Section II: Disorders
Autism Spectrum Disorders in Young Children

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Signs of ASD in young children

In this section, we discuss research conducted on very young children that highlights the early age at onset and specific signs that can be observed before age 2 years in children diagnosed with ASD. Such a research review is limited, however, and we strongly recommend reading case presentations of children diagnosed before 18 months of age19, 20 as well as reviewing the ASD Video Glossary of early signs, now available through Autism Speaks (http://www.autismspeaks.org/video/glossary.php). This

Screening and early detection

As awareness of ASD prevalence, early emergence of symptoms, and the value of early detection and intervention for enhanced long-term outcomes have increased, screening initiatives have been developed to increase early detection in the general population. For example, the American Academy of Pediatrics now recommends routine ASD screening to be included as part of a general developmental assessment during regular well-child visits at 18 and 24 months of age.58 However, there is still debate

Diagnostic assessment

In light of the greater instability in diagnoses prior to 3 years of age, assessments of young children often focus on establishing or confirming diagnosis, whereas assessments at later ages typically focus on measuring skills.79 However, both accurate diagnosis and identifying strengths and weaknesses of the child's developed skills are central to inform treatment planning for young children, whether they are newly diagnosed or being seen for reevaluation.

The gold standard diagnostic tools in

Family considerations

All young children are embedded in family relationships. When a child is diagnosed with ASD, families are affected in different ways. Elevated parenting stress and depressive symptom scores have often been reported among parents raising children with ASD, whether they are compared with parents raising typically developing children or to parents of children with other developmental delays.88 This finding has been replicated among parents raising young children with ASD.89, 90

There are several

Interventions

In concert with efforts to enhance earlier detection of ASD, there has been a great deal of work to improve early interventions for young children with ASD. This work has been informed by our deepening understanding of the earliest signs and relationships between deficits in joint attention, play, social communication, and language.18, 107 The existing studies document that early intervention improves later communication and adaptive outcomes,108 but there are many questions regarding early

Summary

There is now clear evidence that the first signs and symptoms of ASD are evident for most children by 12 to 18 months of age. This knowledge, coupled with emerging evidence that early intervention that targets social-communicative behaviors improves long-term outcomes, has led to increased early detection efforts. Families who are confronted with a diagnosis of ASD often experience significant parenting stress and strain as they must navigate complex intervention decisions and learn to adapt to

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      In a study comparing parenting stress in mothers of children with Fragile X syndrome, Down syndrome, and ASD, mothers of children with ASD showed the lowest levels of psychological well-being and coping (Abbeduto et al., 2004). A number of researchers argue that diagnosis of a child with ASD can be more stressful for parents compared with other disorders due to the lack of clarity in diagnostic criteria, as well as the associated symptoms that may add to the complexity of an ASD diagnosis (i.e., sleep or eating difficulties) (Howlin & Moore, 1997; Lord & Risi, 1998; Martinez-Pedraza & Carter, 2011). Family and couple relationship strain can be intensified if a child with ASD requires more time and effort; most notably if the child exhibits problem behaviours (Brobst, Clopton, & Hendrick, 2009; Pozo, Sarria, & Brioso, 2014).

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    This work was supported by a grant to A. Carter from Autism Speaks.

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