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Exciting Times in Early Diagnosis and Treatment

Posted by Brooke Ingersoll, PhD, clinical psychologist, Michigan State University, East Lansing, and the recipient of an Autism Speaks 2011 Treatment Research Grant

We now diagnose autism spectrum disorders (ASDs) between the ages of 2 and 3 years, when symptoms become obvious. But over the last five years, we’ve been actively studying how to identify ASD symptoms in younger children, with the hope that earlier intervention can produce greater improvements in outcomes.

I was recently invited to write a review of these research efforts for the scientific journal Current Directions in Psychological Science. I’m excited to relate these findings to our families and friends as well:

In essence, the evidence is strong that many children who go on to a clear diagnosis of autism are already showing fewer early social and nonverbal communication skills at 12 months than do typically developing babies. These “missing” behaviors including imitating, showing objects to others and pointing to objects or events in the room.

My review of the research also showed clear evidence that targeted therapies can improve these early skills in young children with ASD —and might also produce improvements in other, later-emerging skills such as language and more mature social interactions. Despite these advances, much remains unknown about the early presentation of ASDs and the best way to intervene to improve these children’s outcomes.

While it is wonderful to see that we can identify and help very young children, I feel strongly that we must also increase research and improve therapies for older children with ASD. My current work, recently funded by an Autism Speaks treatment research grant, is evaluating the benefits of an intervention called reciprocal imitation training, designed to increase social engagement in adolescents with ASD and limited language.

With this intervention, we encourage non-verbal social behaviors such as imitation, gestures and eye contact. The intervention is adapted from social communication therapies that have shown success with young children with ASD who have not yet learned language. The early results have been encouraging, and we are very excited to continue this work in an effort to identify appropriate social interventions for older, nonverbal individuals with ASD.

Read more news and perspective on the Autism Speaks Science page.

  1. Sarah
    November 15, 2011 at 8:32 am

    :)

  2. November 15, 2011 at 9:09 am

    My youngest son was diagnosed three years ago with Autism/ADHD and a friend introduced me to a natural product made primarily from milk.
    I used this product and saw results in two months. Today my son shows no signs of Autism/Adhd, he is doing great in school and takes the initiative to do everything, truly a turnaround from the way he used to be. After the production of this milk it is the closest to mother’s milk and it is recognized by many Doctors today, if anyone is interested in finding out more about this, please email me at asha.persaud@gmail.com. Thank you.

  3. Katie Wright
    November 15, 2011 at 9:35 am

    Very nice work here Brooke.
    However, remember that AS has recently discovered at least 50% of ASD causation is derived from environmental factors.

    While undertaking a vigorous and comprehensive early intervention program parents must be advised to pay close attention to factors negatively impacting a child’s health and cognitive progress. For example, although my son was in therapy w/in months of his dx he barely progressed because of chronic, yet undiagnosed illnesses/ infections. Despite wonderful therapists Christian only regressed further due to food allergies I was urged to ignore and a dietary intervention I was advised against.

    Remember early dx is only the beginning and that social interactions are greatly influenced by environmental factors.

  4. November 16, 2011 at 10:13 am

    I saw a story on my local news about a little girl who was born with much of her brain damaged. The doctors said she would never progress past infancy. The mother refused to give up on her child. At the time of her birth the parents saved the childs cord blood. Sometime later they took the child to a hospital away from their home state and a doctor infused the little girl with her cord blood. That child today is practically “normal”. Her head is misshapen because of swelling at birth, but you would not otherwise know that she was born in such dire straits. I was wondering if cord blood could offer any hope in Autism. The doctor treating this child said infusing the cord blood completely rewired the little girls brain. Could the same thing happen in autistic children. Unfortunately I didn’t save my sons cord blood, but maybe this could offer hope to other parents.

  5. Sarah
    November 16, 2011 at 12:50 pm

    I’m all for early intervention BUT a critical piece of the treament puzzle is medical interventions to address among other things GI and brain inflammation, disruption in mitochondrial energy pathways and immune deficieny. Unless doctors identify and address the underlying medical issues associated with autism, progress with our children will be slow. Medical intervention can make a huge difference in how our children function. The approach to autism treament must be comprehensive cobining behavioral therapeutic intervention with medical interventions.

