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Elanor

Simple early detection test for ASD

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I heard a fascinating article about detecting autism and aspergers in babies, and suggesting a form of early intervention, on Radio 4's 'Leading Edge' programme last night. the programme can be listened to for a week using 'Listen Again' (BBC Radio 4 website), and the following was taken from http://www.psych.ufl.edu/archive/tiet.htm

 

 

"Home videos of infants' movements can be used to help detect a form of autism in a child?s first year of life, years earlier than the disorder typically is identified, University of Florida researchers have discovered.

 

The key to detecting Asperger?s syndrome, a milder yet little-understood form of autism, lies in analyzing infants? movements rather than waiting for them to reveal the disorder through social behavior in school or later in adulthood, according to Osnat and Philip Teitelbaum, a husband-and-wife team of UF psychology researchers whose study will be published this week in the online edition of the Proceedings of the National Academy of Sciences.

 

�The usual method of diagnosing autism and Asperger?s syndrome relies mostly on social interaction - how the child reacts to peers, how the child gets along with the mother, even how the child reacts to a stimulus like light or noise,� Osnat Teitelbaum said. �But until our work in 1998 and now, no one has looked at these children?s movements when they were infants.�

 

The advantage of an earlier diagnosis is that a child can be treated sooner when the brain is more elastic, likely resulting in changes to the nervous system and fewer behavior problems.

 

�The earlier the intervention the better the outcome, not only for the child but, we must stress, for the parents as well,� she said. �The behavior of autistic kids is really tough to control on a daily basis, and having to go from one doctor to another who refuses to take a parent?s concerns seriously can be torture.�

 

After viewing a colleague?s videos in which older children with severe autism walked with a slight abnormality, the Teitelbaums wondered if differences in movement might be detectable as early as infancy. Using a tactic they had employed successfully in their 1998 research on infants with severe autism, the researchers extended their study to Asperger?s syndrome, asking parents of children with the disorder to send them videos of the children when they were infants. These recordings were solicited at meetings of support groups for the disorder.

 

In viewing the family videos they received of 16 babies with Asperger?s, the Teitelbaums found disorders in some or all of the milestones of early motor development, including crawling, walking, lying down, sitting and the ability to right themselves. Some of the symptoms were similar to those the Teitelbaums found in their 1998 study.

 

In the most recent study, the babies showed an asymmetrical pattern in their movements. For example, some children crawled by stepping with the foot of the right leg and crawling with the knee of the left leg, or when lying prone, they extended the left arm forward to support the chest while the right arm was trapped beneath the chest, the Teitelbaums found. In addition, they discovered that when lying on their sides, babies with Asperger?s syndrome would remain stuck there instead of smoothly turning over in a corkscrew fashion, first with the hips, followed by the torso and then the shoulders.

 

Six of the 16 Asperger?s babies did not sit independently by 6 months, and one baby, in his first attempts at walking, failed to extend his arms in a protective reflex to prevent falling and keeled over vertically like a tree falls over, Osnat Teitelbaum said.

 

Clumsiness is a trait of Asperger?s syndrome, she said. �From our preliminary observations, we have a strong tendency to believe that some of the clumsy characteristics seen in Asperger?s syndrome are based on infantile reflexes gone astray,� she said. �When these reflexes persist too long or do not appear when they should, the motor development of the infant, and subsequently other aspects of his behavior, will be affected.�

 

While autism is sometimes characterized by mild to severe mental retardation and extreme social awkwardness, those with Asperger?s are more socially inclined and can have very high IQs, with their intelligence often focused on one narrow field of interest. They are typically diagnosed much later than autistic children because they are able to acquire and use language early, she said.

 

Typically diagnosis of autism occurs about age 3, compared with age 6 at the earliest for Asperger?s, and sometimes not until the mid-20s or even the 30s, she said.

 

One simple way to treat children with the syndrome is to swing them in a playground or backyard swing, she believes. This stimulates the inner ear and helps to regulate balance, which appears to be defective in those with autism and Asperger?s syndrome.

 

�One mother of a 6-month-old baby who couldn?t get any answers from her pediatrician called us and said her child would not look at her or coo when she cooed to him,� she said. �We suggested she swing him, and after two or three weeks of doing this, she (the mother) said the child had changed so much and started smiling at them.�

 

Wayne Gilpin, president of Future Horizons, a publisher of books on autism and Asperger?s syndrome who has a 24-year-old son with autism, said the study?s findings are important to parents of children with autism. �All the experts in the field are leaning very strongly to trying to determine if a child has Asperger?s sooner because the early diagnosis leads to early assessment and the earlier you begin working with a child there is no question that his progress is much better,� he said.

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Junior didn't roll over until she was about 14 months old. she started crawling around the same time and I do remember it looked a bit odd but can't remember why.

 

She did use to love going on a swing until about age 2 and now she screams if you put her on it as she prefers to push it!

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Hi Elanor -

 

I read a book about 8-9 years ago which said that a very simple pre-school screening programme would have an accuracy hit rate of (if memory serves correctly) around 90%...

Problem was funding, of course...

 

The book was 'Children with autism - diagnosis and interventions to meet their needs.' (Trevarthen C. et al)... sorry to be so "formal" with the reference details, but I just looked it up from an old research project I did at the time, and that's how we had to write them.Haven't a clue this far down the road what the 'C' stands for!

 

So, the possibility of early screening has been around for nearly a decade... still that same old funding issue, I guess, but also (being a real cynic) the political implications regarding increasing numbers (and the possible reasons), education opportunities etc etc etc.

 

Thanks for the post. Lots of food for thought! :D

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I noticed this on Autism Connect site a few weeks ago.

