The Road to Recovery: Early Intervention

There has never been a more accurate mantra in the field of developmental disability: “Early diagnosis leads to timely intervention…timely intervention leads to better outcome.”  We know that children with autism demonstrate signs of the disorder even before the age of nine months.  However, the average child with autism is not diagnosed with the condition until the age of six.  As a result of this delay, there have been about five years of lost opportunity which is especially important because the years from birth to three are so crucial in a child’s life. Sometimes the reason for such delay is that parents harbor an antiquated ‘picture’ of children with autism.  They believe that autism means institutionalization and a life of disability.  However, parents are learning that effective intervention for a child with autism can dramatically improve the chances that a child will lead a highly productive, happy and independent life.  As far back as 1987, researchers (Lovaas) discovered that 47% of children who received intensive early intervention could be mainstreamed into regular education and were “indistinguishable” from their typically-developing peers. Another reason for delay is a lack of understanding, particularly among health professionals.  Most children from birth to three only have contact with one professional-their pediatrician.  Unfortunately, only about 20% of children who are in need of early intervention services are identified by their doctor.  It happens.  When my wife was pregnant about 14 years ago, we carefully interviewed several pediatricians whom we thought would be a highly qualified and responsible.  We selected a doctor who had won many accolades and was considered a child expert.  Things went awry when we brought our son’s delays to the attention of the doctor, but unfortunately were told: “You’re just a nervous parent…this is your first child isn’t it?” and “Boys develop later than girls.”  I was led to believe that it was much ado about nothing.  As my son’s delays worsened, we luckily received a second opinion from a sensitive and patient doctor within the same practice.  This doctor offered referrals for early intervention, special needs preschool, occupational, speech, and physical therapies. Fortunately, there has been an increased emphasis on helping doctors recognize the early signs of developmental delay and autism so that they can offer referrals for further assessment.  These screenings are typically conducted during well visits.  The doctor or nurse practitioner can utilize ‘The First Signs’ developmental screener (Greenspan, Prizant, Wetherby, 2001, “Is your baby meeting these important milestones?  Key social, emotional, and communication milestones for your baby’s healthy development, Merrimac, MA: First Signs Inc.)   To help identify early signs of autism, there are now several questionnaires which pediatricians can use such as the Modified Checklist for Autism in Toddlers (M-CHAT).  For older children, the Special Learning Autism Checklist is a good instrument. If you are concerned about your child’s development, request that your child’s doctor complete a brief assessment using one of the tools mentioned above.  Document your concerns in a journal and bring those descriptions to well visits to discuss with the doctor.  Request that a developmental evaluation be conducted by a psychologist, developmental pediatrician, or child psychiatrist.  Request a referral for a hearing evaluation or for a lead screening.  Remember, early detection offers your child timely treatment and the best prognosis.