The average age of diagnosis of autism is four years. According to Martin Stein, M.D., professor of pediatrics at the University of California, San Diego, that's about two years too late. He believes that early intensive behavioral therapy can make a significant difference in the child's behavior.
One study found that 15% of children in special education programs have undiagnosed autism. Early screening can find these children and allow them to receive the therapy they need.
He suggests that doctors include a simple, five question checklist as part of the routine 18 month exam. The checklist, called Checklist for Autism in Toddlers (CHAT) consists of:
1. Note whether the child has made any sustained eye contact. A normal 18 month old should.
2. Get the child's attention; then point out an interesting object in the room and bring it to the child's attention. A child without autism should look to where the physician is pointing.
3. Ask the child to point to something in the room, such as the light, saying, "Show me the light," or "Where's the light?" Absence of pointing behavior at 18 months is a cardinal sign of either autism or a pervasive developmental disorder.
4. Show the child a doll and a cup and ask, "Can you give the baby some juice?" An autistic child will have difficulty engaging in such pretend play.
5. Ask the child to build a tower of two or three blocks. The purpose of this task is to gauge the child's ability to interact, rather than his/her motor skills.
Children who fail items two, three, and four are at particular risk for autism and need further evaluation.
Dr. Stein suggests the following nine questions for parents to ask about their 18 month olds:
1. Does your child enjoy being swung or bounced on your knee?
2. Does your child take interest in other children?
3. Does your child like climbing things?
4. Does your child play peekaboo?
5. Does your child ever pretend?
6. Does your child ever use his/her index finger to point to ask for something?
7. Does your child ever use his/her index finger to point to indicate interest in something?
8. Can your child play appropriately with small toys without just mouthing, fiddling, or dropping them?
9. Does your child ever bring objects to you to show you something?
The more "no" answers to these questions, the greater the chance of autism. Of particular importance are questions five and seven.
Autism can and should be diagnosed by two years of age. The earlier the diagnosis is made, the sooner behavioral therapy can be started, and the better the child's chances of achieving maximal improvement.
Family Practice News, 6/1/03
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