26.10: Specific Considerations

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Amanda Taintor & Emily Elam

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Autism Spectrum Disorder -ASD

During the last two decades, research has made tremendous progress with regard to early identification and diagnosis of ASD. As a result, in many cases, ASD can now be reliably diagnosed between 18 and 24 months of age (Ozonoff S, Young GS, Landa RJ, Brian J, Bryson S, Charman T, et al, 2015). Advances in best practices related to early identification are reflected in a 2006 policy statement published by the American Academy of Pediatrics (2006), asserting that Primary Care Providers (e.g., family physicians, pediatricians) administer formal screening tests during every well-child visit scheduled at 18 and 24 months, independent of known risk factors or reported concerns. Moreover, Primary Care Providers are urged to promptly refer children for Early Intervention services as soon as ASD is seriously considered as a possibility for diagnosis.

Among the children with a documented clinical ASD diagnosis, children's median age at first diagnosis was 51 months. The median age of children's first comprehensive developmental evaluation was 40 months, with 44% being first evaluated at or prior to 36 months, and 37% being first evaluated later than 48 months.

The intersection between (1) the complex ECE system in the US, and (2) characteristic delays in ASD diagnoses has important implications for children's access to inclusive ECE environments. On one hand, many children who are eventually diagnosed with ASD are enrolled in ECE programs prior to receiving a formal diagnosis. Thus, ECE teachers serve as an important source of social and professional support during a time when parents begin to recognize concerns about their child's social-communication development, navigate the diagnostic process, and begin to access ASD-specific resources. ECE teachers begin to implement individualized instruction and classroom adaptations prior to children's ASD diagnoses in many instances. On the other hand, because most children with ASD do not receive their formal ASD diagnosis until they are 4 years of age or older, the Pre-K and kindergarten years are often the first realistic opportunity for implementing formal special education services in inclusive classroom settings.[1]

[1] Siller M, Morgan L, Wedderburn Q, Fuhrmeister S and Rudrabhatla A (2021) Inclusive Early Childhood Education for Children With and Without Autism: Progress, Barriers, and Future Directions. Is licensed CC B