Dr. PAULINE FILIPEK sizes up her tiny patient in her toy-strewn clinic in Orange. As the 22-month-old boy enters the room, he doesn't look at Filipek or anyone else. He plows into a pile of toys on the floor, sometimes walking or crawling over them, but doesn't speak.
He could easily pass as a good-natured child who needs little attention. But Filipek, a neurologist, sees something else, behaviors "that make the hair on the back of my neck stand up." Most toddlers will carry a toy in only one hand -- this child clutched a toy in each fist when entering the room. And children this age typically will scope out a room full of strangers warily, sticking close to Mom or Dad for reassurance.
The scene is familiar to Filipek. At the end of a 90-minute exam she tells the child's parents that their son has autism. Filipek pulls her chair close to the couple, first-time parents in their 30s, and leans toward them before she continues. "The fact that you're here with him, this young, is wonderful."
It is balm intended to soothe the harsh news. And Filipek's encouragement is sincere. She is among a growing number of child development experts who say that autism often can be identified much younger than is typically done today, and that early treatment can alter, sometimes dramatically, the course of the brain disease that affects about one in 500 U.S. children.
Geraldine Dawson, director of the Autism Center at the University of Washington's Center on Human Development and Disability, says doctors now can reliably diagnose autism by age 2 and researchers are developing screening tools to identify kids as young as 18 months. "The long-range goal," she says, "is to be able to detect autism at birth or in very early infancy."
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Cases on the rise
Early recognition is one of the most hopeful developments in the sobering world of autism, a neurological disorder in which people have difficulty communicating and interacting socially with others. Autistic children often speak little, ignore others and display repetitive behavior, such as spinning in circles or focusing on one object for hours. They may excel at something in detail, such as spelling or playing a musical instrument, but become overwhelmed when trying to navigate the world at large. The disorder is also known as "autism spectrum disorder," reflecting the wide range in severity of cases and the various subtypes of autism, such as Asperger's disorder and pervasive developmental disorder.
In California, an estimated one in 322 children has been diagnosed with autism, according to the state Department of Development Services. According to its 2002 report, autism cases increased 273% from 1987 to 1998. Between 600 and 800 children with autism are added to the DDS's service rolls every three months. No one knows what causes autism or why more children are developing it.
Many doctors see the effort to diagnose autism earlier as a significant development that could yield clues to what causes autism and how best to treat it.
But the trend in early diagnosis has also created a backlog of parents who are demanding diagnostic evaluations earlier -- often for babies. Doctors and insurers frequently deny these services for several reasons: Evaluations are costly, there is a lack of trained therapists and some healthcare providers say that autism can't reliably be identified before age 3 or 4.
"It's like there are two camps. You have some doctors -- the few -- who are comfortable diagnosing children at the age of 1," says Rebecca Landa, director of the Center for Autism and Related Disorders at the Kennedy Krieger Institute in Baltimore. "And you have others who feel strongly that you can't diagnose before age 3. They won't even talk about it. Research on early diagnosis is coming off the press as we speak; it's that recent. People are just starting to list what the red flags are in infants and toddlers."
Those lists are beginning to make their way into the hands of parents and pediatricians. Later this month, the national Centers for Disease Control and Prevention will launch a campaign to promote earlier diagnosis of autism. A lack of nonverbal communication could be one of the first signs that a child isn't developing normally, experts say.
At about 8 months, Dawson says, babies should babble and pay attention when their names are called. By 12 to 14 months, they should point, wave, gesture, imitate others and play peekaboo.
"This is the age when the child points at something and looks at the mother to see if she sees it," she says. "They show things to their parents. Even before kids are using formal words, they are using their bodies for pointing and showing. This is important because with a child with autism both the verbal and nonverbal systems are affected."
