Autism Diagnosis in Younger Kids Holds up Over Time

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mom_of_an_autie
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Autism Diagnosis in Younger Kids Holds up Over Time

Postby mom_of_an_autie » Wed Jun 07, 2006 3:46 pm

Autism Diagnosis in Younger Kids Holds Up Over Time

By Neil Osterweil, Senior Associate Editor, MedPage Today
Reviewed by Rubeen K. Israni, M.D., Fellow, Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine
June 05, 2006
Also covered by: FOX News



Review
ANN ARBOR, Mich., June 5 — A diagnosis of autism in a two-year old child stands a pretty good chance of holding up when that child is nine, according to researchers here.


On the other hand, a two-year-old diagnosed with pervasive developmental disorder not otherwise specified (PDD-NOS) is more likely to be re-classified as having autism or another disorder seven years down the road, according to Catherine Lord, Ph.D., and colleagues in North Carolina, England, and Israel.


Getting the early diagnosis right may be important for researchers developing therapies for autism, and for educators developing early intervention programs targeted at the social, behavioral and adaptive deficits of children with autism, the authors suggested in the June issue of the Archives of General Psychiatry.


"Several intervention projects reported diagnostic changes and extraordinary levels of improvement in a substantial minority of young children with autism," the investigators wrote. "Other reports found little diagnostic change and fewer marked improvements. Possible explanations for these conflicting results are diagnostic instability or the lack of age-appropriate diagnostic criteria for very young children."


The authors undertook a study looking at the diagnostic utility of standard instruments for detecting autism in children under three years old. They also attempted to identify the features seen in two-year-olds that best predict a later diagnosis, whether that is autism or another disorder.


They conducted a prospective study of 192 children referred before their third birthdays for possible evaluation of autism, plus an additional 22 children with developmental delays but no diagnosis of autism from the same referral sources, who served as controls.


The children enrolled in the study were referred from both a state-supported community autism program in North Carolina, and from a privately funded university hospital in Chicago. Controls came from the same referral sources as the children in the North Carolina program.


The children were evaluated at two, five, and nine years with standard instruments, including the Autism Diagnostic Interview-Revised (ADI-R, a parental interview), the Pre-Linguistic Autism Diagnostic Observation Schedule/Autism Diagnostic Observation Schedule (an observational scale), and with independent clinical diagnoses made at ages two and nine.


The results were compared with those of a clinical research team's standard, best-estimate diagnoses.


A total of 172 children were available for examination at age nine, and 58% of these kids had a best-estimate diagnosis of autism, up from 49% at age two.


Overall, two-thirds (67%) of best-estimate diagnoses remained the same from age two to age nine. Among those with an original (age two) diagnosis of autism, 76% were diagnosed autism again at age nine.


Diagnostic stability was even greater among children with an original diagnosis of an autism spectrum disorder, with 90% of such children having a diagnosis of either autism or an autism spectrum disorder such as Asperger syndrome, atypical autism or PDD-NOS at age nine.


In a simple additive logistic regression mode for best-estimate autism diagnosis, the investigator found that the parental interview (ADI-R), observational scale, and clinician diagnosis at two years were all statistically significant, independent predictors for an autism diagnosis at nine years.


In cases where the diagnosis shifted from age two to age nine, the change was for the better (i.e. more accurate) in 8% of the cases, but worse in 18% of the cases, and an early diagnosis of autism was more likely to be right seven years later than an early diagnosis of PDD-NOS.


Whereas only one in 84 children diagnosed with autism at age two was determined at age nine not to have the disorder, more than half the children with the more vague diagnosis of PDD-NOS were diagnosed with autism when they were nine.


"There are real questions about the usefulness of pervasive developmental disorder not otherwise specified as a categorical diagnosis," the investigators wrote. "However, especially for very young children, having a way for experienced clinicians to acknowledge their uncertainly about some two-year-olds was ultimately helpful as a means of flagging children who by age 9 years had a range of difficulties from autism to very mild social deficits."


They additionally caution that "health care professionals should be wary of telling parents that their young children do not have autism, only pervasive developmental disorder not otherwise specified."


The authors also noted that judgment of clinicians who were trained on specific diagnostic instruments can help to improve upon the information obtained from parental interviews and observational studies.

LM
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Postby LM » Wed Jun 07, 2006 7:01 pm

I guess I would be interested to know what intervenions were employed. There are 3-4 districts in the entire state of NC that offer private aba. Anyone outside of those districts is left to the mercies of their respective districts. Where I live it's 6-8 autistic kids in a room with 1 exhausted teacher and 1-2 aides. I'd also say that 90% of parents w/asd kids that I know in our area privately pay for their own home program because the school services are so awful.

On the other hand, I have friends who work w/LAUSD and am always told about the wonderful progress kids are making at regional centers and with the Help Group.

