Early detection is important when it comes to treating children with autism. And now, new research presented in May at the International Society of Autism Research 2019 Annual Meeting in Montreal suggests that a routine developmental screening tool already used in doctors’ offices might help identify children with autism sooner and with more accuracy.
Using the developmental screening, along with traditional autism screens, allowed researchers to retrospectively detect signs of autism by 30 months old in 75 percent of the children who would later be diagnosed with autism, compared with traditional autism screening methods, which picked up autism in just 50 percent of the kids with autism by about the same age.
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“Early intervention is the best tool we have in our toolkit to help kids reach their full potential, in part because the brain is much more plastic when kids are younger,” explains Whitney Guthrie, PhD, the codirector of the data and statistical core at the Center for Autism Research at the Children’s Hospital of Philadelphia.
It’s worth noting that both of these screening tools alert clinicians that a child is at increased risk for autism, but further diagnostic testing is still needed following those screens to make an autism diagnosis. Currently, if a traditional screening suggests a child shows signs of autism, the child’s pediatrician should refer them to a specialist for evaluation and, if needed, a diagnosis, Dr. Guthrie explains. The results of this work would therefore suggest that this type of improved early screening would lead to earlier diagnosis for children with autism, too, she says.
“The brain is changing so much more between birth and a child’s third birthday than the brain is changing after that,” she says. “We think if we can deliver autism-specific interventions before a child turns 3, we can really capitalize on how much that child’s brain is still changing.”
Not every child will benefit in the same way from early intervention, Guthrie notes. But current evidence suggests it gives each individual the best potential for reaping the biggest gains, she says.
Even though the American Academy of Pediatrics (AAP) recommends that kids be screened for autism at 18 and 24 months, most children with autism aren’t diagnosed until after age 4, according to the Centers for Disease Control and Prevention.
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“Right now we know we’re not catching every child with autism as early as possible,” Guthrie says. “This research might eventually help pediatricians catch some kids earlier.”
Using Big (and Real World) Data to Improve Autism Diagnosis
For the new study, researchers analyzed data from 32,280 children who received developmental screenings during their wellness visits at one of 31 primary care clinics that were part of Children’s Hospital of Philadelphia, 2.4 percent of whom were eventually diagnosed with autism. The specific screening, known as the Survey of Well-Being in Children (SWYC), is typically administered by pediatricians or family doctors at 9, 18, and 24 to 30 months old, according to AAP guidelines.
Guthrie and her team used the data from the surveys to identify specific markers of developmental deceleration (signs that a child is developing more slowly than average) over the course of these multiple screenings, between 9 and 30 months, and which researchers predicted may have been indicative of autism. “It’s not really kids losing skills, but instead kids are failing to hit those developmental milestones at the same rate that we might expect for other kids their age,” says Guthrie.
The research team compared the participants’ developmental trajectories against autism screenings that had taken place by age 10 to see if those early signs of developmental deceleration were linked to future autism diagnosis.
The data showed that 65 percent of the individuals who would later be diagnosed with autism could have been identified by 30 months old using the developmental deceleration method, whereas a traditional autism screening tool (the Modified Checklist for Autism in Toddlers, which is routinely given to children when they're 18 to 24 months old) detected only 50 percent of the individuals with autism. And used together, the tools detected 75 percent of the children who would later be diagnosed with autism.
“It seems like the combination of our new developmental deceleration method and our existing method works better than either one alone,” Guthrie says.
It’s a concept similar to the growth chart that pediatricians use for height and weight, says Guthrie. “You want to see kids maintain their same percentile over time. When kids ‘fall off’ the growth chart and get further and further behind, that’s a reason for concern. In the same way, when kids have their developmental skills falling further and further behind, that’s a concern for their development, and our data suggests that it might also be a concern for autism,” she explains. “And this evaluation is already happening in primary care.”
A Promising New Tool to Identify Autism Earlier
The work is very impressive, notes Antonio Hardan, MD, the director of the Autism and Developmental Disabilities Clinic at Stanford University Medical Center in Palo Alto, California, who was not involved in the research. “This is a good step forward in trying to develop efficient and effective strategies in identifying kids who are at risk,” he says.
“What’s nice about this research is that it’s not a study where they had to start from scratch with a new tool,” says Dr. Hardan. “They looked at existing data obtained in a natural environment,” Hardan says.
Because the SWYC screening is already performed by pediatricians, this tool could be implemented low cost, adds Hardan. “This would be a very easy strategy to implement,” he says.
Both Hardan and Guthrie agree that the results and strategies used in the study need to be replicated in other healthcare systems. The sample in this study was large, but everyone was from the Children’s Hospital of Philadelphia system, Guthrie says. “I would want to see these results replicated so that we could make sure these results weren’t just specific to our cohort,” Guthrie says.
“The biggest takeaway from our research is that there are many potential indicators of autism risk; we always trying to find earlier and earlier indicators,” says Guthrie. “It’s possible that some kids are showing developmental deceleration even before we can see clear autism symptoms, and so we’re hopeful that this method will help us identify children with autism even earlier,” Guthrie says.
Our goal is to see if we can identify developmental deceleration under the age of 18 months, says Guthrie, which would be earlier than the current AAP guidelines. “We really believe that autism begins to manifest itself before 18 months — the earliest age at which we’re currently screening, but we still have a ways to go until we get there,” she says.
“For parents, it’s important for them to think about their child’s developmental milestones and talk to their pediatrician about the rate that their child is acquiring new milestones,” says Guthrie. It’s important for them to alert their provider if they have concerns that their child is not hitting those markers at the same rate that they used to be, she adds.