A quarter century of progress on the early detection and treatment of autism spectrum disorder

Abstract

The last 25 years have witnessed tremendous changes in our ability to detect autism very early in life and provide interventions that can significantly influence children's outcomes. It was once questioned whether autism could be recognized before children had developed language and symbolic play skills; now changes in early behaviors, as well as structural brain changes, have been documented in infants 6-12 months of age who later develop autism. Advances in brain imaging and genetics offer the possibility of detecting autism before the syndrome is fully manifest, thereby reducing or preventing symptoms from developing. Whereas the primary mode of behavioral intervention a few decades ago relied on operant conditioning, recent approaches integrate the methods of applied behavioral analysis within a developmental, relationship-focused intervention model that are implemented by both parents and clinicians. These interventions have been found to have positive effects on children's developmental trajectory, as measured by both behavioral and neurophysiological assessments. Future approaches will likely combine both behavioral and pharmacological treatments for children who have less robust responses to behavioral interventions. There has been a paradigm shift in the way that autism is viewed, evolving from a lifelong condition with a very poor prognosis to one in which significant gains and neuroplasticity is expected, especially when the condition is detected early and appropriate interventions are provided. The grand challenge for the future is to bridge the tremendous gap between research and the implementation of evidence-based practices in the broader community, both in the United States and worldwide. Significant disparities in access to appropriate health care for children with autism exist that urgently require advocacy and more resources.

Early detection of child and adolescent mental disorders: some elements of a necessary debate

“…There are a lot of expectations from such a strategy. Some have suggested with respectable arguments that success is at hand: we could expect to improve dramatically patients with ASD in the foreseeable future thanks to very early and intensive psychological interventions [1]. It seems, however, that things are not so clear; let us remember that very recently the "United States Preventive Services Task Force" declined to recommend universal screening for ASD features [6].…”

Life Course Health Development in Autism Spectrum Disorders

“…However, to date, no studies have directly assessed the impact of genetic testing on health outcomes such as earlier age of diagnosis or reduced use of other diagnostic tools such as MRI (Sun et al 2015). In the future, we anticipate that there will be an increased application of genetics and neuroimaging to the early identification of ASD (Dawson and Bernier 2013). It is also likely that the discovery of genetic variants that impact the development of the synapse will lead to clinical trials of new (or "repurposed") drugs targeting those mechanisms.…”

“…Novel approaches to understanding ASD are welcome given that ASD represents a major public health challenge. The estimated annual cost of caring for individuals with ASD in the USA is $137 billion, with a lifetime cost per individual estimated to be $2.4 million for those with co-occurring intellectual disability and $1.4 million for those without intellectual disability (Dawson and Bernier 2013). The following chapter is not an exhaustive review of the literature in ASD; rather, we highlight some issues and findings that are pertinent to an understanding of ASD using the lens of the life course health development principles.…”

Tapping into Technical Talent: Using Technology to Facilitate Personal, Social, and Vocational Skills in Youth with Autism Spectrum Disorder (ASD)

“…Calls to action to address the needs of these youth indicate that there are few interventions or programs to support vocational preparation in this population (Levy and Perry 2011;McDonald and Machalicek 2013). The current focus in autism is an emphasis on early intervention, in order to remediate the deficits associated with the disorder, and in fact, these early interventions show positive effects on children's development (Dawson and Bernier 2013;Reichow 2012). In comparison, few interventions focus on vocational interventions for adolescents or young adults with ASD (Taylor et al 2012).…”