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April 25, 2017

With autism diagnoses on the rise, UW establishes clinic for babies

Research scientist Tanya St. John works with a baby at the University of Washington Autism Center.

To new parents, a baby’s every gurgle and glance are fascinating, from a smile at mom or dad to a reach for a colorful toy.

But when a baby doesn’t look at parents and caregivers, imitate gestures and sounds, or engage in play, parents have questions. And a growing number are bringing their babies to the University of Washington Autism Center for answers.

As autism diagnoses have increased over the years — an estimated one in 68 people has autism spectrum disorder — parents have looked for signs earlier in their children’s lives, especially if they have an older child with autism. While the average age for autism diagnosis in the United States is around 4 years, a growing body of research and practice suggests accurate assessment of children as young as 12 months old, though rare, is not only possible, but also useful.

“Many people have an unfounded belief that you have to wait until 36 months of age to diagnose autism. That is not the case,” said Annette Estes, who directs the UW Autism Center and is a research affiliate at the Center on Human Development and Disability. “There is a great deal of value in diagnosing as soon as symptoms emerge — it gives parents a great deal of relief and allows appropriate intervention to begin.”

With only a few infant autism clinics scattered around the country, families have brought their  infants to the UW Autism Center from elsewhere in the United States, and in a few cases, the world, Estes said. The natural next step was to dedicate services to them.

The center’s Infant Clinic, officially established this spring, provides four clinical psychologists to evaluate infants and toddlers up to 24 months of age, along with teams of behavior analysts to create a treatment plan with clinic- and home-based activities — just as would happen with older children. The difference, Estes explained, is the specific expertise with the infant population.

The Autism Center, part of the UW Department of Speech & Hearing Sciences, has conducted a number of studies into the signs of autism and the effectiveness of intervention strategies. Earlier this year, Nature published findings from the center’s involvement in a North American effort that examined brain biomarkers in infants, including those with at least one autistic sibling. The study showed that magnetic resonance imaging (MRI) helped correctly identify 80 percent of babies who would go on to be diagnosed with autism at 2 years of age Researchers are wrapping up another study, focused on toddlers 12 to 24 months old, that looks at structured intervention activities versus a more play-based approach.

That work bolsters the center’s diagnostic and treatment capacity with infants, Estes explained.

For older infants and toddlers, psychologists focus on social and communication deficits, said Tanya St. John, a research scientist and clinical psychologist at the center. Typically-developing infants and toddlers spend time engaging and interacting with their caregivers, which helps them learn language and fosters their social development.

“Children showing the early signs of autism don’t do those things as much as expected, or they don’t do them at all,” St. John said. “We look at a repertoire of other behaviors as well: Do they do the same thing over and over? Do they pick up a toy and inspect it closely? Do they have a hard time when you change activities?”

It is less common to diagnose a very young child, St. John said, but when that happens, it’s typically because the symptoms are clear.

“Most people are hesitant to give a diagnosis to a child who isn’t showing clear signs of ASD. We tend to give early diagnoses to children who meet all of the criteria for a diagnosis, and if they’re not, we take an assessment-and-monitoring approach, where we give parents specific recommendations based on the child’s current challenges, and then see the child back 3 to 6 months later,” she explained.

Treatment would follow the same general trajectory, depending on the infant’s symptoms and development, as toddlers and older children. Specialists might work on communication, for instance, through strategies to encourage eye contact. As children age, they work with specialists on cognitive, social and motor skills, both individually and in peer groups. Much of the Autism Center’s approach is designed to give parents tools that they can use at home, Estes said.

Spotting the signs of autism early is critical, she added, so that a family can connect with the right services, whether in the clinic or out in the community.

A little over three years ago, the Autism Center accurately diagnosed its youngest client: a 10-month-old boy. Thanks to subsequent intervention activities, Estes said, he has developed communication skills, engages socially and is thriving in preschool.

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For more information, contact Annette Estes, estesa@uw.edu; 206-543-1051.