 

28/07/2004

 

Swing test 'could help to diagnose Asperger's as early as six months old'

 

 

MIAMI, Florida, USA: A simple test of whether a six-month-old can hold his head high on a swing could help to diagnose a form of autism - Asperger's syndrome - years earlier than at present.

 

People with Asperger's are more able than those with autism but they still lack social skills. On July 27, an American team reported that affected children could be diagnosed as early as infancy by studying how reflexes

 

go astray.

 

Autistic children typically experience a delay or absence in language use, making it possible to diagnose them by

 

the age of three. However, individuals with Asperger's syndrome may develop language abilities on the same

 

timescale as normal children, hindering diagnosis until the age of seven or later.

 

Previous research by Dr Osnat Teitelbaum of the University of Florida, her husband Professor Philip Teitelbaum and colleagues claimed to that infants who were later diagnosed with autism exhibited a host of abnormal

 

movements before diagnosis.

 

To determine whether similar patterns exist in infants later diagnosed with Asperger's syndrome - which is known to be marked by clumsiness - the team examined videos of babies and toddlers later found to have the disorder.

 

The researchers reported in the Proceedings of the National Academy of Sciences on July 27 that infants displayed movement abnormalities comparable to those previously seen in autistic children, such as characteristic facial paralysis, falling to one side while walking, and failing to keep the head vertical when the body is tilted (the

 

"tilting test").

 

Although not all the abnormal movements were present in each affected infant, the team suggested that performing the tilting test routinely on all infants at six months of age might catch many cases early.

 

"Since such early diagnosis was not possible before our work, no treatment has really been developed for

 

infants," they added.

 

However, now that it is possible to detect the disorder much earlier, work on such treatments can begin.

 

�The usual method of diagnosing autism and Asperger?s syndrome relies mostly on social interaction ? how

 

the child reacts to peers, how the child gets along with the mother, even how the child reacts to a stimulus like

 

light or noise,� Osnat Teitelbaum said. �But until our work in 1998 and now, no one has looked at these

 

children?s movements when they were infants.�

 

The advantage of an earlier diagnosis is that a child can be treated sooner when the brain is more elastic,

 

and could result in changes to the nervous system and fewer behavioural problems.

 

�The earlier the intervention the better the outcome, not only for the child but, we must stress, for the parents as well,� she said. �The behaviour of autistic kids is really tough to control on a daily basis, and having to go from one doctor to another who refuses to take a parent?s concerns seriously can be torture.�

 

After viewing a colleague?s videos in which older children with severe autism walked with a slight abnormality, the Teitelbaums wondered whether differences in movement might be detectable as early as infancy. Using

 

a tactic they had employed successfully in their 1998 research on infants with severe autism, the researchers

 

extended their study to Asperger?s syndrome, asking parents of children with the disorder to send them videos

 

of the children when they were infants. These recordings were solicited at meetings of support groups for the

 

disorder.

 

In viewing the family videos they received of 16 babies with Asperger?s, the Teitelbaums found disorders in some or all of the milestones of early motor development, including crawling, walking, lying down, sitting and the ability to right themselves. Some of the symptoms were similar to those the Teitelbaums found in their 1998 study.

 

In the most recent study, the babies showed an asymmetrical pattern in their movements. For example,

 

some children crawled by stepping with the foot of the right leg and crawling with the knee of the left leg, or

 

when lying prone, they extended the left arm forward to support the chest while the right arm was trapped

 

beneath the chest, the Teitelbaums found. In addition, they discovered that, when lying on their sides, babies with Asperger?s syndrome would remain stuck there instead of smoothly turning over in a corkscrew fashion, first with the hips, followed by the torso and then the shoulders.

 

Six of the 16 Asperger?s babies did not sit independently by the age of six months, and one baby, in his first attempts at walking, failed to extend his arms in a protective reflex to prevent falling and keeled over vertically like a tree falls over, Osnat Teitelbaum said.

 

Clumsiness is a trait of Asperger?s syndrome, she said. �From our preliminary observations, we have a

 

strong tendency to believe that some of the clumsy characteristics seen in Asperger?s syndrome are based on

 

infantile reflexes gone astray,� she said. �When these reflexes persist too long or do not appear when they

 

should, the motor development of the infant, and subsequently other aspects of his behaviour, will be affected.�

 

While autism is sometimes characterised by mild to severe mental retardation and extreme social

 

awkwardness, those with Asperger?s are more socially inclined and can have very high IQs, with their

 

intelligence often focused on one narrow field of interest. They are typically diagnosed much later than autistic

 

children because they are able to acquire and use language early, said Osnat Teitelbaum..

 

Typically diagnosis of autism occurs at around the age of three, compared with the age of six at the earliest for Asperger?s, and sometimes not until the mid-20s or even the 30s, she said.

 

One simple way to treat children with the syndrome is to swing them in a playground or backyard swing, she

 

believes. This stimulates the inner ear and helps to regulate balance, which appears to be defective in those with

 

autism and Asperger?s syndrome.

 

�One mother of a 6-month-old baby who couldn?t get any answers from her paediatrician called us and said

 

her child would not look at her or coo when she cooed to him,� she said. �We suggested she swing him, and

 

after two or three weeks of doing this, she (the mother) said the child had changed so much and started smiling

 

at them.�

 

The Teitelbaums said: "The tilting test should be routinely performed on all infants beginning at six months, particularly if there is a history of autism or Asperger's syndrome in the family. This simple, non-invasive test takes 20-30 seconds and can be performed by the infant's paediatrician or parents."

 

An abnormal result would mean the child would need more testing for the possibility of Asperger's syndrome or

 

other autistic spectrum disorders, they said.

 

(Sources: University of Florida, Daily Telegraph, BBC News Online, July 28, 2004)

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