Autism in the Doctor's Office
Some children exhibit signs of autism from birth, though often parents and caregivers recognize those signs only in hindsight. Other children appear to be developing normally, then dramatically shut down, losing language and social skills seemingly overnight. Some researchers have even examined family videos of first- and second-year birthday parties to look for unseen-at-the-time clues that children were slipping into autistic behavior.
When Adams's son was diagnosed a few months before he turned 3, she swung into action, putting Jonah (a pseudonym) on a special diet and visiting a slew of doctors, psychologists, and specialists before settling on intensive speech and behavioral therapies. Today he's a fully functioning 8-year-old enrolled in a regular education classroom with a shadow aide to assist when he needs help with a slight auditory-processing delay. In the language of autism advocates, Jonah isn't "cured" but "recovered." "He's an amazing, wonderful boy," Adams says, "living a typical child's life."
Such aggressive interventions are somewhat controversial: Not all children respond, and it's not yet clear how recovered kids fare as they enter adolescence and adulthood. (In a new wrinkle, data from patients at the Children's Hospital of Philadelphia released this summer show that some of the improvement seen in children with IQs over 70 may occur on its own as part of the natural course of autism.) What is clear is that behavioral therapies have their best chance of working the earlier autism is diagnosed. Couple that knowledge with a recent Canadian study that detected autism in infants as young as 12 months and what emerges is a newly intensified, high-stakes emphasis on early developmental milestones that's changing the traditional peek-in-the-ears, chart-the-weight childhood checkup into something else entirely.
Spurred on in part by concern over the rising number of autism diagnoses, the CDC this year launched "Learn the Signs. Act Early," a public-awareness campaign designed to emphasize that it's as important to measure a child's neurological development as it is to monitor physical milestones like sitting and walking. Pediatricians and parents are being taught to track a baby's progress in hitting such markers as developing a social smile (3 months), reacting to expressions of emotion (7 months), responding to a verbal request (1 year), and using two- to four-word phrases (2 years). It's the CDC's hope, says Marshalyn Yeargin-Allsopp, M.D., a medical epidemiologist with the CDC's National Center on Birth Defects and Developmental Disabilities, that the campaign will serve as a springboard for parents and healthcare providers to talk more openly about developmental delays.
This new focus has the potential to help many preschoolers--not just those with autism, says Nancy Wiseman, founder of First Signs, Inc., an organization focused on early identification and intervention in developmental disorders and author of the forthcoming Could It Be Autism? A Parent's Guide to the First Signs and Next Steps. "Learning disabilities, language delays, nonverbal learning disorders, attention deficit hyperactivity disorder, vision and hearing problems, metabolic disorders, mental retardation," she ticks off. "Any of these that we can catch in the net now can help that child."
If early identification and treatment is the silver lining of autism awareness, its darker flip side is a kind of milestone mania that can rob new parents of some of the bliss of their babies' very earliest days and months. "The neurological stuff is always in the back of my mind," admits Handler. "My son is very social, but I am still always asking my mom, 'Is this okay? Is that okay? What do you think?'"
"There's a lot of free-floating anxiety among these young moms," says Handler's mother, Dr. Berkowitz, who notes that autism anxiety seems most prevalent in middle- and upper-class parents, perhaps because they have both the education and the time to keep up on developmental issues. Marsha Winokur, Ph.D., a psychologist with the Child Development Center at the Jewish Board of Family and Children's Services in New York City, worries about this worry. She's concerned that parents are missing the forest as they stare at one tree, then another, watching their babies for any kind of developmental delay.
"Not every developmental blip means something," says Dr. Winokur. "If there's a problem, you'll know. The trusted adults in your child's life will know -- the pediatrician, the daycare, the school, the grandparents. In the meantime, you have a responsibility to relax and celebrate your child."