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(HealthNewsDigest.com) – BETHESDA, Md. – According to a 2013 report published by the Centers for Disease Control and Prevention, 1 in 68 children are diagnosed with autism -spectrum disorders. With a rise in the diagnosis in recent years, the pressure is on to intervene with therapy earlier in life and improve function and quality of , ext. life. But just how early are the signs of autism evident?
Research conducted by a team of occupational therapists and physicians at Washington University in St. Louis aims to help detect signs of autism and altered development earlier in life, so that services, like occupational therapy, can be offered sooner to improve children’s adaptive skills and outcome. A study published in the current issue of theAmerican Journal of Occupational Therapy identified differences in early eye movements among pre-term infants who later had a positive screening result for autism. However, the differences observed were not consistent with the traditional symptoms of autism observed later in childhood.
The team evaluated and observed 62 pre-term infants initially hospitalized at St. Louis Children’s Hospital. Early neonatal neurobehavioral testing was conducted at the infant’s due date (the time when the infant would have been born if not born early and typically the age that the infant is discharged from the neonatal intensive care unit). This included observations about social interaction and visual and auditory responses. At age 2 years, participants were assessed again using a screening tool for autism, the Modified Checklist for Autism in Toddlers, and also underwent standardized developmental testing with the Bayley Scales of Infant and Toddler Development, 3rd Edition. A positive screening result for autism is not a diagnosis but indicates the need for diagnostic testing for autism and is often the first result leading down the pathway to diagnosis. Thus, children identified in this study were not diagnosed with autism, but a screening tool indicated they were at higher risk for autism.
The team then explored different early neonatal visual, auditory, and social behaviors that were related to poor outcome, specifically developmental delay and autism risk. It was hypothesized that infants who later had a positive screening result for autism would demonstrate early avoidance of social interaction; would have abnormal visual signs, such as visual locking and nystagmus; and would have alterations in self-regulation and interaction.
“We expected to see avoidance of social interaction among infants who later screened positive for autism risk, as avoidance of social interaction and failure to make eye contact are often seen in children with autism,” said Roberta Pineda, PhD, OTR/L, Assistant Professor of the Program in Occupational Therapy, Department of Pediatrics, School of Medicine at Washington University in St. Louis. “Instead, our findings did not support our hypothesis, and positive screening for autism risk was associated with absence of gaze aversion in the neonatal period. In fact, infants who avoided visual interaction through gaze aversion in the neonatal period were 5 times more likely to have good outcome at age 2 years. While this was an unexpected finding, pre-term infants in the NICU may avert their gaze to protect themselves from stimuli that is too intense, and infants who later went on to screen positive for autism risk did not demonstrate this same gaze aversion response as their peers. This is, however, a different pattern from what is observed later when children with autism are more likely to avoid social interaction.”
The team identified that infants with later autism risk as well as poor developmental outcome were less likely to demonstrate gaze aversion and less likely to demonstrate end-point nystagmus in the neonatal period.
The conclusion: Early identification of altered development is important so that therapy services can provide early, targeted interventions. It is important to understand early patterns of development among normal and atypically developing children, but more research is needed to better understand early behaviors that may indicate alterations in function.
The research was conducted by Pineda; Kelsey Melchior, a student in the Program in Occupational Therapy, School of Medicine at Washington University, St. Louis; Sarah Oberle, OTD, OTR/L, an occupational therapist in the Program in Occupational Therapy School of Medicine at Washington University, St. Louis; Terrie Inder, MD, professor in pediatrics in the field of newborn medicine at Harvard Medical School and Brigham and Women’s Hospital, Boston; and Cynthia Rogers, MD, assistant professor in the Department of Psychiatry and Pediatrics in the School of Medicine at Washington University in St. Louis. Findings appear in the current edition of the American Journal of Occupational Therapy.
The American Journal of Occupational Therapy is the flagship journal of the American Occupational Therapy Association, which represents the professional interests and concerns of more than 185,000 occupational therapists, assistants, and students nationwide. It is a peer-reviewed publication focusing on research examining the effectiveness and efficiency of occupational therapy practice so that occupational therapy and other health care professionals can make informed, evidence-based decisions in their practice. AJOT publishes 6 times each year in print and with additional online supplements. Articles cover topics such as children and youth; mental health; rehabilitation, disability, and participation; productive aging; health and wellness; work and industry; education; and professional issues. Recent special issues include sensory processing and sensory integration, older drivers and community mobility, Alzheimer’s disease and dementia, traumatic brain injury, and stroke. For more information, visithttp://otjournal.net or www.aota.org.
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To read the entire abstract or other articles in the July/August issue of the American Journal of Occupational Therapy, visit http://otjournal.net and click on “Current Issue.” A full version of this study is available upon request.
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