Saturday, March 26, 2005

Early signs of Autism Spectrum Disorder.

Like many new mothers, Tina Fougere kept a diary after her twins were born. With great joy, she traced their tiny feet. She diagramed their sprouting teeth. And she diligently chronicled first steps, first words and first birthdays.
What Fougere didn't know at the time was that her son, Nathan, was autistic. The personal journals, which detailed everything from sleep patterns to facial expressions in the two children, have become illuminating scientific documents that show autism can be seen in children as young as 6 months.
Autism, a devastating and confounding neurological disorder, is rarely diagnosed before age 2 and often not until age 3 or 4. The findings generated from the diaries, which were published in last month's scientific journal Neurocase, offered an unprecedented glimpse at the early warning signs.
The information can be crucial to early intervention. But these red flags also give parents even more to worry about if a child isn't developing precisely on schedule. Boys and girls are notorious for reaching milestones at different times.
Now, in addition to tracking a child's height and weight, the U.S. Centers for Disease Control and Prevention want parents to note when their child smiles, how often, when the child starts to speak, when he learns to play and how he interacts with others.
Specific therapies haven't yet been designed for children who show autistic-like symptoms under a year of age. And there is growing concern that pediatricians aren't adequately trained to diagnose children with neurodevelopmental disorders in the first place.
"It's a new area, and we're still asking the question: Are the signs reliable enough to predict?" said Mel Rutherford, an assistant professor of psychology at Ontario's McMaster University, who studied the Hamilton, Ontario, mother's journals. "The danger is not whether we (diagnose) too early. The danger is not being accurate."
The number of children who have a condition in the autism spectrum is staggering. In the 1980s it was thought that 1 in 2,500 had one. It's now 1 in 166, according to recent CDC estimates. Yet no one can explain why.
Instead, the effort is focused on early diagnosis. Last month, the CDC launched its "Learn the Signs. Act Early" campaign ( to teach parents the signs of normal development.
By 15 to 18 months, for example, a child should be able to say several single words, according to the guidelines. But what parents should know is that autistic children have delays in all forms of communication, verbal and non-verbal. A lack of words at 15 to 18 months isn't necessarily cause for concern as long as he can point and grunt to show parents what he wants.
"If a whole suite of skills is not coming or is late, then you should start to wonder what is going on," Rutherford said.
In Fougere's case, the twins appeared to develop normally for the first six months. Both smiled, were vocally responsive and showed a preference for family members over other people, Rutherford said. Nathan even crawled and walked before his sister.
By age 1, however, Nathan showed less eye contact, less verbal communication and less affection toward others than his sister. In hindsight, a telling moment for Fougere was when Nathan seemed uninterested in his own 1st birthday party.
Still, warning signs are rarely obvious. Betsy Marks' 3-year-old son, Jonah, developed normally for the first year and began speaking. At 13 months the eight words he knew vanished from his vocabulary. But the changes were subtle. "We thought he wasn't talking and he was fussier because he broke his leg (about that time)," said Marks of Highland Park, Ill. "It happened really slowly. Even though it was my fourth child, there was never one minute where I said, `You know what, he's lost every single word!'"
In addition, her oldest child, who does not have autism, didn't start speaking until he was 2. "The thing about autism is no one kid fits a particular profile," Marks said. "Jonah had fantastic eye contact and loved his brothers and sisters. Our regular pediatrician told us his eye contact was too good for autism. But that's just one component."
Marks found pediatrician Alan Rosenblatt, a specialist in neurodevelopmental pediatrics. Since then, over the last year, she said her son has made extraordinary gains. "He's on track to be indistinguishable from his peers by kindergarten," Marks said, her voice full of hope.