Nowadays, enormous attention is paid to the discussion of early diagnosis and intervention in ASD. This is based on the frequent occurrence of this disorder and high possibility of positive treatment results in case of relevant identification and addressing the issue. This paper provides an extensive literature review of the recent peer-reviewed articles about early diagnosis and intervention in ASD, emphasizing the determination of the examined children of concrete age. The precise analysis of various researches and studies enable to synthesize the literature that supports the theoretical argument that early diagnosis and intervention can be justified at the age under 24 months.
Synthesis of the Scientific Literature
Camarata (2014) addresses weak evidence for available support of early diagnosis and intervention in ASD reflected in the studies of autism in Pediatrics journal. The major purpose of this work was the examination of potential contributors of early diagnosis and intervention that could be missed due to enormous diagnosis development in recent years.
The scholar also noted that according to Kanner’s researches introduced in 1943, infantile autism was considered to be a rather rare condition that can be determined by observing the evident discrepancy on the following domains: motivation for social interaction, interest and repetitive behavior, and communication disorders. In 1950s, the term of infantile autism was referred to AD and ASD diagnosed in school ages, since the majority of cases of identification were observed during this period of a child’s life (Camarata, 2014). This understanding formed the background for introduction of various diagnosis tools. At the same time, Camarata (2014) introduced the idea of considerable relevance of earlier intervention basing it on the estimation that autism is a lifelong disorder, the symptoms of which are rooted in the above-mentioned domains since the pre-school years. The researcher tried to address the opposing views, since while the American Academy of Pediatrics that stresses the necessity of early identification – at the age of 24 months, British National Health Service stands against early diagnosis. This was performed by reviewing existing evidence of validity and necessity of early intervention with putting the emphasis on communication pathologies. Camarata (2014) based his ideas on the relevance of early diagnosis and interventions regarding the analysis and support of stability of autism compared to ASD and a central role of communication speech-language discrepancies. According to him, the fact that “accuracy of performing of…differential diagnosis, heterogeneity and difficulty in constructing objective testing procedures” is a matter of paramount importance, because it questions the relevance of any judgments (Camarata, 2014, p. 3). This study promoted further discussions and researches of the role and implications of early diagnosis and intervention in ASD, which are also introduced in this work.
Fernell et al. (2013) have conducted a narrative review of early diagnosis of ASD and its impact on final prognosis. Currently, ASD is perceived as “a set of clinical phenotypes mirroring an early onset neurodevelopmental disorder” (Fernell, Eriksson, & Gillberg, 2015, p. 33). This disorder has enormous negative effects on individual’s imagination, behavior, and ability to communicate with others. The symptoms of ASD overlap with the symptoms of ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations) disorders such as, for example, ID, DCD, and ADHD (Fernell, Eriksson, & Gillberg, 2015). The researchers based their study on the analysis of the reviews and meta-analysis regarding cognitive behavioral interventions published in the Public Med base from 2008 to 2012 and other relevant papers that are related to the topic of ASD. They have discussed the relevance of the issue by providing the number of affected individuals (about 1 % of the population) and gender discrepancy (male-to-female ratios vary from 3-5:1 to 1.1 – 2.0 depending on a research) (Fernell, Eriksson, & Gillberg, 2015).
The researchers stated that the major symptom of ASD is primary deficiency in social instincts, which is reflected in reduced desire for social communication. Due to the difficulty of clear identification of pathognomonic symptoms, the works that were analyzed focusing on identification of autism gestalt on the background of Wing’s suggestion that there are some interconnections among social problems as well as imagination and communication impairments with the application of the DSM-IV, DSM-5, and the Gillberg’s criteria (Fernell, Eriksson, & Gillberg, 2015). The majority of authors of the reports under discussion agree upon the necessity of early ASD screening, as it enables to apply appropriate educational and behavioral strategies to the improvement of the child’s condition. The determination of autism at early age provides an ability to use APA and TEACCH early intervention programs connected with parent involvement and trainings. The first program is based on positive reinforcement, education, and motivation, while the second one makes highlights visualization, structured learning, and positive routines. Such programs as “early intensive behavioral interventions [EIBIs], the Picture Exchange Communication System, More Than Words, and the TEACCH approach” were discovered to show the most positive changes (Fernell, Eriksson, & Gillberg, 2015, p. 37).
