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Importance of Early Diagnosis and Intervention



The First Years Last Forever

A child's first smile, first steps, first words. Grasping a spoon. Babies turning their head in recognition of a mother's voice. Calling "mama" and "papa" for the first time. What do these things have in common? All of them are examples of a young child's developmental "steps" forward. Perhaps no aspect of child development is as miraculous and transformative as the development of a child's brain.

Brain development allows a child to develop the abilities to crawl, speak, eat, laugh and walk. Healthy development of a child's brain is built on the small moments that parents and caregivers experience as they interact with a child. The everyday moments, the simple loving encounters, provide essential nourishment to child's brain.

Some facts about the normal development of human brain in the childhood period are:

  • Most of the brain's cells are formed before birth, but most of the connections among cells are made during infancy and early childhood.
  • Early experience and interaction with the environment are most critical in a child's brain development.
  • A 3-year-old toddler's brain is twice as active as an adult's brain.
  • Talking to young children establishes foundations for learning language during early critical periods when learning is easiest for a child.
  • What children need most is - loving care and new experiences, not special attention or costly toys.
  • Talking, singing, playing and reading are some of the key activities that build a child's brain.

During early life, the brain circuitry that supports social and language behaviour is rapidly developing and shaped by our experiences. One of the first autism symptoms to emerge during infancy is a lack of attention to other faces of other people, emotions, gestures, and speech. The infant with autism, who is not paying attention to other people, does not have the learning opportunities that are afforded through social interaction to promote and shape the development of social brain circuitry.

Thus, it is very important that all the kids irrespective of being neuro-typical or not, need learning opportunities for social, language, emotional, cognitive and play development. The neuro-typical children are able to create these opportunities themselves, but our children whose brain develop in a different way need help from us to guide and direct them and create opportunities for them.

If we observe the symptoms of autism in the early childhood, we should start an early intervention program to draw the infant's attention to others and engage them in pleasurable interactions, thereby increasing the opportunities for learning and a more normal trajectory of brain development.


Parent's Role in Early Detection

As a parent, you're in the best position to spot the earliest warning signs of autism. You know your child better than anyone. You can observe behaviours and quirks that a paediatrician, in a quick fifteen-minute visit, might not have the chance to see. Your child's paediatrician can be a valuable partner, but don't discount the importance of your own observations and experience. The key is to educate yourself so you know what's normal and what's not.

Monitor your child's development - Autism involves a variety of developmental delays, so keep a close watch on child's development checklist. Keeping a close eye on when-or if-your child is hitting the key social, emotional, and cognitive milestones is an effective way to spot the problem early on. While developmental delays don't automatically point to autism, they may indicate a heightened risk.

Take action if you're concerned - Every child develops at a different pace so you don't need to panic if your child is a little late to talk or walk. When it comes to healthy development, there's a wide range of "normal". But if your child is not meeting the milestones for his or her age, or you suspect a problem, share your concerns with your child's doctor immediately. Don't wait.

Don't accept a wait-and-see approach - Many concerned parents are told, "Don't worry" or "Wait and see". But waiting is the worst thing you can do. You risk losing valuable time at an age where your child has the best chance for improvement. Furthermore, whether the delay is caused by autism or some other factor, developmentally delayed kids are unlikely to simply "grow out" of their problems. In order to develop skills in an area of delay, your child needs extra help and targeted treatment.

Trust your instincts - Ideally, your child's doctor will take your concerns seriously and perform a thorough evaluation for autism or other developmental delays. But sometimes, even well-meaning doctors miss red flags or underestimate problems. Listen to your gut if it's telling you something is wrong and be persistent.

Schedule a follow-up appointment with the doctor, seek a second opinion, or ask for a referral to a child development specialist.

Be Proactive and bring a difference to your child's life - The autism symptoms that are apparent before 6 months of age are typically subtle and difficult to detect. Most children meet their major motor milestones, such as sitting and walking. Many infants who develop autism, however, begin to show symptoms between 6 and 12 months.

