Early autism detection

In an attempt to spot autism earlier, the American Academy of Pediatrics has recently recommended that all children be screened for autism twice by age 2 - advice that many St. Louis families already heed thanks to a partnership between Saint Louis University and Parents as Teachers.

Since October 2006, Saint Louis University has been working with local Parents as Teachers to train their educators to spot warning signs of autism. Rolanda Maxim, M.D., assistant professor of pediatrics at Saint Louis University and a SLUCare developmental pediatrician at SSM Cardinal Glennon Children’s Medical Center, is providing the medical and neurodevelopmental expertise for the program.

“Autism is a pervasive communication disorder, often diagnosed after age 3 in the United States,” Dr. Maxim says.

“Communication develops primarily in the first two years of life, so it is critical to improve early screening and diagnosis for autism. Everybody agrees the kids with autism who have the best prognosis start intervention early.

“Parents as Teachers sends specially trained educators into the homes of young parents to offer support and share information about child development. We’re working with these educators to give them the tools so they know when not to worry about autism and when to refer.”

The parent educators observe the child in his or her home as well as discuss developmental milestones with parents. Currently, five St. Louis area school districts participate in the program, while other local districts have expressed interest in joining the initiative.

“This is the first unified initiative,” Dr. Maxim says. “It’s a new efficient model that, to my knowledge, has not been done in any other state.”

While doctors can’t definitively diagnose autism until a child is 18 months, “red flags” for autism can begin as early as 6 months, Dr. Maxim says. Collecting data on early developmental milestones could help to develop diagnostic criteria for autism in the first year of life.

Parent educators were trained to assess development and red flags for autism in infants at 6, 12 and 18 months. If the baby fails the 18-month screening, parent educators refer the families for an evaluation at the Knights of Columbus Developmental Center at Cardinal Glennon.

Among the behaviors to watch for at 6 months: Does the child babble, look you in the eye for more than a second or two, smile at you or turn the head when his or her name is called.

Babies at 1 year might also use “dada” and mama” for a parent, put a toy or object in front of an adult to capture attention, imitate faces you make, use an index finger to point to something he or she wants, wave bye-bye and look at things that you are looking at.

The screening at 18 months – called the M-CHAT (Modified Checklist for Autism in Toddlers) -- is a bit longer and includes questions such as whether the child enjoys being swung or bounced on your knee, takes an interest in other children, likes climbing, enjoys playing peak-a-boo or hide-and-seek, plays pretend games or makes unusual finger movements hear his or her face or walks.

MOFEAT, the parent support group for autism, is paying for the developmental screening questionnaires, but red flags for autism screening questionnaires developed by Dr. Maxim and M-Chat are free. Dr. Maxim also is donating her time to train parent educators and assess children who have failed the M-CHAT.

With the Centers for Disease Control and Prevention this year reporting that 1 in 150 children in Missouri have autism spectrum disorder, parents are increasingly concerned about detecting autism at the earliest possible stage.

“We’re trying to get to them as soon as possible,” Dr. Maxim says.

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, liver disease, heart/lung disease, aging and brain disease, and infectious disease.