Very Early Screening for Autism may be Inappropriate

Because of the growing number of articles and public service announcements about autism, more parents of young children are concerned about autism in their child.

Often when worried mothers and fathers contact me, they don’t come right out and say they think their child might be autistic, but the implication is very clear. For example, Cindy, the mother of one-year-old Joshua, said this:

“I’m worried about my son and I need advice,” Cindy said. “Joshua doesn’t have good eye contact with people and he isn’t talking yet. I’m concerned that something might be wrong with him.”

And Sid, the father of a six-month-old child, said: “My daughter doesn’t seem to have the kinds of social skills I would expect of a child her age. She doesn’t babble and she just seems to look through you when you talk to her.”

Both of these parents had heard that more and more young children are currently being diagnosed with autism and they wondered if their child was one of those children with the disorder.

A research study conducted at the University of California at Davis, and recently published in the Journal of the American Academy of Child & Adolescent Psychiatry, helps to shed light on when parents can expect symptoms of autism to show up.

Following children from birth to beyond age three, the researchers found that symptoms of autism do not show up by six months of age, but do emerge between six and 12 months. The symptoms – a lack of shared eye contact, smiling, and communicative babbling – only emerge gradually after six months. When researchers compared normally developing children with those later diagnosed with autism, there were virtually no differences at six months of age. By months 12 through 18, though, the infants who developed autism showed declines in social communication, including rapid declines in eye contact, declines in social smiling, and declines in every other measure conducted by the researchers.

So, while most children will appear similar during the first six months of life, there are declines in social skills after that for children who develop autism. The loss of skills seen in autistic children continues past 12 and 18 months and often continues well into the second and third years of life. Autism, this study points out, has a slow, gradual onset of symptoms, rather than a very abrupt loss of skills.

This research is valuable because it was meticulously conducted evaluating children at five different ages on a series of widely used diagnostic tools. In addition, the researchers recorded the exact numbers of social and communicative behaviors displayed by the children during evaluation sessions. Also, the way this longitudinal study was conducted eliminated any reliance on the memory of the parents, which has been found to be somewhat faulty in remembering what behaviors their children displayed at different ages and stages.

The significance of this study for parents and pediatricians is that screening for autism early in the first year of life will not be successful very often as the symptoms don’t really appear until the second half of the first year. Furthermore, screenings for autism should focus on social behaviors, since these are the skills that decline. And, finally, screening should take place between 12 months and 36 months as symptom emergence is gradual during this period of growth for children.

It is estimated that about one in 100 American children are diagnosed with autism. According to the American Academy of Pediatrics, while it is known that genetics may play a strong role in autism, the exact cause is not known. The guidelines for pediatricians advocated by the American Academy of Pediatrics is that children be screened at 18 months and 24 months during well-child visits or if the parents raise a concern.

These guidelines seem very appropriate given this latest study. But, again, if you are a parent of an infant, keep in mind that very likely no symptoms of autism will be apparent before the end of the first year.