Diagnosis by 18 Months
Researchers are “confident” that it will become “routine to diagnose autism for children just 18 months old and sometimes even younger” after a five-year study to be conducted by researchers at the University of Michigan, the University of California-Davis and the University of Washington. A total of 108 children between the ages of 12-24 months who have “symptoms of autism” will be enrolled in the study, the University of Michigan notes. The researchers in the study include Catherine Lord, University of Michigan professor of psychology, psychiatry and pediatrics, and director of the U-M Autism and Communication Disorders Center, and UC Davis M.I.N.D. Institute researcher Sally J. Rogers and University of Washington Autism Center researchers:
Lord is confident U-M research will make it routine to diagnose autism for children just 18 months old and sometimes even younger.
The intervention to be tested—the Early Start Denver Model—fuses developmental and relationship-based intervention techniques with applied behavior analysis teaching strategies. It focuses on using play and positive reciprocal interactions to teach a developmental curriculum designed for each child based on current abilities and interests. The individualized approach makes the model easy to adapt for younger children.
A combination of the developmental curriculum, teaching techniques based on applied behavior analysis, and warm, engaging social exchanges between an adult and the child is used to achieve measurable treatment goals targeting affective connection, social relatedness and communication skills.
As the parent of a 10 1/2 year old son with autism who was diagnosed when he had just turned two years old in July of 1999—and who had been showing symptoms of autism by the time he was 18 months and subtle gross and fine motor delays throughout his babyhood—-what is most noteworthy about this new study is how familiar the “Early Start Denver Model” sounds to me. The combination of intensive ABA and play, “positive reciprocal interactions” with “warm, engaging social exchanges between an adult and the child” is pretty much what Charlie did when he started an intensive ABA program in September of 1999; it’s a combination that Charlie seems to like and to learn best from: Not that every child will, or that every child will continue to do this combination of therapies in a 1:1 setting as Charlie has. Charlie did not simply “benefit” from Early Intervention; he needed it and we needed it to learn, at that early time in his life how to help him.
That said, in any discussion of Early Intervention, and about the need to “hurry, hurry, hurry” and “intervene” in a child’s delayed developed and perhaps even prevent autism, I have to note that there are some things that Charlie has learned not because of our intense efforts to teach, but because he has gotten older. Yes, growing up raises new questions and concerns, but an older Charlie is—like older children of any diagnosis—an older child, able to understand more, do more, help us, try to be independent. For us, it was good to get an early diagnosis and start learning about autism and about how best to help Charlie, and to understand how being the parents of a disabled child is full of much that is different and unexpected—–and too good to miss a moment of.
Tags: 18 months, asd, asperger, autism, autism spectrum disorder, children, early intervention, Family, mothers, pdd-nos, pscyhology, Psychiatry, PsychologyRelated Stories
POSTED IN: Diagnosis, Education, Family, Parenting, Psychiatry, Psychology
15 opinions for Diagnosis by 18 Months
Hsien Lei
Jan 30, 2008 at 7:55 am
It’s encouraging to hear that kids do grow older and grow out of some less than desirable behaviors. *sigh*
Autismville
Jan 30, 2008 at 8:02 am
With hindsight, no doubt Jack could have been diagnosed MUCH earlier than two. (I have photographs of him spinning wheels on his toys when he was less than a year old.)
I find studies like this exciting and empowering.
ASDmomNC
Jan 30, 2008 at 8:35 am
We tried to get my son dx’d at 18 mos., but the doctor said they couldn’t “formally” diagnose anyone until age 2. My son was very obviously on the spectrum at that time, and it was very frustrating to not get the diagnosis. Labels open doors to therapies, and without that label, our hands were tied. I think this is a good thing.
RAJ
Jan 30, 2008 at 8:49 am
“A combination of the developmental curriculum, teaching techniques based on applied behavior analysis, and warm, engaging social exchanges between an adult and the child is used to achieve measurable treatment goals targeting affective connection, social relatedness and communication skills”.
Early identification and intervention is a positive development but I find this comment to be disturbing on a number of levels. First, it implies that the parents of autistic children do not provide a warm and engaging social engagement towards their children. This is consistent with the so-called ‘Broad Autism Phenotype’ theory that has described parent(s) as emotionally cold parents who have managed to defrost just long enough to produce a genetically defective child.
Second, it reinforces the nonsense that extreme emotional deprivation, abuse and neglect (Romanian orphans) is associated with an autism spectrum disorder.
KimJ
Jan 30, 2008 at 10:49 am
When my son was first suspected to be autistic, at 2 1/2 years, it was met with a lot of suspicion and disbelief. Personally, I think the timeline was appropriate and I don’t see how an earlier assessment would have been drastically better. As it was, we spent some time after the initial evaluation reading and learning about autism before signing up for “early intervention”. He ended up with just a few months of EI and had already started speaking.
His big changes seemed to correlate with meeting peer friends when he started preschool at 3.
Let me tell you that having a nonverbal toddler who couldn’t ask for the most basic of things, I was certainly engaging as much as I could. Video of the time reveals a one-sided conversation going on (on the part of the filmmaker) with a toddler sometimes seemingly engaged to running off at random.
