A program of early diagnosis for autism is showing promise for creating better outcomes for children with the condition.
Abundant research has shown that early intervention can make a big difference for children with autism, but this relies on detection. In all too many cases children are not diagnosed with autism until they start school, with the years in which greatest difference can be made having been lost.
Currently the main method for screening for Autism Spectrum Disorder (ASD) is known as M-Chat. It relies on parental reports and, according to La Trobe University’s Dr Josephine Barbaro “When used in low-risk, community based samples has very poor predictive value and sensitivity.” Parents who are natural worriers may over-report rare behaviors, while others will fail to notice more frequent signs.
Barbaro has found a low correlation between parental reports of early signs of autism and professional observations. Instead she is trialing the Social Attention and Communication Study (SACS) in which 241 Maternal and Child Health nurses have been trained to recognize signs of autism at 12, 18 and 24 month consultations. Children diagnosed as “at risk” are followed up every six months, with the diagnosis confirmed at three years and six months.
The nurses keep watch for a suite of behaviors including failure to make eye contact, not responding to their name or pointing to objects.
In a presentation to the Amaze Victorian Autism Conference this month Barbaro presented evidence just over 1% of children seen by nurses trained for the SACS program were referred as potentially having ASD. Of these 81% were diagnosed with ASD by specialists, an impressively high confirmation rate.
Barbaro says, “Until we follow up all children at 3.5 years to determine how many children with ASD that we missed, we can only estimate sensitivity based on current prevalence rates.” However, in the light of other studies showing the rate of ASD in the community as 1.1-1.5% these results suggest that, after some modifications Barbaro made after an initial study, SACS is picking up most children with the condition in the sample. A few of these are being found as early as 12 months, and most at 18 months or two years.
Children identified through the process are refereed to intervention services and advised of the success of the Early Start Denver Model pioneered by Professor Sally Rogers for children with autism under four.
The original Australian program is being replicated around the world, including in China and Bangladesh.