02-27-2007, 02:06 AM
Ped Med: The autism diagnosis challenge
By LIDIA WASOWICZ
UPI Senior Science Writer
SAN FRANCISCO, Feb. 26 (UPI) -- Before a therapy for autism can be considered, a diagnosis must be made; yet here, as in many aspects of childhood health, the U.S. healthcare system often fails to make the grade.
As with attention-deficit/hyperactivity disorder, depression and other psychiatric conditions, the problem starts long before the child -- or for that matter the physician herself -- enters the doctor's office.
Studies indicate many pediatricians feel ill-prepared by their medical schools and residency hospitals for the realities of modern-day practice.
"(E)ven though we had trained in some of the best pediatric training programs in the country, we were seeing a new population of kids that we knew nothing about, and we were learning from parents about kids with a variety of disorders that we had never heard of before in our pediatric training," Dr. Eileen Costello said at an autism conference sponsored by the Brookings Institution in Washington.
Costello is a children's physician at the Boston University School of Medicine, co-author of "Quirky Kids," (Random House, 2003) and mother of a teenage son with a mild case of an autism spectrum disorder called Asperger's syndrome.
In the 15 years since her graduation, meningitis and other infectious diseases and metabolic disorders she had so painstakingly learned to treat have all but disappeared into the folds of the U.S. immunization program, she said.
In their place, a new generation of childhood ailments has emerged -- a trend with which medical training programs have yet to catch up, specialists said.
"(As pediatric residents), we're not doing what we're going to do when we graduate, that's for sure," Costello said.
Instead of checking for rashes and stiff necks, she now finds herself looking out for entirely different symptoms, including an infant's ultra-sensitivity to his surroundings, she said.
"I watch the babies when I put them on the exam table with that crinkly white paper that we pull out for each new patient," Costello related. "And some babies love the feeling of the paper. They can't wait to squeeze it, put it in their mouth."
"And then, every now and then, I see a baby who, the minute they hit the paper, they can't stand the feeling of it, they can't stand the sound of it, they have to be picked up immediately," she continued.
"And that may be a subtle signal that we can see very early, this is a child who's going to have some sensory issues. They're going to be sensitive to sound, to touch, to texture, to lights."
New research is starting to identify a variety of behaviors that appear to predict autism.
In landmark studies, researchers reported that high-risk infants -- those with older brothers and sisters with autism -- show language differences, making unusual sounds and words, and are less likely than typically developing babies to respond to their own name at around 12 months, long before the disorder is typically diagnosed nowadays.
Other investigators observed abnormalities in gestures such as pointing, eye contact and body or limb posturing as well as modes of play -- for example spending an inordinate amount of time manipulating objects -- that researchers said might be used as aids in early diagnosis.
"By identifying these differences very early on, we know then we ought to be targeting for example early language development even before maybe the child has begun to speak or we could even expect them to begin speaking," Helen Tager-Flusberg, professor of anatomy, neurobiology and psychology, said at an international autism meeting in Boston sponsored by the University of California, Davis, M.I.N.D. Institute, Cure Autism Now and the National Alliance for Autism Research.
Tager-Flusberg, director of the Lab of Developmental Cognitive Neuroscience and of the Autism Research Center of Excellence at Boston University, has studied autism-related language and social awareness for more than 25 years.
Other investigators are hoping to catch problems in infants by retooling special cameras and software that calculate the precise direction of a subject's gaze at any given point.
Using these instruments, they have observed older children and adults pay less attention to facial expressions and other social cues than do their non-autistic counterparts.
These technologies might be adapted to track eye movements of newborns and infants to espy any subtle hints of what's to come.
A team at Binghamton University in New York has combined such tools with miniaturized monitoring devices, multiple, high-speed computers and video cameras built into a small desk to observe in minute detail where, how and how long an autistic child casts a glance in the presence of faces, objects and actions, either live or on video.
The researchers then compare these measures with those for a youngster without the disorder to determine any differences in how the two process information and stimuli from their surroundings.
Because none of the apparatus has to be worn, the system provides a workable tool even for very young children, the scientists said.
The premise driving all these experiments is that the sooner the problem can be identified, and treated, the better.
No one has found a cure for autism. However, consensus is growing that intensive early intervention -- at least 25 hours a week with one or more specialists, by the latest government standards -- is both essential and effective, though for some inexplicable reason there are children for whom it makes no difference at all, according to several reports in the journal Pediatrics.
The treatment is best started before age 2 or 3, and no later than 5, to take full advantage of a period ripe for molding the still-malleable brain, specialists advised.
(Note: In this multi-part installment, based on dozens of reports, conferences and interviews, Ped Med is keeping an eye on autism, taking a backward glance at its history and surrounding controversies, facing facts revealed by research and looking forward to treatment enhancements and expansions. Wasowicz is the author of the new book, "Suffer the Child: How the Healthcare System Is Failing Our Future," published by Capital Books.)