Early symptoms include a lack of eye contact and communicative babbling and not responding when the child's name is called. Some symptoms, such as delays in use of words and gestures, lack of imaginary play, and poor peer relationships, are not apparent until 18 to 24 months, when such skills are typically acquired. Thus, you lose a lot of time if you miss noticing your child's missing milestones.

Regression of any kind is a serious autism warning sign - Some children with autism spectrum disorders start to develop communication skills and then regress, usually between 12 and 24 months. For example, a child who was communicating with words such as "mommy" or "up" may stop using language entirely, or a child may stop playing social games he or she used to enjoy such as peek-a-boo or waving "bye-bye". Any loss of speech, babbling, gestures or social skills should be taken very seriously, as regression is a major red flag for autism.


Importance of Early Intervention

How early the intervention should start?

Intervention should start as early as possible. When parents begin to notice their child is not developing as expected and they voice these concerns, a common response is "They'll grow out of it, just wait". Unfortunately, the longer you wait the more difficulty you and your child may have. If you are concerned about your child's development, their communication, social skills or behaviours, then you should begin seeking information and assistance as soon as you can.

Intervention should be started as early as the problems are identified. Early the intervention begins, it's more likely for the child to learn the skills needed to communicate, engage in social interactions and manage their behaviour.

If you're still waiting for an official diagnosis, you shouldn't be waiting to start intervention. If you think there is something that needs to be addressed, get the information, services and training you need to address it.

Why start intervention so early?

Research shows that children who receive intensive early intervention services are more likely to have improved long-term outcomes. These services can maximize their learning potential by addressing communication, play, problem behaviours and overall skill development from a very early age. We know, through extensive brain research, that neural plasticity (the brains ability to learn new skills) decreases with age. When children are very young their neural plasticity is high, but as they get older it decreases. When this plasticity decrease, it becomes more difficult to learn new skills.

This is not to say that individuals with autism are not able to learn skills if intervention is not started by a certain age. Their brains, just like everyone else's, are capable of learning and using new skills and information at any time. Behaviourally speaking, however, as we all age and grow the skills we have learned which are effective and efficient will be more difficult to change due to a longer history of reinforcement. So the earlier we intervene to address an individual's difficulties with communication, social interactions and problem behaviours the more likely we are to elicit quick and positive change.

This quote from the book "Overcoming Autism" by Lynn Koegel and Claire LaZebnik best reiterates this point:

"I can't stress strongly enough the importance of diving into action immediately. Every expert in the field agrees that early intervention is essential and critical. The "wait and see" approach is detrimental to your child. Children with autism tend to avoid things that are difficult, and communication is difficult for them, so they avoid situations where they might be expected to communicate. As a result, they become more isolated and withdrawn. So it's critical that you get a program started right way."

How much intervention should the child receive?

Research suggests that children should receive 25-40 hours of intensive early intervention per week. While this may seem like an extraordinary amount of time for a child, this intensity of intervention has been shown to be the most effective in addressing the needs of children. Intervention hours may be provided by ABA therapists, speech therapists, occupational therapists, parents or other family members (after receiving training on intervention implementation) or other service providers. In an ideal situation, intervention procedures should be implemented throughout the day, across settings and across people with whom the child interacts. This intensity and consistency of intervention can help catapult a child to success.

What are the goals of early intervention?

The basic goals that should be addressed with early intervention are child engagement, independence, functional spontaneous communication, cognitive skill development, social competence, play skill development, generalization of skills, and proactive approaches to problem behaviour. The specific goals for intervention will be based on the child's chronological age, developmental level, specific strengths and weaknesses, and the needs or priorities of their family.


How to get the Diagnosis

Once you have noticed a few of the early signs of any developmental delay or disorder then without wasting any time the parents should seek out a medical diagnosis.

Diagnostic tests and other clinical evaluations help to determine the nature, scope, and intensity of each child's unique abilities and deficits. This section will explore the types of diagnostic testing recommended for children with autism spectrum disorders.

