Magazine article Clinical Psychiatry News

Universal Autism Screening for Children by Age 2 Is 'Practical Goal,' Expert Says. (Diagnosis by Age 4 Deemed Too Late)

Magazine article Clinical Psychiatry News

Universal Autism Screening for Children by Age 2 Is 'Practical Goal,' Expert Says. (Diagnosis by Age 4 Deemed Too Late)

Article excerpt

KOHALA, HAWAII -- Every toddler should be screened for autism, because early behavioral therapy can make a difference, Dr. Martin Stein said at a meeting sponsored by the American Academy of Pediatrics.

He believes that physicians should consider incorporating such screening into a child's 18-month exam.

"Screening for autism is a practical goal," said Dr. Stein, who is a professor of pediatrics at the University of California, San Diego. "Watchful waiting is not appropriate for these children," he added.

The average age at which children are diagnosed with autism is 4 years. That is about 2 years too late, Dr. Stein said at the meeting, which was also sponsored by the AAP's California District IX, Chapter 2, and the University Children's Medical Group.

Intensive behavioral management, which has a demonstrable effect in at least 75% of autistic children, needs to be started at about age 2 years.

Also, there is evidence that there are many children with autism who are missed completely.

One study found that 15% of children in special education programs who had not been diagnosed with autism actually met the criteria.

Screening can be incorporated fairly easily into the child's 18-month visit through use of the Checklist for Autism in Toddlers (CHAT).

This is made up of a simple five-item checklist for the physician, as well as a nine-item questionnaire for the parent, Dr. Stein said.

"Once you have encoded this in your brain, it will be like asking about running and climbing and self-feeding at 18 months," Dr. Stein said.

During the appointment, the physician should:

1. Note whether the child has made any sustained eye contact. A normal 18-month old should.

2. Get the child's attention; then point out an interesting object in the room and bring it to the child's attention. A child without autism should look to where the physician is pointing. …

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