Early Identification of Autism Spectrum Disorder: Recommendations for Practice and Research

Lonnie Zwaigenbaum¹, Margaret L Bauman², Wendy L Stone³, Nurit Yirmiya⁴, Annette Estes⁵, Robin L Hansen⁶, James C McPartland⁷, Marvin R Natowicz⁸, Roula Choueiri⁹, Deborah Fein¹⁰, Connie Kasari¹¹, Karen Pierce¹², Timothy Buie¹³, Alice Carter¹⁴, Patricia A Davis¹⁵, Doreen Granpeesheh¹⁶, Zoe Mailloux¹⁷, Craig Newschaffer¹⁸, Diana Robins¹⁸, Susanne Smith Roley¹⁹, Sheldon Wagner²⁰, Amy Wetherby²¹

Affiliations

¹ Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; lonniez@ualberta.ca.
² Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts;
³ Departments of Psychology and.
⁴ Department of Psychology, Hebrew University of Jerusalem Mount Scopus, Jerusalem, Israel;
⁵ Speech and Hearing Sciences, University of Washington, Seattle, Washington;
⁶ Department of Pediatrics, University of California Davis MIND Institute, Sacramento, California;
⁷ Yale Child Study Center, New Haven, Connecticut;
⁸ Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio;
⁹ Division of Developmental and Behavioral Pediatrics, University of Massachusetts Memorial Children's Medical Center, Worcester, Massachusetts;
¹⁰ Department of Psychology, University of Connecticut, Storrs, Connecticut;
¹¹ Graduate School of Education & Information Studies, University of California Los Angeles, Los Angeles, California;
¹² Department of Neurosciences, University of California San Diego, La Jolla, California;
¹³ Harvard Medical School and Massachusetts General Hospital for Children, Boston, Massachusetts;
¹⁴ Department of Psychology, University of Massachusetts, Boston, Massachusetts;
¹⁵ Integrated Center for Child Development, Newton, Massachusetts;
¹⁶ Center for Autism and Related Disorders, Tarzana, California;
¹⁷ Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania;
¹⁸ A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania;
¹⁹ USC Mrs T.H. Chan Division of Occupational Science and Occupational Therapy, Los Angeles, California;
²⁰ Behavioral Development & Educational Services, New Bedford, Massachusetts; and.
²¹ Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida.

PMID: 26430168
PMCID: PMC9923897
DOI: 10.1542/peds.2014-3667C

Practice Guideline

Early Identification of Autism Spectrum Disorder: Recommendations for Practice and Research

Lonnie Zwaigenbaum et al. Pediatrics. 2015 Oct.

. 2015 Oct;136 Suppl 1(Suppl 1):S10-40.

doi: 10.1542/peds.2014-3667C.

Authors

Affiliations

¹ Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; lonniez@ualberta.ca.
² Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts;
³ Departments of Psychology and.
⁴ Department of Psychology, Hebrew University of Jerusalem Mount Scopus, Jerusalem, Israel;
⁵ Speech and Hearing Sciences, University of Washington, Seattle, Washington;
⁶ Department of Pediatrics, University of California Davis MIND Institute, Sacramento, California;
⁷ Yale Child Study Center, New Haven, Connecticut;
⁸ Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio;
⁹ Division of Developmental and Behavioral Pediatrics, University of Massachusetts Memorial Children's Medical Center, Worcester, Massachusetts;
¹⁰ Department of Psychology, University of Connecticut, Storrs, Connecticut;
¹¹ Graduate School of Education & Information Studies, University of California Los Angeles, Los Angeles, California;
¹² Department of Neurosciences, University of California San Diego, La Jolla, California;
¹³ Harvard Medical School and Massachusetts General Hospital for Children, Boston, Massachusetts;
¹⁴ Department of Psychology, University of Massachusetts, Boston, Massachusetts;
¹⁵ Integrated Center for Child Development, Newton, Massachusetts;
¹⁶ Center for Autism and Related Disorders, Tarzana, California;
¹⁷ Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania;
¹⁸ A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania;
¹⁹ USC Mrs T.H. Chan Division of Occupational Science and Occupational Therapy, Los Angeles, California;
²⁰ Behavioral Development & Educational Services, New Bedford, Massachusetts; and.
²¹ Department of Clinical Sciences, Florida State University College of Medicine, Tallahassee, Florida.

PMID: 26430168
PMCID: PMC9923897
DOI: 10.1542/peds.2014-3667C

Abstract

Early identification of autism spectrum disorder (ASD) is essential to ensure that children can access specialized evidence-based interventions that can help to optimize long-term outcomes. Early identification also helps shorten the stressful "diagnostic odyssey" that many families experience before diagnosis. There have been important advances in research into the early development of ASDs, incorporating prospective designs and new technologies aimed at more precisely delineating the early emergence of ASD. Thus, an updated review of the state of the science of early identification of ASD was needed to inform best practice. These issues were the focus of a multidisciplinary panel of clinical practitioners and researchers who completed a literature review and reached consensus on current evidence addressing the question "What are the earliest signs and symptoms of ASD in children aged ≤24 months that can be used for early identification?" Summary statements address current knowledge on early signs of ASD, potential contributions and limitations of prospective research with high-risk infants, and priorities for promoting the incorporation of this knowledge into clinical practice and future research.

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Conflict of interest statement

FINANCIAL DISCLOSURE: Dr Zwaigenbaum was the site Principal Investigator of a study sponsored by SynapDx (he received operating funds but no honoraria). Drs Fein and Robins are co-owners of M-CHAT, LLC, which licenses use of the Modified Checklist for Autism in Toddlers in electronic products. Dr Stone is the author of the Screening Tool for Autism in Two-Year-Olds and receives a share of royalties from sales of this instrument. The authors received an honorarium as well as travel expenses from Autism Forum for contributing to the expert panels.

References

1. Myers SM , Johnson CP American Academy of Pediatrics Council on Children With Disabilities . Management of children with autism spectrum disorders. Pediatrics. 2007;120(5):1162–1182 - PubMed
1. Daniels AM , Mandell DS . Explaining differences in age at autism spectrum disorder diagnosis: a critical review. Autism. 2014;18(5):583–597 - PMC - PubMed
1. Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators. Centers for Disease Control and Prevention (CDC) . Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2010. MMWR Surveill Summ. 2014;63(2):1–21 - PubMed
1. Fountain C , King MD , Bearman PS . Age of diagnosis for autism: individual and community factors across 10 birth cohorts. J Epidemiol Community Health. 2011;65(6):503–510 - PMC - PubMed
1. Mandell DS , Morales KH , Xie M , Lawer LJ , Stahmer AC , Marcus SC . Age of diagnosis among Medicaid-enrolled children with autism, 2001-2004. Psychiatr Serv. 2010;61(8):822–829 - PMC - PubMed

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Early Identification of Autism Spectrum Disorder: Recommendations for Practice and Research

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Early Identification of Autism Spectrum Disorder: Recommendations for Practice and Research

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