Issues in Early Diagnosis and Intervention with Young Children with Autism

Abstract

In the past few years, the reported incidence of autism has increased at a remarkably high rate across the world. There are at least two reasons for this: broader boundaries of the definition, including high functioning persons with autism (and Asperger’s syndrome) and the diagnosis of very young children (Filipek et al., 1999; Stone et al., 1999). These two trends have increased the numbers from the historical 4–5 per 10,000 to as high as 1 per 200 (depending on how loosely the criteria are applied). This dramatic explosion in the number of diagnoses may be attributable to more knowledge of the parameters, better trained clinicians, a broader definition of the condition, an actual increase in affected cases, and possibly false-positives diagnoses. Nonetheless, the practical reality is that this disorder and its variants have shifted from a low-incidence problem to a significant diagnostic and treatment challenge to the wide professional community. This rise is especially noted in the area of early intervention, which has become both a fertile ground for the development of innovative and effective techniques (Dawson & Osterling, 1997; Harris & Handleman, 1994; Hurth, Shaw, Izeman, Whaley, & Rogers, 1999) and a battleground for controversial claims and disputes (Gresham & MacMillan, 1998; see Schopler, Chapter 2, this volume). Although it is not exactly clear what differentiates effective from ineffective early intervention, there is little doubt that providing education and treatment to very young children can have a very positive effect on their future development and prognosis (Rogers, 1996). There is consensus that early intervention should target those areas of weakness (social, communicative, cognitive) that form the constellation of characteristics of autism (Dawson & Osterling, 1997). It appears equally true that although there are many programs and approaches that report good outcomes, no comparative studies exist, so that at this stage in our knowledge it would be premature and unwise to consider any one method a treatment