Autism spectrum disorders (ASD) refer to a range of psychological conditions characterized by widespread abnormalities of social interactions and communication, as well as restricted interests and repetitive behaviour (World Health Organization. International Statistical Classification of Diseases and Related Health Problems, 10th edn (ICD-10). Geneva: WHO, 2006).
Identifying autism at an early age allows children to start treatment sooner, which can greatly improve their later development and learning. How-ever, many studies show a significant delay from the time that parents first report concerns about their child’s behaviour and the eventual ASD diagnosis, with some children not receiving a diagnosis until well after they have started school.
However, a five-minute checklist (validated in 2002) that the parents of one-year-olds can fill out in the waiting rooms of their naturopathic physicians can help in the early diagnosis of ASD. This should reassure anxious parents where there are no such concerns, as well as lead to earlier treatment in cases where there may be reason for concern.
There is clearly a need for early ASD screening, and one study suggests that there is definite value in making systematic screening for ASD part of
the 1-Year Well-Baby Check-Up Approach (J Pediatrics, 28 Apr 2011; doi: 10.1016/j.jpeds. 2011.02.036).
The CSBS DP Infant-Toddler Checklist comprises 24 questions under seven main headings-emotion and eye gaze, communication, gestures, sounds, words, understanding and object use-that are answered by ticking boxes for ‘not yet’, ‘sometimes’ and ‘often’. Questions include, for example, ‘Do you know when your child is happy or when your child is upset?’ and ‘Does your child smile or laugh while looking at you?’ under ‘Emotion and eye gaze’ while, under ‘Words’, the parent/caregiver is asked ‘About how many different words does your child use meaningfully that you recognize (such as baba for bottle; gaggle for doggie)?’
The answers form the basis of social, speech and symbolic composite scores, and total scores, for the infant/toddler aged six to 24 months, and is ultimately used to construct a percen-tile rank and developmental profile. Any child who fails the screen is referred for further testing and is reevaluated every six months up to the age of 3 years.
Of the 10,479 infants so screened, 32 were identified as having ASD. After the exclusion of late-onset and regression cases, this was consistent with the current rates expected at 12 months, according to the researchers. When those identified as having language, developmental and other forms of delay were included, the simple screen gave an accurate diagnosis 75 per cent of the time.
Following the screening, all toddlers diagnosed with ASD or developmental delay, and 89 per cent of those with language delay, were then referred for behavioural therapy. On average, the children referred for treatment were around age 17 months. In comparison, an earlier (2009) study using data from the US Centers for Disease Control and Prevention (CDC) found that, on average, children currently receive an ASD diagnosis at around 68 months of age, with treatment beginning some time after that.
In view of the virtual lack of universal screening at 12 months, this programme is one that could be adopted by any naturopathic practice at virtually no cost, and can aid in the identification of children who have true developmental problems.
Indeed, such a screening programme would be able to answer parents’ concerns over their child’s possible ASD symptoms earlier and with more confidence than ever before.
Harald Gaier
WDDTY VOL. 22 NO. 3
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