Is a child at risk of autism? Don’t ‘watch and wait’ to find out

Australian children with undiagnosed autism will continue to fall through the cracks unless screening programs are overhauled, according to a leading UNSW child psychiatrist.

Children with undiagnosed autism will continue to fall through the cracks unless there is a fundamental change to the way developmental checks are undertaken in Australia, according to a leading UNSW child psychiatrist.

Writing in the upcoming edition of the Australian & New Zealand Journal of Psychiatry  UNSW Professor Valsamma Eapen said as rates of autism spectrum disorder (ASD) continue to rise, current programs are failing to provide universal access to testing for all children at developmental risk. Prof Eapen is calling for ASD screening to be made available within the context of an ongoing health check program, as is recommended by the American Academy of Paediatrics.

“These checks should occur from the age of nine months for overall developmental progress and 18 months for autism-specific checks,” she said. “Earlier referral and intervention of those identified to be at developmental risk, regardless of diagnostic labels, can substantially improve outcomes and this is in keeping with the early childhood early intervention approach within the NDIS,” she said.

Internationally, the rate of ASD has risen from one in 2,500 children 40 years ago, to one in 200 in the past decade, to the current estimate of one in 68 children in 2014.

“Recognising early signs and symptoms of ASD is challenging for both parents and GPs,” said Prof Eapen, who is based at the Ingham Institute and Liverpool Hospital.

“This is particularly relevant for the increasing number of children diagnosed with high-functioning autism, where symptoms of speech and language delay may be less obvious, which means the diagnosis may be easily missed.” It is estimated that around 10 per cent of parents will not raise any concerns in children identified as having ASD. Further, 50-70 per cent of GPs are not using standardised instruments during child health checks that can pick up developmental problems, including ASD, and instead are relying solely on their clinical judgement.

Prof Eapen said that health professionals must get out of their ‘watch and wait’ mindset and also put aside concerns that children and families may be put through unnecessary anxiety. The risk of causing undue anxiety in false-positive cases is far outweighed by the benefits of early identification of autism spectrum disorder.

“The risk of causing undue anxiety in false-positive cases is far outweighed by the benefits of early identification of ASD,” she said. “Given that early intervention is vital for improving outcomes by maximising a child’s brain plasticity, no effort should be spared in offering access to developmental checks to every single child in Australia. “Parents should also be encouraged to raise any developmental concerns they have with their GP or other health professionals during ‘well baby’ checks or vaccination visits.”

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