Autism Spotted at Age 14 Months

Early Autism Detection Widens Window for Effective Treatment

Medically Reviewed by Louise Chang, MD on June 02, 2006
From the WebMD Archives

June 2, 2006 -- Autism in children can be detected as early as age 14 months, a new study shows.

Autism is rarely diagnosed before a child is 3 years old. Cutting that time in half means less precious time lost in getting autistic children the treatment they urgently need -- when it's likely to do the most good.

The new finding comes from researchers including Rebecca Landa, PhD, director of the center for autism and related disorders at Kennedy Krieger Institute in Baltimore. Landa tested motor, language, and visual skills in the younger siblings of autistic children. Such children are 100 times more likely to be autistic than other children.

"At 6 months of age, babies with autism were no different than anybody else," Landa tells WebMD. "By 14 months, though, kids with autism are different in both language development and motor control. They are not globally mentally retarded. Whatever is wrong with them, it influences their motor system as well as the development of their language system."

Using tests of motor and language development at age 14 months, Landa says, allowed her to predict autism in 70% of children ultimately diagnosed with the condition. The prediction isn't the same as a diagnosis. But it offers these children a chance for early treatment. And the earlier a child enters autism treatment, the better that child's ultimate outcome.

Autism expert Jana Iverson, PhD, of the University of Pittsburgh, calls the Landa finding "a huge step forward."

"This is a huge improvement in our ability to pick up kids who might be at risk and get them involved in early intervention," Iverson tells WebMD. "Right now, it is hard to get a reliable diagnosis before age 3. Parents feel they are missing really valuable time in getting kids involved in early intervention."

Landa and colleague Elizabeth Garrett-Mayer, PhD, of Johns Hopkins University, report their findings in the June issue of the Journal of Child Psychology and Psychiatry.

Parent: Child Seemed Normal

Jennifer Maloni's already had a child with autism. Dominic's odd behavior -- instead of playing with his toy cars, he'd line them up in order of size -- led to a relatively early autism diagnosis at age 21 months. At that time, her second son, Dylan, was 6 months old.

Knowing Dylan was at increased risk of autism, the Mt. Airy, Md., resident enrolled him in Landa's study when he was 13 months old. His first evaluation indicated he had autism. By age 18 months, he was diagnosed.

"Dylan was very different from Dominic -- his signs of autism were very, very subtle," Maloni tells WebMD. "If I hadn't had him in a study where they watched him for hours on end, they would not have picked up on it. I was able to get early intervention for him right away."

Autism clearly has a strong genetic component. But genes aren't destiny, Landa says.

"Your brain development isn't just engineered by your genetics. Your experience plays a role in your outcome," Landa says. "So if a toddler isn't attending to social cues and develops these patterns of behavior that make it hard to engage with others, the child isn't getting learning opportunities. It becomes a vicious cycle. We want to disrupt this cycle, to teach children how to engage with objects in diverse ways. We teach them to have joint interactions with people that are rewarding."

It isn't easy. Maloni says she tries to engage her sons in social play "every waking moment." But the results are more than rewarding.

"Normal kids, when a parent walks out the door, the child is screaming, and when they come back they are glad to see them. But our children didn't even notice we were gone," Maloni says. "Now we walk through the door and they run over to us. They are happy when we are there and know when we are not there. It is very gratifying."

Spotting at-Risk Kids

Landa says every parent with a family history of autism -- or who suspects that a child may not be developing normally -- should have that child screened for autism by age 18 months if not sooner.

"Parents usually just look at whether their child walks on time and talks on time," she says. "They might not pay attention to the kinds of objects a child gravitates toward, or lack of diversity in play, or failure of a child to give and show objects. But if you specifically ask parents about certain behaviors, it can be a wake up call for the parents. That is why I advocate screening."

Autism strikes 1 in every 166 children -- it is not rare. A simple one-page, 23-item questionnaire called the M-CHAT helps identify toddlers who need further testing. The test can be found on the Internet, but Landa warns parents to take the completed test to a health care professional for evaluation. The test is not meant to be scored by the person taking it.

Identifying a 14-month-old child as at risk for autism is not the same as an autism diagnosis, Landa warns. Children vary widely in their speed of development.

"Kids who aren't talking or walking or have developmental delays; children who have problems with social reciprocity, who are not very responsive to having their name called, who are not responsive to silly little teasing games, who are not giving objects to you and giggling with you and playing turn-taking games -- those things are really big red flags," she says. "But developmental fluctuations at this age are not uncommon. So when we talk to parents of children under 24 months of age, we should be talking about social communication delays and risk for autism, rather than laying out a diagnosis at this time."

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SOURCES: Landa, R. and Garrett-Mayer, E. Journal of Child Psychology and Psychiatry, June 2006; vol: 47 pp. 629-638. Rebecca Landa, PhD, director, center for autism and related disorders, Kennedy Krieger Institute; and associate professor, Johns Hopkins University, Baltimore, Md. Jana Iverson, PhD, assistant professor of psychology, University of Pittsburgh. Jennifer Maloni, Mt. Airy, Md.

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