The earlier parents and doctors realize that a child has autism, the earlier that child gets help. The American Academy of Pediatrics today issued new guidelines aimed at making it easier for children with autism to be diagnosed earlier and get appropriate therapy sooner.
Chris Plauché Johnson, a clinical professor of pediatrics at the University of Texas Health Science Center at San Antonio and coauthor of the new clinical reports, spoke with U.S.News & World Report about the tools available to parents and pediatricians.
The American Academy of Pediatrics issued guidelines on diagnosing autism not very long ago. What's new?
What's brand-new is that we're asking pediatricians to screen all children for autism at the 18-month and 24-month well-baby visits—not just children with speech delays and children of parents who have a concern. We're also telling pediatricians to ask parents about social and language deficits that may be present in very young children.
The reason is that we know a lot more about what autism looks like in young children than we did seven years ago. And we have developed a tool kit that is a step-by-step plan on how a pediatrician can conduct surveillance and screening at a well-baby visit, with over 100 tools (from formal methods of screening for disabilities to the simple "point test," to see if a baby follows a person's point and gaze) for identifying these children and managing their disability.
In a very brief office visit, the biggest barrier for pediatricians is, when do I find time to do this? The technique we have suggested for surveillance and screening is a lot of waiting-room stuff. Once parents check in, they'll be given questionnaires, and the office staff can score it. Then the pediatrician can look at it. If it's negative, fine. If it's positive, they can deal with it on the spot. The screening is done minutes before the patients see the pediatrician.
In the past, pediatricians often told parents who were worried about their baby to wait and see how the child does as a toddler.
That's exactly what we're trying to eliminate, the let's-wait-and-see. Early intervention is crucial to effective treatment. When parents do have a concern, most of the time there is something. It may be a speech delay, but it's good to know. We don't want the pediatrician to say, I'm going to refer you to a specialist, then wait six to 13 months. The key point is: Don't wait to send them to early intervention. Those intervention people are good. They will tailor the intervention to the child. They don't need a diagnosis to get started and help the child, even if the intervention is for a simple speech delay.
All parents seem to worry that their baby may have autism. What can parents do to allay those fears before they see the pediatrician?
There is a wonderful website that has just gone up from Autism Speaks, Florida State University, and First Signs Inc. It lists signs and symptoms of autism and shows them in video clips comparing a normal baby with a baby later diagnosed with autism.
When parents see videos like that, isn't there a risk that they'll be convinced their baby has autism when he's fine?
That's the concern. We're already seeing that with all the media attention about autism in general over the past five years. I've been in the business for 30 years. In the past, parents would come in with concerns about speech. It's totally different now. Parents come in saying, "I'm worried my child has autism," where it's only a little speech problem. There is a danger that these videos can make a parent overanxious. But on the other hand, when parents go to the doctor they will bring it up, and it clicks into the screening. Screening helps eliminate the false concerns or the overanxious concerns. The screening process can help allay fears as much as identify kids who do have autism.
If a child is diagnosed with autism, what treatment choices do parents have?
Pediatricians have an important role to play in managing autism spectrum disorders. The academy also has published a new report evaluating the many treatments available for autism, which include intensive intervention of at least 25 hours a week, pharmacologic and nonpharmacologic intervention for medical conditions that often accompany autism, and use of complementary and alternative treatments. The goal is not only to help pediatricians provide medical care to children on the autism spectrum but to support and educate families, and guide them to empirically supported interventions for their children.
The two new American Academy of Pediatrics reports, "Identification and Evaluation of Children With Autism Spectrum Disorders" and "Management of Children With Autism Spectrum Disorders," are available at www.aap.org.