Can a brief checklist help pediatricians detect autism as early as an infant’s first-year checkup? New research released on Thursday in the Journal of Pediatrics, indicates that in some cases, it probably can.
Dr. Karen Pierce, a neuroscience professor at UC San Diego, got 137 nearby doctors on board to screen their 1-year-old patients, using a simple, five-minute checklist of questions.
Parents filled out the questionnaire in the waiting room. Despite the young age, Pierce believes the test picked up about half of those children with autism.
Questions involved a child’s use of eye contact, words they used, sounds they made and object recognition. Examples of questions:
- When your child plays with toys, does he or she look at you to see if you’re watching?
- When you look at or point to a toy across the room, does your child look at it?
- When you call your child’s name, does he or she respond by looking or turning toward you?
The survey relied on a simple point system. The parent checks “not yet,” “sometimes” or “often” for each question. “Not yet” scores 0 points; “sometimes” scores 1 point; “often” gets 2 points. A baby who scores under 27 points falls in the range of concern.
The children were then followed for two years after the screening. Among the more than 10,000 children tested, 184 infants failed the initial screening, and 32 of those were later diagnosed with autism. Ninety-two others were diagnosed with language or other developmental delays. That means the screening had a “positive predictive value” of 75 percent.
“The well accepted number is that about 65 children per 10,000 births have autism,” Pierce said. “It’s not an accident that we cut the study off at about 10,000. We found 32 children with autism. That’s where I get my estimate that the screening will pick up around half.”
What the test didn’t do was follow the children who passed to see if the early predictor held. “It will be important for pediatricians, when they use the screeners, to repeat them at 18 to 24 months of age, since some children don’t develop symptoms until then,” said Geraldine Dawson, chief science officer with Autism Speaks. About 25 percent of children with autism start developing normally, and then sometime after 18 months, lose their skills or regress.
But, she added, most babies show signs earlier. And studies have shown that children with autism who started treatment early had higher IQs, better language abilities and behavior and fewer autism symptoms.
“Brain circuitry is starting to be formed in heavy earnest during the first three years of life,” Pierce said. “If you can get in there before or even while these brain cells are starting to talk to each other, and if you can try to reinforce and expose the child to learning situations, social situations and give treatment while these connections are being formed, you have a much better chance at changing outcomes.”
This is not the first screening tool to test developmental progress among infants. The difference, Pierce said, is that this one focuses on social and language communication, rather than motor development and self-help skills.
Screeners that can reliably diagnose early are also important for advancing research on the causes and biomedical signatures of autism.
“I think this is very promising,” Dawson said. “This is the first time a group has used this kind of screener in a pediatrician’s office and been able to show that pediatricians will use it, that it does pick up children with autism, and that it’s quick and feasible.”
But, she cautioned, it’s a first step. “We’ll need to see how effective it could be in a larger study,” Dawson said. “In this study, pediatricians were working closely with a center that specialized in autism. We don’t know how effective it will be if it’s not affiliated with a center that specializes in autism.”
Watch our recent series of reports on autism here.