Research update: Autism and related disorders

Our awareness and understanding of autism has come a long way since Dr. Leo Kanner first described it in 1943. We now recognize autism as part of a spectrum of related disorders that include classic autism, Asperger Syndrome and Pervasive Development Disorder. Affected children all have challenges related to social interaction, preoccupations and restricted interests. Many also have profound difficulties with language.

No genetic or biological diagnostic test is available for autism: Diagnosis is based on observations of the child's social and communicative behavior. Diagnosing autism can be difficult since there is a great deal of variability in its presentation. While some children may not use eye contact, others may be awkward but persistent in seeking social interaction. Some children may not use spoken language, while others talk "too much." In addition, some children may show repetitive motor movements, while others develop hobbies that are all consuming.

While the current prevalence of autism spectrum disorders is still unknown, estimates range from a rate of one in 250 to one in 1,000 children. These numbers highlight the importance of effective recognition and treatment. Despite the fact that we can now recognize autism symptoms by 12 to 18 months of age, children with autism often are still not diagnosed until they reach 3 or 4 years old. However, this is a vast improvement over even 10 years ago, thanks to advances in early recognition and increased awareness and understanding of the disorder by health professionals, such as pediatricians and early childhood educators.

Why is early recognition of autism important? It's been demonstrated that early intervention effectively increases a child's cognitive and language ability and reduces autism symptoms. Ideally, such intervention involves systematic behavioral teaching and often incorporates speech and language therapy.

Research has shown that certain features are common to effective early intervention programs (see sidebar) and can produce tremendous gains for some children with autism. In fact, a few children show such improvement that they no longer meet the criteria for autism. Research also indicates that the optimal window for beginning early intervention is between 2 and 3 years of age.

Given the effectiveness of early intervention, it is important for researchers and families to work together to improve early recognition of the syndrome. Significant advances in this area were made in the 1990s, when University of Washington researchers collected videotapes of 1st birthday parties from families with children with autism and those with typically developing children. The 1st birthday party served as a standardized setting in which the behaviors of both groups of children could be compared while the videotape viewers were unaware of the child's subsequent diagnosis.

Four behaviors were found to distinguish 1-year-old infants who developed autism from typically developing infants. Those who developed autism engaged less in pointing at objects, showing objects to others, looking at others, and responding when his or her name was called.

Armed with new research findings, leading autism experts have worked to identify best practices for the early screening and diagnosis of autism. Experts have identified red flags for autism (see sidebar) and have also outlined procedures for properly evaluating the disorder.

Today, scientists at the UW and elsewhere are developing screening techniques that can be used at 18 months to recognize toddlers at risk for autism. These include instruments that can be used with all children, are easy to administer, and quick to complete. The screening instruments incorporate red flag items and other early emerging autism symptoms - such as a child's failure to respond to his or her name - to effectively identify at-risk children.

Our understanding of how to identify and intervene in autism has come far in the past 60 years, but there is still more research to be done. It is only through the collaboration between parents, researchers and clinicians that we can move forward in understanding and treating this disorder.

Geraldine Dawson, Ph.D., is the director of the University of Washington Autism Center. Raphael Bernier, M.S., is one of Dr. Dawson's graduate students.

Intervention Models

Features of successful programs for helping children with autism:
  • 1. Comprehensive curriculum that addresses attention, imitation, play, language and social interaction.
  • 2. Sensitivity to normal developmental sequence.
  • 3. Teaching strategies that follow applied behavioral analysis (ABA) principles.
  • 4. Use of behavioral strategies for reducing interfering behaviors.
  • 5. Parent involvement.
  • 6. Gradual and careful movement from highly structured to more naturalistic environments.
  • 7. Intensive intervention, about 25 hours per week for two years.

Red Flags for Autism

Evaluation is recommended if a child fails to meet the any of the following milestones:

  • 1. Babbling by 12 months of age
  • 2. Use of gestures, such as waving bye-bye or pointing, by 12 months
  • 3. Use of single words by 16 months
  • 4. Spontaneous use of two- word phrases by 24 months
  • 5. Loss of any social or language skills at any time

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