With autism spectrum disorder, the key is to detect and treat early.
“Access to early intervention services prior to the age of three is really addressing those issues with the child when they are most malleable and they are most able to make really great strides and progress,” said Michal Cook, a social worker at the Autism Clinical Center in the Division of Child and Adolescent Psychiatry at Washington University School of Medicine.
Autism spectrum disorder describes developmental disabilities caused by brain abnormalities, which manifest as problems with communication, social development and interaction and repetitive behavior, according to the Centers for Disease Control and Prevention. It occurs in all socioeconomic and racial groups and in boys four times as often as in girls.
Autism may cause people to communicate, interact, behave and learn in ways that are different from most people. Impairment is life-long and can be mild to severe. Additionally, many people with autism have sensory sensitivities, such as gastrointestinal disorders, seizures or sleep disorders, as well as mental health challenges, such as anxiety depression and attention issues, according to Autism Speaks.
An early clue involves the child’s language development. Cook said to pay attention if a child is delayed or regressing in speech. Cook said by 18 months of age, children should have six words, moving up to two-word phrases by two years of age.
In the U.S., most children are diagnosed by age 4, although autism can be diagnosed at age 2. However, African-American children tend to get diagnosed with autism later, when they are already in school. Anna Abbacchi, a clinical research specialist in Social Developmental Studies at Washington University’s Child and Adolescent Psychiatry, said while parents express concerns about their children at about the same time, “African American children experience significant lags in timing between first parental concern and the age at which they receive a diagnosis for autism.”
Why?
“African-American children have higher rates of misdiagnosis,” Abbacchi said. “African-American children are more likely to receive a diagnosis of another condition, such as conduct disorder, adjustment disorder.”
She also said African-American children are less likely to get diagnosed on their first visit to a physician compared to Caucasian children. “They may require multiple visits to physicians before receiving that diagnosis – and that’s problematic,” Abbacchi said.
Upon diagnosis, Abbacchi said the most recent national data, monitored by the CDC, show that African-American children have higher rates of a co-occurring diagnosis.
“African American children are twice as likely to have co-occurring diagnosis of autism and intellectual disabilities (formerly called mental retardation),” Abbacchi said. African-American children have approximately 44 percent rate of co-occurring diagnosis and Caucasian children have approximately 22 percent.
She said children with co-occurring diagnoses need more intensive services.
Maggie Nygren, executive director of the American Association on Intellectual and Developmental Disabilities, said there are three criteria involved in making a diagnosis for intellectual disability: substantial limitations in intellectual functioning and in adaptive behavior, with both apparent during the developmental period before the age of 18.
Nygren said identifying autism and intellectual disability requires a skilled clinician who understands both conditions to make a good diagnosis.
“When black children are diagnosed with intellectual disability or autism in comparison to their white peers, they tend to be diagnosed with more severe forms of the conditions,” Nygren said. “Children who are black are overrepresented in special education compared to their peers who are white or Hispanic or Asian.”
Nygren said now researchers have to find out why.
For more information about early intervention in autism spectrum disorder, call Missouri First Steps at 866-583-2392 or visit https:mofirststeps.com.
Track the CDC’s developmental milestones for a child by age at http://tinyurl.com/jl6vdhs.