However, in these works, the most appropriate time of determination varies because “of the extremely heterogeneous etiology of autism, with varying degrees of associated brain disorder” (Fernell, Eriksson, & Gillberg, 2015, p. 36). Fernell et al. (2013) did not discover the significant discrepancy in the outcomes of children with ASD, whose diagnosis was set very early, and children with later diagnosis (still at preschool age). This outcome was attributed to the stability of symptoms of autism, while the symptoms of atypical autism and pervasive development changed in course of time.
Koegel et al. (2014) discussed the importance of early investigation and intervention of ASD. This work represents the analysis of the article “Early identification and early intervention in autism spectrum disorders: Accurate and effective?” prepared by Camarata. The authors agree with the necessity to expand the evidence base and with the enormous relevance of early diagnosis and intervention. They support their statement by investigating theoretical works and case research studies.
This article defines and describes ASD and its crucial importance in the modern world and discloses major symptoms and their manifestations. Nevertheless, the authors reflect their concerns regarding the necessity and relevance of setting early diagnosis, because they did not find sufficient evidence of its benefits.
This article was focused on the early identification by the application of DSM-5 change. Fernell et al. (2013) concentrated their attention on such main ASD symptom as discrepancies in behavior and communication. The authors also noted the possibility of overlapping of symptoms of ASD with other disorders. At the same time, Koegel et al. (2014) put the major emphasis on the sufficient accuracy of early diagnosis: “studies have documented high reliability of diagnosis at the age of 18 months if the examiner is highly trained” (Koegel et al., 2014, p. 52). They also emphasized that the intervention should be started as early as possible, because this strategy would enable to prevent the development of secondary symptoms, reduce the expenses, help to control parental stress, and overcome disabilities. In the majority of cases, secondary symptoms are connected with the communicative function. They can be “avoided, reduced, or eliminated with early intervention focused on teaching functionally-equivalent behavior” (Koegel et al., 2014, p. 52). Parents who clearly understand health condition of their child and have enough knowledge and tools to address it are less vulnerable to stressful conditions and provide intervention that is more effective. Koegel et al. (2014) also noted that some studies provide the examples when early interventions cause significant partial or even total recovery from the disability. Additionally, early interventions can avoid the necessity to perform more substantial and expensive interventions in later life. These also researchers strived to address the concern that too early diagnosis may show the false positive ASD (especially in more mild cases) and unnecessary intervention by stating that the positive influence of early intervention is far greater than possible negative effects of ASD on the person, the family, and the community. Thus, the case of initial intervention is totally justified. This work explains the enormous relevance of early identification that can be performed from the age of 18 months, since it enables to address the secondary symptoms and even overcome the disability, manage parental stresses, and lower expenses on the treatment.
The authors of the article entitled “Early Identification of Autism Spectrum Disorder: Recommendations for Practice and Research” (2016) reviewed numerous previous theoretical works for justification of the extreme benefit of early identification of ASD for the children smaller than 24 months. Similarly to the authors of the previous articles, these researchers agree that there is a “substantial heterogeneity in the presentation and natural history of clinical features associated with ASDs” (Zwaigenbaum et al., 2015, p. 12). Such symptoms of ASD as the lowered levels of social communication and attention, abnormal body movements, and dysregulation of temperament can be observed in the age between 12 and 24 months (Zwaigenbaum et al., 2015). At the same time, behavioral symptoms of ASD cannot be identified prior to this age (Zwaigenbaum et al., 2015). That is why, the performance of ASD identification of children aged before 12 month may be less significant. Among the major development trajectories, which can influence direction, degree, and rate of ASD, there are non-verbal development, early language, and early social communication skills (Zwaigenbaum et al., 2015). This research provides an insight into the fact that effective screening that would provide relevant results for the identification of ASD can be performed starting from the age between 12 and 24 months.
