prevalence of autism in the U.S. has soared in recent decades.
There is no single verifiable cause and no magic pill for
treatment. But new research suggests earlier diagnosis is
possible and, with that, hope for a better outcome.
earlier we start good targeted intervention, the better chance
we have at molding some of the brain circuits that we know are
important for language and social interaction and the things
that are impaired in autism," said Dr. Shafali Jeste, an
autism expert at the University of California, Los Angeles.
no blood test to quickly alert parents that their young
children need help. Instead, diagnoses often donít come
before age 4 or 5 and are made when behaviors seem atypical or
when childhood milestones are missed.
regular developmental screenings by doctors, the U.S. Centers
for Disease Control and Prevention encourages parents to
contact their doctors if they suspect a problem with the way
their child plays, learns, speaks, acts or moves.
year the CDC raised its autism prevalence estimate to 1 in 68
American children from 1 in 150 in 2000. The advocacy group
Autism Speaks says that the number of children in the U.S.
with autism has increased tenfold in 40 years.
many things in the world of autism, there is controversy about
the reasons for the increase. Some of the increase likely can
be attributed to changes in the way the disease is diagnosed.
In 2013, the American Psychiatric Association changed the
guidelines for diagnosing autism, putting Asperger syndrome
and childhood disintegrative disorder, among others, under one
category now known collectively as autism spectrum disorder,
or ASD. A Danish study published in JAMA Pediatrics suggests
that much of the increase is due to such a broadening of the
criteria for diagnosis. But the authors also noted that the
changes donít account for all of the increase.
aside, the ability to make an early diagnosis is improving.
While the CDC reports that the median age for autism diagnosis
is after a childís 4th birthday, there is evidence that use
of a simple questionnaire for parents and pediatricians can
reduce that age by about two years.
Robins, who heads a research program at the A.J. Drexel Autism
Institute, has developed, with others, the M-CHAT-R (Modified
Checklist for Autism in Toddlers, Revised). Robins reports in
a recent study in the journal Pediatrics that use of the tool
can reduce the diagnosis age to about 25 months. An earlier
diagnosis means intervention can begin earlier, and thatís
the good news.
who start treatment earlier have a better chance of developing
fluent language," Robins said. "They have a better
chance of being integrated into a typical classroom in
elementary school, and they have a better chance of long-term
success in terms of independence, the ability to go into
higher education or be part of the work force."
early intervention is no panacea, Robins added.
complicated because some kids who get the very best early
intervention are not able to be in a typical classroom and do
not develop fluent language," she said.
the UCLA behavioral child neurologist studying the biological
and psychosocial basis of autism, noted that the disorder
typically is diagnosed based on a list of symptoms that donít
show up until a childís second or third year, sometimes
later. But over the last decade, she said, itís become more
evident that doctors should be able to find some signs of
autism, either through behavioral examination or through brain
markers, before a formal diagnosis is made.
know that brain development is very dynamic and is constantly
changing in response to environment in the first few years of
life," Jeste said. "And we know that any kind of
experience modulates brain development."
at Yale School of Medicine have reported spotting deficits in
6-month-old infants who later developed ASD.
video of a woman trying to engage a group of babies,
researchers studied the infantsí eye movements, comparing 67
infants at risk for developing ASD and 50 low-risk infants.
Compared with the control group, the at-risk infants later
diagnosed with ASD looked less at the video and spent less
time watching the womanís face.
study highlights the possibility of identifying certain
features linked to visual attention that can be used for
pinpointing infants at greatest risk for ASD in the first year
of life," said Katarzyna Chawarska, associate professor
at the Yale Child Study Center, in a press release. "This
could make earlier interventions and treatments
recent studies of small groups of children have shown
successful results from interventions with children as young
as 6 months.
University of California, Davis, a treatment known as Infant
Start was provided to seven infants aged 6 months to 15 months
who had shown symptoms such as decreased eye contact, lack of
social engagement or repetitive movement patterns.
of the children in the study, six out of seven, caught up in
all of their learning skills and their language by the time
they were 2 to 3," said Sally J. Rogers, professor of
psychiatry and behavioral sciences and lead author of the
study. "We have speeded up their developmental rates and
profiles, not for every child in our sample but for six of the
in September 2014 in the Journal of Autism and Developmental
Disorders, the treatment was based on the Early Start Denver
Model intervention, which coaches parents on best practices to
optimize attention and engagement. Treatment began with 12
one-hour sessions with infant and parent, followed by six
weeks of biweekly visits and follow-up assessments at 24 and
36 months. When compared with infants who had similar symptoms
but did not get the therapy, the study group had significantly
lower autism severity scores at 18 and 36 months.
study published in February by researchers at the University
of North Carolina at Chapel Hill found that simple strategies
known as Adapted Responsive Teaching (ART) that are used by
parents can be effective for 12-month-old infants at risk for
Baranek, the studyís author and an autism researcher at UNCís
School of Medicine, said researchers worked with individual
parent-baby pairs to teach parents strategies that promote
playful engagement and social interaction.
were very encouraged that this novel intervention, using
relatively simple strategies on a daily basis, improved both
parental interaction styles and important child-development
outcomes," Baranek said. "Infants who received ART
were generally more attuned to the environment around them and
showed significantly better socialization and communication
skills than those who did not receive ART."
a study published in January in The Lancet Psychiatry,
professor Jonathan Green of Britainís University of
Manchester, said video-based therapy aimed at coaching parents
improves infantsí engagement, attention and social behavior.
with autism typically receive treatment beginning at 3 to 4
years old," he said. "But our findings suggest that
targeting the earliest risk markers in autism ó such as lack
of attention or reduced social interest or engagement ó
during the first year of life may lessen the development of
these symptoms later on."
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