Diagnosis and assessment
University of North Carolina, Chapel Hill, notes that not
Experts are finding they can now reliably diagnose ASD in
all children will respond to the same treatment, though.
children from 12 to 18 months old by looking at their social
Additional studies have underscored that it’s the earliness of
deficits or repetitive actions. But the trajectory of the disorder
the intervention — not the method itself — that leads to the
is unpredictable, says Catherine Lord, PhD, who has studied
positive outcomes. “There is more than one way to get good
high-risk ASD babies from 18 months to 36 months (Journal of
outcomes, and different therapists will gravitate to different
Consulting and Clinical Psychology, Lord, et al. 2012).
methods,” she stresses.
“In young children — especially under 2-and-a-half years
LEAP (Learning Experiences and Alternative Program
— we shouldn’t treat it as a lifetime diagnosis. We can offer
for Preschoolers and Their Parents) is another successful
parents some hope that a very young child will move out
intervention for young children. This treatment model mixes
of the autism spectrum or improve,” says Lord, who directs
children with ASD with typically developing preschool kids in
the Center for Autism and the Developing Brain at the Weill
the classroom. In this way, the ASD child has the opportunity
Cornell Medical College/New
to learn appropriate language
York Presbyterian Hospital.
At the same time, she
adds, other children with
ASD regress — and this can
happen whether or not the
Psychologists need to
stress to parents that the
and behavior from other
kids who are taught how
to interact with them. The
learning program is designed
so kids become engaged with
child receives treatment. The
reasons are unknown, but
activities “organically” — not
through the direction of a
Lord’s study highlights the need
to frequently monitor and re-
is not appropriate when
One study found that the
evaluate the child throughout
the preschool years.
Psychologists need to advise
autism is suspected.
best LEAP outcomes were
linked to how well the teacher
complied with the protocol
parents that the “wait-and-see”
approach is not appropriate when autism is suspected, says Laura
Schreibman, PhD, a professor at the University of California, San
Diego, who directs the university’s Autism Intervention Research
Program. Delaying a diagnosis can mean giving up the significant
gains of intervention that have been demonstrated before age 6.
Early intervention can even prevent regression of communication
and social skills in some cases, she says.
Rogers explains that it’s easier to develop comprehensive
treatment approaches for infants and toddlers than for older
children. “This is because they are not as diverse a group
as 10-year-olds,” she says. “We haven’t yet isolated the key
ingredients and variables affecting treatment outcome in older
children who need a more individual approach,” she says.
Intervention for young children
One research-proven intervention for very young children with
ASD is the Early Start Denver Model (ESDM), a structured
teaching and relationship-based approach in the child’s home
that uses play as a learning tool. A randomized, controlled
trial over two years found that children age 18 to 30 months
participating in ESDM significantly improved their IQs, social
interaction and language abilities (Pediatrics, Dawson, et al. 2010).
(Topics in Early Childhood
Special Education, Strain, et al. 2011). Teachers who received
intensive training and coaching over the two-year study
adhered to the LEAP practices 90 percent of the time. Their
students with ASD showed significantly greater improvements
on behavioral measures and symptoms than the ASD students
whose teachers were simply given the LEAP manual to follow.
Properly trained parents can also help infants and toddlers
with autism make gains in areas such as “joint attention,” says
Dawson. Joint attention skills involve sharing through pointing
or coordinating looks, for instance, or sustaining attention
with a parent or an activity. In one study (Journal of Autism
Development Disorder, Kasari, et al. 2010), parents were trained
from once a month to several times a week on how to expand
their children’s interest in play. The quality of the parents’
participation — not the number of training sessions — was
linked to how much progress was made.
Causes: prenatal development factors
Researchers have not yet been able to pinpoint the exact causes
of ASD, but they are closer. They do know that autism results
from a genetic mutation in 15 percent to 20 percent of cases.
But environmental factors can combine with and increase a
The children received 20 hours per week of ESDM intervention
plus five or more hours of guided care from parents.
Rogers, who co-authored the study and developed the
ESDM approach with Geraldine Dawson, PhD, chief science
officer for Autism Speaks and professor of psychiatry at
genetic susceptibility, says Dawson. Risk factors identified to
• Advanced age of fathers (Nature, Stefánsson, et al. 2012).
• Low birth weight or small for gestational age (Journal of
Pediatrics, Lampi, 2012, and Pediatrics, Pinto-Martin, 2011).