Elsevier

The Journal of Pediatrics

Volume 159, Issue 3, September 2011, Pages 458-465.e6
The Journal of Pediatrics

Original Article
Detecting, Studying, and Treating Autism Early: The One-Year Well-Baby Check-Up Approach

https://doi.org/10.1016/j.jpeds.2011.02.036Get rights and content

Objectives

To determine the feasibility of implementing a broadband screen at the 1-year check-up to detect cases of autism spectrum disorders (ASD), language delay (LD), and developmental delay (DD).

Study design

The Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist was distributed at every 1-year pediatric check-up; 137 pediatricians and 225 infants participated. Screens were scored immediately, and failures referred for further evaluation.

Results

Pediatricians screened 10 479 infants at the 1-year check-up; 184 infants who failed the screen were evaluated and tracked. To date, 32 infants received a provisional or final diagnosis of ASD, 56 of LD, nine of DD, and 36 of “other.” Five infants who initially tested positive for ASD no longer met criteria at follow-up. The remainder of the sample was false positive results. Positive predictive value was estimated to be .75.

Conclusions

The 1-Year Well-Baby Check-Up Approach shows promise as a simple mechanism to detect cases of ASD, LD, and DD at 1 year. This procedure offers an alternative to the baby sibling design as a mechanism to study autism prospectively, the results of which will enrich our understanding of autism at an early age.

Section snippets

Methods

The overall design of the study included establishing a network of pediatricians throughout San Diego County and initiating a systematic screening program for all infants at the 1-year check-up. Conceptually, the program included five parts. First, pediatricians and their staff participated in a 1-hour educational seminar that provided general information about autism, as well as instruction regarding implementation and scoring of a screening tool to be used at all 1-year well-baby visits.

Screening Form Failures and Referrals

A total of 10 479 screens were administered; the mean age at screening was 12.54 months (range 10.08 to 15.97 months). On the basis of the 10th percentile cutoff scores that were used,17 it was expected that approximately 1047 infants would fail the screening. In our San Diego sample, 1318 children failed the screening (12.5 %); 346 were referred to our laboratory as indicated by the referral check box. Compliance, for purposes of this study, is defined as the rate of parent enrollment of their

Discussion

On the basis of 10 479 simple screening forms administered at the first-year pediatric examination, 32 infants were identified as having ASD. Current epidemiologic estimates report that 65 of every 10 000 infants born will be diagnosed as having an ASD by early childhood.22 Given that late onset (approximately 20% of cases), regression (25% of cases23), and Asperger’s cases (10% of cases24) would not be expected to be detected by screening at the first birthday, rates obtained by this study are

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  • Cited by (0)

    Supported by Organization for Autism Research, Autism Speaks (formerly Cure Autism Now), and NIMH (R01-MH080134 to K.P). The authors declare no conflicts of interest.

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