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Brief observations insufficient to diagnose autism symptoms
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The presence of typical behaviors — or absence of atypical behaviors — among children during brief observation periods at a medical visit was not sufficient to provide evidence for symptoms associated with autism in a recent study.
“Little research exists to determine ratios of typical or atypical behaviors exhibited by children who have autism spectrum disorder during the timespan of an average medical visit,” Terisa P. Gabrielsen, PhD, from the departments of psychiatry and educational psychology at the University of Utah, and colleagues wrote. “During brief observations, low frequency atypical behaviors may not stand out among high frequencies of typical behavior.”
To evaluate the ratio of typical and atypical behaviors that could be observed during a standard 10-minute medical visit, researchers recruited children aged 15 to 33 months (n=42) to participate in 10- to 20-minute clinical diagnostic sessions, which included autism screening, evaluation and video recording of the children before and after familiarizing themselves with the examiner and room.
After the session, two 10-minute video samples of each participants’ autism evaluations were given to licensed psychologists with toddler and autism expertise for analysis, measuring five behaviors: responding, initiating, vocalizing, play and response to name.
The psychologists, unaware of the prior diagnostic status, were required to provide autism referral impressions based solely on individual 10-minute observations. They wrote that children with autism exhibited high rates of typical behavior (89% of the time) compared with atypical behavior (11% of the time) overall. Furthermore, autism experts were found to have missed referrals for 39% of children with autism, based on the brief, intense observation periods.
“Certainly, some young children with autism are clearly impaired and easy to recognize,” researcher Judith Miller, PhD, at the University of Utah, said in a press release. “However, this study looked at the entire range of children who present to the pediatrician’s office, and we found that many children’s impairments are not immediately obvious. For those children, formalized screening instruments and more time with a specialist may be critical.”
The researchers said this study is the first to quantify the high base rates of typical behavior among young children with autism and language delay. Gabrielsen and colleagues also highlighted that when observation times are brief, the dominance of typical behaviors could negatively impact the accuracy of a referral decision.
“It’s often not the pediatrician’s fault that referrals are missed,” Gabrielsen said in the release. “Even autism experts missed a high percentage of referrals within that short time frame. Decisions for referral need to be based on more information, including autism screening and information from parents. We’re hoping that this information can really empower parents to talk with pediatric care providers about their concerns.”
Disclosure: The researchers report no relevant financial disclosures.
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