Mary
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Postby Mary » Wed Jun 07, 2006 9:01 pm

Interesting that most clinicians are diagnosing autism correctly. I recall reading a while back that some were afraid that children were being over-diagnosed with autism. This study seems to refute that idea.

BTDT
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Postby BTDT » Wed Jun 07, 2006 9:10 pm

On the other hand, a two-year-old diagnosed with pervasive developmental disorder not otherwise specified (PDD-NOS) is more likely to be re-classified as having autism or another disorder seven years down the road, according to Catherine Lord, Ph.D., and colleagues in North Carolina, England, and Israel.


I thought this was interesting.

Here's the study abstract:

http://archpsyc.ama-assn.org/cgi/conten ... t/63/6/694

Autism From 2 to 9 Years of Age
Catherine Lord, PhD; Susan Risi, PhD; Pamela S. DiLavore, PhD; Cory Shulman, PhD; Audrey Thurm, PhD; Andrew Pickles, PhD


Arch Gen Psychiatry. 2006;63:694-701.

Context Autism represents an unusual pattern of development beginning in the infant and toddler years.

Objectives To examine the stability of autism spectrum diagnoses made at ages 2 through 9 years and identify features that predicted later diagnosis.

Design Prospective study of diagnostic classifications from standardized instruments including a parent interview (Autism Diagnostic Interview–Revised [ADI-R]), an observational scale (Pre-Linguistic Autism Diagnostic Observation Schedule/Autism Diagnostic Observation Schedule [ADOS]), and independent clinical diagnoses made at ages 2 and 9 years compared with a clinical research team's criterion standard diagnoses.

Setting Three inception cohorts: consecutive referrals for autism assessment to (1) state-funded community autism centers, (2) a private university autism clinic, and (3) case controls with developmental delay from community clinics.

Participants At 2 years of age, 192 autism referrals and 22 developmentally delayed case controls; 172 children seen at 9 years of age.

Main Outcome Measures Consensus best-estimate diagnoses at 9 years of age.

Results Percentage agreement between best-estimate diagnoses at 2 and 9 years of age was 67, with a weighted of 0.72. Diagnostic change was primarily accounted for by movement from pervasive developmental disorder not otherwise specified to autism. Each measure at age 2 years was strongly prognostic for autism at age 9 years, with odds ratios of 6.6 for parent interview, 6.8 for observation, and 12.8 for clinical judgment. Once verbal IQ (P = .001) was taken into account at age 2 years, the ADI-R repetitive domain (P = .02) and the ADOS social (P = .05) and repetitive domains (P = .005) significantly predicted autism at age 9 years.

Conclusions Diagnostic stability at age 9 years was very high for autism at age 2 years and less strong for pervasive developmental disorder not otherwise specified. Judgment of experienced clinicians, trained on standard instruments, consistently added to information available from parent interview and standardized observation.


Author Affiliations: University of Michigan, Ann Arbor (Drs Lord and Risi); University of North Carolina, Chapel Hill (Dr DiLavore); Hebrew University, Jerusalem, Israel (Dr Shulman); National Institute of Mental Health, Bethesda, Md (Dr Thurm); University of Manchester, Manchester, England (Dr Pickles).

LittleManzParents
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Postby LittleManzParents » Wed Jun 07, 2006 9:16 pm

Mary wrote:Interesting that most clinicians are diagnosing autism correctly. I recall reading a while back that some were afraid that children were being over-diagnosed with autism. This study seems to refute that idea.


Yes, this is interesting. But of course it doesn't list when the study began. It could have been ten years ago ?

Also, I'd be really interested in hearing from anyone about which diagnostic tests were used by the professionals who evaluated your child/children. Do you know/remember?

I'm taking Litty Man for his "interview" with a developmental ped. tomorrow morning. :shock:

mom_of_an_autie
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Postby mom_of_an_autie » Wed Jun 07, 2006 9:47 pm

Well LMP since I just happened to have our medical binder right here :wink: I looked up my sons evaluation the day he was dx'd. They used ADOS (Autism Diagnostic Observation Schedule) and the Bayley Scales of Infant Development and the Vineland Adaptive Behavior Scales
Hope this helped :D

LittleManzParents
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Joined: Fri Apr 21, 2006 4:27 am

Postby LittleManzParents » Thu Jun 08, 2006 3:29 pm

Thanks, mom...

We had our 2nd of 3 appointments this morning. This is the one in which the doc met with Cole and administered developmental tests and observation. We meet again next week for scoring, diagnosis and recommendations.

I believe she is using ADOS as well, along with CARS (which she surprisingly had me fill out on my own) , MCHAT and something called Caputi scale?? I haven't heard of this from anyone else. She mentioned one other developmental screening tool, but I do not remember the name at the moment. Obviously I'll know a little more next week...


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