Sunday, February 10, 2013

Early Detection Critical for Autism

It is well established that early intervention is a critical determinant in the course and outcome of autism spectrum disorders (ASD). Nevertheless, it is estimated that the US is facing $90 billion annually in costs related to autism. Research suggests that costs can be reduced by 2/3 with early diagnosis and treatment/intervention. The signs and symptoms of autism do not generally appear suddenly, but rather develop gradually during the first three years of life. The earlier the child is identified and intensive intervention can begin, the better the outcomes tend to be for children with ASD. In fact, numerous studies have described the benefits of early identification and intervention for children with developmental disabilities and, particularly, for children on the autistic spectrum. There is strong empirical support for the use of intensive behavioral programs for young children with ASD. In addition to increasing cognitive, linguistic, social, and self-help skills, early intervention helps to minimize the potential for secondary behavioral and emotional problems (e.g., anxiety, depression). Because most children with ASD are educated in public school settings, early identification and intervention also help to insure the implementation of appropriate and effective teaching methods to address the core social-communication deficits of ASD. While the components of intervention programs might vary, it is generally agreed that program intensity combined with early identification can lead to substantial improvement in child functioning.
At present, early intensive behavioral intervention (EIBI) is considered the central feature of intervention programming for children with autism. EIBI programs are among the most and best researched of the psychoeducational interventions. Several research publications and meta-analysis indicate that early intensive behavioral intervention (EIBI) may improve the quality of life and level of functioning for children with autism spectrum disorders (ASD). EIBI programs are based on applied behavior analysis (ABA), a behavioral approach that is well supported in the research literature.  Although there is general professional agreement that EIBI is an effective treatment, on average, for children with autism, we should be mindful that it does not produce significant changes in all areas of children’s functioning or result in similar gains for all children. Moreover, EIBI may not be appropriate for all children. Because no two children are alike, no one program exists that will meet the needs of every child with autism. 
There are no interventions or treatments that can cure autism, and there are very few which have been scientifically shown to produce significant, long-term benefits. At the present time, the most effective treatment is a comprehensive and intensive program consisting of educational interventions, developmental therapies, and behavior management with a focus on reducing symptom severity and improving the development course of the child. Unfortunately, intervention research cannot predict, at the present time, which particular intervention approach works best with which children. No single approach, intervention strategy, or treatment is effective for all children with ASD, and not all children will receive the same level of benefit. Generally, it is best to integrate scientifically validated approaches according to a child’s unique needs and abilities.
Despite the increased awareness and prevalence of ASD and the benefits of early intervention, studies continue to indicate a delay in identification and acquisition of services. Because many children are not identified until well after five years of age, future efforts should place an emphasis on recognition and diagnosis among school-aged children, not just among young children. Accurate differential identification and provision for services are critical since a high proportion of children may be overlooked, misdiagnosed with another psychiatric condition, or present with comorbid psychiatric disorders such as depression and anxiety.
The following resources provide important information about early identification and intervention. 
American Academy of Pediatrics. Understanding Autism Spectrum Disorders [pamphlet]. Elk Grove Village, IL: American Academy of Pediatrics; 2005.
Autism Society of America
Best Practice Autism
National Autism Center
National Institute of Child Health and Human Development Autism Site
National Professional Development Center on Autism Spectrum Disorders
Organization for Autism Research
Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers.

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