized tools. He/she will also take into consideration any associated medical conditions.

What is the prognosis for autism?

There is currently no known cure for autism². Children recover occasionally thereby loosing their diagnosis of ASD; this occurs sometimes following intensive treatment and sometimes it does not. Currently, it is unknown how often recovery occurs, however, reported rates in unselected samples of children have ranged from three percent (3%) to twenty-five percent (25%). In most cases an autistic child can acquire language by age five (5) or younger, though some have developed communications skills in later years. Although not always the case, many children with autism lack social support, meaningful relationships, future employment opportunities, or self-determination. Although core difficulties associated with autism tend to persist, symptoms often become less severe as the child grows older

1Rett syndrome is a neuro-developmental disorder of the grey matter of the brain that almost exclusively affects females.

Source: Wikipedia.com (http://en.wikipedia.org/wiki/Rett_syndrome)

2Myers, S.M.; Johnson, C.P. (2007) "Management of children with autism spectrum disorders", Pediatrics , pp. 1162 - 1182