Issue 12 / 7 April 2015

REDUCING the age at which children are diagnosed with autism spectrum disorder will ensure the best outcomes are achieved, says a leading autism expert, after researchers found there may be diagnostic delays of up to 2 years in children aged under 7 years.

Professor Andrew Whitehouse, head of the developmental disorders research group at the Telethon Kids Institute, said these delays prevented children from accessing the early intervention services that could make a “massive” difference to their development.

“There’s not a person in Australia who thinks we are currently diagnosing autism as early as we can. We know we can reliably diagnose at 24 months of age, but the services required to get the actual age of diagnosis down from age 4 to age 2 require substantial investment and, at this stage, the investment just hasn’t come”, he told MJA InSight.

Research published in this week’s MJA found that although current research suggested a reliable diagnosis of autism could be made as early as 24 months, the average age of diagnosis in children under 7 years was 49 months, with children commonly diagnosed at 71 months. (1)

The researchers analysed de-identified data on 15 074 children aged under 7 years, who had registered from 2010 to 2012 with the Helping Children with Autism Package (HCWAP), a federally funded program to provide access to early intervention and support services.

Professor Whitehouse, who is also a director of the Autism Co-operative Research Centre (Autism CRC), told MJA InSight a priority of his centre was to drive down the age at which autism spectrum disorders were diagnosed. (2)

He said a hurdle in reducing the age of diagnosis was the lack of uniform diagnostic standards in Australia. Autism CRC was conducting a major survey to better understand how autism was diagnosed in Australia, and it had also developed a university course to improve health professionals’ diagnostic skills.

Equally important was arming parents, child health professionals and early childhood educators with the knowledge to identify potentially problem behaviours in children as soon as possible, Professor Whitehouse said.

Data were also emerging that “very early intervention” in children showing potentially red-flag behaviours could significantly mitigate the development of symptoms.

“Intervention at 12 months of age can actually mitigate or reduce the symptoms to the point where the behaviours observed may not reach the diagnostic threshold”, he said.

Associate Professor Kylie Gray, acting director of Monash University’s Centre for Developmental Psychiatry and Psychology, said the MJA study provided an important analysis of a national database.

However, she warned caution was needed in interpreting the data as it captured only children aged under 7 years who had accessed the HCWAP. These limitations were acknowledged by the authors.

Professor Gray said while some children might be missing out on beneficial early intervention, others might be receiving early intervention for general developmental delay before a diagnosis of autism was made.

While she agreed research showed early intervention in autism had huge benefits for children, it was important to note that interventions provided to children older than 4‒5 years were still beneficial and important.

“The push for early intervention can leave some families worried that if they can’t get their child into services by age 4, then there’s really nothing that can be done and that’s certainly not true. Intervention and support is something that continues throughout childhood, adolescence and into adulthood as well”, Professor Gray told MJA InSight.

She said the past decade had seen significant gains in the identification of early markers for autism.

“There is a heightened public awareness and an enormous amount of research has been done in developing really good assessment tools, questionnaires and observation schedules for clinicians and for professionals.”

However, Professor Gray said, efforts now needed to focus on translating these findings into clinical practice.

“Education of the next generation of professionals is absolutely critical. If we’re not teaching our next generation of psychologists, paediatricians, speech pathologists, etcetera, about best practice and translating the knowledge base that we generate in research into our teaching and services, then that’s a major loss of information and expertise,” she said.

 

1. MJA 2015; 202: 317-320
2. Autism CRC

(Photo: warrengoldswain / iStock)

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