Early Autism Diagnosis

Can Autism Be Accurately Diagnosed by Close to One Year of Age?


Written on 27 September 2010, for:
The International Center For Autism Research and Education

Many scientists are eager to find a common pattern in early behaviors. The purpose of these studies is to point fingers at a diagnosis from earlier on. If you can predict an autism diagnosis based on early behaviors, then you can better provide services to the child from an earlier age. The purpose is not to label sooner, but rather to lead to a helpful direction to parents and caregivers from early on.  Early diagnosis of the Autism Spectrum Disorder allows for early intervention, which can make a major difference in helping children with autism reach their full potential.

Some promising studies are very interesting.  For example, we all know that hand flapping and lack of eye contact, as well as communication delay is a really strong indication for autism.  However, what about some children who show a preference for geometric patterns at an early age? This is actually a study that was done by the University of California, San Diego School of Medicine and published online September 6, 2010.  It is interesting to note that although not all the children with autism showed this preference, 100 percent of the children who spent more than 69 percent of their time fixated on geometric images had an autism spectrum disorder.

In a bold announcement, three years ago, from the experts at the Kennedy Kreiger Institute of Baltimore MD in July of 2007, the announcement stated that “New Study Shows Half of Children With Autism Can Be Accurately Diagnosed at Close to One Year of Age”.  Half of the children with a final diagnosis of ASD made at 30 or 36 months of age had been diagnosed with the disorder at 14 months, and the other half were diagnosed after 14 months. Through repeated observation and the use of standardized tests of development, researchers identified, for the first time, disruptions in social, communication and play development that were indicative of ASD in 14-month children. Multiple signs indicating these developmental disruptions appear simultaneously in children with the disorder.  After completing the study, the results were compared three years later with how many of the participants ended up with an autism diagnosis.

“What’s most exciting about these important advancements in autism diagnosis is that ongoing intervention research leads us to believe it is most effective and least costly when provided to younger children,” said Dr. Gary Goldstein, President and CEO of the Kennedy Krieger Institute. “When a child goes undiagnosed until five or six years old, there is a tremendous loss of potential for intervention that can make a marked difference in that child’s outcome.”

Although parents would love to have the ease of mind with a quick blood test to rule out an autism diagnosis, it is not yet a reality. On the other hand, parents of children who have a sibling already diagnosed with autism, should probably be the only ones eager to participate in these early childhood studies at this time, until more promising science is discovered.

Theory Of Mind

“I Cannot Tell a Lie,” Children with Autism, Missing Milestone

Written on 28 August 2010, for:
The International Center For Autism Research and Education

How many times do parents ask for small truths to be told from their child, or students (for the teachers out there). For a child without autism, it can be a very hard task to admit that they are the ones who took the cookie from the cookie jar.

Anecdotal evidence and observational studies suggest that children as young as 2 years begin to tell lies (1).   A new study was published June 17, 2010, titled “Lie-Telling, Theory of Mind, and Verbal Ability in Children with ASD” (2).

Parents of young, typically developing children, oftentimes may find it frustrating when their child begins to demonstrate deceptive behaviors and the ability to tell increasingly convincing and sophisticated lies. Nevertheless lie-telling is an important developmental milestone in a young child’s life. The goal of telling a lie is to try to make someone else believe something that the lie-teller does not believe is true.

This milestone consists of two developmental stages which are important for this study, described as Early Deception and Theory of Mind.  The researchers conclude that while 2- and 3-year-olds can be encouraged to engage in deceptive ploys, only 4-year-olds clearly demonstrate that they have a ToM (3).

Early Deception and Theory of Mind

Early deceptive acts are learned strategies used only to manipulate the behaviors of others, such as lying to avoid punishment. Theory of Mind (ToM) is the two-part ability to understand that other people have knowledge and beliefs, and their own knowledge and beliefs may differ from the lie recipient’s knowledge and beliefs. The second ability with ToM is an understanding that the person you lie to does not know what your knowlefge of beliefs are.  If you have ToM, you will instinctively understand that just because you know something, it doesn’t mean that I know it too. If you have ToM, you are not just manipulating the behaviors of others, but you are also manipulating the behaviors of others by virtue of changing others’ beliefs.

For example, when a child, who ate a cookie that he was forbidden to eat until after dinner, is asked whether he ate the missing cookie, he says, “No, I didn’t,” to avoid reprimand from his mother.  This is early deception, found in children as young as age 2.  However, if the child would say “the dog ate the cookie”, or hiding the cookie behind his back, that would reflect on the child’s ability to have presence of ToM, which is usually found in typically developing child as young as four years of age.

Without the presence of ToM, a child will not attempt to manipulate the beliefs of another person. Lie-telling can be seen as a real-world application of an understanding of others’ minds (4) and the emergence of lie-telling in young children can be taken as an indicator for the presence of at least a rudimentary ToM.

The Sally-Ann test is a famous test used to judge whether a person has ToM or not.  A child lacking in Theory of Mind will only see the situation from her own point of view. Most people of low intelligence will not be able to do the test, even though they may be otherwise very sociable, such as people with Down’s Syndrome. People with another disability,William’s Syndrome are exceptional in their ability to do this test, despite apparently low, functional intelligence.  However, most children with ASDs will not be able to complete the test, as is true for ASD adults.

Many researchers have demonstrated that children with ASD have a deficit in ToM and parents of children with ASD report that unlike their typically developing children, theirautistic children do not tell lies. However, there are no published empirical research studies on this population and their ability to produce or generate their own lies. This study aims to bridge this gap in the literature, and provide therapeutic recommendations to promote ToM for children and adults on the Autistic Spectrum.

Some findings of this study explains why children with ASD would not tell prosocial lies because children with ASD have impairments in recognizing and understanding other people’s affective states (5).

This interpretation suggests the possibility that the lies told by children with ASD may be learned strategies used to manipulate others’ behaviors and consequently avoid punishment. These strategies may be scripted and not involve manipulating the beliefs of another person. For example, a child with ASD may have learned that when he commits a transgression, the adult who had previously warned him against committing the transgression will be angry and may punish him. However, if he denies having committed the transgression, he is usually able to avoid punishment.  Such deceptive acts may simply demonstrate that children can manipulate others’ behaviors but do not necessarily reflect the presence of a ToM.

In summary, two possible interpretations of the results from the present study are: (A) the lie-telling abilities of children with ASD are merely learned behaviors and are not indicative of a ToM, and (B) lies told by children with ASD are only manifestations of a rudimentary ToM.

References:

(1) Bussey, 1992; Darwin, 1877; Leekam, 1992; Newton, Reddy, & Bull, 2000; Wilson, Smith, & Ross, 2003

(2) Lie-Telling, Theory of Mind, and Verbal Ability in Children with ASD by Annie S. Li1, Elizabeth A. Kelley, Angela D. Evans, Kang Lee, of the Department of Psychology, Queen’s University, Canada and the Institute of Child Study, University of Toronto, Canada.

(3) Sodian, Taylor, Harris, & Perner, 1991

(4) Talwar & Lee, 2008b

(5) Brent, Rios, Happé, & Charman, 2004;Hobson, 1986; Tager-Flusberg, 1992