Guthrie et al. (2013) were involved into investigations of stability of ASD diagnosis in children younger than 3 years old. For this purpose, the researchers prepared diagnostic evaluations of 82 children at the age between 19.39 and 36.89 months. These evaluations contained observations of health care providing institutions and homes. Unlike children who did not suffer from ASD, children who were diagnosed with ASD were observed to have higher “Restricted and Repetitive Behavior scores (i.e. worsening)” (Guthrie et al., 2013, p. 582). Consequently, the researchers supported the existence of short-term stability of children of the age of 19 months. At the same time, they noted unclear diagnostic presentations during assessment of the minority of children. Early intervention was observed with the purpose of enhancing the improvement of communication and resistive behaviors in children who suffer ASD (Guthrie et al., 2013).
Taylor et al. (2014) suggested that the effective diagnosis and intervention in ASD in early age can be performed with the application of biomarkers, especially those “which can be used in conjunction with behavioral screening” (Taylor, Maybery, & Whitehouse, 2014, p. 19). The work of these researchers represents some kind of response to the works of Camarata, who discussed theoretical and practical issues of early diagnosis and intervention of children with ASD and directed his efforts at the improvement of these practices. Taylor et al. (2014) focused on supporting this idea by applying the uncommon approaches that involved biomarkers. In fact, this approach is considered to be quite beneficial, because it could increase the reliability of determination of the risk of occurrence of ASD and provide more accurate diagnosis of child’s health issue distinguishing ASD from other disorders (Taylor, Maybery, & Whitehouse, 2014). The use of markers enables to discover early biological signs of autism that are connected to the further behavioral reflections. The examples of these reflections are the following: atypical neurological responses, neutral response of eye gaze, absence of hemispheric asymmetry, qualitative differences in white matter development, extent of extra-axial fluids, and brain volumes (Taylor, Maybery, & Whitehouse, 2014). These markers should be applied in the combination with behavioral measures to increase the accuracy of identification. Hence, the first ASD diagnosis can be established in the children of the very early age. It depends on the type of applied biomarker: while such discrepancies as extra-axial fluids can be observed at 6-9 months, increase of brain volumes can be identified only starting from 12-24 months (Taylor, Maybery, & Whitehouse, 2014). This article is extremely important in the context of discussion of the chosen topic, because it describes the way how additional mechanism of early diagnosis of ASD improves the relevance of behavioral analysis and can be applied to children at the tender age.
Talbott et al. (2013) studied the early difficulties in communication, which can be observed in children who are susceptible to have ASD. They examined “the gesture production of infants at risk of autism and their mothers at 12 months age” and interconnection between their language at that early age and at the age of 18 months (Talbott, Nelson, & Tager-Flusberg, 2015, p. 5). This study revealed the existing discrepancies in gesturing of children’s mothers who have low risk and are non-diagnosed with ASD at the age of 12 months old that were associated with language scores of these children at the age of 18 months. This research showed the influence of such dimension as language deficiency on maternal behavior. In addition to previous researches presented in the paper, the work by Talbott et al. (2013) serves as an additional proof that relevant diagnosis and intervention in ASD can be performed at child’s early years by analyzing the reflections of diverse factors associated with them.
Jo et al. (2015) paid attention to existing discrepancies in the obvious symptoms of ASD in children aged between 3-5 years old of different races, ethnicities, and languages identified by parents. They have analyzed the information from the American National Survey performed during 2009-2010. Moreover, this article identified striking differences between examined prevalence rated to ASD among non-Hispanic-whites and non-Hispanic-blacks of any languages as well as Hispanics who speak English or Hispanics who speak other languages (Jo et al., 2015). This work seeks to prove that such factors as child’s race and language should be taken into consideration during early diagnosis of ASD.
In conclusion, this research provides the theoretical justification of the relevance of early diagnosis and intervention in ASD that could be performed at children aged less than 24 months. Various theoretical studies support the statement that discrepancies in the major domains, which are associated with the high risk of occurrence of ASD (motivation for social interaction, interest and repetitive behavior, and communication disorders), can be observed at this particular age. These discrepancies are regarded as stable and unchangeable in course of the child’s development. Moreover, the relevance of the diagnosis and identification during this time can be improved by using biomarkers. At the same time, additional attention should be paid to the possibility of discrepancies in symptoms with regard to the child’s ethnicity.