Children should be screened for autism during routine checkups beginning in infancy, say new guidelines promoting early treatment of the socially isolating disorder that affects one in 500 youngsters.
Autism is characterized by problems with spoken and unspoken communication as well as withdrawal from the outside world. Although it usually appears within the first three years of life, some of the earliest signs are often dismissed as common developmental delays.
"Most primary-care physicians, not just pediatricians, tend to reassure parents that everything is going to be OK, that they're going to grow out of it, that boys don't talk until later than girls anyway so don't worry about it," said Dr. Pauline A. Filipek, lead author of the guidelines. "It's not OK for a boy not to talk until he's 3."
Under the guidelines, published in the Aug. 22 issue of Neurology, any child with an indication of possible autism should be tested for hearing and developmental problems. If the results continue to suggest autism, the child should have a neurological evaluation by a physician experienced in diagnosing autism.
"The first hallmark is kids who don't point or babble or gesture by age 12 months, or any child who loses any language--who seems to not be responding as well to his or her name as they once did," said Filipek, an associate professor of pediatrics and neurology at UC Irvine.
Other key indicators are an inability to speak single words by 16 months, a lack of two-word phrases by 24 months, or loss of social skills at any age.
If a child misses those milestones, parents should demand an evaluation, Filipek said.
A recent survey showed that among 1,300 families, the autistic child was diagnosed at an average age of 6, even though most parents felt something was amiss by 18 months.
Fewer than 10% of autistic children were diagnosed when their symptoms first appeared, the survey found.
Early diagnosis makes it easier to devise an educational plan for the child, locate support and education for the family and arrange appropriate medical attention. Because autism is 50 to 100 times more frequent in close relatives, it's important to screen siblings.
Liz Anderson, a Fort Wayne, Ind., mother of two autistic sons, says doctors in California, where her family used to live, missed the diagnosis in both boys, now 5 and 4.
