Autism Spectrum Disorders: What Can Otolaryngologists Do?

The First Words Project is an ongoing nine-year-old program that involves administering autism screening to children under age 24 months in Florida’s Panhandle.

You may be aware of the recommendations of the American Academy of Pediatrics that developmental surveillance should occur at every well-child visit from nine months to 30 months and that all children should be screened specifically for autism spectrum disorder at 18 months and at 24 months, Dr. Morgan said. The First Words Project takes over the screening of these children for participating pediatricians. Most studies of babies or toddlers in autism are baby sibs’ studies. We are doing a prospective longitudinal study with a general population sample.

We work with pediatricians’ offices. Parents fill out a 24-item checklist that we have developed. They fill it out right in the office. We get those checklists. We score them. If the child fails, we call the family directly and schedule an autism-specific screen. We also bring them in for a face-to-face evaluation. We always videotape this session.

We have screened hundreds and hundreds of children thus far. We get them in as early as nine months or 12 months of age, and we follow them every three months. We have this fabulous dataset to look at children prospectively. Following the face-to-face evaluations, if we start to see some red flags for autism, we will invite them in for follow-up diagnostic observation. We are doing diagnoses as early as 18 months and we are repeating that diagnostic battery at 30 months, she said.

Dr. Morgan said that in most practices, parental concern about the child’s not talking or isn’t listening may result in the clinician considering autism as a problem. But data collected by the project indicates that parental concern isn’t a good bellwether for problems with young children.

I think we need to be looking out for kids whose parents aren’t necessarily concerned, Dr. Morgan said in her panel lecture. In the checklist that we use, which we have now administered to more than 6000 children in trying to identify all communication disorders, we are sensitive to true positives [82% to 98%, depending on the age groups] and we have a good rate of true negatives [78% to 89%].

On the other hand, when looking at parent concern, the true positive rate ranges from 24% to 60%-generally increasing with the age of the child-whereas the true negative correlation ranged form 84% to 39%, as the age of the child increased.