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Top Stories in Family Medicine April 30, 2019 (4 of 4)


Autism spectrum disorders (ASD) can be accurately diagnosed in children under the age of 14 months, potentially allowing earlier treatment, researchers from the University of California report in San Diego in the paper online today JAMA Pediatrics.

"Because we have shown the diagnosis is quite stable, ranging from 14 months, pediatricians should start screen in this age. Even if our results showed that the diagnosis is less stable for 12 months, our research shows that there is a benefit for screening, even young as 12 months, "said Reuters Health by e-mail the first author of the study, Dr. Karen Pierce, co-director of autism center at UCSD.

Dr. Matthew Siegel, director of developmental disorder behavioral health programs Maine in South Portland, said it was "very important and well done," the study shows that expert diagnostic assessments conducted in children aged 14 months makes "pretty stable," the ASD diagnoses.

"The study also underlines the huge challenge for the region, since it suggests that we need to perform a reliable screening at 12 months later, and then quickly get the baby, who screened positive for expert ASD diagnostic evaluation," said Dr. Siegel, who not involved in the study.

The American Academy of Pediatrics (AAP) currently recommends to start screening for ASD at 18 months, but most children in the United States nya nya diagnosed until the age of 3 to 4.

UCSD team studied the reliability of earlier ASD diagnoses in a study involving 1,269 toddlers (72% men, 441 ASD, 828 without ASD), which received its first diagnostic assessment for ASD from 12 to 36 months, and at least one track evaluation. Diagnoses Var & # 39; Irawan by ASD ASD and features of language and developmental delays or other issues of development. Overall diagnostic stability for ASD was 0.84, which is higher than any other diagnostic group.

Only seven toddlers (1.8%) was originally supposed to have ASD moved into a definitive diagnosis of a typical development. In the group diagnosed with ASD, it was the most common transition of ASD to ASD functions (9%). ASD Diagnostic stability was poor from 12 to 13 months (0.50), but increased to 0.79 at 14 months 0.83 at 16 months.

A total of 105 infants were identified as having an ASD during their first visit, but were determined at a later visit. "Our research shows that 24% of children who eventually received a diagnosis of ASD at the age of 3 years have been" missed "(that is, not identified as ASD), if a licensed psychologist did a diagnostic assessment, instead of the children were defined as having only a slight language delay or a global delay, but not ASD, »said Dr. Pearse Reuters Health.

"Because so many children were missed, which means that pediatricians must escape several times between the ages of 12-36 months Mainly 3 times 14, 18 and 24 months. Thus, we can hope that no children are missed ,. "said Dr. Pierce.

She added: "While many scientists believe that very early treatment (ie start between 14-16 months) will stand the best chance to significantly improve symptoms of ASD, now, in the long-term effects of early treatment is unknown. Because our research has shown that we now have the ability to accurately identify and diagnose around the first birthday, we can carry out a study to determine if the treatment is started about 14-16 months has more impact than the treatment started later in life. "

The human brain is experiencing "an unprecedented period of growth during the first 36 months of life. For example, the number of synapses twice [the] frontal cortex. If treatment is started within this important critical period, we have the best chance of reversing the potentially key ASD symptoms at all in some children, "Dr. Pierce said.

Dr. Siegel said the findings in this study, the current "a huge public health problem as not all pediatricians screening series, and certainly not before the age of 12 months, and waiting lists for diagnostic clinics are often very long."

"The current recommendation for the AAP screening for 18 months, which in this study, and others, involves too late. This study adds fuel to the burning need to develop more effective, practical and reliable means of screening and diagnosis of children with autism spectrum disorders in the early, early childhood so that they can take full advantage of available treatments. At this age, every month counts on the development of the brain, "said Dr. Siegel.

"There's a & # 39 are a study using technology, such as an iPhone app and video coding algorithms, to enroll the child and the screen for autism symptoms, which may help control age identification before, but these programs are in the early stages and wait for checks and replication" , said Dr. Siegel.

The study was supported by grants from the Novo Nordisk Foundation, the National Institute of Mental Health and the National Fund for autism research. The authors declared no conflicts of interest are not relevant.

-Megan Brooks

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