Checklist offers early alert to autism spectrum disorders

Finding out that your child has an autism spectrum disorder (ASD)—or some other developmental delay—is difficult or parents. But getting your child tested at a younger age can lead to earlier intervention, and potentially a better long-term outcome.

So it's encouraging news that researchers at the University of California, San Diego, studied the use of a simple checklist that parents can fill out at their baby's one-year checkup. The checklist is designed to help pediatricians identify delays that can indicate autism spectrum disorders (ASD) as well as language and other developmental issues. The checklist won't specifically diagnose a condition, but will alert the physician to possible developmental conditions requiring further monitoring.

The checklist was used in a study led by Karen Pierce, Ph.D., assistant professor in the UC San Diego Department of Neurosciences. The study screened 10,479 infants at their one-year checkup in the San Diego area. Of those, 184 babies were sent for further testing, and 32 were later found to have ASDs.

The study was published in the April 29th online edition of The Journal of Pediatrics. Working with 137 local pediatricians, parents were asked to complete a one-page questionnaire that asked such questions as whether the baby:
• looks at you when playing with toys,
• smiles or laughs when looking at you,
• is interested in playing with a variety of objects,
• uses words in a meaningful way,
• points to objects, or nods her head to mean ‘yes'.

"It's really designed to screen for communication problems," said Amy Wetherby, Ph.D., distinguished research professor in the College of Medicine, Florida State University, Tallahassee, Florida, who designed the checklist with Dr. Barry Prizant during the past decade. "It's important to test children for communication problems. Rather than waiting for a delay in talking, the checklist asks parents about pre-linguistic skills that predict later language skills."

The purpose of the checklist is that "it uses parent report to maximize useful information without taking the doctor's time," said Dr. Wetherby. "It's a tool for parents to give information about developing milestones. When children come in for their 12-month check up, it's a way to screen early."

Still, Dr. Wetherby cautioned that, even though parents fill out the questionnaire, it's not meant as a home testing tool and should be used under the guidance of a physician or other professional.

Only 22 percent of the participating pediatricians had previously done screening like this. After participating in the study, 96 percent of the pediatricians rated the program positively and virtually all participating pediatric offices have continued using the screening tool. Currently, the American Academy of Pediatrics recommends ASD screening at 18 and 24 months, with ongoing surveillance if there are concerns.

"The key thing about this paper is that it's the first and only study to show the feasibility of a screening measure in a regular medical setting to detect autism as young as 12 months," said Lisa Gilotty, Ph.D., chief of the Research Program on Autism Spectrum Disorders at the National Institute of Mental Health at the National Institutes of Health. "This demonstrates something can be done as part of a routine standard of care." She added that because this checklist was a "broad measure, it can get at language delays and social issues that children may have."

If your pediatrician doesn't offer the checklist at your baby's 12-month check up, it's worth asking for it.

Check out Consumer Reports buying advice and Ratings for a wide array of products for babies and kids.

—Merri Rosenberg