Autism Signs May Be Missed in Short Checkups

By Tara Haelle

HealthDay Reporter

MONDAY, Jan. 12, 2015 (HealthDay News) -- The 10 to 20 minutes of a typical well-child visit isn't enough time to reliably detect a young child's risk of autism, a new study suggests.

"When decisions about autism referral are made based on brief observations alone, there is a substantial risk that even experts may miss a large percentage of children who need a referral for further evaluation," said lead study author Terisa Gabrielsen. She conducted the study while at the University of Utah but is now an assistant professor in the department of counseling, psychology and special education at Brigham Young University in Provo, Utah.

"In this study, the children with autism spectrum disorder were missed because they exhibited typical behavior much of the time during short video segments," explained one expert, Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center of New York.

"Video clips without clinical context are not sufficient to make a diagnosis -- just like the presence of a fever and cough doesn't mean a child has pneumonia," said Adesman.

In the study, Gabrielsen's team videotaped two 10-minute segments of children, aged 15 months to 33 months, while they underwent three assessments for autism, including the "gold standard" test known as the Autism Diagnostic Observation Schedule.

The 42 children included 14 already diagnosed with early signs of an autism spectrum disorder, 14 without autism but with suspected language delays and 14 who were typically developing.

The researchers then showed the videos to two psychologists who specialized in autism spectrum disorders. These experts rated typical and atypical behaviors observed, and determined whether they would refer that child for an autism evaluation.

About 11 percent of the autistic children's video clips showed atypical behavior, compared to 2 percent of the typically developing children's video clips. But that meant 89 percent of the behavior seen among the children with autism was noted as typical, the study authors noted.

"With only a few atypical behaviors, and many more typical behaviors observed, we suspect that the predominance of typical behavior [in a short visit] may be influencing referral decisions, even when atypical behavior is present," Gabrielsen said.

When the autism experts picked out who they thought should be referred for an autism assessment, they missed 39 percent of the children with autism, the researchers found.

"We were surprised to find that even children with autism were showing predominantly typical behavior during brief observations," Gabrielsen said. "A brief observation doesn't allow for multiple occurrences of infrequent atypical behavior to become evident amidst all the typical behavior."

The findings, published online Jan. 12 in the journal Pediatrics, were less surprising to pediatric neuropsychologist Leandra Berry, associate director of clinical services for the Autism Center at Texas Children's Hospital.

"This is an interesting study that provides an important reminder of how difficult it can be to identify autism, particularly in very young children," Berry said. "While informative, these findings are not particularly surprising, particularly to autism specialists who have in-depth knowledge of autism symptoms and how symptoms may be present or absent, or more severe or milder, in different children and at different ages."

The observations in this study also differ from what a clinician might pick up during an in-person visit, Adesman suggested.

"It is important that information be gained from the child's parents and other caregivers," Adesman said. "Questions should ask about social engagement, verbal and non-verbal communication, interactions with the environment (especially toys) and behavior in general."

Gabrielsen agreed, adding that a thorough autism diagnosis requires a team.

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