Regan
Jan 30, 2008 at 1:35 pm
I first really started to suspect that something was happening and we might need professional advice at 20 months. It took until 30 to get formal diagnosis and intervention, (and not because I didn’t try to find out what was going on–there were detours to speech therapy, which were prescribed, but not helpful.)
In the recent couple of years I have been concerned that there has been a push to earlier diagnosis, but not a recommended or demonstrated model of intervention for such young children. Not everything done intensively has to be helpful; a lot of the wrong thing delivered incompetently can be harmful, so the outcome for this, and the training of direct providers is going to be important.
The study and the outcome of this model has only started, not concluded with results published. So it is interesting, and I hope fruitful and helpful, but not done.
FWIW, The Denver Model has been around at least since Eleanor was diagnosed 9 years ago; the details of the intervention model itself are pretty easily searchable.
Emily
Jan 30, 2008 at 2:21 pm
We saw (and recognized in hindsight) the signs of autism in our oldest son VERY early…obsessions with odd things (acorns, eggs), spinning anything that would spin but not actually playing with the toy the “normal” way; massive meltdowns we just couldn’t figure out, triggered by we didn’t know what; a relative inability to use language as communication or close “circles of communication”; repetitive, nonproductive behaviors; and echolalia. BUT…he looked at us! He talked on time! These were the two primary criteria at the time he was two, so we thought everything was fine. Now…his social problems, major anxiety, etc., really started to emerge when he was three. But now, I’d look for not closing those circles, for a lack of imaginary play or “appropriate” play with toys, lining up things, and spinning as those earliest signs.
We’ve been watching our youngest closely because of his oldest brother’s diagnosis (our middle son is not on the spectrum). He’s shown some “red flags” that are far more evident and that we’d even have noticed were he our first. The most obvious is that he does not talk, and he’s almost 18 months old. Not a word to communicate specifics. He has no words for the people in his life. He lost the one word he had at age one, which was “Daisy,” the name of our dog. He just recently began to sign “more,” which he uses for everything. He had major motor milestone delays and now exhibits obvious hemiplegia, tucking up his left arm in the guard position and hold the hand rigidly, making a circle with his thumb and middle fingers. These are far more obvious signs, and he’s not quite 18 months yet.
He does three therapy appts a week, two for speech and one for his motor skills; he just started the speech appts and has been doing motor skills since before turning one because his deficits were so obvious. How will he turn out? We obviously do not know. We are not refrigerator parents by any stretch, but even after all of our experience with our first son, we are still learning some new things from therapies that we find are useful.
Moi ;)
Jan 30, 2008 at 3:07 pm
Well, “back in the day”….meaning circa 1995, we took Bug to DuPont Children’s Hospital and saw the head of developmental pediatrics (among others). They had no clue.
A ped that worked in the office we used to go to said Bug was retarded, because he was hiding under the table (playing hide and seek with the doctor). Had he done one test? No.
The school said he had one thing, an audiologist said yet another. We had a total of **7** different Dxes for him from people who didn’t know their hind from a hole in the ground. AND had to wait 4 years on a waiting list to get an appointment at CHOP before we got the final (accurate) Dx.
In total, it took us TEN YEARS to get the proper diagnosis. Even though *I* knew, just from reading the internets.
So while it’s a good idea to have early dx, you’d better be sure that the doctor(s) in question know what the hell they are doing. Because a wrong Dx can hold your child’s education back for YEARS. (I am not going to even get started here on what havoc the wrong Dx does with services in school. Rest assured, it is hell.)
Emily
Jan 30, 2008 at 3:34 pm
TH *still* hides under tables or beds when someone new comes in. And now the baby does the same thing.
Owl
Jan 30, 2008 at 8:13 pm
Is sign language acquisition before verbal language acquisition common for autism (in a normal hearing child)? I know a boy like that whose parents are looking into a spectrum diagnosis, but never found it in the literature.
Kristina Chew, PhD
Jan 30, 2008 at 8:31 pm
@Owl, Charlie learned to sign before he was able to speak—-he was 2 and some months, and could imitate actions, but was not yet able to imitate sounds. But this was after he had been diagnosed, too.
Leila
Jan 30, 2008 at 9:10 pm
I’d say the most important red flag is lack of pointing and sharing. Since the presence of verbal language and even eye contact may vary so much for kids in the spectrum, I think that this early form of shared attention and communication is the one that’s pretty much absent in autistic toddlers. Typical kids may not talk yet but they are pointing at things and babbling or grunting to get our attention to that interesting object. They bring things and toys to show you.
Regan
Jan 31, 2008 at 12:17 am
FirstSigns
http://www.firstsigns.org/
This would have useful to us in the way back when.
Kristina Chew, PhD
Jan 31, 2008 at 1:18 am
It was chiefly joint attention that Charlie lacked—the one thing that he did not do, was to show and share with us some thing that had caught his fancy. It felt very novel to me, when I first saw a baby do this, and I realized that Charlie never had.
Marla
Jan 31, 2008 at 2:24 pm
We saw many neurologists, child psychiatrists, child psychologists and pediatricians…none diagnosed M as being autistic early on. Most said, “She may outgrow it. It is too early to know.’ or worse blamed us for certain developmental issues. I wish, looking back I would have taken her to the Clevevland Clinic in Ohio much earlier than we did. We did not get a real good diagnosis until she was nine years old. That is a long long time of not knowing.
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