Next: Early autism diagnosis effective yet elusive
By LIDIA WASOWICZ
UPI Senior Science Writer
SAN FRANCISCO, Feb. 26 (UPI) -- Before a therapy for autism can be considered, a diagnosis must be made; yet here, as in many aspects of childhood health, the U.S. healthcare system often fails to make the grade.
As with attention-deficit/hyperactivity disorder, depression and other psychiatric conditions, the problem starts long before the child -- or for that matter the physician herself -- enters the doctor's office.
Studies indicate many pediatricians feel ill-prepared by their medical schools and residency hospitals for the realities of modern-day practice.
"(E)ven though we had trained in some of the best pediatric training programs in the country, we were seeing a new population of kids that we knew nothing about, and we were learning from parents about kids with a variety of disorders that we had never heard of before in our pediatric training," Dr. Eileen Costello said at an autism conference sponsored by the Brookings Institution in Washington.
Costello is a children's physician at the Boston University School of Medicine, co-author of "Quirky Kids," (Random House, 2003) and mother of a teenage son with a mild case of an autism spectrum disorder called Asperger's syndrome.
In the 15 years since her graduation, meningitis and other infectious diseases and metabolic disorders she had so painstakingly learned to treat have all but disappeared into the folds of the U.S. immunization program, she said.
In their place, a new generation of childhood ailments has emerged -- a trend with which medical training programs have yet to catch up, specialists said.
"(As pediatric residents), we're not doing what we're going to do when we graduate, that's for sure," Costello said.
Instead of checking for rashes and stiff necks, she now finds herself looking out for entirely different symptoms, including an infant's ultra-sensitivity to his surroundings, she said.
"I watch the babies when I put them on the exam table with that crinkly white paper that we pull out for each new patient," Costello related. "And some babies love the feeling of the paper. They can't wait to squeeze it, put it in their mouth."
"And then, every now and then, I see a baby who, the minute they hit the paper, they can't stand the feeling of it, they can't stand the sound of it, they have to be picked up immediately," she continued.
"And that may be a subtle signal that we can see very early, this is a child who's going to have some sensory issues. They're going to be sensitive to sound, to touch, to texture, to lights."
New research is starting to identify a variety of behaviors that appear to predict autism.
In landmark studies, researchers reported that high-risk infants -- those with older brothers and sisters with autism -- show language differences, making unusual sounds and words, and are less likely than typically developing babies to respond to their own name at around 12 months, long before the disorder is typically diagnosed nowadays.
Other investigators observed abnormalities in gestures such as pointing, eye contact and body or limb posturing as well as modes of play -- for example spending an inordinate amount of time manipulating objects -- that researchers said might be used as aids in early diagnosis.
"By identifying these differences very early on, we know then we ought to be targeting for example early language development even before maybe the child has begun to speak or we could even expect them to begin speaking," Helen Tager-Flusberg, professor of anatomy, neurobiology and psychology, said at an international autism meeting in Boston sponsored by the University of California, Davis, M.I.N.D. Institute, Cure Autism Now and the National Alliance for Autism Research.
Tager-Flusberg, director of the Lab of Developmental Cognitive Neuroscience and of the Autism Research Center of Excellence at Boston University, has studied autism-related language and social awareness for more than 25 years.
Other investigators are hoping to catch problems in infants by retooling special cameras and software that calculate the precise direction of a subject's gaze at any given point.
Using these instruments, they have observed older children and adults pay less attention to facial expressions and other social cues than do their non-autistic counterparts.
These technologies might be adapted to track eye movements of newborns and infants to espy any subtle hints of what's to come.
A team at Binghamton University in New York has combined such tools with miniaturized monitoring devices, multiple, high-speed computers and video cameras built into a small desk to observe in minute detail where, how and how long an autistic child casts a glance in the presence of faces, objects and actions, either live or on video.
The researchers then compare these measures with those for a youngster without the disorder to determine any differences in how the two process information and stimuli from their surroundings.
Because none of the apparatus has to be worn, the system provides a workable tool even for very young children, the scientists said.
The premise driving all these experiments is that the sooner the problem can be identified, and treated, the better.
No one has found a cure for autism. However, consensus is growing that intensive early intervention -- at least 25 hours a week with one or more specialists, by the latest government standards -- is both essential and effective, though for some inexplicable reason there are children for whom it makes no difference at all, according to several reports in the journal Pediatrics.
The treatment is best started before age 2 or 3, and no later than 5, to take full advantage of a period ripe for molding the still-malleable brain, specialists advised.
(Note: In this multi-part installment, based on dozens of reports, conferences and interviews, Ped Med is keeping an eye on autism, taking a backward glance at its history and surrounding controversies, facing facts revealed by research and looking forward to treatment enhancements and expansions. Wasowicz is the author of the new book, "Suffer the Child: How the Healthcare System Is Failing Our Future," published by Capital Books.)
Next: Early autism diagnosis effective yet elusive