When to screen for autism? New study suggests that as early as 14 months

NEW YORK (CNN) – When screening for autism spectrum disorder, a new study suggests that children can be reliably diagnosed with autism at an earlier age than currently recommended.

The current recommendations are for children to be specifically screened for autism spectrum disorders during regular doctor visits at 18 and 24 months of age.

New data suggests that the detection and diagnosis of autism can begin with great precision as early as 14 months of age, which could give autistic children the opportunity to start treatment earlier, according to the report. Study published Monday in the medical journal JAMA Pediatrics.

"This opens up an unprecedented opportunity for them to undergo early treatment – a potentially early intensive treatment – and then to see what kind of impact it will have upon their arrival at school age," said Karen Pierce. , Professor of Neuroscience Director of the Center for Autism Excellence at the University of California San Diego, first author of the new study.

"The brain is very plastic at the beginning of its development and can be affected by the contributions of the environment," she said. "The frontal cortex in particular – the part of the brain essential to the development of social skills – establishes a large number of connections between brain cells during the first two years of life."

Historically, children with autism usually do not start their treatment until the age of 3 or 4, after much of that wiring has already occurred, she said.

The American Academy of Pediatrics has recommended that all children be screened for autism spectrum disorder at the age of 18 and 24 months, concurrent with ongoing screening of development. This recommendation was made in 2015.

In 2016, the US Preventative Services Working Group concluded that the current body of evidence remains insufficient to assess the benefits and harms of screening for autism spectrum disorder in young children with no signs or symptoms reported by their parents. or their clinician. The working group is an independent group of national medical experts who make recommendations that impact on clinical practice.

The study involved 1,269 young children who were screened for autism spectrum disorder and general developmental delay during doctor visits between 2006 and 2018. If a toddler failed the screening form, he was referred for a full assessment. After each assessment visit, psychologists completed a diagnostic judgment form regarding each child and entered it into a database.

Toddlers received their first diagnostic evaluation between 12 and 36 months and were followed up with at least one subsequent assessment.

The study included more than 3,000 evaluation visits among toddlers.

The researchers looked closely at the accuracy and stability of diagnoses in toddlers over time. For example, infants who were not diagnosed with autism on their first visit but were on their last visit were identified as having "late identified" autism.

Among infants, an initial diagnosis of autism, particularly when screening began around the age of 14 months, was more stable than any other diagnosis, including typical development, the authors wrote. researchers.

Overall, the data showed that 84% of the young children in the study who had been diagnosed with autism at their first visit to the doctor had retained this diagnosis at the age of 3 or 4 years. .

In addition, the researchers found that 23.8% of infants diagnosed with autism at an assessment age of 3 to 4 years had initially been diagnosed with autism. Autism forgotten during their first assessment visit.

The study had certain limitations, including the fact that the practitioners conducting the assessments did not know if the young children had ever been diagnosed.

In the future, researchers plan to conduct a follow-up study to determine outcomes in children diagnosed early in this study.

"We have a new grant under review right now to see if we can recall all those kids from the JAMA Pediatrics newspaper when they reach school age and test them again to see what their results are, because that Is really vital – that's the point of doing all this, "said Pierce.

The new findings of the study surprised no one, Michael Morrier, Assistant Professor and Director of the Screening and Assessment Program at the Emory Autism Center of the Emory University School of Medicine in Atlanta, who did not participated in the study.

He said that it has long been understood by practitioners that you can and should diagnose autism spectrum disorders at a younger age.

"The biggest benefit of diagnosing young people is really twofold.One would be to prevent difficult behaviors," he said.

Some of these behaviors may be when a child bangs his head against a table to attract the attention of others or isolates himself from himself. These types of behaviors usually develop over time.

"It's because they've learned over time if I'm not communicating and I'm starting to bang my head, that's causing a reaction," Morrier said.

So, diagnosing early, "we will probably prevent many of these types of behaviors from starting," he said. Secondly, for families, "we can give them the skills and competencies they need to feel supported when they come to the community and experience real social experiences that all young children should have."

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Thomas Frazier, scientific leader of the Autism Speaks Autism Defense Group, described the new study as "very strong" and the study's interpretation that autism can be detected at a younger age as "appropriate".

As the father of a 15-year-old autistic boy, Frazier knows too well the importance of reliable screening – and how that can lead to intervention efforts and more therapies. sooner than later.

"My son was diagnosed just before his second birthday." It was a difficult time because we knew we had to find ways to help him get the interventions he needed, which he needed. are not always easy to obtain, "said Frazier. did not participate in the study.

"Many studies show that early intensive behavioral intervention is effective.Many children benefiting from an early intensive behavioral intervention show substantial improvements in cognitive function, language skills, and daily living as well as in children." 39, a reduction in the symptoms of autism, "he said. "Some data also suggest that starting treatment earlier improves outcomes."

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