Short checkups may overlook autism clues

The usual 10 to 20 minutes allotted to a well-child visit may not allow enough time to pick up atypical behaviors that point to autism risk, according to a new study.

To find out what is “optimally observable” in a 10-minute autism assessment, researchers videotaped 42 children aged between 15 and 33 months during 3 assessments, including the Autism Diagnostic Observation Schedule. Fourteen of the children had been diagnosed previously with early signs of autism; 14 had suspected language delays but not autism; and 14 were developing normally.

Two licensed psychologists with expertise in autism spectrum disorders analyzed 2 10-minute videos of each child’s autism assessment without knowing the child’s diagnostic status. They evaluated 5 behaviors-responding, initiating, vocalizing, play, and response to name-then decided whether they would refer the child for an autism evaluation.

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Based on the video clips, the psychologists missed recommending referrals for 39% of the children with autism. Within the 10-minute time frame, the children with autism exhibited more typical behaviors (89% of the time) than atypical behaviors (11%) overall. During brief observations, the researchers note, typical behaviors may exceed atypical behaviors in some children with autism to such an extent that even experts have trouble discerning whether a referral for evaluation is warranted.

They conclude that “brief clinical observations may not provide enough information about atypical behaviors to reliably detect autism risk” and suggest that the decision-making process for referral should take into account all available data, including autism screening tools, parent observations, developmental testing, and a detailed history.

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