Routine Autism Screening Should Be Done at an Early Age, Experts Say
Children as young as 2 should be routinely screened for autism, just as they are for vision and hearing problems, a national committee of experts recommended Wednesday.
Early diagnosis is crucial because prompt intervention using various educational programs greatly improves the chances that very young autistic children will learn to communicate properly and develop appropriate social skills, according to a report by the National Research Council panel. Autism is a disease of the brain, which is more malleable at younger ages.
“We need to have coordination of services and intensive intervention starting very early,” said Catherine Lord, a professor of psychiatry at the University of Chicago who headed the panel. “These efforts should be systematically planned, tailored to the needs and strengths of individual children and their families, and regularly evaluated.”
The panel urged that federal, state and local public agencies coordinate efforts to ensure that children receive services free of charge. Because of sparse funding and the growth in autism cases, the availability of services varies drastically from school to school, district to district and state to state. Many children seeking services end up on long waiting lists.
“It shouldn’t be up to parents to pay for that or have to fight for that,” Lord said.
Autism is a severe and perplexing developmental disorder in which children often become isolated from the world around them and develop poor communication and social skills. Diagnoses within the autism spectrum include autism, pervasive developmental disorder not otherwise specified, Asperger’s syndrome and childhood disintegrative disorder. These disabilities differ in severity and the age of onset.
The reported incidence of autism has surged over the last two decades, the researchers noted in their report. From 1975 to 1985, studies showed the worldwide rate of autism to be about 4 cases per 10,000 people. From 1985 to 1995, the numbers tripled to 12 per 10,000. Researchers now believe that the actual rate is much higher, on the order of 1 in 500 or even 1 in 250.
As of April, there were 14,777 children with autism enrolled in the California Department of Developmental Services’ 21 regional programs. That was up more than 280% from the number enrolled in 1987.
In the Los Angeles Unified School District, the number of students eligible for special education services because of autism has soared to 2,797 from 623 a decade ago.
Whether the reported increases result from improved diagnosis and greater awareness or from an actual growth in the disorder has yet to be settled, researchers said.
The notion that children should be screened at a very young age grows out of the recommendation of another group of psychologists, speech pathologists and pediatricians. That group recently developed screening guidelines and is attempting to get the word out to pediatricians, who often serve as the first line of defense.
“Routinely, we weren’t picking up kids [with autism] until about age 3,” said Susan Schmidt-Lackner, an assistant professor at UCLA’s Neuropsychiatric Institute. “Now I’m picking them up as early as a year to 14 months.”
Although much about how to treat autism remains a mystery, Schmidt-Lackner said, “the one thing we do know is that early intervention, when the brain is still very plastic and connections can be changed, will optimize prognosis and outcome.”
The panel recommended that services for young children be offered a minimum of 25 hours a week year-round, although many autism experts say it should be more like 30 to 40 hours, if the child can tolerate it. The recommended education programs would include training in how to conduct appropriate conversation, read body language and control aggressive behaviors.
The panel also endorsed a rich ratio of teachers to students and called for further research to sort out treatments work best.
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The report is available on the Web at https://www.national-academies.org.
