It’s the things a young child doesn’t do that may give the clues to the presence of Autism. Because early symptoms of Autism are often characterised by an absence of normal behavioural development rather than the presence of unusual behaviour, diagnosis and early intervention can be crucially delayed.
To counter a poor understanding of the presentation of early symptoms, Flinders University psychologist Associate Professor Robyn Young and her colleagues have developed Autism Detection in Early Childhood (ADEC), a tool to assist in early diagnosis.
Early diagnosis is important because research shows that children are most responsive to intervention in the early years – particularly before the age of three.
Although anecdotal reports suggest that children diagnosed with an Autistic Disorder (AD) may exhibit characteristics early on, possibly even from birth, an AD is often not diagnosed until children are three or four years of age.
The ADEC describes 16 specific behaviours. If a child fails to demonstrate these behaviours by 18 months to two years of age, it may lead to consideration of an early diagnosis of Autism.
Associate Professor Young said that many of the ‘classic’ behaviours that form our impression of the disorder are rarely observed among children less than two years old.
“Many of the classic behaviours associated with AD, such as delayed or repetitive, non-communicative speech and obsessive interests, develop or become more apparent later in life,” she said.
While such behaviours are often considered part of the clinical picture of a person with AD, they should not be considered as defining characteristics in a positive diagnosis.
“The difficulties in making a diagnosis are often because it is typically the absence of behaviours that are reason for concern, rather than the presence of atypical or unusual behaviours,” Associate Professor Young said.
“Therefore, unless one is aware of when skills should develop and how they should develop, their absence may not cause concern. It is only when the secondary behaviours develop, and the more obvious milestones of speech and social play do not develop, that the child may receive more serious attention.”
By that time, many of the early behaviours are no longer evident, complicating the clinical picture.
With the ADEC, Associate Professor Young and colleagues Professor Neil Brewer and Dr Paul Williamson have attempted to identify the early concerns. Behaviours of interest identified in the tool include response to name, stereotypical behaviour, poor play and imitation, and joint attention difficulties.
The relationship between these behaviours and AD are supported empirically, and the tool has now, with support from Flinders Technologies, been published through the Australian Council of Educational Research (ACER).
” I hope that tools such as this will enable professionals to become familiar with the early presentation of the disorder,” Associate Professor Young said.
Autism spectrum disorders are a significant global issue with annual health costs in Australia alone estimated at between $4.5 and $7.2 billion annually (2007). As such, there has been considerable international interest in ADEC and its potential benefits: Mexico plans to use a modified Spanish version as part of a national screening tool and a Chinese version of the tool is also undergoing research in Malaysia and China.
Associate Professor Young said the Flinders research is being extended to identify signs of the disorder even earlier, possibly from birth.
PhD student Danielle Robson is recruiting typically developing newborns and those at risk of developing Autism due to hereditability factors to be involved in a longitudinal study of infant development.
The study will follow younger siblings of children already diagnosed with the disorder over 18 months to investigate whether there are early abnormalities in their development that distinguishes them from typically developing children.
The researchers are interested to hear from any mothers with a newborn or from expectant mothers who would be willing to participate in the study.