Earlier autism prognosis related to larger trait enchancment | Spectrum
Timely Tests: An earlier diagnosis of autism improves social communication outcomes, but not restricted and repetitive behaviors.
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According to a new study, children diagnosed with autism before the age of two and a half show, on average, greater gains in their social skills than children diagnosed later.
Early diagnosis is generally considered important because it enables early treatment of children. However, there’s little evidence that treating autistic children early will benefit children, says lead researcher Ilan Dinstein, associate professor of cognitive and brain sciences at Ben-Gurion University of the Negev in Beersheba, Israel.
Autistic children who are intervened early in a clinical trial often show promising results, but those who are treated in community facilities usually don’t have as many benefits as previous studies show.
This loophole raised a burning question for Dinstein and his colleagues: “Is there any reason to hurry and diagnose early in situations where the intervention is messy, heterogeneous and not carried out by world-renowned experts?” He says.
According to the results published by Dinstein and his colleagues in Autism in October, the answer seems to be yes.
“I hope these and related findings continue to put pressure on advisory boards that provide guidance, as well as insurers to urge that children be screened for autism earlier in life and that healthcare professionals act quickly if positive screening is found “Says David Mandell, a professor of psychiatry at the University of Pennsylvania in Philadelphia who was not involved in the study. Mandell is the outgoing editor-in-chief of Autism but did not publish this particular study.
Promotion of social communication:
Dinstein and his team collected data from 131 children diagnosed with autism at a clinic in Israel; 57 were diagnosed before they were two and a half years old, and 74 were diagnosed after – with a mean age of 3.1 years. At the time of diagnosis and a year or two later, clinicians ran the Autism Diagnostic Observation Schedule (ADOS) to measure autism characteristics and asked parents how many hours per week their children received any type of intervention.
About 65 percent of the children diagnosed early showed a significant improvement in the ADOS social affect domain in the 1 to 2 years after their diagnosis. In contrast, about 23 percent of later diagnosed children showed significant improvement over the same period.
The earlier diagnosed children who showed improvements in the area of the social affects of ADOS also showed greater improvements in this measurement than the later diagnosed children. The two groups in the study received a similar number of hours of interventions, and the type of intervention did not significantly affect the results.
The children diagnosed earlier tended to have higher social affect scores and less severe restricted and repetitive behaviors (RRB) at diagnosis than the later diagnosed group. However, none of the groups showed a statistically significant change in RRBs over time. The result suggests that early interventions that disproportionately focus on social communication should also focus on RRBs, says Dinstein.
A comparison of early and late diagnosed children who had started with comparable ADOS values again showed that about three times as many children diagnosed early showed significant improvements in ADOS than children diagnosed late – which confirms that the results do not only reflect differences the severity of the characteristics at the time of diagnosis.
“I think this is the first time that a direct comparison has been made between those diagnosed two and a half years ago and those diagnosed later,” says Dinstein. “The difference in the outcome of social communication is immense. I didn’t think it would be that big. “
Results may vary:
Dinstein and his team chose two and a half years as the cut-off because “most autism screening tools are designed to detect autism between the ages of one and a half and two and a half years,” he says.
This cutoff also captures a unique window of time in child-clinician relationships, says Pamela DeGuzman, an adjunct professor of nursing at the University of Virginia at Charlottesville who was not involved in the study. After about 18 months, but before 4 years when a baby’s vaccinations are completed, parents tend to be less urgent in bringing their child to the doctor. “They know vaccinations are one thing, but they’re not that set up to test for developmental delays.”
But these routine doctor visits are crucial opportunities for healthcare providers to emphasize the importance of early autism screening, she says. “We now have even more evidence that it is really important to have children screened during their visits to good children.”
The results also underscore the importance of child referrals for early intervention, says Mandell. “We often put emphasis on screening and diagnosis, and we don’t necessarily put as much emphasis on making sure these children get adequate care quickly as if there was something magical about an earlier diagnosis.”
The current study only focused on key autism traits, not cognitive outcomes or adaptive behavior. Dinstein and his group follow a different group of participants to assess the extent to which age at diagnosis and type and intensity of intervention influence these factors.
Cite this article: https://doi.org/10.53053/FYGC3433
