Today is part two. Yesterday was part one, which you can find here. This portion discusses the questions: What makes early diagnosis difficult? and Where do we go from here? Here is what author, Nicole Magaldi, has to say in response to these two paramount questions…
written by Nicole Magaldi, Ph.D., CCC/SLP
What Makes Early Diagnosis Difficult?
Taken together, studies examining early development paint a picture of a different course of development for infants who are later diagnosed with autism. This includes difficulty with various social and communicative behaviors that become evident between six and 12 months of age. This is likely puzzling to many who may wonder why a definitive diagnosis of autism isn’t possible in infancy. There are many reasons for this because there are a variety of factors that contribute to the issue.
For starters, a diagnosis of autism is typically made by diagnosticians who see a child on an individual basis outside of controlled research environment. Diagnosing subtle social and communicative differences without the benefit of a comparison group in a controlled research setting is especially challenging in very young children. in addition, since there are no biological methods for diagnosing autism, a diagnosis is typically based on parent report and direct observation of the child. And although there is much evidence to suggest that children with autism behave differently in infancy, identifying those differences can be challenging. One of the reasons for this stems from the fact that most of the behavioral differences exhibited by children with autism in infancy involve negative as opposed to positive symptoms. In other words, they do not involve the presence of abnormal behaviors but rather the lack of demonstration of normal skills. For example, they respond less to their names being called, make less eye contact, and make fewer gestures and vocalizations directed toward others. This makes picking up on these differences in infancy quite challenging.
Another factor that negatively impacts early diagnosis is that of regression, as it is now widely accepted that a portion of children diagnosed with autism demonstrate regression in development occurring in the second year of life. Over the years there have been many family reports of children who displayed skills such as pointing and using single words only to have slowly lost those skills. While at an earlier time many professionals were skeptical of these accounts, there is a growing body of evidence documenting that a significant portion of children diagnosed with autism present with a regressive course of development (Hansen, Ozonoff, Krakowiak, Angkustsiri, Jones, Deprey, Le, Croen, and Hertz-Picciotto, 2008).
Where Do We Go From Here?
The growing body of evidence indicating that autism manifests itself in social and communicative differences in infancy is encouraging for the development of screening and assessment tools that could help with the early identification of autism. With more research into the early indicators of the disorder and the trajectory of development in young children with autism, perhaps in the future a reliable diagnosis will be possible in infancy. For now, however, the identification of early red flags falls to parents and pediatricians who need to be vigilant observers so that children can be assessed over time and can start to receive treatment as early as possible.
I wish I had read this article as a new mom. The second paragraph hits home the most. I was completely unaware of Cali’s differences until other friends and family started to notice and bring their awareness to my attention. I wish I could have been more in tune with Cali’s lack of response to her name, lack of laughter and smiling at others, and only limited eye contact. I wonder if Cali would be that much more developed if I had taken the time to work on these slower developing areas when she was an infant to 18 months??
And the last paragraph…one day I think there will be “screening and assessment tools that could help with the early identification of autism.” What a day that will be! Early intervention given at infancy…not a bad thing at all!!
“Parents and pediatricians…need to be vigilant observers so that children can be assessed over time and can start to receive treatment as early as possible.” Yet again, we see how much falls on the parent to get the child the help they need. Most everything falls on the parents shoulders to move things along, for some even the therapy falls on their shoulders. So, is there really a need to be a vigilant and proactive parent. MOST CERTAINLY. If not the parents then who? Maybe a teacher will help here and there or a grandparent will step in on occasion, but ultimately the move forward is pushed along and made constant by the parent. We are our child’s biggest advocate!
A few more from when Cali was just an infant…