Monday, October 27, 2014

Spotting Autism at 18 Months

We’re learning more about autism every year – how families can flourish when a child has autism; how important screening can be early in the life of a child who may be at risk; or the ways in which early interventions before age 5 are helpful.
We are also learning, as a society, how to actively surround and support autism in the simple things of every day life – in school, in work pursuits, in our families, in our circles of friends.
A good example of just how far we are able to imagine autism working in all aspects of society is a highly innovative new play that just opened on Broadway to rave reviews – including a five-star New York Times review that called it “one of the most fully immersive works ever to wallop Broadway.”
“The Curious Incident of the Dog in the Night-Time,” based on the 2003 best-selling book by Mark Haddon, is lit up by checkered, flashing lights and squares on the stage. It’s presented through the eyes of a highly functioning autistic child who is gifted in math, but struggles with daily interactions with friends and family.
 The play, like the book, is mesmerizing for the audience. By the end, it’s nearly impossible not to be drawn deeply into a completely different reality as seen through the mind of an autistic child – a feat that isn’t easy to imagine or pull off, but is well worth the journey.
Now, a comprehensive new study by Yale researchers adds to this growing body of knowledge. It found that signs of autism can be seen as early as 18 months in children who have older siblings who are autistic – an important finding considering that about 20 percent of children who have older siblings with autism also develop autism spectrum disorder (ASD).
“While the majority of siblings of children with ASD will not develop the condition themselves, for those who do, one of the key priorities is finding more effective ways of identifying and treating them as early as possible,” said Katarzyna Chawarska, an associate professor at the Child Study Center at Yale’s School of Medicine.
The large-scale study was designed to identify specific social and communicative behaviors that distinguish infants with autism as early as 18 months of age.
The Yale researchers combined data from eight clinical sites participating in the Autism Speaks Baby Siblings Research Consortium, and then looked carefully at social, communicative and repetitive behaviors in 719 infants when they were 18 months old.
For the study, published in the Journal of the American Academy of Child & Adolescent Psychiatryresearchers looked for patterns that might predict a later diagnosis of autism. They then followed up when the study participants at the eight sites were age 3.
The research team found about half of the siblings who were later diagnosed with autism displayed signs that were suggestive of the disorder at 18 months; while symptoms for those later diagnosed with autism showed signs between the ages of 18 months and 36 months.
The ability to see signs of autism in siblings as early as 18 months allows for early intervention, which is why the study is important.
“Our study reinforces the need for repeated diagnostic screening in the first three years of life to identify individual cases of ASD as soon as behavioral symptoms are apparent,” said Chawarska.
For about half of the siblings studied, a combination of poor eye contact and lack of communicative gestures or imaginative play was most strongly associated with a later diagnosis of autism, the team found.
In a small percentage of those later diagnosed with ASD, eye contact was relatively normal - but they began to display early signs of repetitive behaviors and had limited non-verbal communication skills.
“So not only do the behavioral symptoms appear at different ages, but different combinations of early symptoms may predict the diagnostic outcome (of autism),” Chawarska said.
One of the real advantages of such an early diagnosis is that personalized treatment can be developed for a child – precisely at the age where significant development is occurring, which in turn allows the child to develop meaningful ways to cope with autism.
Broadway plays and media attention around autism helps public understanding of the disorder. Meanwhile, advances in the scientific understanding of the signs of autism in early childhood (like this Yale study) help parents and clinicians intervene at critical times.


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