Recognition of Autism Before Age 2 Years

Abstract

1. Chris Plauche Johnson, MEd, MD* 1. *Editorial Board After completing this article, readers should be able to: 1. Characterize the deficits of a child who has autism. 2. Describe the role of observing linguistic and social development in children who have autism. 3. Implement a strategy for surveillance and screening of young children. 4. Discuss the management of autism, including the use of medication. Primary care physicians (PCPs) caring for 1,000 children in a general practice should expect approximately six of their patients to meet the diagnosis of an autism spectrum disorder (ASD). (1) The impact of this prevalence is illustrated by a 2004 survey of PCPs revealing that 44% cared for 10 or more patients who had an ASD. (2) The ASDs include: autistic disorder (AD), Asperger disorder, and pervasive developmental disorder—not otherwise specified (PDD-NOS), a threshold term used when a child meets some but not all criteria necessary for a diagnosis of either AD or Asperger disorder. Research has documented the positive benefit of developmental and behavioral intervention for children who have ASDs, particularly when it is initiated prior to 3 years of age. (3) Early recognition of ASDs also is important for timely genetic counseling because younger siblings of children diagnosed as having ASDs have a 10 times increased risk of also having an ASD. The purpose of this review is to help the clinician recognize signs of ASDs that occur before age 2 years. Because the signs of Asperger disorder usually appear later, they are not discussed. The term “autism” is used in this review to represent both AD and its milder form, PDD-NOS. Currently, autism is diagnosed infrequently in children younger than 3 years of age. The diagnostic process is prompted most often by parental concern about absent or delayed speech. However, signs of autism, especially deficits in social skills and in preverbal gestural language, are present …