With autism spectrum disorder prevalence as high as 1 in 59 children in the United States, many parents are starting to recognize the signs of developmental delay and are asking the question “is my child developing at the rate they should be?”
While the American Academy of Pediatrics recommends screening for autism be done on all children at their 18 month and 24 month checkups, there aren’t any biological tests they can currently use. And since autism is such a wide spectrum, it’s leaving a lot of gray areas for specialists trying to diagnose ASD.
This could be why the average age of diagnosis hasn’t changed in 15 years, despite advances in understanding of the disorder. While it’s universally agreed that autism spectrum disorder can be accurately diagnosed as young as two years old, the national average is still hovering over 53 months, or 4.5 years old. This paper even points out evidence that parents may detect developmental concerns in children with autism before they turn one.
This is in part due to long wait times for autism specialists, time-consuming evaluations, cost, and lack of comfort in diagnosing by primary care providers. Not to mention, families are dependent on the resources in their local community, which can vary drastically based on location. This NIH study claims “Only 7% of developmental pediatricians practice in rural areas. Some states do not have a developmental pediatrician.”
Furthermore, the same study reveals a national shortage of subspecialist providers nationwide.
“A 2012 survey by the Children’s Hospital Association reported national shortages in all of the pediatric subspecialties that diagnose and treat ASD: Developmental Pediatrics, Pediatric Neurology, and Child and Adolescent Psychiatry. According to this study and others, the average wait time to schedule an appointment with these specialists was 3.5 months; however, in some areas of the country, wait times are significantly longer, and it may take up to a year to have a comprehensive evaluation,” the study states.
Overall, children are being diagnosed with autism spectrum disorder, on average, two years later than the recommended timeline.
What Can Parents Do?
To start, know the signs of autism spectrum disorder. The Central for Disease Control and Prevention, CDC, offers a comprehensive list of signs and symptoms for ASD in young children. This list includes, but is not limited to…
- not pointing at objects to show interest
- not looking at objects when another person points at them
- having trouble relating to others or not have an interest in other people at all
- avoiding eye contact and wanting to be alone
- having trouble understanding other people’s feelings or talking about their own feelings
- preferring not to be held or cuddled, or might cuddle only when they want to
If you’re noticing signs of autism spectrum disorder in your child, bring it up at your pediatricians office. Unfortunately, the average pediatric appointment lasts just 18 minutes. That doesn’t give your child’s doctor a large amount of time to investigate their behavior, if the parent doesn’t bring it up. In more traditionally obvious cases, this could pose no problem. But in less severe cases, your child could appear to be developing neurotypically and ultimately will delay their diagnosis.
Talk to Your Baby
A recent language-skills study revealed that infants later diagnosed with autism can benefit from exposure to more speech from their parents.
In this study, published in the journal Autism Research, researchers focused on the relationship between speech from a caregiver and infant language development on children with autism, and those developing typically.
Dr. Megan Swanson, shared the results of her study, claiming “the study results directly tied the number of words an infant hears, as well as the conversational turns he or she takes, to the performance on the 24-month language evaluation- both for typical children and those with autism.”
Turns out, talking to your kids makes a big difference.
Dr. Joseph Piven, director of the Carolina Institute for Developmental Disabilities at UNC-Chapel Hill, shared “any impact on early language skills will almost certainly have an impact on a wide range of later abilities in school-age children and significantly enhance their probability of success.”
Dr. Swanson says the biggest takeaway from her study is that parents can make a significant difference in language development, even in children who are diagnosed with autism spectrum disorder.
Get the Right Diagnosis
Autism spectrum disorder is one of the most commonly misdiagnosed disorders in children. Often children are mistaken for having autism due to a lack of development with their speech, which is a common symptom of ASD. However, in reality, the child could just be suffering from selective mutism, or restricted speech.
Psychologist Steven Kurtz believes it’s important to note the distinction between a skills deficit and a performance deficit before making a diagnosis.
“Children with selective mutism have a performance deficit because they have the ability to speak but cannot demonstrate it in every setting, while children on the spectrum have skills deficits, so can’t demonstrate certain skills regardless of the setting.”
A recent study about the M-CHAT, a screening tool for autism that can be administered on children as young as 18 months, found that the tool might not be that helpful afterall to kids under 20 months.
“This study also shows that use of the M-CHAT/F does not substantially improve the relatively low PPV of the M-CHAT in low risk toddlers younger than 20 months, confirming the published M-CHAT study which compared screening results between younger and older toddlers, and included the use of the M-CHAT/F.”
Furthermore, “Strategies other than simply lowering the threshold are needed to make ASD screening as accurate for younger toddlers as it is for older ones, especially since referral rates are already higher for the younger toddlers as seen in this study and that of Pandey and colleagues (2008). The false discovery rate was twice as high in the younger group than the older one in this study making referral of all positives impractical.”
What’s the Solution?
To accurately diagnose autism spectrum disorder as young as 18 months old, when it’s recommended, clinicians need a biological, objective tool.
Coming soon, the Clarifi autism saliva test will be able to provide that extra support that clinicians need in making an accurate ASD diagnosis. This saliva test measures non-coding RNA and the microbiome to detect if a child is developing typically, if the child has autism spectrum disorder, or if the child is developing delayed, but doesn’t have autism.
The saliva test is a great route to take for parents of young children struggling to get a diagnosis, because it can be administered in their primary care doctor’s office, cutting out long wait times for specialists, or long travels to them. The Clarifi autism saliva test can be ordered anywhere in the country, (with the exception of New York State), making it a nationwide resource, similar to the MCHAT or ADOS, but with more objectivity and concrete answers.
In all, while there have been several tests for autism spectrum disorder for children as young as 18 months old floating around, none of them prove to be exceedingly accurate. As parents struggle to attain a diagnosis, the child loses valuable time for intervention services that can change the trajectory of their life.
By introducing the Clarifi autism saliva test into the mix of practices, children as young as 18 months old can start being accurately diagnosed with ASD.