The Sooner the Better

Autism spectrum disorders affect about one in 150 children. Often doctors don't diagnose the disability--which is characterized by impairments of social interaction and communication--until age 3. And yet, experts say earlier diagnosis is critical, since it can lead to earlier intervention and better outcomes. The good news: in a study appearing this week in the Archives of General Psychiatry, researchers say they have successfully identified autism in children as young as 14 months--the earliest the disorder has ever been diagnosed. The authors say the findings indicate that about half of autism cases can be diagnosed within months of the first birthday. Researchers at the Kennedy Krieger Institute in Baltimore, Md., evaluated social and communication development among 107 high-risk kids  (children whose siblings have autism) and a control group of 18 low-risk kids (no family history of autism). Speech pathologist Rebecca Landa, director of Kennedy Krieger's Center for Autism and Related Disorders,  and lead author of the study, spoke with NEWSWEEK 's Karen Springen about the implications for the 1.5 million Americans with autism. Excerpts:

NEWSWEEK: What does this mean for the theory that vaccines and other environmental factors may play a role in autism?
Rebecca Landa: This study doesn't really touch on that. There may come a time when we can look at these children's records and see what kind of vaccines they were exposed to. There are different onset patterns. Basically, in the one pattern, there are clear, clear problems in social development and communication development at 14 months of age. The children are quite distinguishable. [But] for about half of the children we studied, their autism symptoms didn't really show up until later, sometime after 14 months, but certainly before 24 months. The point is that some parents are concerned that when their child gets a vaccine at around 15 months, like the MMR [measles, mumps, rubella], that their child is suddenly changing. What these data are indicating is that there is going to be a progressive phase to the disorder of autism in at least half of the children, where you're going to see that around 14 months, they look pretty healthy. It begins to gradually dwindle. They gradually begin to look pretty different. This is probably not an incident that comes upon a child instantaneously. This is an ongoing process.

Why were you able to diagnose just half the kids at 14 months?
That's a very good question, and we are going to be looking at that to see if there are certain very subtle predictors of children who are going to have this downward turn. Most of the children who ended up with this downward turn did show some mild, subtle developmental disruptions at 14 months, but nothing that would be alarming.

How did you pick the kids for your study?
This study was designed to try to understand the very earliest possible markers of autism in life and also how autism develops over time. We did pick babies who were at high risk for developing autism. We had a sample of 107 baby sibs of kids with autism. Somewhere around 30 of them developed autism.

Why is early diagnosis so important?
Because we believe that we can prevent certain aspects of the autism behavioral picture from either emerging or from becoming a major problem.

How?
I'm not saying we can do this for every child, but you really contour how they learn to interact with people, how they play, how they learn to learn. In a typically developing infant, everything is a learnable moment. In an infant or toddler with autism, their attention gets hyperfocused on things that aren't important--like for example, the letters on a wooden block.