Carol Vickers knew there was something wrong. Where other
toddlers babbled and smiled, her 18-month old Anthony
just seemed to look right through her. Then he started
throwing terrible tantrums whenever she tried to dress
him. She took her concerns to her family doctor, but he
assured her that Anthony was just gearing up for the terrible
twos.
Sadly, he was mistaken. Three years
later, Anthony was diagnosed with an autism spectrum
disorder (ASD).
Now, in light of the recent BC
court decision that the provincial government is not
obliged to pay for costly autism therapy for children
beyond the age of six, parents and doctors are eager
to beef up infant diagnosis so they don't miss out on
those crucial early years of treatment.
RECOGNIZING
EARLY SIGNS
According to Dr Vikram Dua, a child and adolescent psychiatrist
at British Columbia's Children's Hospital and the author
of the province's Standards and Guidelines for the Diagnosis
and Assessment
of Young Children with ASD, it's
not unusual for doctors to miss out on the early signs.
"Two recent studies on children with autism found that
almost all of the parents interviewed were concerned
about their child's behaviour by the age of 18 months,"
he explains, but in spite of repeated doctor visits,
the average age of diagnosis was around four-and-a-half.
The trouble is, early detection
can make all the difference. "The research suggests
that there is some brain plasticity," Dr Dua says. "If
we're able to intervene intensively at an early age,
it may result in longterm, permanent improvement."
One of the difficulties doctors
face is a lack of adequate ASD screening tools. "What
we're left with is surveillance — routinely evaluating
children within your practice for developmental progression
in a number of domains." GPs already monitor motor and
cognitive development in infants. To detect autism,
they need to add social and communicative development
into the mix. The BC guidelines include a checklist
of milestones for young children (print a copy by visiting
www.healthservices.gov.bc.ca/cpa/publications/asd_standards_0318.pdf).
"Keep them handy," Dr Dua suggests. "Get a sense of
what a child should be able to do — and if a child's
falling off the curve, that's when you start to become
concerned."
But the most important thing
a doctor can do to detect autism is to listen to parents.
A series of 1990s studies by autism expert Dr Frances
Glascoe, PhD, revealed that parental concerns about
their child's social development have a specificity
and sensitivity of 85 to 90%. As Dr Dua puts it, "That
supercedes any screening instrument."
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