New Autism Screening Guidelines

I got a call yesterday from a mom who was interested in my reaction to the news release by the American Academy of Pediatrics recommending that pediatricians screen children for signs of autism at 18 and 24 months at well-visit checkups.

The American Academy of Pediatrics released the following on their website:

Two new clinical reports from the American Academy of Pediatrics (AAP) will help pediatricians recognize autism spectrum disorders (ASDs) earlier and guide families to effective interventions, which will ultimately improve the lives of children with ASDs and their families. The first clinical report, “Identification and Evaluation of Children With Autism Spectrum Disorders,” provides detailed information on signs and symptoms so pediatricians can recognize and assess ASDs in their patients. Language delays usually prompt parents to raise concerns to their child’s pediatrician – usually around 18 months of age. However, there are earlier subtle signs that if detected could lead to earlier diagnosis. These include:

not turning when the parent says the baby’s name;
not turning to look when the parent points says, “Look at…” and not pointing themselves to show parents an interesting object or event;
lack of back and forth babbling;
smiling late; and
failure to make eye contact with people.
Most children, at some time during early development, form attachments with a stuffed animal, special pillow or blanket. Children with ASDs may prefer hard items (ballpoint pens, flashlight, keys, action figures, etc.). They may insist on holding the object at all times.

The report advises pediatricians to be cognizant of signs of ASD, as well as other developmental concerns, at every well-child visit by simply asking the parents if they or their child’s other caregivers have any concerns about their child’s development or behavior. If concerns are present that may relate to ASD, the clinician is advised to use a standardized screening tool. The report also introduces universal screening, which means pediatricians conduct formal ASD screening on all children at 18 and 24 m

In addition, Autism Speaks, an organization that has had a tremendous impact on funding research for autism and communicating the signs to look for has an “autism video glossary” on its website, www.autismspeaks.org, that shows videos of typically developing children and those with autism at specific ages. This is very helpful for parents to see what these signs “look like” in the behavior of a child.

How do I feel about this news? I am thankful to the AAP for taking leadership in the area of early diagnosis. If all children are screened beginning at 18 months, I am sure there will be many more early detections of autism, and therefore better outcomes for our children. I know it is scary to moms and dads to think that they have to face such a screening but the potential positive effect is great.

In my many years working with three-year-olds with special needs at the Early Childhood Center in Fairfield, CT, I have had both experiences–of working with children who were diagnosed early, before their second birthday, and those who came to me without a diagnosis but showing obvious signs of autism at the age of three. I found it interesting to look back at their records from a year earlier, and many times regarding those diagnosed early, I hardly recognized the child described in the year-old reports because the child had made so much progress in that year between 2 and 3.

When I work with new moms and dads of typically developing children, beginning at 3 months to show them how to talk, read and play with their child to enhance language, I see children as young as 9 months where they have signs of autism and I have referred them for an evaluation. I do not make light the heaviness of such a diagnosis but early detection means early intervention and treatment and the opportunity to make real gains in speech, language and social skills.

Remember, you as the parent know your child the best. Use these tools and if you have concerns, talk with your pediatrician.

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