Early Autism Detection and Screening
What is Screening?
Screening is a way to detect a disorder, such as autism, in a population before the onset of full-blown symptoms.
Currently, there is no standardized screening approach for the early identification of autism. To promote and improve the early identification of autism, the American Academy of Pediatrics (AAP) has recently published practice guidelines that recommends screening for ASD at the 18 and 24 month visits.
Despite these guidelines, most busy pediatric practices do not consistently implement screening. A new paper published by King and colleagues (2010) describes the barriers to early screening. As a result, most children are not diagnosed until age 3 or later.
The 1-Year Well-Baby Check-Up Approach
A new paper published by Karen Pierce and colleagues of the UCSD Autism Center of Excellence in the Journal of Pediatrics showed that it is indeed possible to create a standardized system of early screening for autism and other developmental delays as young as 12 months.
Using a procedure called “The 1-Year Well-Baby Check-Up Approach,” Dr. Pierce and colleagues created a network of 137 pediatricians in San Diego County. Next, each pediatric office was taught how to administer and score a simple broad band screening tool developed by Amy Wetherby and Barry Prizant in 2002 called the CSBS DP IT Checklist (available for free download at http://firstwords.fsu.edu/pdf/checklist.pdf).
Over the course of several years, more than 10,000 toddlers were screened at the routine pediatric
1-year visit using the CSBS DP IT. Any baby that failed the screening tool was referred for in-depth testing of that baby’s language, social and cognitive abilities. Results of the study indicated that approximately 75% of babies that initially failed the screening form at the 1-year check up in fact had a true delay. Specifically, toddlers were shown to have either autism, language delay, global developmental delay or an associated condition. The remaining 25% of toddlers that failed the screening tool were false positives. That is, the in-depth evaluation revealed that they were developing normally.
Importantly, all of the toddlers shown to have a true delay based on the full developmental evaluation were referred for early treatment. Most toddlers began treatment at or before age 18 months.
The 1-Year Well-Baby Check-Up Approach and Latino Families
One in 68 babies born today are diagnosed with ASD, yet many children are overlooked or diagnosed at a late age because Spanish-speaking families don’t know where to get help. The Latino Outreach program is designed to promote early detection and early treatment in monolingual and bilingual families. Supported by the National Foundation for Autism Research, this program provide free, comprehensive evaluations by licensed psychologists for infants and toddlers showing signs of delay, including autism. As of June, 2014, this program has provide free developmental evaluations to over 100 toddlers with suspected autism, and most toddlers begin treatment around 18 months in age.
Why is This Study Important?
Results from the Pierce et al., (2011) study suggest the following:
- Autism can be detected at age 1 year in some (but not all) toddlers
Results of the Pierce study (2011) indicated that it is possible to detect some toddlers showing early signs autism and other delays at 12 months using a simple, broad band screening tool (i.e., the CSBS DP IT Checklist) that takes only 5 minutes for a caregiver to complete. The form is next scored by a trained medical professional, and any toddler that fails the CSBS Checklist should be referred for an in-depth developmental evaluation.
This study focuses our attention on the first birthday as a key age for efforts in early screening.
- Pediatricians are the first line of defense
Pediatricians in San Diego, who collectively screened over 10,000 babies as part of their involvement in this study, stand as clear a example of what can be done when people work together. Today over 170 pediatricians have joined the Autism Center of Excellence pediatrician network and have screened over 18,000 toddlers at the routine 1-Year Check-Up.
- Early detection leads to early treatment
The very early treatment of autism can have a significantly positive impact on the health and well being of children and their families. For example, a new research study by Dawson and colleagues (2010) has shown that toddlers with autism who received specialized treatment based on a developmental model between 18-30 months were shown to have an increase in 15 IQ points following treatment.
- Early detection and early treatment stand the greatest chance of positively impacting brain development
If we consider the positive impact of treatment from a brain development standpoint, the importance of early treatment becomes even clearer. Consider that babies are born with all the brain cells that they will ever have (with the exception of the hippocampus and olfactory bulb which have been shown to produce new neurons postnatally). It is during the first 3 years of life that connections between brain cells in the frontal lobe – the part of the brain that is essential for the development of complex social behaviors – and the rest of the brain begin to become established. If treatment starts before mature brain circuitry is established (i.e., between ages 1 and 3 years), then it makes sense that treatment efforts may stand the best chance of promoting positive and effective connections between brain cells because stimulation and treatment will be happening while brain connections are actively being created.
In contrast, treatment that starts later in development (i.e., at age 4 or later) will have the more challenging job of trying to change connections in the brain that are already somewhat established.
- Early detection may help scientists in the search for early biomarkers and causes
Screening for autism at 1 year using a broad band screen allows scientists the opportunity to study the disorder during the first year or two of life. This is before the onset of glaring symptoms, a key time point in development and an age that is virtually unstudied in the field of autism.
At the UCSD Autism Center of Excellence, we use the 1-Year Well-Baby Check-Up Approach as a way to study autism during the first years of life. As a result, we have made several important discoveries about how the brain functions differently in babies at risk for autism relative to typically developing babies (see information on MRI and fMRI research).
Here at the UCSD ACE, we hope that early biological signatures of autism collected from information about the brain and genes in autism at or around the first birthday will translate into highly effective medical tests for the early detection of the disorder.