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Even Experts May Miss Signs of Autism

By Carol Church, Writer, Family Album
Reviewed by Heidi Radunovich, PhD, Department of Family, Youth, and Community Sciences, University of Florida

It’s been in the news a lot in recent years: the rise in the number of American children being diagnosed with Autism Spectrum Disorder, or ASD, a developmental disability affecting social skills, behavior, and communication. As of 2014, the CDC reports that 1 in 68 US children has been diagnosed with an ASD. Boys are about four times more likely than girls to have ASD.

Early Diagnosis and Treatment are Key

One thing we know about ASDs is that early diagnosis and intensive early intervention can make a big difference in outcome. Experts believe that children as young as 18-24 months, perhaps even younger, can be reliably diagnosed.

But can parents rely on their pediatricians to “catch” signs of Autism Spectrum Disorder? In a recent study in the journal Pediatrics, researchers had two psychologists, both experts in ASD diagnosis, watch 20 minutes of video of 42 toddlers between the ages of 15 and 33 months. The experts were asked to observe the children for typical and atypical behaviors when it came to things like responding to their names, playing, vocalizing, and social interactions. Then, after viewing the full 20 minutes, they were asked whether they would refer each child for an autism evaluation, relying on what they’d seen.

Can Signs be Spotted During a Brief Encounter?

In reality, a third of of these children had already been diagnosed with autism spectrum disorder, based on exhaustive screening, parent history, and lengthy observation. Another third had been diagnosed with suspected language delays, and the last third had been screened and deemed typically developing. However, the experts watching the videos didn’t know any of this.

And here’s what happened: half of the children who had already been diagnosed with autism were deemed not to need evaluation for ASD by one or both experts. This probably happened in part because the videos were short. But it was also true that even those children with an ASD diagnosis appeared typical much of the time. In fact, according to the analysis, the children with ASD behaved atypically only 11% of the time (vs. 2% of the time for children without ASD).

Parental Awareness is Important

These findings suggest that it’s very possible for even an expert in ASD to miss symptoms in young children during a brief office visit. With this in mind, parents who have concerns about symptoms of ASD in their toddlers and children shouldn’t rely on doctors’ general impressions, but should seek out more specialized screenings and more complete diagnostic work-ups. Parents should also keep in mind that their own deeper knowledge of their child is really important, and speak up about any possible issues.

Every parent of a young child should be familiar with some red flags that could indicate ASD. The American Academy of Pediatrics also recommend that all children undergo specific screenings for ASD at 18 and 24 months. For more on what to look for, visit Further Reading.

(Photo credit: You’ve got a strong heart! by Hubert KCC BY-NC-SA 2.0. Cropped.)

Further Reading

Learn the Signs, Act Early

ASD: Signs and Symptoms

Learn the Signs of Autism

Early Signs of Autism

References:

CDC. (2014a). ASD: Data and statistics. Retrieved from http://www.cdc.gov/ncbddd/autism/data.html

CDC. (2014b). ASD: Treatment. Retrieved from http://www.cdc.gov/ncbddd/autism/treatment.html

Earls, M., & Curry, E. The AAP autism screening guidelines. Retrieved from http://www.aap.org/en-us/professional-resources/practice-support/quality-improvement/Quality-Improvement-Innovation-Networks/Documents/Autism_PreSIP.pdf

Gabrielsen, T., et al. (2015). Identifying autism in a brief observation. Pediatrics, 135(2), e330-e338. http://dx.doi.org/10.1542/peds.2014-1428

Glicksman, E. (2012). Catching autism earlier. Retrieved from http://www.apa.org/monitor/2012/10/autism.aspx