Early Screening of Autism Spectrum Disorder: Recommendations for Practice and Research

Zwaigenbaum, Lonnie; Bauman, Margaret L.; Fein, Deborah; Pierce, Karen; Buie, Timothy; Davis, Patricia A.; Newschaffer, Craig J.; Robins, Diana L.; Wetherby, Amy M.; Choueiri, Roula; Kasari, Connie; Stone, Wendy L.; Yirmiya, Nurit; Estes, Annette; Hansen, Robin; McPartland, James C.; Natowicz, Marvin R.; Carter, Alice S.; Granpeesheh, Doreen; Mailloux, Zoe; Roley, Susanne Smith; Wagner, Sheldon

doi:10.1542/peds.2014-3667d

Cited by 239 publications

(198 citation statements)

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“…1 With the advances reviewed by Zwaigenbaum et al 2,3 in this special issue of Pediatrics, and the growing evidence that ASD can be diagnosed accurately before 2 years of age, 4,5 the need for ASD treatment programs specifically designed for this age group has never been greater. Some authors have also argued that the second year of life is a particularly critical developmental period for children with ASD, for various reasons.…”

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Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research

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This article reviews current evidence for autism spectrum disorder (ASD) interventions for children aged ,3 years, based on peerreviewed articles published up to December 2013. Several groups have adapted treatments initially designed for older, preschool-aged children with ASD, integrating best practice in behavioral teaching methods into a developmental framework based on current scientific understanding of how infants and toddlers learn. The central role of parents has been emphasized, and interventions are designed to incorporate learning opportunities into everyday activities, capitalize on "teachable moments," and facilitate the generalization of skills beyond the familiar home setting. Our review identified several comprehensive and targeted treatment models with evidence of clear benefits. Although some trials were limited to 8-to 12-week outcome data, enhanced outcomes associated with some interventions were evaluated over periods as long as 2 years. Based on this review, recommendations are proposed for clinical practice and future research. Pediatrics 2015;136:S60-S81

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Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research

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“…8 Recent studies indicate that intensive behavioral therapy starting as early as 18 months of age is associated with decreases in core symptoms of ASD and improvement in cognition, language, and adaptive skills. 9,10 After diagnosis, children with ASD require ongoing care within a medical home to address associated medical conditions, coordinate care with specialists, and provide family support.…”

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Improving Early Identification and Ongoing Care of Children With Autism Spectrum Disorder

2016

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BACKGROUND AND OBJECTIVE: Poor adherence to recommended screening for autism spectrum disorder (ASD) and pediatricians’ lack of confidence in providing care for children with ASD reflect quality gaps in primary care. This study aimed to increase the proportion of toddlers screened for ASD and improve physicians’ self-efficacy in providing care to children with ASD. METHODS: Twenty-six Utah primary care practices participated in a 3 to 6 month learning collaborative (LC) to improve identification and ongoing care of children with ASD. Monthly chart audits assessed whether an ASD screening tool was administered at 18- and 24-month visits. Physicians completed pre-LC and post-LC surveys to assess changes in self-efficacy in providing care and changes in perceived barriers to implementation of screening and caring for children with ASD. RESULTS: Before the LC, 15% of 18- and 24-month visits had documented ASD screening, compared with 91% during the last month of the LC (P < .001). This rate of ASD screening was sustained 4 years after the LC by most practices. Compared with survey responses before the LC, physicians reported significant improvement in their ability to care for children with ASD and decreases in their perceived barriers to screening and caring for children with ASD. CONCLUSIONS: The LC was effective in increasing and sustaining recommended ASD screening of toddlers and improving physicians’ perceived self-efficacy in caring for children with ASD. Improving primary care screening, skills, and knowledge may improve the timing of diagnosis, initiation of treatment, quality of care, and outcomes for children with ASD.

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“…• Evidence supporting this statement is summarized in Table 2 of the article by Zwaigenbaum et al 17 • Emerging data suggest that ASD diagnoses before 24 mo of age are stable, although further research is needed, particularly involving children identified via early screening 5.…”

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“…To inform the work of each group, literature searches were conducted on Medline to identify relevant articles for each topic (the specific search terms are provided in the other articles in this supplement to Pediatrics [16][17][18] ). Search results were complemented by additional publications identified by working group members.…”

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Early Identification and Interventions for Autism Spectrum Disorder: Executive Summary

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Autism spectrum disorders (ASDs) are neurodevelopmental disorders characterized by impaired social communication skills and isolated areas of interest. 1 The current prevalence of these disorders is estimated to be 1 in 68, 2 and recent estimates of the risk of recurrence in families with at least 1 child diagnosed with ASD are 10% to 19%. [3][4][5] Advances have been made in identifying genetic variants that can account for biological vulnerability to ASD, 6,7 although recent studies examining patterns of heredity implicate environmental factors and potential gene-by-environment interactions. 8 Although the exact etiology remains unknown in most families, some researchers suggest that the pathogenesis of the disorder begins during prenatal life. 9,10 It is likely that ASD is heterogeneous in its etiology as well as in its clinical presentation. 11The American Academy of Pediatrics has recommended screening for ASDs at 18 and 24 months of age, 12 but recent research suggests that atypical behaviors may be detectable in some children at even younger ages. 13,14 However, we are still learning how the timing and developmental course of early ASD symptoms vary across children and how best to detect such symptoms across the continuum of children seen in community practice. In addition, reports 15 that early intervention can improve developmental and behavioral outcomes in infants and toddlers have lent urgency to identifying children across the autism spectrum at an earlier age. Advances in genetic, neuroimaging, and other neurobiological research have also raised the potential of biomarker screening. Given the progress in these areas, a review of the current state of the science on early identification, screening, and intervention of ASD was warranted.These issues were the focus of an international, multidisciplinary panel of clinical practitioners and researchers with expertise in ASD and developmental disabilities. A meeting of the panel was convened in Marina del Rey, California in October, 2010, to develop best practice standards for early identification, screening, and early intervention for ASD in very young children and to identify priorities for future research. To complement previously published reports, our literature review on early identification and screening for ASD focused on children aged #24 months, whereas our review of intervention studies focused on children aged #36 months. The panel reached consensus in 3 areas:What are the earliest signs and symptoms of ASD in children aged #24 months that can be used for early identification?How can we optimize developmental course and outcomes through ASD screening programs for children aged #24 months?What interventions have shown efficacy in children with ASD aged ,36 months?

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Early Screening of Autism Spectrum Disorder: Recommendations for Practice and Research

Cited by 239 publications

References 105 publications

Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research

Early Intervention for Children With Autism Spectrum Disorder Under 3 Years of Age: Recommendations for Practice and Research

Improving Early Identification and Ongoing Care of Children With Autism Spectrum Disorder

Early Identification and Interventions for Autism Spectrum Disorder: Executive Summary

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