![]() Identifying a child as having an ASD diagnosis in the first or second year of life can be challenging, as development during the first years of life progresses at a rapid and sometimes uneven pace across developmental domains. Stability of Diagnosis in the Second Year of Life 2008 Wetherby and Woods 2008 Zwaigenbaum et al. 2004), as well as very successful educational campaigns by the US Center for Disease Control and parent organizations such as Autism Speaks, the number of children under the age of 3 years undergoing comprehensive diagnostic evaluations and entering early intervention programs in the US has increased considerably in the past decade ( Chawarska et al. 2009), development of early screening instruments (e.g., Robins et al. However, due to increasing awareness of early symptoms of autism amongst parents ( Chawarska et al. ![]() 2001), and limited availability of specialized diagnostic services for children under the age of 3 years. 2003), limited parental awareness of symptoms of ASD or delayed action by pediatricians after initial concerns are voiced by parents (e.g., Shevell et al. These delays can be due to a number of factors, including inadequate screening practices (e.g., Dearlove and Kearney 1990 Sices et al. 2007), parents report that the time between their first concerns and their child’s ASD diagnosis was, on average, 1.7 years for autism, 2.1 years for PDD-NOS, and 4.6 years for a diagnosis of Asperger’s Syndrome, with the average age at first diagnosis around 3.2, 3.7, and 7.2 years for Autism, PDD-NOS, and Asperger’s Syndrome respectively ( IAN 2010). 2003 De Giacomo and Fombonne 1998 Volkmar et al. While most parents report having concerns about their children in the first or second year of life ( Baghdadli et al. Thus, this paper translates research on early ASD symptomatology into a practical guide for psychologists, child psychiatrists, developmental pediatricians, and other practitioners faced with the growing need to provide differential diagnoses for very young children presenting with concerns for autism.ĭespite advances in early identification, diagnosis of ASD is often delayed until early preschool age. The complexity that these factors introduce can be especially challenging for clinicians who, until now, have not been called upon to make early diagnoses. In this case, it can also be difficult to ascertain how behaviors that are often associated with cognitive disability, such as repetitive behaviors, contribute to the diagnostic formulation. 2009), making it challenging to assess how much the child’s social disability may exceed delays in other domains. Symptoms of ASD often present in the context of marked developmental delays ( Akshoomoff 2006 Chawarska et al. Because the eventual severity of the disorder is as yet unknown at these early ages, it is common for clinicians to refer to the emerging disorder as ASD (indicating the presence of a clinically significant disorder on the autism spectrum) rather than by the current diagnostic labels of Autistic Disorder, Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), or Asperger’s Disorder. Rather than observing the full-blown disorder, the clinician is often observing the unfolding symptoms of social and communicative dysfunction. However, diagnosis of very young children can be quite complex, as the presentation of children in the first 2 years of life can vary from that of an older child with autism. Research now suggests that the diagnosis of autism spectrum disorders (ASD) can be reliably made in the second year of life, and these early diagnoses appear to be relatively stable over time ( Chawarska et al.
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