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Reliable Autism Screening Takes More than Mere Observation at Checkups

Simply observing toddlers during checkups may miss many autism cases; study reinforces need for doctors to perform proper screening
January 14, 2015

A new study finds that even experts can’t reliably detect autism by merely observing a child during a 10- to 20-minute well-child checkup. The finding underscores the American Academy of Pediatrics’ recommendation that all toddlers receive formal screening for autism at 18 and 24 months.

“For quite some time we’ve known that it’s not enough for anyone – even autism specialists – to observe a child for a few minutes,” comments developmental pediatrician Paul Wang, Autism Speaks head of medical research. “Screening has to be done systematically, using standardized, validated instruments that include questions for parents, who know their child best.”

Unfortunately, many doctors continue to rely on their informal observations during a toddler checkup.

In the study, at Brigham Young University, autism experts viewed two 10-minute videos for each of 42 children, ages 15 to 33 months, receiving checkups. Unknown to the experts, 14 of the children had been diagnosed with autism.

The experts viewing the videos missed just over a third of the autism cases.

What’s more, the researchers found that the children who had autism showed obvious signs of autism just 11 percent of the time. In other words, their behavior during checkups was “typical” of children their age almost 90 percent of the time. This further emphasizes the need for screening that involves a questionnaire for caregivers who spend extensive time with a child, they conclude.

Recommended autism-screening questionnaires for parents include the Modified Checklist for Autism in Toddlers (M-CHAT). In a doctor’s office, it takes about five minutes for a parent to complete and two minutes to score. Autism Speaks has an autoscoring electronic version on its website. See “Screen Your Child,” and bring a print-out to your doctor.

Read the full study in Pediatrics here