Early Autism Testing: Boon or Bane?

New guidelines urge earlier screening for autism -- and earlier intervention.

BySTEPHANIE TODD, M.D.<br>ABC News Medical Unit
February 09, 2009, 9:12 PM

Oct. 29, 2007&#151; -- When Nancy Wiseman noticed her 24-month-old baby girl seemed to have trouble communicating and responding to her name, she took her to her pediatrician's office for an explanation.

But she was surprised that her concerns went unnoticed. Not until Sarah was diagnosed with autism at 29 months did she get treatment.

That was nearly a decade ago. Today, Sarah is functioning like a normal 11-year-old, and Wiseman believes this is thanks to early diagnosis.

"Today, Sarah is more socially related than most typically developed children," says Wiseman, founder and president of the autism organization First Signs, and author of the book Could It Be Autism? The Parent's Guide to the First Signs and Next Steps. "She is even performing at or above her grade level."

Publicity surrounding experiences like Wiseman's may be the reason why today, more than ever, parents want to know sooner than later if their child is affected with autism spectrum disorders (ASDs).

On Monday, the American Academy of Pediatrics (AAP) released two new reports that may help pediatricians recognize autism spectrum disorders earlier and guide families to effective interventions.

These are the "most comprehensive reports that target pediatricians," says lead author Dr. Chris Johnson, clinical professor of pediatrics at the University of Texas Health Sciences Center in San Antonio.

But while many autism experts applaud the new screening recommendations, some remain concerned that the new guidelines could spark fears in parents -- particularly if normal children are misdiagnosed.

"It might also mislabel and create undue anxiety, given the wide range of normal for development in this age group," says Dr. Charles Shubin, associate professor of pediatrics at the University of Maryland in Baltimore.

The last time such a report was compiled was in 2001. The new reports, Johnson says, represent a complete overhaul of this previous information, and they also include recommendations that all children be screened for this category of conditions at one-and-a-half and two years of age.

"The big difference is the focus on screening at 18 and 24 months rather than when children develop symptoms," Johnson adds.

"The goal is to catch as many affected children as early as possible," says co-author Dr. Scott Myers, a neurodevelopmental pediatrician at Geisinger Medical in Danville, Pa. "Those who are involved in early intervention -- special pre schools, speech and language therapy, and behavioral interventions -- have better outcomes."

The reports also advise intervention once an ASD diagnosis is considered -- rather than when a definitive diagnosis is made. Johnson says that this is because a definitive diagnosis may take six months to one year.

Dr. David Beversdorf, assistant professor of neurology at The Ohio State University Medical Center in Columbus, Ohio, agrees that this delay could have big implications for timely intervention.

"The barriers to obtaining further evaluation in a timely manner, as well as appropriate implementation of treatments, can be significant," he says.

Cutting down this delay may empower parents to seek help earlier, Wiseman says.

"Many of the warning signs are the very ones that often trouble parents months or years before a child is formally diagnosed with a developmental delay or disorder," she says. "Parents must learn to trust their instinct... They know their child best."

As for pediatricians, the reports urge these doctors to be aware of complementary and alternative medicine (CAM) therapies that families dealing with autism may look to, such as diet restrictions, chelation therapy, and vitamin and mineral supplements.

Some experts feel that screening may alleviate parents' uncertainties by obtaining an earlier diagnosis when parents already know that their child is "just not right." But others, such as University of Maryland's Shubin, are concerned that it may instill unnecessary fear due to incorrect diagnoses.

Also, because many ASDs are still not completely understood, there exists no "cure" per se, only treatment.

"Better treatment options need to be studied," says Dr. Steven Pavlakis, professor of neurology and pediatrics at Maimonides Medical Center in Brooklyn, N.Y.

But, Johnson says, this does not mean that early treatment cannot have significant benefits.

"There are meds that may improve --- although not cure -- their behavior," she adds.

Screening could also offer relief for other families who feel that something is not quite right with their child, only to discover that they do not have any form of ASD.

"Screening that shows their kids do not have autism should be a relief," says Dr. Mark Groshek, a pediatrician at Kaiser Permanente in Littleton, Colo.

Although surprised with the very small number of pediatricians that currently use standard tools to screen for autism-spectrum disorders, Groshek feels that the new guidelines are a "call to arms" for intervention, allowing pediatricians to more easily take the necessary steps, including referral to the appropriate specialist for a complete evaluation.

Groshek is also optimistic that early intervention would help them reach that level of function earlier and more completely.

"The change being suggested is to move much faster in getting services for kids who do or might have autism-spectrum disorders, based on screening," he adds.

Wiseman says she believes such early intervention was the key to her daughter's ability to overcome the odds.

"My daughter is a symbol of what early intervention is all about," she says.

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