    • November 16, 2011 at 4:40 pm

      Totally agree! And I left that out of my comment. His doctor’s willingness to acknowledge his need for these things also greatly helped in this fight.

  6. Jackie
    November 16, 2011 at 3:48 pm

    The earlier diagnosis, the better I know. But without the availability and access to the therapies to then help the child, it doesn’t help much. I wonder how much better my son would be if we had had the ability/insurance to get him the therapies he needed to succeed. Now he’s older, so new interventions would be great, but we still have no way to access any new therapies. Still, the more people doing research on this, the better. Maybe more insurances and more states and more doctors will hop on board. Can you believe I still run into doctors who think this is all hokey?

  7. gabriela
    November 16, 2011 at 4:14 pm

    I always wonder why so many grants and funding from different organizations. It seems that not even in the autism community there is an agreement in what seems very obvious, treat/research the cause and maybe therapy as early or as aggressive wouldn’t be necessary, I don’t want to diminish the work of this Ms. Ingersoll but it bothers me that the use of those dollars are on the wrong side of the equation. In that light I have to agree with other parents of ASD kids that there is a conspiracy theory and this condition is caused by environmental exposure (vaccine injured kids) financed by the drug manufacturing companies, by the way, who funded this research??

  8. November 16, 2011 at 4:20 pm

    I think it is absolutely POSSIBLE to spot it early early. I think more needs to be researched and brought to mainstream media about signs before the age of 18 months. I began sucpecting around the time my son was 7 months old, fairly certain by 9 months old. and when he got to 13 months old, TO ME, there was no denying it. We started EI before he was 2. World of difference in our case. He seemed to be more on the severe end of the spectrum when he was 13 months old. We started EI at 15 months old. He got his DX at 33 months old. He is now turning 4 next month and is on the mild end of the spectrum. I am forever grateful for EI.

    • Nancy
      November 18, 2011 at 1:02 pm

      My grandson/adopted son is now almost 4 1/2 years and we don’t have a diagnosis. He has been in early intervention and pre-k 3 and 4 through school. We have an educational diagnosis. Is that enough? I hear so many people who get diagnosis but don’t know who to use. Suggestions?

      • Donna
        November 19, 2011 at 7:30 am

        Your grandson’s pediatrician could give a referral to see a pediatric neurologist. They can make a diagnosis. That is a good place to start. Good luck and take care.

      • Donna
        November 19, 2011 at 7:52 am

        Also, having a diagnosis opened the door for us to get all kinds of services. We were able to talk to insurance about covering Speech, OT and ABA services – these are additional services you can get outside of school.

  9. November 16, 2011 at 4:23 pm

    At 18 months, our daughter had no speech, no pointing, no play skills, and was a bundle of misery we couldn’t get through to.

    After a year and half of pretty intense therapy (1.5 hrs/wk OT, 1.5 hrs/wk Speech, 10 hrs/wk Special Instruction), daily Zantac, and milk elimination, she is turning 3 this week talking, playing, and CONNECTED with us.

    Without early identification and both the developmental and medical intervention, she would have only slipped further from us and who knows if she would have ever come back.

  10. November 16, 2011 at 4:38 pm

    My son was diagnosed with Autism Spectrum Disorder when he was 2. Even before the “official diagnosis” I knew something wasn’t right. We couldn’t talk, he couldn’t walk, no interest in other kids or people, etc, etc. I started him in speech therapy(there was no charge for this)through an awesome place called Bona Vista and started him in preschool there to expose him to other children. They were actually the ones that got the ball rolling. In the small town in IN where I lived, the school system “takes over” at age three. I was nervous about having a special needs child in such a small school system, but OMG! They jumped right in with speech, occupational and physical therapies. His teachers, starting at kindergarten were total God-sends. He is now 12 years old, still on an IEP as he also has hearing disabilities, but he nno longer exhibits enough autistic characteristics to qualify for services. He is totally mainstreamed and is on the honor roll every semester. He loves other kids and is quite the “social butterfly”. He does require a lot of attention to help him “stay on track” and is going to counseling to deal with some “irrational fears”. I have often credited his teachers to their faces for his tremendous progress and I must do it again here. I am sure that without their love and dedication, my son would not be where he is today. His kindergarten teacher(who also has a special needs child) told me I would be fighting for his rights and being his advocate the rest of my life. She is so right. But it is totally worth it! I have to encourage all of you to hang in there. Concentrate on each individual need and fight til somebody is willing to give it to you. Blessings to you all.

