Questionnaire May Help Predict Autism at 1 Year
By Amanda Gardner
THURSDAY, April 28, 2011 (Health.com) — A quick and simple questionnaire given to parents during a regular checkup in a pediatrician's office may help detect autism in children as young as 1 year old, a new study suggests.
The 24-item questionnaire, which assesses a child's ability to communicate with eye contact, sounds, and gestures, may steer infants who show early signs of autism spectrum disorders (ASDs) into appropriate treatment at earlier ages, the researchers say.
Identifying language and developmental delays in babies may also help scientists uncover the underlying neurological processes of autism, paving the way for more effective treatments, says Karen Pierce, Ph.D., the lead author of the study.
"Most of the studies on autism are on adolescents and adults," says Pierce, an assistant professor of neuroscience at the University of California San Diego (UCSD), in La Jolla. "Some [are] on children, but very few people have the ability to study autism in babies, because we can't diagnose it until 3 or 4 years. How in the world are we going to discover the causes if we're studying brains that have had a lifetime of living with autism, and [have] a host of compensatory mechanisms?"
The average age of ASD diagnosis is around 5 years old, though most of those children show signs of developmental problems before age 3, according to the Centers for Disease Control and Prevention. There are no biomarkers to indicate that a child has autism, so clinicians have to rely on behavioral clues, making diagnosis tricky. And even when a child is accurately diagnosed early, he or she often doesn't start treatment until some time after the diagnosis.
The questionnaire used in the study is a simple checklist that asks parents to say whether their baby displays certain types of communication "often," "sometimes," or "not yet." It takes just five minutes to fill out and can be scored on the spot.
The checklist does not zero in specifically on autism but "will tell you something is wrong," Pierce says. That could be the early signs of autism or another type of language or developmental delay.
Next page: More than 10,000 children screened
In the study, which appears in the Journal of Pediatrics, 137 pediatricians in the San Diego area screened more than 10,000 children who were undergoing their one-year checkup. Of those, 184 were determined to be below the appropriate levels of development for their age, and were referred to UCSD's Autism Center of Excellence for further evaluation.
Doctors examined them every six months until they were 3 years old. So far, 32 children have been definitely or provisionally diagnosed with an autism spectrum disorder, 56 with a learning disorder, and nine with another disorder.
Based on these findings, the researchers estimate that 20% of children flagged by the checklist at 12 months will go on to develop autism and 55% will develop a learning or developmental disorder. Twenty-five percent will get a false-positive result, they say, giving the questionnaire a high accuracy rate of 75%.
Five children in this study sample who were initially diagnosed with ASD were later determined not to have an autism disorder. And, as hoped, the children who were assigned a diagnosis of autism or a learning or developmental delay started treatment at an average age of 19 months.
In theory, earlier treatment might influence how connections between neurons are being made in the brain, greatly influencing a child's emotional and social development, Pierce says.
But that remains an open question, says Keith A. Young, PhD, vice chairman for research in the department of psychiatry and behavioral science at the Texas A&M Health Science Center College of Medicine, in Temple.
"At this point in time, there are no validated treatments at that young of an age," Young says. "There are various treatments that have been tested in older kids, but do they work in younger kids? How do we need to adapt them? All of that stuff needs to be done before we go out and say, 'OK, there needs to be screening.'"