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Earlier Autism Screening Shows Promise

Brief parent questionnaire enables pediatricians to screen for autism at one-year well-baby check up

Early detection of autism allows for early intervention with behavior therapies that can improve outcomes. Current American Academy of Pediatrics guidelines call for screening all toddlers at 18 and 24 months, the age at which existing screening methods are best able to identify children with autism. Physicians have lacked validated autism screens for younger children—until now.

This year, research demonstrated that a brief parent questionnaire, administered at a baby’s one-year well-baby check-up, can help pediatricians identify babies who have autism or are at high risk of developing it.

The study involved 137 pediatricians who handed out a simple 24-item checklist to all parents bringing in babies for routine one-year checkups. The questionnaire, called the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist, took the parents about 5 minutes to complete. It included such questions as “Does your child smile or laugh while looking at you?” and “How many blocks or rings does your child stack?” The pediatricians then reviewed the checklist (a 2-minute process), flagging those babies who scored below a pre-set threshold. (A previous study showed this checklist to be valid.)

In all nearly 10,500 children were screened, and 346 were flagged as at risk for autism and referred to an autism clinic for further evaluation. Of these, about half were followed to 3 years, 32 of them receiving a diagnosis of autism spectrum disorder (ASD). Another 56 were diagnosed with language delay, 9 with developmental delay, and 36 with other diagnoses.

The screen was able to accurately predict autism or other developmental delays about 75 percent of the time. This suggests that the questionnaire or a similar screen may be useful for earlier identification of ASD and other developmental delays that would benefit from early intervention.

The study, led by Karen Pierce, Ph.D., of the University of California-San Diego School of Medicine, also highlighted the ease of putting an early infant screening program into practice. At the time of the study’s publication, all of the 137 pediatricians who had participated in the project said they were still using the screening tool at one-year well-baby checkups. Prior to their participation in the study, only 30 of the pediatricians (22 percent) had routinely screened for autism at one year.

Pierce K, Carter C, Weinfeld M, et al. Detecting, Studying, and Treating Autism Early: The One-Year Well-Baby Check-Up Approach. J Pediatr. September 2011;159(3):458-465.


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