The road to an autism diagnosis can be difficult and time-consuming. In fact, it is often 2 to 3 years after the first symptoms of autism are recognized before an official diagnosis is made. This is due in large part to concerns about labelling or incorrectly diagnosing the child. However, an autism diagnosis can also be delayed if the doctor doesn't take a parent's concerns seriously or if the family isn't referred to health care professionals who specialize in developmental disorders.

If you are worried that your child has autism, it's important to seek out a medical diagnosis.

But don't wait for that diagnosis to get your child into treatment.

Early intervention during the preschool years will improve your child's chances for overcoming his or her developmental delays. So look into treatment options and try not to worry if you're still waiting on a definitive diagnosis.

Putting a potential label on your kid's problem is far outweighed by the need to treat the symptoms.

Although educators, parents, and other health care professionals identify signs and symptoms characteristic of autism, a clinician experienced in the diagnosis and treatment of autism is usually necessary for accurate and appropriate diagnosis. Diagnostic testing for Autism Spectrum disorders is not a one-time procedure; it is a complex process.

There is no single medical test that can diagnose it definitively instead, in order to accurately pinpoint your child's problem, multiple evaluations and tests are necessary.

The team of specialists involved in diagnosing ASD include:

  • Audiologists
  • Child Psychologists
  • Child Psychiatrists
  • Developmental Paediatricians
  • Occupational Therapists
  • Paediatric Neurologists
  • Speech Pathologists
  • Special Education Teachers

The diagnosis of an ASD needs the following types of evaluations:

Parent Interview

In the first phase of the diagnostic evaluation, you will give your doctor background information about your child's medical, developmental, and behavioural history. The doctor will also want to know about your family's medical and mental health history.

Hearing Test

Since hearing problems can result in social and language delays, they need to be excluded before an autism spectrum disorder can be diagnosed. Your child will undergo a formal audio logical assessment where he or she is tested for any hearing impairments, as well as any other hearing issues or sound sensitivities that sometimes co-occur with autism.

Observation

Developmental specialists will observe your child in a variety of settings to look for unusual behaviour associated with the autism spectrum disorders. They may watch your child playing or interacting with other people.

Medical Examination

The medical evaluation includes a general physical, a neurological exam (e.g. EEG and MRI), lab tests, and genetic testing. Your child will undergo this full screening to determine the cause of his or her developmental problems and to identify any co-existing conditions. The diagnostic assessment also includes speech, intelligence, social, sensory processing, and motor skills testing. These tests can be helpful not only in diagnosing autism, but also for determining what type of treatment your child needs:

Speech and Language Evaluation

A speech pathologist will evaluate your child's speech and communication abilities for signs of autism, as well as looking for any indicators of specific language impairments or disorders.

Cognitive Testing

Your child may be given a standardized intelligence test or an informal cognitive assessment. Cognitive testing can help differentiate autism from other disabilities.

Adaptive Functioning Assessment

Your child may be evaluated for their ability to function, problem-solve, and adapt in real life situations. This may include testing social, nonverbal, and verbal skills, as well as the ability to perform daily tasks such as dressing and feeding him or herself.

Sensory-motor and Occupational Therapy Evaluation

Since sensory integration dysfunction often co-occurs with autism, and can even be confused with it, a physical therapist or occupational therapist may assess your child's fine-motor, gross-motor, and sensory processing skills.

Neuropsychological, Behavioural, and Academic Assessments

These assessments may be performed by a psychologist or other experienced clinician. A child's behaviour, cognitive abilities, and social skills are core elements of these evaluations. An assessment of family resources is also important in order to determine if additional supports or resources may be needed.


References

[1] Autism Symptoms and Early Signs. Authors: Melinda Smith, M.A., Jeanne Segal, Ph.D., and Ted Hutman, Ph.D (UCLA Center for Autism Research & Treatment). Website: www.helpguide.org

[2] www.autism-community.com

[2] www.autismspeaks.org