Autism Detection: Look and See

All children should be screened for autism spectrum disorders (ASD) at the 18-month and 24-month well child visit, according to November 2007 guidance from the American Academy of Pediatrics, which replaces the original 2001 policy. Implementing this would mark a big change. Right now, about 92 percent of kids are not formally screened for ASD. The new policy goes even further: If a child has a sibling with ASD, or if the parents, other caregivers, or pediatrician are concerned, then the possibility of ASD should be looked into at any age. And at every well child visit, pediatricians should be on the lookout for red flags that should prompt immediate evaluation, such as no babbling or pointing or other gesture by age 12 months, no single words by 16 months, no two word phrases by 24 months (just repeating back what others say doesn’t count), or loss of language skills at any age. The big message is that a “wait-and-see” approach is inappropriate: children should be referred immediately for either a worrisome screening result or if there are two other sources of concern (family history, parents, or other caregivers). This decidedly does not mean that these children will have ASD; it only means that they deserve a closer look to be sure either way. Good screening polices will prompt care for those who need it, but to be on the safe side, will also flag a number of completely healthy children. Here at DrGreene.com, I’ve suggested a very simple autism screen for more than ten years. At the appropriate ages, physicians should be using one of the more comprehensive formal screens such as the M-CHAT, which is not designed to be scored by the person filling it out. ASDs affect about 1 in 150 kids in the United States and Canada (and far more boys than girls). Early diagnosis and early help clearly results in better outcomes. Let’s join together to turn “wait-and-see” into “look-and-see”!

Alan Greene, MD, FAAP