The American Academy of Pediatrics (AAP) recommends that all children be screened for autism twice – at 18 months and again at 24 months. According to Anthony Malone, MD of Developmental Pediatrics in Latham, the 23-question screening test called the M-CHAT has a large gray area, which can lead to both over- and under-identification. If a parent’s answers indicate that their child demonstrates some autistic behaviors, then the doctors ask the parent follow-up questions to determine if their child should be referred to a diagnostician.
“We’re looking at a large population of children of different ages and we want to find the ones that might show some inkling they may be on the spectrum for autism,” says Malone. “We’d like it to be so we don’t miss anybody; we’d also like it to be so we don’t over identify children who really don’t have a problem."
Just like each child is different, the path to an autism diagnosis varies from child to child too. Although Malone’s practice sees children as young as nine months, he said that diagnosing autism in older children is easier because as a child develops, certain behaviors might become more prominent. “In general, the more serious the problem is with autism, the easier it is for the clinician to make the diagnosis because things are so obvious,” he says. “It is more difficult when symptoms are quite mild.”
Malone still advises parents to go with their gut instincts, noting that if parents are concerned about their child and his or her behaviors, there is almost always a problem. Kristi Wilson knew her autistic son Jake needed services so she reviewed the list of certified EIP (Early Intervention Program) groups in the area and interviewed each of the team leaders. “We wanted to find someone who was good for Jake,” says Kristi, “You don’t go to a college without looking at it. I feel the same way about programs for our kids.” By the time Jake received his official diagnosis from a neurologist, he had speech, occupational and behavior therapy services in place.
Rita Wood, director of EIP for Ulster County, says that in the 12 years she has worked for the program, she has seen an increase in the number of children being evaluated for services. She also says that she has definitely seen the benefit of special needs children receiving early intervention services even before 18 months.
According to Malone, there is reliable data about the effectiveness of services for children 18 months old and up, but much less so for children 15 months and under. “The assumption is that it would probably be as helpful as it is in older children, but it is an assumption. It is fairly tricky because personally I think really if there is a significant concern, I’d like to start services early, but it is not as easy to identify, and it takes a fair amount of skill,” he says.
Wood notes that one of the positive aspects of receiving services early is that specialists can work with the family as well as the child. This is especially important for children who are diagnosed with Pervasive Developmental Disorder (PDD), which means the child is autistic but doesn’t meet the criteria for high-functioning autism. Parents learn coping strategies and techniques to work on with their child, and Wood finds that as these children age and become preschoolers, they tend to not need as many services.
Mom to her two daughters, Jennifer E. O’Brien taught English for seven years at Kingston High School. She currently works as a freelance writer and editor.