Military Doctor Cites Need for Early Intervention of Autism

By Navy Lt. Jennifer Cragg
Special to American Forces Press Service

April 13, 2009 - A Uniformed Services University of the Health Sciences faculty member discussed Autism Awareness Month and the importance of early, proper diagnosis and treatment of children. "Parents should feel confidence in raising questions about whether their child has autism," Dr. Janice Hanson told "Dot Mil Docs" listeners during an April 9 webcast on Pentagon Web Radio. "They are often the first ones to raise concerns and to raise them in a way that a pediatrician can sort out whether to be concerned, how concerned to be, and what to do about it next."

According to Autism Speaks, a science and advocacy organization dedicated to funding research into the causes, prevention, treatments and a cure for autism, early intervention is critical to gain maximum benefit from existing therapies. While there are no effective means to prevent autism, no fully effective treatments, and no cure, current research suggests that early educational intervention for at least two years during the preschool years can result in significant improvements for many children with autism-spectrum disorders.

Hanson said children can be diagnosed with autism by age 3, but parents might notice changes in a child as young as 6 months. Three categories of characteristics describe a child with autism, she said.

"Before complete diagnosis of autism, a child would show some symptoms in ... [each of] three areas: communication, social interaction, and stereotypical behavior," Hanson explained. The three categories that go along with a diagnosis of autism include delayed speech or language; differences in social interaction, such as avoiding eye contact or misunderstanding social cues; and stereotypical behaviors such as playing with toys with a ritual behavior or rocking over and over again.

"Autism is a disorder of communication and social interaction," the doctor said. "There is a range of disorders actually that fall within a spectrum that we call pervasive developmental disorders. The range goes from classic autism, with a fairly significant difference in communication and social interaction, to Asperger's Syndrome, which is more mild and sometimes more difficult to diagnose.

"Also included in the spectrum is a group of children that don't exactly fit the criteria, but have many of the characteristics," she continued, "and they are called children with pervasive developmental disorder not otherwise specified."

Hanson said the number of children diagnosed is hard to pin down with current data.

"That is actually a subject of debate and research as we speak," she said. "I just read a study that summarized 43 studies in the literature from the last several decades, trying to pin down what that number might be, so what we have is a range of numbers. The greatest number would be about one child out of 150, and this would be the most broad use of the diagnostic categories, which would include children with autistic diagnoses all along that spectrum from the most severe to the most mild."

Hanson said whether the number of diagnoses is increasing is another controversial subject.

"There has been a lot of controversy for the past 10 to 15 years about whether the incidence of autism is increasing, and if so why," she said. "Some people think yes, it is definitely increasing. Others think we have improved our ability to identify these children and we've changed our criteria to include broader numbers."

The Uniformed Services University of the Health Sciences is working toward educating and training physicians and nurses to accurately diagnosis autism early.

"We have a medical school and a graduate school of nursing that educates and trains physicians and nurse practitioners to work in the military health system, and that is where I am on the faculty," Hanson said. "We do an intense, focused job of providing education for these students, not only about autism, how to diagnosis, and what to watch for, but also about the military environment and the special challenges for military families.

"We are trying very hard to send new doctors into our military health system with a strong awareness of when to refer, where to refer and how to get a child accurate diagnosis and effective interaction," she added.

(Navy Lt. Jennifer Cragg serves in the Defense Media Activity's Emerging Media directorate.)