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Autism,
a developmental disorder characterized by social
withdrawal and an inability to communicate, is usually
diagnosed during the preschool years. But the disorder
begins in infancy, and a group of British researchers
have developed a behavior checklist that may help
identify toddlers at risk for autism so they can get
treatment earlier.
"There is some, although not uncontroversial,
evidence of the benefits of early intervention
programs," notes Dr. Tony Charman of the
Institute of Child Health in London, and colleagues.
"The possibility of early identification of
autism merits investigation."
The researchers developed a questionnaire called the
Checklist for Autism in Toddlers, or CHAT, that can be
used by parents and health care workers to identify
toddlers who are at risk for developing autism,
pervasive developmental disorder, and language
disorders. The checklist focuses on behaviors that are
usually missing in children with autism: interacting
or playing with others, showing interest in things
around them, and communication through language or
pointing.
Of the more than 16,000 children screened with the
CHAT at 18 months, 38 were considered at high risk for
autism, and 369 at medium risk. The researchers looked
at whether the screened children had autism or another
developmental problems at ages 3 1/2 years, 5 1/2
years, and 7 to 8 years
The team found that CHAT correctly identified 38% of
the children who were later diagnosed with autism, and
32% of those later diagnosed with pervasive
developmental disorder. Among the high-risk group, 27
of the 38 were not diagnosed with autism, but four of
these developed language disorders and three had other
developmental disorders.
The 38 high-risk children and half of the 369
medium-risk children were screened twice about one
month after their first use of the CHAT. With these
two screenings, the checklist's ability to predict
later disorders went up: 83% of those identified as
high risk were later diagnosed with either autism or
pervasive developmental disorder. The researchers
note, however, that this method of screening also
missed a number of children who did later develop these
disorders.
Writing in the June issue of the Journal of the
American Academy of Child and Adolescent Psychiatry,
Charman and colleagues concluded that "the CHAT
can be used to identify cases of autism and related
pervasive developmental disorder at 18 months of
age." They note, however, that the checklist is a
screening tool only, and children identified through
the screening tool require more detailed examination
by experts.
"It is emphasized that the CHAT is not a
diagnostic instrument but can identify potential cases
of autism spectrum disorders for a full diagnostic
assessment," the researchers stated.
SOURCE: Journal of the American Academy of Child and
Adolescent Psychiatry 2000;39:694-702.
To view this
checklist, go to CHAT.
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