  11. Diane
    November 16, 2011 at 5:36 pm

    We noticed differences in our daughter at just after 12 months, sought some help and began eval/intervention with Birth to Three at 14 months for social/communication delays (no words at all, no imitating, no gesturing, very little human engagement, etc.), got a “provisional” (because of her age) diagnosis of ASD after an intensive evaluation at a university-based child study center at 16 months. At which point we were able to switch her to an autism-specific Birth to Three program, with greatly increased hours of service (20 h/wk). At nearly 3 she’s doing amazingly well, people who don’t know her diagnosis can’t tell that she has it. But we’re very aware that her progress has come with intensive support, and we’re very hopeful that the school system she transitions into very soon will recognize and continue to provide appropriate support (looks good so far, fingers crossed). I would love to know if there are any longitudinal studies underway or planned of children who get diagnosed and treated prior to age 2 –it seems like this is a very recent development with the potential for profound lifelong impact on the prognosis and outcomes.

  12. Terra Marroquin
    November 17, 2011 at 9:02 am

    I support researchers creating tools for earlier detection. Insurance won’t typically pay for treatment for kids with ASD until there is a formal diagnoses in place. My son was evaluated three times until someone got it right. The key in his diagnoses was the psychologist evaluating him using an assessment tool specific for Autism. If there is a question of ASD, it seems that professionals conducting developmental evaluations should administer these tools. My son is now getting treatment at age 6 instead of since the early months of life. I have known there was a problem since birth. I was able to get a little treatment on my own, but it was very expensive. Now with a diagnoses, insurance is helping and he is making much faster improvement.

  13. November 18, 2011 at 9:25 pm

    It’s great to hear that so much is being done now for kids with ASD, and it’s especially great to hear that my alma mater is involved in these efforts. I can recall when I was growing up, when three different mental health professionals found three different ways to blame my Mom for my difficulties. Those days are long past. I say, keep up the good work!

  14. La Donna HArdin
    November 19, 2011 at 10:26 pm

    I am witness to the early intervention process and how much differance it can make. My son will be 3 this December and was diagnosed with autism this past June througth a program called CARDS. He started getting speech therapy about age 18 monthes when he was not yet speaking. It was an early intervention program for “delayed” children in Indiana were I live. Since the diagnosis we have added occupational and developmental therapy all free to us, througth the first steps program. We also enrolled him 2 half days a week in a very small preschool to help with his social skills. I am very happy to say he now says around 100 words and is communicating and is doing GREAT!! He does still struggle with flapping, toe walking, and some fine motor skills but we have nothin but faith!! My advise, if you think it….. get a good doctor!!! Bring it up, don’t wait!!!!

  15. November 21, 2011 at 2:13 pm

    Looking back there were signs as early as 4 months old, but I didn’t know they were red flags for autism, couldn’t get the diagnosis until 3 years and 3 months, but I knew it was autism when he was 18 months, dr didn’t agree. My son is 9 and a half now and still very much autistic, but his behavior is good and he learns well. He is mostly non-verbal, but he isn’t letting that hold him back, he is using a Vantage Lite communication device with much success. The one intervention that made the most difference for him was the gluten free, casein free, soy free diet along with eliminating food dyes, MSG and artificial junk from his diet. He was healthy and happy after eliminating those things from his diet, which allowed him to benefit from his therapy. He has been on this diet for almost 8 years now and every time I second guess myself he accidentally gets some forbidden food and shows us he still needs this diet. This last time he got the wrong food, his face swelled up and he had hives all over his body and was saying pain, throat, so off to the ER. No more, now if only these cutting edge therapies were actually available to regular families.

  16. Paul Campeau
    December 8, 2011 at 5:17 pm

    My grandson is showing signs of autism and my son has inquired about having him tested but was told it could take up to 17 months before they can fit him in. It this delay not going to be harmful to him because of the delayed treatment? Are there any testing clinics in the Ottawa area that may have a shorter waiting time?

  1. November 16, 2011 at 5:05 pm

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