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April Autism Awareness Month- Early Detection & Intervention

Posted by Alexandra Solano on April 3, 2011

autism spectrum disorders, neurology

April is Autism Awareness Month at Milwaukee Center for Longevity Medicine. CDC's most recent report from the 11 sites that make up the Autism and Developmental Disabilities Monitoring (ADDM) Network identified 2,757 children with autism spectrum disorders (ASDs) in a total population of 308,038 children aged 8 years, indicating a prevalence of approximately one in 110 (or 1% of children)

Early Detection & Identification

Early Detection:

• Signs of developmental disruption  may be observable in some children with Autism Spectrum Disorders (ASDs) before their first birthday, while in other children, signs may not clearly appear until the second or third year of life.
• In most cases, the early signs of autism  involve decreased frequency of expected behaviors (such as smiling at others), and decreased variety of behaviors (words, gestures, actions in play).
• The first warning signs may differ from one child to another, but there is always difficulty showing a social connection to others, and usually some delayed aspect of communication (e.g.: babbling, gesture, first words, word combinations).
• On average, parents express their first concerns about their child with autism between 15 and 24 months of age.
• Loss of social and/or language skills, known as regression, occurs in around one-third of children with autism, usually sometime around 15 - 21 months of age.  Loss of skills may be very gradual in some children, but are often regained.  In some children, skills may plateau.

Diagnosis/Prognosis

• About half of children with ASDs could be diagnosed around their first birthday by professionals who have extensive experience with very young children and autism.  On average, nationally, children are diagnosed with autism at three years of age, while children with high intellectual functioning and ASD tend to be diagnosed later (often around six years of age).
• On average, nationally, there is a 13-month gap between the time a child is first evaluated due to concerns about development and the subsequent time of diagnosis of ASD.
• In children younger than 30 months, the diagnosis of autism is least stable.  Some very young children, especially those with higher developmental levels, may improve so much by the third birthday that a diagnosis of ASD is no longer appropriate.  Many of these children do have residual language and/or social delays at three years of age.

Early Intervention:

• Early intervention is associated with improved cognitive, social, communication and play development in children with ASDs.
• Intervention with children as young as two years old has been shown to improve rate of learning as well as core deficits of autism involving joint attention (sharing others’ focus of attention as when looking where they are looking, or by getting others to share your focus of attention by pointing things out to them), imitation, affect sharing (smiling while giving eye contact to another person), and social communication.
• Teaching within natural contexts is important. Intervention strategies need to be integrated into daily life at home in order to achieve optimum success.
• Early gains in language and social functioning during early intervention are associated with better outcomes.
• Level of nonverbal cognitive functioning (e.g., problem solving using visual information) is a major predictor of treatment response.
• Proper training of intervention staff is essential.  As parents’ input into the selection of intervention goals is critical, early intervention should also include parent training.

Types of Early Intervention

• Although there is no scientifically validated recommendation for a specific number of hours per week of intervention, there is general agreement that by age three years, children should be receiving intensive intervention (approximately 20-25 hours per week).   Home-based routines may be considered to be part of the intervention time if these incorporate teaching strategies that help children to practice new and established skills.
• Autism interventions based on principles of Applied Behavior Analysis (ABA), as well as developmentally-based interventions, are  most commonly associated with improvements. ABA can be employed by adults in a highly-structured environment (such as with intensive early intervention) or with lower levels of adult-imposed structure where the child’s own interests and actions are utilized in the intervention.
• Early intervention techniques and approaches thought to be beneficial for communication and language development include: developing social and play routines and using these to build new skills; modeling and reinforcing desired behaviors and skills during parent-child interactions, such as talking about what the child is doing, imitating the child, and expanding upon behaviors by play acting into more complex levels; utilizing visual symbols and augmentative communication to teach new concepts to children with ASD, as well as teaching spoken language to very young children with ASD; and exposing children with autism to typically developing peers, particularly when some such interaction occurs under the guidance of a trained professional.

Source: Kennedy Krieger Institute research studies

Landa, RJ (2008) Nature Clinical Practice Neurology, 4:138-147; Sullivan M, Finelli J, Marvin A, Garrett-Mayer E, Bauman M, & Landa R. (2007) J of Autism and Developmental Disorders, 37:37-48; Flanagan J & Landa R. (2007) American Occupational Therapy Association Annual Conference; Bhat A, Galloway C, & Landa R. (2007) Society for Research in Child Development Conference; Landa R, Holman K, & Garrett-Mayer E. (2007) Archives of General Psychiatry, 64: 853-864; Landa R & Garrett-Mayer E. (2006). J of Child Psychology and Psychiatry, 47: 629-638.