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Early identification of Autism Spectrum Disorders

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Can autism and ASD be reliably diagnosed at age 2? ... Of children who had a diagnosis of autism at 2. 84% had autism diagnoses at 9 ... – PowerPoint PPT presentation

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Title: Early identification of Autism Spectrum Disorders


1
Early identification of Autism Spectrum Disorders
  • Catherine Lord
  • University of Michigan Autism and Communication
    Disorders Center (UMACC)

2
Collaborators
  • Pamela C. DiLavore
  • Susan Risi
  • Cory Shulman
  • Audrey Thurm
  • Families and children in the Early Diagnosis
    project
  • Deborah Anderson
  • Rosalind Oti
  • Michael Rutter
  • Andrew Pickles
  • Rebecca Niehus
  • Rhiannon Luyster

3
Can autism and ASD be reliably diagnosed at age 2?
4
Is there a reason to distinguish narrowly defined
autism from more broadly defined ASD in young
children?
5
What are the trajectories associated with early
development in ASD?
6
Autism as a developmental disorderWhat is
manifested as autism changes with
developmentDevelopment is affected by having
autism
7
  • Both positive (abnormal) behaviors, and negative
    (the absence of normal) behaviors are required to
    make a diagnosis of ASD.
  • This means that developmental level and
    contextual effects (in what kind of circumstances
    does the child or adult function?) can both have
    significant effects on diagnostic judgments.

8
Information from earlier studies
  • Conflicting information from treatment versus
    epidemiological/longitudinal studies
  • Empirical studies of preschool children
  • Joint attention response to/initiation
  • Looking at faces gaze
  • Response to name
  • Pretending

9
  • Canadian follow-up study (N 30)
  • Clearest discriminators at age two from parent
    report (ADI)
  • Attention to voice
  • Child spontaneously directing others attention
    (in any way)
  • Understands no words out of context

10
  • Clearest discriminators at age three
  • Attention to voice
  • Pointing to express interest
  • Hand and finger mannerisms
  • Use of others body as a tool
  • Uses no meaningful words spontaneously

11
North Carolina/Chicago Early Diagnosis Study
  • Multiple measures
  • Parent report and direct observations
  • Larger sample
  • Greater diversity

12
Participants with 9 Year-Old Data
s.
13
Can autism and ASD be reliably diagnosed at age 2?
14
Percent of age two diagnostic combinations and
best-estimate judgments accurately predicting
diagnosis at 9
(Age 2 best-estimate autism prevalence based on
N214) Age 9 best-estimate autism prevalence
based on N172
15
Best Estimate Diagnoses at 2 and 9 (NC and
Chicago)
At 9 years
At 2 years
16
Using Best Estimate Diagnoses Overall diagnoses
of autism were very stable from 2-9 Of children
who had a diagnosis of autism at 2 84 had
autism diagnoses at 9 15 had PDD-NOS dx at 9
1 had nonspectrum dx
Of children who had a diagnosis of autism at
9 71 had autism diagnoses at 2 27 had PDD-NOS
dx at 2 2 had nonspectrum dx at 2
17
Is there a reason to distinguish narrowly defined
autism from more broadly defined ASD in young
children?
18
Two Year-old Measures Predicting ASD at 9,
including Best Estimate Diagnosis (est. R2
.63 TPV 92)
19
Two Year-old Measures Predicting ASD at 9,
excluding Best Estimate Diagnosis (est. R2
.52 TPV 89)
20
PDD-NOS as a category was much less stable Of
children with PDD-NOS at 2 61 autism at 9 25
PDD-NOS at 9 14 nonspectrum at 9
Of children with PDD-NOS at 9 39 autism at
2 33 PDD-NOS at 9 27 nonspectrum at 9
21
More diagnostic changes were between 2 and
5. Between 25 21 more severe 13 less
severe 65 same
Between 59 11 more severe 8 less
severe 81 same
22
What are the trajectories associated with early
development in ASD?
23
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Patterns of Change in VIQ From Age 2- to 9-Years
N17
N18
N40
N62
VIQ
N36
N78
N93
Age in Months
Age in Months
28
Patterns of Change in NVIQ From Age 2- to 9-Years
N61
NVIQ
N68
N43
Age in Months
29
Patterns of Change in ADOS Algorithm Totals From
Age 2- to 9-Years

ADOS TOT
N91
N91
N19
N46
N28
N35
N34
Age in Months
Age in Months
30
Mullen Ratio IQ(7/29/05) VIQ 55 NVIQ
95Younger sibling minimal intervention
ADOS Social Scores
ADOS Repetitive Scores
Age (mos)
31
Mullen Ratio IQ(5/26/05) VIQ 112 NVIQ
98Younger sibling intensive intervention
(Verbal Behavior)
ADOS Social Scores
ADOS Repetitive Scores
Age (mos)
32
What would you tell professionals about giving
early diagnoses?
  • At age 9
  • Dont give too much information too soon
  • Dont stress negative prognoses
  • Present all options
  • Provide written information

33
Summary
  • Autism can be reliably diagnosed at 2 years.
  • Diagnoses of milder cases of ASD with less
    clinician certainty were less reliable over time.

34
Conclusions Most diagnostic change occurred
before 5. Most common outcome for children with
PDD-NOS at 2 was autism, but there was great
variation. Little evidence of complete
recovery (1). A significant minority (1 in 6) is
doing quite well.
35
Conclusions (cont)
Considerable improvement in verbal IQs from 2 to
5 and 5 to 9. Repetitive behavior was not
crucial for diagnosis at age 2, but was an
important predictor of diagnosis at 9. Small
differences in development made large differences
in prognosis.
36
Estimates of Expressive Language Level at Age 9
-- Percent of 151 Participants
37
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38
University of Michigan Autism and Communication
Disorders Center (UMACC)
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