New Study Shows Half of Children With Autism Can Be Accurately Diagnosed at Close to One Year of Age

Jul 03, 2007, 01:00 ET from Kennedy Krieger Institute

    BALTIMORE, July 3 /PRNewswire-USNewswire/ -- In a study published today
 in the Archives of General Psychiatry, researchers from the Kennedy Krieger
 Institute in Baltimore, Maryland found that autism can be diagnosed at
 close to one year of age, which is the earliest the disorder has ever been
 diagnosed. The study, which evaluated social and communication development
 in autism spectrum disorders (ASD) from 14 to 36 months of age, revealed
 that approximately half of all children with autism can be diagnosed around
 the first birthday. The remaining half will be diagnosed later, and their
 development may unfold very differently than children whose ASD is
 diagnosable around the first birthday. Early diagnosis of the disorder
 allows for early intervention, which can make a major difference in helping
 children with autism reach their full potential.
     Researchers examined social and communication development in infants at
 high and low risk for ASD starting at 14 months of age and ending at 30 or
 36 months (a small minority of the children exited the study at 30 months).
 Half of the children with a final diagnosis of ASD made at 30 or 36 months
 of age had been diagnosed with the disorder at 14 months, and the other
 half were diagnosed after 14 months. Through repeated observation and the
 use of standardized tests of development, researchers identified, for the
 first time, disruptions in social, communication and play development that
 were indicative of ASD in 14-month olds. Multiple signs indicating these
 developmental disruptions appear simultaneously in children with the
     Dr. Rebecca Landa, lead study author and director of Kennedy Krieger's
 Center for Autism and Related Disorders, and her colleagues identified the
 following signs of developmental disruptions for which parents and
 pediatricians should be watching:
     -- Abnormalities in initiating communication with others: Rather than
        requesting help to open a jar of bubbles through gestures and
        vocalizations paired with eye contact, a child with ASD may struggle to
        open it themselves or fuss, often without looking at the nearby person.
     -- Compromised ability to initiate and respond to opportunities to share
        experiences with others: Children with ASD infrequently monitor other
        people's focus of attention.  Therefore, a child with ASD will miss
        cues that are important for shared engagement with others, and miss
        opportunities for learning as well as for initiating communication
        about a shared topic of interest.  For example, if a parent looks at a
        stuffed animal across the room, the child with ASD often does not
        follow the gaze and also look at the stuffed animal.  Nor does this
        child often initiate communication with others.  In contrast, children
        with typical development would observe the parent's shift in gaze, look
        at the same object, and share in an exchange with the parent about the
        object of mutual focus.  During engagement, children have many
        prolonged opportunities to learn new words and new ways to play with
        toys while having an emotionally satisfying experience with their
     -- Irregularities when playing with toys: Instead of using a toy as it is
        meant to be used, such as picking up a toy fork and pretending to eat
        with it, children with ASD may repeatedly pick the fork up and drop it
        down, tap it on the table, or perform another unusual act with the toy.
     -- Significantly reduced variety of sounds, words and gestures used
        to communicate: Compared to typically developing children, children
        with ASD have a much smaller inventory of sounds, words and gestures
        that they use to communicate with others.
     "For a toddler with autism, only a limited set of circumstances -- like
 when they see a favorite toy, or when they are tossed in the air -- will
 lead to fleeting social engagement," said Landa. "The fact that we can
 identify this at such a young age is extremely exciting, because it gives
 us an opportunity to diagnose children with ASD very early on when
 intervention may have a great impact on development."
     The current study reveals that autism often involves a progression,
 with the disorder claiming or presenting itself between 14 and 24 months of
 age. Some children with only mild delays at 14 months of age could go on to
 be diagnosed with ASD. Landa and her colleagues observed distinct
 differences in the developmental paths, or trajectories, of children with
 early versus later diagnosis of ASD. While some children developed very
 slowly and displayed social and communication abnormalities associated with
 ASD at 14 months of age, others showed only mild delays with a gradual
 onset of autism symptoms, culminating in the diagnosis of ASD by 36 months.
     If parents suspect something is wrong with their child's development,
 or that their child is losing skills during their first few years of life,
 they should talk to their pediatrician or another developmental expert.
 This and other autism studies suggest that the "wait and see" method, which
 is often recommended to concerned parents, could lead to missed
 opportunities for early intervention during this time period.
     "What's most exciting about these important advancements in autism
 diagnosis is that ongoing intervention research leads us to believe it is
 most effective and least costly when provided to younger children," said
 Dr. Gary Goldstein, President and CEO of the Kennedy Krieger Institute.
 "When a child goes undiagnosed until five or six years old, there is a
 tremendous loss of potential for intervention that can make a marked
 difference in that child's outcome."
     While there are currently no standardized, published criteria for
 diagnosing children with autism at or around one year of age, Landa's goal
 is to develop these criteria based on this and other autism studies
 currently underway at the Kennedy Krieger Institute. Landa and her
 colleagues at the Institute plan on releasing preliminary diagnostic
 criteria for very young children with autism in an upcoming report.
     Participants in the current study included infants at high risk for ASD
 (siblings of children with autism, n=107) and low risk for ASD (no family
 history of autism, n=18). Standardized tests of development and play-based
 assessment tools were used to evaluate social interaction, communication
 and play behaviors in both groups at 14, 18 and 24 months of age.
 Researchers assigned diagnostic impressions at every age, indicating
 whether there were clinically significant signs of delay or impairment.
 After their last evaluation at 30 or 36 months, each participant was then
 given a final diagnostic classification of ASD, non-ASD impairment, or no
 impairment. The ASD group was further divided into an Early ASD diagnosis
 group and a Later ASD diagnosis group based on whether they were given a
 diagnosis of ASD at 14 or 24 months.
     About Autism
     Autism spectrum disorders (ASD) is the nation's fastest growing
 developmental disorder, with current incidence rates estimated at 1 in 150
 children. This year more children will be diagnosed with autism than AIDS,
 diabetes and cancer combined, yet profound gaps remain in our understanding
 of both the causes and cures of the disorder. Continued research and
 education about developmental disruptions in individuals with ASD is
 crucial, as early detection and intervention can lead to improved outcomes
 in individuals with ASD.
     About the Kennedy Krieger Institute
     Internationally recognized for improving the lives of children and
 adolescents with disorders and injuries of the brain and spinal cord, the
 Kennedy Krieger Institute in Baltimore, MD serves more than 13,000
 individuals each year through inpatient and outpatient clinics, home and
 community services and school-based programs. Kennedy Krieger provides a
 wide range of services for children with developmental concerns mild to
 severe, and is home to a team of investigators who are contributing to the
 understanding of how disorders develop while pioneering new interventions
 and earlier diagnosis. For more information on Kennedy Krieger Institute,

SOURCE Kennedy Krieger Institute