Friday, August 22, 2008

Dr. Larry McCleary - ASDs: Time is of the Essence!

Dr. Larry McCleary - ASDs: Time is of the Essence!

ASDs: Time is of the Essence!
6/30/2008 11:52 PM MST

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Autistic Spectrum Disorders (ASDs) are neurodevelopmental disorders that have much better outcomes the earlier they are diagnosed.and the sooner children are enrolled in appropriate intervention programs. To help disseminate information to more effectively avoid a delayed diagnosis it important to make available some of the earliest signs and symptoms to watch for.

The Child Neurology Service "red flags" screening parameters include the following as absolute indications for immediate evaluation for autism:

1) no babbling or pointing or other gesturing by 12 months of age

2) no single words by 16 months

3) no spontaneous 2-word phrases by 24 months

4) loss of language or social skills at any age

Speech delays usually prompt parents to raise concerns with their child's pediatrician at 16 to 19 months. However, certain social deficits occur earlier and may be more specific but more difficult to recognize. Presenting symptoms can vary widely from one child to the next. Some may be perceived by parents as just "being different" during the first few months of life. Inability to manifest social relatedness by developing connections with others and sharing complementary states is common. These children are content being alone, ignore their parents bids for attention, and seldom make eye contact or bid for other's attention with gestures or vocalizations.

Difficulty with skills such as joint activity is a distinguishing characteristic of very young children with autism. Joint activity refers to the behavior whereby the infant shows enjoyment in sharing an object or an experience with another person by looking back and forth between the two. Early in life it frequently appears as joyous smiling in recognition of a parent's attention or vocalization. At about 8 months of age, an infant starts to follow a parent's gaze and look in the same direction. At 10-12 months children begin to look in the same direction when a parent points at an interesting object. This is usually accompanied by the child looking back at the parent as if to acknowledge a shared appreciation. At 12 to 14 months children typically begin to initiate pointing themselves usually to request a desired object and then to draw the parent's attention to share an interesting object. These pointing episodes are frequently accompanied with a back and forth gaze of the child between the object and the parent in effect to "share" the experience. Orienting to social stimuli such as turning consistently to respond to one's name is an early (8-10 months) trait that is often deficient.

Most children later diagnosed with autism are sent to their doctor for "speech delay." Most parents sense that something is wrong by 18-20 months. Earlier pre-speech deficits often exist and should be looked for. These traits include:

1) lack of appropriate gaze

2) lack of warm, joyful expressions

3) lack of the alternating to-and-fro pattern of vocalizations between infant and parent that usually occurs at approximately 6 months of age (ie, infants with autistic tendencies usually continue vocalizing without regard for the parent's speech)

4) lack of recognition of parent's voice

5) disregard for vocalizations such as calling of the child's name but with preserved awareness of environmental sounds

6) delayed onset of babbling past 9 months

7) decreased use of pre-speech gestures such as waving or pointing

8) lack of expressions such as "oh oh" or "huh"

9) Lack of interest or response of any kind to neutral statements such as "Oh no, it's raining again!"

If you see these changes, please suggest that the child be evaluated as soon as possible because an early, proper diagnosis means starting treatment at a time when the intervention is likely to result in a better outcome for the child.

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