Detecting, studying, and treating autism early: the one-year well-baby check-up approach

Abstract

Objectives: To determine the feasibility of implementing a broadband screen at the 1-year check-up to detect cases of autism spectrum disorders (ASD), language delay (LD), and developmental delay (DD).

Study design: The Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist was distributed at every 1-year pediatric check-up; 137 pediatricians and 225 infants participated. Screens were scored immediately, and failures referred for further evaluation.

Results: Pediatricians screened 10 479 infants at the 1-year check-up; 184 infants who failed the screen were evaluated and tracked. To date, 32 infants received a provisional or final diagnosis of ASD, 56 of LD, nine of DD, and 36 of "other." Five infants who initially tested positive for ASD no longer met criteria at follow-up. The remainder of the sample was false positive results. Positive predictive value was estimated to be .75.

Conclusions: The 1-Year Well-Baby Check-Up Approach shows promise as a simple mechanism to detect cases of ASD, LD, and DD at 1 year. This procedure offers an alternative to the baby sibling design as a mechanism to study autism prospectively, the results of which will enrich our understanding of autism at an early age.

Figure 1

Sample treatment inventory form.

Figure 1

Sample treatment inventory form.

Figure 2

Flow chart of study design and participation.

Figure 3

Scatter plot illustrating the distribution of CSBS-DP-IT-Checklist total scores normalized as the number of points an infant failed or passed by. Available data are presented as # of points failed or passed by rather than total raw score due to different cut off scores for different ages (eg, total test cut off score is 27 at 12 months, but 28 at 13 months). Note that an infant can fail the CSBS-DP-IT-Checklist in one of three ways: by falling into the “range of concern” on the social subsection, the symbolic subsection, or the overall test score. Given this, an infant can “pass” the overall test but still be considered in the concern range due to the failure of a single subsection. In the current sample this was the case with 17 toddlers who passed the overall test, but were referred for evaluation due to a failure on one of the subsection scores.

Figure 4

A, Age that a toddler was referred for treatment in each diagnostic group in comparison to the age that treatment actually began. As illustrated, toddlers from all groups were referred for treatment at an average age of 17 months and began treatment around age 20 months or younger. B, Quantity of treatment received for each diagnostic group.