Earlier autism diagnosis could mean earlier interventions

EAST LANSING, MI – Autism is usually diagnosed in children between the ages of two and three or later, but new research shows that it's possible to find symptoms in much younger children and to diagnose autism at 18 to 24 months. Brooke Ingersoll is an assistant professor of psychology at Michigan State University. She recently wrote a paper on autism published in the journal Current Directions in Psychological Science. Ingersoll told WKAR's Gretchen Millich that if children can be diagnosed earlier, it might be possible to prevent them from developing autism.

BROOKE INGERSOLL: Autism is a behaviorally-defined disorder. The way you identify it or diagnose it is based on behaviors. The current diagnostic criteria that we have are based on slightly older children, so it's really difficult right now to pick up autism in children younger than about three, and in the United States, most children with autism are actually getting picked up a little bit later, closer to four or five. However, there is evidence that symptoms are present in younger children, but until more recently, we didn't really have an idea of what those symptoms actually looked like in younger kids, because they involved behaviors that weren't part of the diagnostic criteria.

There have been a number of researchers in the United States and internationally who have recently been doing what we call "prospectus studies," which is where they follow children forward to see how their behavior unfolds over development. This allows us to get an idea of what autism may look like in the very first year of life, because prior studies have really relied on retrospective studies, where once a child already has a diagnosis, people try to go back in time and think about what they looked like when they were 8 months, 10 months, 12 months. Then we're relying on parent report and parent memory. We're relying maybe on videos that were taken before the parents knew the child had a problem. That's not really the quality of data we really need to get a really good picture.

GRETCHEN MILLICH: At age two or three, there are some really obvious symptoms, because children with autism often don't talk as much, or interact socially, or have eye contact, but what are the symptoms that you would see in a much younger child?

INGERSOLL: In a much younger child, 12-month-olds are only really beginning to use single words anyway, so what we're really looking for are these early non-verbal behaviors, such as joint attention, which is the ability to share attention between a person and an object. These behaviors include things like showing, pointing, giving, following someone else's point, as well as the ability to imitate spontaneously actions with objects, gestures, or social referencing, where you use eye contact to sort of check in with a social partner, typically an adult, to get an idea of what they're thinking about a situation.

MILLICH: Does earlier diagnosis mean earlier intervention?

INGERSOLL: One of the reasons this is very exciting is it has the potential to lead to targeted interventions that can focus on these symptoms in very young children before the full expression of autism plays out. The hope there is if we can target some of these skills we are now starting to identify in some children at 12 months, then we might be able to prevent the development of later problematic behaviors. We really don't have a lot of evidence yet that that is the case, but there are some studies that have been done with slightly older children that have shown that if you target some of these important, core social communicative skills, like joint attention, you do get better gains in language a year down the line. So, hopefully we can get in there and maybe target them in these younger children and have better outcomes for these kids.

MILLICH: Are you saying that it's possible to prevent autism, prevent the onset of autism, or possibly make it much less severe than it might be?

INGERSOLL: That is our hope. I mean, at this point, we do not have enough data to know whether or not we can prevent the development of autism. Theoretically, if we can improve some of these behaviors that we know are very important for the development of social and language skills, we at least have the potential to ameliorate those symptoms which prevent the development of more impaired symptoms. So, the hope is that we can lead to much better outcomes in these kids.