Why Early Detection Is The Key
I went to a full day conference in Melbourne back in April and whilst part of it was a lovely excuse to get some shopping in (who doesn’t want to shop in Melbourne?), I was also interested in the latest research and presentations that would be offered. I now want to take the time to reflect and write about some thoughts that have been swimming around in my head since leaving the conference.
The event was hosted by ABA Today in partnership with the Autism Behavioural Intervention Association. ABA (applied behavioural analysis) therapy being the leading intervention for teaching new skills, improving symptomology and reducing challenging behaviour in young children on the autism spectrum. I will not delve into the specifics of ABA in this blog (maybe save that for another day!) but know that I have been a longtime advocate of ABA. I have been trained in its principals, I have read the research that supports its efficacy and I have used it myself frequently over my years of clinical practice. The conference was divided into streams of home, school and community whereby you could go and listen to short presentations throughout the day. A personal interest of mine has been in the area of early detection and intervention, so this was a stream I followed!
The most important information I added to my knowledge bank, and one I would like to share with families and professionals, is related to early detection. As a diagnostician, I have experience and knowledge in understanding some of the earliest signs of autism. I am also trained in diagnostic tools that are designed to screen for autism in very young children. But one key message that captured my interest was that presented by Cheryl Dissanakye, who is a leading expert in the field. She spoke about their research in America and key findings of early detection. One being that one of the earliest signs of autism in young children (12 months of age!) is a lack of attention to social stimuli. This means that children with autism are not naturally paying attention to social events and stimuli around them from a very young age. Instead they are more focused on objects/stimuli without seeking a social response. As they are not paying attention to social stimuli their brain is then not making the next and very important social connections such as sharing experiences with others through pointing, gaze switching, social smiling, reacting to social events, imitation, eye contact, responding to their name, etc. This then actually affects the way the rest of the brain develops. If these early connections are not happening, the rest of the connections do not happen (like a top-down affect). This is how the brain wiring starts to become more apparently different with time as compared to neuro-typical children. A child with autism does not naturally seek to pay attention to social stimuli early on in development the way a child without autism does naturally seek it.
However, the message was clear – we can intervene in this process. We can implement naturalistic but structured tasks that start to teach our children to pay attention to social stimuli so that they can form those social connections and skills that are not naturally occurring from a very young age. The earlier we can screen and detect red flags of autism, the earlier we can teach parents how to implement naturalistic therapy goals in their play and interactions. This essentially helps the brain wire those social connections from early on when the brain is still very plastic and malleable. It also means we are more likely to avoid challenging behaviour that may develop later on in development.
And so I have been, and still am, one of the biggest advocates of screening children for ASD from very young ages (12 months onwards). I do not enforce or believe in a “wait and see” approach. I do not enforce or believe that “they might catch up.” Why are we so afraid of assessing and diagnosing ASD in very young children or of at least raising the presence of red flags with a parent in a very young child? It likely comes from the diagnostician’s fear of ‘making a mistake’ in a child so young and the knowledge that developmental trajectory is more variable the younger you are. My counter argument is three fold:
1) We have come a long way in developing tools for screening autism in young children.
2) Any identified red flags and behaviours can only benefit from targeted intervention however a wait and see approach can be detrimental.
3) Personally, I would celebrate a family revisiting me two or three years later after an early diagnosis and for their child to no longer be meeting the ASD criteria. This doesn’t necessarily mean we got it wrong but that we helped them reach their ultimate potential.
We also have a system where the first point of call for a parent/caregiver is with a professional that may not be trained in early detection of ASD and so it is often missed or disregarded, and then diagnosed much later when we have lost valuable intervention time. And this is not the fault of the professional (you cannot be a specialist in everything) but a lack of training in ASD early screening. This is scary given the prevalence of ASD is sitting at around 1 in 88 people. I feel so frustrated for a family when they have been told by a professional their child is too young for an assessment or that they absolutely could not have autism when under a trained eye we know this is a positive diagnosis. We need mandated training in screening for ASD so they are better equipped to know when to refer on. I have no straight forward answer of how to build a better system of knowledge and training in Australia. All I know is that early detection and intervention is absolutely the key to ensure our children reach their potential and access only the best bits of the ASD brain they were lucky enough to be born with.