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How clinicians can talk to worried parents about autism

Diagnosing young children soon after symptom emergence expedites the start of interventions for autism spectrum disorder, and can help prepare children and their parents, according to a JAMA Network Insight published in JAMA Psychiatry.

“Despite increasing public awareness, only 43% of children with ASD receive a comprehensive developmental evaluation by age 3 years,” Annette Estes, PhD, from University of Washington Center on Human Development and Disabilities, and colleagues wrote. “Timely detection facilitates access to appropriate developmental and behavioral intervention that, when begun soon after symptom onset, can substantially improve outcomes and reduce parents’ stress.”

The American Academy of Pediatrics recommends screening young children at ages 18 months and 24 months for ASD, according to the paper. Estes and colleagues wrote that parents may observe some possible early indications of problems, like minimal or no babbling, not a lot of eye contact, not pointing out interests, few or no social smiles, reduced engagement or not reacting to voices/their name.

Very early developmental signs of ASD could occur in the first year of life in siblings at high risk for the disorder. Possible subtle sensory motor differences can occur in the first 6 months, deficits in social communication may start to emerge later in the first year and repetitive behaviors may arise early in the second year of life, according to the researchers.

“Individual differences are observed in the timing of ASD symptom onset, but by 24 months, most affected individuals can be diagnosed clinically,” they explained. “A small number of siblings at high risk exhibit slower symptom emergence, suggesting the utility of continued monitoring of at-risk populations.”

Estes and colleagues also wrote that children should receive a referral for further assessment and treatment recommendations if they screen positive for ASD or if parents or physicians believe they are at risk.

The Autism Diagnostic Observation Schedule, other validated evaluation tools and expert clinician judgment can diagnose a child with ASD and help guide intervention recommendations, the researchers reported. However, standardized assessment tools do not replace clinician judgment, they wrote.

According to a paper, a comprehensive diagnostic evaluation should include:

• direct examination of social communication (like gesture use and quality of social initiations), presence of repetitive behavior and unusual sensory interests;
• standardized assessment of intellectual ability, speech and language skills and adaptive functioning; and
• parents report of their child’s developmental history. – by Savannah Demko 

Disclosures: Estes reports grants from the BRAIN Initiative Postdoctoral Fellowship and the NIH/Eunice Kennedy Shriver National Institute of Child Health and Human Development. Please see the study for all other authors’ relevant financial disclosures.