Wieckowski is an assistant research professor in the A.J. Drexel Autism Institute.
Robins is a professor in and director of the Autism Institute.
The earlier a child receives an autism diagnosis, the sooner they and their family benefit from early services. But even though autism is diagnosable by age 2 (or earlier), a backlog among practitioners has meant that the average wait time for a diagnosis is 51 months.
Unfortunately, this means many families lose time before they receive services.
“We really need strategies to lower that age of diagnosis,” says Assistant Research Professor Andrea Wieckowski in the A.J. Drexel Autism Institute. “Children who receive high-quality, autism-specific early intervention services make greater developmental gains.”
Clinicians’ high-confidence hunches about a child are usually correct. When they are less confident, their initial impressions that a child is not on the spectrum tend to be wrong. That means that if their confidence is low, more observation and testing is needed.
Wieckowski and Diana Robins, professor and director of the institute, studied the accuracy of early and repeated screening for Autism Spectrum Disorder (ASD) during the first five minutes of well-child visits beginning at 12, 15 or 18 months.
They studied clinician interactions with 294 children aged 12–53 months who had been referred for an ASD evaluation. After five minutes observing each child, expert clinicians recorded whether they thought the child would meet criteria for ASD following a complete evaluation, along with their confidence in this impression.
The duo found that a seasoned clinician can usually spot autism within the first five minutes; 92% of positive initial diagnoses turned out to be accurate. And when clinicians were highly confident in a diagnosis, they were typically correct. When they lacked confidence in a “no” diagnosis, the final diagnosis often turned out to be “yes.”
“If an expert clinician thinks the child is on the autism spectrum in the first five minutes, they’re probably right,” says Robins. “But if they don’t think the child is on the autism spectrum in the first five minutes, they should keep looking and get more information.”
The study — which appeared in Autism Research, the journal of the International Society for Autism Research — has implications for early intervention.
“When it’s very clear that a child is likely to have autism, we should fast-track them into the intervention,” even if there’s a wait list for a full diagnosis, Robins says. The goal is to get more kids into treatment sooner. And by digging deeper into an initial negative assessment, clinicians will prevent more cases from going undetected.
While regulatory and insurance hurdles can slow the process, research like this could help to drive policy changes.
“The A.J. Drexel Autism Institute was the first in the U.S. to focus on the public-health side of autism, rather than on the biomedical realm,” Robins says. “Our science can improve lives for autistic individuals much more quickly.”