Article

Clinical Assessment and Management of Toddlers With Suspected Autism Spectrum Disorder: Insights From Studies of High-Risk Infants

Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
PEDIATRICS (Impact Factor: 5.3). 06/2009; 123(5):1383-91. DOI: 10.1542/peds.2008-1606
Source: PubMed

ABSTRACT With increased public awareness of the early signs and recent American Academy of Pediatrics recommendations that all 18- and 24-month-olds be screened for autism spectrum disorders, there is an increasing need for diagnostic assessment of very young children. However, unique challenges exist in applying current diagnostic guidelines for autism spectrum disorders to children under the age of 2 years. In this article, we address challenges related to early detection, diagnosis, and treatment of autism spectrum disorders in this age group. We provide a comprehensive review of findings from recent studies on the early development of children with autism spectrum disorders, summarizing current knowledge on early signs of autism spectrum disorders, the screening properties of early detection tools, and current best practice for diagnostic assessment of autism spectrum disorders before 2 years of age. We also outline principles of effective intervention for children under the age of 2 with suspected/confirmed autism spectrum disorders. It is hoped that ongoing studies will provide an even stronger foundation for evidence-based diagnostic and intervention approaches for this critically important age group.

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    • "Abnormal processing is often expressed in the form of diminished eye contact, poor visual tracking , unusual fixation trajectories, especially when presented with social scenes (Klin et al. 2002), excessive visual fixation and sensitivity to irrelevant aspects or changes in the visual environment (Mottron and Burack 2001). Oculomotor abnormalities are observable during the first year of life in children later diagnosed with autism (Elsabbagh et al. 2013; Zwaigenbaum et al. 2005) and are sometimes regarded as predictive markers in early diagnosis of ASDs (Zwaigenbaum et al. 2009). "
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    Experimental Brain Research 11/2014; 233(3). DOI:10.1007/s00221-014-4152-1 · 2.17 Impact Factor
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    • "One question that has motivated recent research in this area is how early in development differences in gamma frequency metrics of neural integration arise. To investigate issues related to very early development, studies rely on infants with an older sibling with ASD [8], [9]. These infants are termed “high-risk” for ASD because they have an increased predisposition to develop ASD, estimated to be around fifteen to twenty times higher than infants with no family history of ASD [10], [11]. "
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    ABSTRACT: In the field of autism research, recent work has been devoted to studying both behavioral and neural markers that may aide in early identification of autism spectrum disorder (ASD). These studies have often tested infants who have a significant family history of autism spectrum disorder, given the increased prevalence observed among such infants. In the present study we tested infants at high- and low-risk for ASD (based on having an older sibling diagnosed with the disorder or not) at 6- and 12-months-of-age. We computed intrahemispheric linear coherence between anterior and posterior sites as a measure of neural functional connectivity derived from electroencephalography while the infants were listening to speech sounds. We found that by 12-months-of-age infants at risk for ASD showed reduced functional connectivity compared to low risk infants. Moreover, by 12-months-of-age infants later diagnosed with ASD showed reduced functional connectivity, compared to both infants at low risk for the disorder and infants at high risk who were not later diagnosed with ASD. Significant differences in functional connectivity were also found between low-risk infants and high-risk infants who did not go onto develop ASD. These results demonstrate that reduced functional connectivity appears to be related to genetic vulnerability for ASD. Moreover, they provide further evidence that ASD is broadly characterized by differences in neural integration that emerge during the first year of life.
    PLoS ONE 08/2014; 9(8):e105176. DOI:10.1371/journal.pone.0105176 · 3.23 Impact Factor
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    • "In response to parents' concerns about their child's development that are present as early as 12 months of age [4], knowledge about and strategies to identify young toddlers with ASD are emerging [5]. It is now possible to identify a child with ASD in the first two years of life based on sociocommunicative behaviors [6]. "
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    ABSTRACT: Background. Now that early identification of toddlers with autism spectrum disorder (ASD) is possible, efforts are being made to develop interventions for children under three years of age. Most studies on early intervention have focused on intensive and individual interventions. However, parent training interventions that help parents interact and communicate with their toddlers with ASD might be a good alternative to promote the development of their child's sociocommunicative skills. Objective. This review aims to systematically examine (1) the use of parent training interventions for children with ASD under three years of age and (2) their effects on children's development, parents' well-being and parent-child interactions. Methods. Systematic searches were conducted to retrieve studies in which at least one parent was trained to implement ASD-specific techniques with their toddlers (0-36 months old) with a diagnosis of or suspected ASD. Results. Fifteen studies, involving 484 children (mean age: 23.26 months), were included in this review. Only two of them met criteria for conclusive evidence. Results show that parents were able to implement newly learned strategies and were generally very satisfied with parent training programs. However, findings pertaining to the children's communication and socioemotional skills, parent-child interactions, and parental well-being were inconclusive.
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