All U.S. children should be formally screened for autism twice by the age of 2, the nation's top pediatrician group recommended on Monday.
The new guidelines issued by the American Academy of Pediatrics focus on early intervention, which can improve a child's chances for effective treatment.
"If you recognize it earlier, you get them into treatment earlier," said Dr. Scott Myers, a pediatrician who specializes in neurodevelopment and who helped write two clinical reports designed to help pediatricians identify and manage autism.
"Kids who start (treatment) earlier do better in the long run," Myers said in a telephone interview.
The guidelines for the first time call for universal screening of babies at the regular 18- and 24-month check-ups, regardless of whether there are warning signs. They will be published in the journal Pediatrics and on the group's Web site at http://www.aap.org.
No one knows what causes autism, a complex developmental disorder that includes problems with social interaction and communication.
Symptoms range from mild awkwardness to severe disability and mental retardation. The U.S. Centers for Disease Control and Prevention estimates that about one in every 150 U.S. children has autism or an autism spectrum disorder, such as Asperger's syndrome.
Delays in communication often are an early warning sign.
The guidelines urge pediatricians to watch for subtle signs, such as a lack of babbling, late smiling and failure to make eye contact. Picking up on these cues could lead to earlier diagnosis and treatment.
"Young children and infants between 9 and 12 months should turn and respond when their name is called," said Myers, of Janet Weis Children's Hospital/Geisinger Medical Center in Danville, Pennsylvania.
"If you say look at something across the room and you point, they ought to follow that with their eyes," he said.
Warnings signs needing immediate evaluation include: no babbling or pointing or other gestures by 12 months, no single words by 16 months, no two-word phrases by 24 months and regression or loss of language or social skills at any age.
If autism is suspected, the guidelines urge parents not to wait for a specialist to confirm the diagnosis before seeking treatment for the specific symptoms.
"You can begin with therapy geared toward the impairments that are there," Myers said.
The reports also review educational therapies and advises that children be engaged in intensive intervention of at least 25 hours per week, 12 months a year, with a low student-to-teacher ratio. Parents should be included in this treatment.
Pediatricians treating patients with autism should make themselves aware of various alternative therapies and to help parents make treatment decisions based on scientific evidence.
But the report suggests doctors should maintain open communication, even when families are pursuing unproven alternative treatments.
While the guidelines stress early intervention, Myers said many children benefit from therapy even if their autism was not detected until later.
"In the milder forms, it may not be possible to diagnose early," Myers said. "It is not hopeless by any means if it is diagnosed later but there does seem to be an advantage to getting intervention going as early as we can."
