New Guidelines Promise Earlier Identification of Autism - CDC/ICDL Working Group Releases New Report during Autism Awareness Month

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Leading experts on child development today presented a new framework for identifying children at risk of Autism Spectrum Disorders (ASD) and other developmental challenges, saying that current guidelines fail to identify many children who need and would benefit from early intervention.

Children identified with developmental or behavioral disabilities earlier have a better chance of reaching their full potential

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Leading experts on child development today presented a new framework for identifying children at risk of Autism Spectrum Disorders (ASD) and other developmental challenges, saying that current guidelines fail to identify many children who need and would benefit from early intervention.

The framework is contained in a report by a special working group formed by the Centers for Disease Control (CDC) and the Interdisciplinary Council on Developmental Learning Disorders (ICDL), co-chaired by Dr. José Cordero, former Director of the CDC’s National Center on Birth Defects and Developmental Disabilities and currently Dean of the School of Public Health of the University of Puerto Rico, and Dr. Stanley Greenspan, chair of the ICDL.

The framework presents newly formulated indicators to identify at-risk children in the first and second years of life, components for a comprehensive evaluation of infants and children determined to be at risk, and essential elements of a successful early intervention program for ASD and other developmental disorders.

The authors say the new rubric casts a wider net than current common practice in an effort to identify all children at risk of developmental disabilities.

“Children identified with developmental or behavioral disabilities earlier have a better chance of reaching their full potential,” said Dr. Cordero. “We believe this framework improves our ability to identify infants, young children, and families at risk and to organize truly comprehensive, developmentally-based intervention efforts.”

The CDC-ICDL framework is based on current understanding of healthy developmental patterns and is designed to detect all possible deviations from those patterns. It uses risk indicators designed to detect a lack of mastery of age-expected emotional, social, and cognitive milestones during a child’s first 2 years of life. These include the inability to:

  • Be calm and focus on sights and sounds by 2 months of age
  • Initiate and sustain warm, joyful interactions with caregivers by 4 months of age
  • Exchange emotional and social gestures (using different sounds), reaching, exchanging, back-and-forth smiling, looking, and searching by 8-9 months of age
  • Engage in shared social problem-solving and playing, including taking a caregiver’s hand to find a toy or favorite food; playing with a toy and caregiver together with lots of back-and-forth exchanges of sounds; and social gestures such as smiles, looks, and pointing by 12-16 months of age.

Early identification and preventive intervention for ASD and other developmental disorders have been long-standing goals, yet until now there has been no widely accepted framework for determining which infants and young children are at risk and the best ways to intervene. The new framework is intended to fill that gap to help more infants and young children overcome early challenges and acquire the foundations for healthy emotional, social, and intellectual development.

The CDC-ICDL report, which is being released during Autism Awareness Month, comes at a time when concern about autism and other developmental disorders is growing. A recent CDC study showed that an estimated 1 in 150 children in the United States has autism, a rate much higher than previously thought. Moreover, nearly 17% of U.S. children present a wide range of developmental challenges, including autism and other learning disabilities, that require early identification and preventive interventions. However, less than 50% of these children are identified as having a problem before starting school.

In presenting the new framework, the CDC-ICDL Working Group Report cautions against evaluations that are limited to specific behaviors or diagnostic criteria. During infancy and early childhood, all children who do not demonstrate mastery of the newly formulated healthy development milestones should receive early diagnostic evaluation and early intervention, the report says.

A comprehensive evaluation must include assessment of social, emotional, cognitive, language, motor, and sensory functioning; parental and family patterns of interaction; and availability of community support, says the report. It recommends that intervention programs focus on infant-parent relationships, family functioning, and overall social-emotional, cognitive, motor, and sensory functioning. The report concludes that narrowly focused intervention programs that target specific behaviors or symptoms may increase risk in infancy and early childhood.

“This report is important to the future of children and families all over the country,” said Dr. T. Berry Brazelton, founder of the Child Development Unit at Children’s Hospital Boston and the Touchpoints Center and member of the CDC-ICDL Working Group. “Without it, many adults would be thrust on our society with untreated autism that might have been effectively treated had intervention been started early in their childhood. We know that the earlier in childhood --or even in infancy-- treatment begins, the more likely people affected by autism can adapt to society and the workplace.”

Brazelton added, “With the frightening rise in the incidence of autism, we are facing a costly epidemic. The ICDL has been working to identify these babies early and to introduce therapeutic intervention as early as possible. This therapy works to increase the process of social and neurological organization that help these children learn to function, to help parents understand their role with them, and to assist the children themselves to reach out for the world they would otherwise shut out. This report is like a lifesaver thrown into a drowning society. We should all be grateful.”

Dr. Greenspan also announced that the CDC-ICDL Working Group will periodically review early detection and intervention programs and the degree to which they are consistent with these new principles. “Early identification and intervention programs that occur early in life can have long-term effects and should receive the same rigorous long-term scrutiny as any pharmacological intervention does,” he said.

Work group members included: Co-Chairs - José F. Cordero, M.D., M.P.H. (former Director, National Center on Birth Defects and Developmental Disabilities – CDC) and Stanley I. Greenspan, M.D. (Chair, Interdisciplinary Council on Developmental and Learning Disorders). Members - Margaret L. Bauman, M.D. (Massachusetts General Hospital), T. Berry Brazelton, M.D. (Harvard Medical School), Geraldine Dawson, Ph.D. (University of Washington), Barbara Dunbar, Ph.D. (Georgia State University), Peter C. Mundy, Ph.D. (University of Miami), Ruth Perou, Ph.D. (National Center on Birth Defects and Developmental Disabilities – CDC), Keith G. Scott, Ph.D. (University of Miami), Stuart G. Shanker, D.Phil. (York University, Toronto, Canada), and Ruth E. K. Stein, M.D. (Children’s Hospital at Montefiore).

The Interdisciplinary Council on Developmental and Learning Disorders (ICDL) is a non-profit organization dedicated to improving the prevention, assessment, diagnosis, and treatment of emotional and developmental disorders in infancy and childhood by promoting dialogue and integrating knowledge from different disciplines.

For the complete report and more information, please visit http://www.icdl.com or contact Cecilia Breinbauer, M.D., M.P.H. at (240) 350-6907 or via e-mail.

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Cecilia Breinbauer
ICDL
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