Early diagnosis is key in autism
A concise but comprehensive review paper has shed much light on a difficult diagnostic area, the diagnosis of autism and autistic spectrum disorders (ASD).
One study has shown that the prevalence of ASD is now 116 per 10,000 nine to ten year olds, or 1% of the child population. The authors conclude that this increase is mainly down to better and more inclusive diagnosis, but do not rule out the possibility of environmental factors. However, several systematic studies have failed to confirm a link between MMR vaccination and autism.
The paper stresses the importance of early diagnosis so that therapeutic interventions may be made to greater effect. Some of the key differential diagnoses are global delay and speech delay. The paper provides a helpful list of some of the early signs and symptoms of autism seen in two-year-olds (see table 1, attached). These are categorised into qualitative abnormalities in communication, qualitative abnormalities in social interaction, and restricted and repetitive interests and behaviours.
It is interesting to be reminded that up to 37% of patients may have an associated medical condition, such as fragile X, neurofibromatosis or tuberous sclerosis.
The review points out that some children may present later, when at school, especially during periods of transition such as moving from nursery to primary, or primary to secondary school. Multiagency assessment of children is recommended (see table 2, attached).
Unfortunately, the authors do not draw any conclusions regarding many measures GPs are often asked to support, such as the benefits of special diets or nutritional supplements such as fish oils.
This paper certainly helps GPs to have a framework to deal with the question of whether or not a child could be autistic.
Dover CJ, Le Couteur A. How to diagnose autism. Arch Dis Child 2007;92:540-5Reviewer
Dr Peter Saul
GP, Wrexham and hospital practitioner in paediatrics (asthma and allergy)
Table 1table 2 Table 2: Components of multiagency assessment of autism - adapted from the NAPC