Quick Screening May Help Spot Autism in Babies04/28/11
THURSDAY, April 28 (HealthDay News) -- A brief checklist that
parents can fill out while waiting to see their child's
pediatrician may aid in diagnosing autism earlier, new research
Researchers recruited 137 pediatricians in the San Diego area to
give parents of 1-year-olds a 24-question screening test to fill
out before seeing the doctor. The test was designed to detect
general communication delays, not specifically autism, a
neurodevelopmental disorder characterized by language and social
deficits and repetitive behaviors.
"I wanted to change clinical practice in San Diego, to give pediatricians a simple tool to catch cases of autism and other disorders and get these kids into treatment earlier," said Karen Pierce, an assistant professor in the department of neurosciences at University of California San Diego and assistant director of the UCSD Autism Center of Excellence. Early treatment is known to improve outcomes, she said.
The questionnaire asks about the child's use of eye contact,
sounds, words, gestures and other forms of communication. Questions
include: Does your child smile or laugh while looking at you? Does
your child pretend to play with toys? Do you know when your child
is happy? Upset?
Babies who failed the screening were referred for more thorough
assessments, including MRIs and a blood test, and were tracked
until age 3.
Of nearly 10,500 babies screened, 184 underwent further
evaluation. About 75 percent of those children were found to have
autism or another language or development delay.
Currently, pediatricians have no way to screen for autism or
other development delays until the child is older, Pierce said.
The study, funded in part by the U.S. National Institute of
Mental Health, was published online April 28 in the
Journal of Pediatrics.
Not only is the test fast and inexpensive, but the children it
identified were referred for behavioral therapy at an average age
of 17 months, much earlier than kids would be otherwise, Pierce
said. A 2009 study from the Centers for Disease Control and
Prevention found that, on average, children receive an autism
spectrum disorder diagnosis at around 5.7 years old.
Dr. Andrew Adesman, chief of developmental and behavioral
pediatrics at Schneider Children's Hospital in New Hyde Park, N.Y.,
called the screening test promising.
However, Adesman noted that 972 kids, about three-quarters of
those who failed the waiting room screening, were either not
referred for further evaluation or never followed up with
Possible reasons could be that the test wasn't scored by staff,
or that pediatricians determined there was no reason for worry and
didn't make the referral, Adesman said.
Of the 346 kids referred for further evaluation, 184 were tested
by the UCSD researchers and tracked over time.
Thirty-two of those were eventually diagnosed with an autism
spectrum disorder, 56 with language delay, 9 with developmental
delay, 36 with "other" delay and 45 were considered a "false
positive." Five kids originally considered to have an autism
spectrum disorder no longer met the criteria at follow-up.
"The very positive things about the study is it demonstrates earlier systematic screening for development delays for children at 1 year, is practical and relatively effective," Adesman said. "The only concern I have is that a significant number of families never followed through with testing."
The dearth of people who followed through with testing could
make the test seem more accurate than it really is, Adesman
About 65 of every 10,000 children have autism, according to
background information in the article. Statistically, that means
the screening test caught about half of those who will eventually
be diagnosed, Pierce said.
Even with fine-tuning, the test will never catch all cases of
autism in 1-year-olds because some cases develop later in childhood
or are marked by regression, in which the child develops mostly
normally until age 18 months or so and then begins to lose
The screening test also would not pick up Asperger's syndrome,
which affects about 10 percent of kids with an autism spectrum
disorder and does not involve language delays.
After the study, 96 percent of the pediatricians rated the
program positively, and all of the practices have continued using
the screening tool.
U.S. National Institute of Mental Health has more
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