Oct. 29, 2007 -- All children should be screened for autism at age 18 months and again at age 2 even if they show no signs of developmental delay, according to new guidelines from the American Academy of Pediatrics (AAP).
The hope is that universal screening during well-child pediatric checkups will lead to earlier diagnosis of the disorder. There is growing recognition that early diagnosis and intervention can result in better outcomes for children with autism and related disorders.
The guidelines were released Monday at the AAP annual meeting in San Francisco, along with reports highlighting developments in the identification and management of autism.
The reports are published in the November issue of the AAP journal Pediatrics.
Possible Signs of Autism
While language delays are the most common reason for evaluating children for autism, more subtle warning signs have been identified for babies who are not yet at the talking stage.
Some of these signs can be recognized before a child's first birthday, including a delay in smiling, failure to follow a parent's gaze, and failure to respond to his or her name or a parent's pointing gesture by age 10 to 12 months.
Other early warning signs include:
- Failure to point as a means of directing a parent or caregiver's attention by age 12 to 14 months
- Lack of "back and forth" babble with a parent or caregiver as a means of communication by around the age of 6 months
- Failure to make eye contact
Forming an attachment with an uncommon object, such as a flashlight, keys, or a ballpoint pin instead of a stuffed animal, blanket, or other soft item may also indicate a problem.
But report co-author Chris Plauche Johnson, MD, is quick to point out that many normally developing children form attachments to unusual objects, just as many children with autism make eye contact.
"None of these subtle indicators should be taken in isolation as a definite sign of autism," the University of Texas Health Science Center pediatrics professor tells WebMD.
But they can alert parents and pediatricians to a potential problem before less subtle indicators become obvious, she says.
Not-So-Subtle Autism Signs
The mostly verbal red flags that have previously been identified as absolute indicators for evaluation are:
- No babbling, pointing, or other communication gestures by 12 months of age
- No single words by age 16 months
- No two-word spontaneous phrases by 24 months
- Loss of language or social skills at any age
Neurodevelopmental pediatrician Scott Myers, MD, tells WebMD that roughly a quarter of children with autism experience verbal regression. The average age that this occurs is about 21 months, he says.
"There is certainly cause for concern if a child that was using 20 words a few months ago suddenly doesn't have any language," he says.
Early Treatment Is Critical
The report on the management of autism and related disorders calls for intervention as early as possible, even before a definite diagnosis has been made.
Treatment should include at least 25 hours a week of intensive behavioral therapy with a low student-to-teacher ratio, parental involvement, and sufficient one-on-one time.
The report also calls on pediatricians to learn about the many alternative treatments being embraced by parents, so that they can discuss these options in an informed manner.
These include vitamin and mineral treatments, chelation therapy, and restricted diets, such as the wheat- and dairy-free diet that actress Jenny McCarthy is promoting in a new book about her son's autism.
"Pediatricians need to keep the lines of communication open and take an active role in helping to educate families about evaluating evidence," Myers says.
He tells WebMD that there has not been enough research done to prove or disprove the value of most alternative treatments.
The exceptions, he says, are treatments involving the digestive hormone secretin and the interactive therapy known as facilitated communication.
Myers says both of these interventions have been well studied and neither has been shown to be effective for the treatment of autism.