Subtle warning signs of autism may warrant referral to developmental specialist before age 18 months

Oct 29 2013

How early can you diagnose autism? The American Academy of Pediatrics (AAP) recommends screening children beginning at 18 months, but research suggests subtle warning signs may be apparent even earlier, according to Patricia Manning-Courtney, MD, FAAP, who delivered a plenary address at 11:10 a.m. ET Tuesday, Oct. 29, at the American Academy of Pediatrics (AAP) National Conference and Exhibition in Orlando.

In her presentation, "Early Screening and Diagnosis in Autism Spectrum Disorders: How Low Can we Go," Dr. Manning-Courtney described studies of siblings of children with autism that helped detect very subtle behaviors that may surface before age 18 months. The earlier a child is diagnosed with an autism spectrum disorder, the earlier critical behavioral and learning interventions can begin.

At age six months, it is very difficult to distinguish kids with autism and kids without autism, said Dr. Manning-Courtney, who is the director of the Kelly O'Leary Center for Autism Spectrum Disorders at Cincinnati Children's Hospital Medical Center. From age 12 to 18 months, there may be extremely subtle differences- too subtle and infrequent to incorporate into diagnostic criteria-in eye contact, visual tracking behavior and play. These children may have more limited and repetitive play, less name response and social smiling, babbling and gesture use.

Pediatricians are sensitive to how overburdened the resources are for children with autism, Dr. Manning-Courntey said, and do not want to further strain the system with an incorrect referral to a specialist. But children at high risk for autism, including siblings of children with autism, should have a lower threshold for concerning behaviors.

"If you have some of these bigger concerns you can and should refer these children," Dr. Manning-Courtney said. A referral can be made to a developmental pediatrician or a multi-disciplinary diagnostic team that may include a neurologist, psychologist, or other health care professionals with expertise in diagnosing autism.

"I hope pediatricians leave with an understanding that they may be able to pick up on things in very young children, even further than that appearing on an MCHAT (Modified Checklist for Autism in Toddlers) or other screening tools," said Dr. Manning-Courtney.

Source: American Academy of Pediatrics