The average age across the United States for the diagnosis of autism and other developmental disorders in the young is 4 years. Many children with disabilities are not identified until 4 years because this is when many of them enter formal educational settings. This has been due in large part to the lack of developmental screening tools available to assess the areas of functioning which are associated with children with ASD and other deficits. These include the ability to interact with others, in particular their difficulties in eye regard and social attentional skills as well as their difficulties in emotional and social interaction with others, including empathy and sharing as well as the self conscious emotions of embarrassment, shame, guilt and pride.
A screening APP for the iPhone and iPad called EARLYThree was developed by Dr. Michael Lewis, a University Distinguished professor of pediatrics and psychiatry, and by Dr. Tara Anne Matthews, a developmental behavioral pediatrician specializing in autism and developmental disorders, in collaboration with WebTeam Corporation, an information technology company. EARLYThree is available on iTunes.
This screening device is designed for parents so that they can assess whether their child’s deficits in the social and emotional domains are suggestive of an Autism Spectrum Disorder or other deficits. It is based on both developmental research as well as pediatric practices. Based on careful research, a series of highly specific questions are asked of parents, some of which require the parents to assess their child’s behavior during the screening. It is designed to examine infants as young as 8 months of age, the time at which ASD and other deficits can be readily detected. It can be used to screen children up to and including 24 to 36 months and it focuses on the child’s social and emotional behaviors as well as communicative skills.
Another unique aspect of this screening device is a set of questions regarding self recognition in mirrors. Professor Lewis first published a book on this developmental milestone in 1979 and it has been used subsequently with children who are mentally challenged and more recently with children with ASD. The results of all of these studies indicate that by 24 months of age, all children developing typically can do this task, however children with ASD and other developmental disabilities including children with Down’s Syndrome and Cerebral Palsy, for the most part are not able to achieve this until 4 years and even then only 60% of them can do so. The use of this competence as part of the screening procedure is an example of the “laboratory to bedside technique” which has guided us in designing a better screening device.
The screening APP is quite simple to use. Parents are asked to enter their child’s birthdate, and based on their age they are presented with a series of questions about their child’s behavior that are age appropriate. The APP has a set of questions for ages 8 months (for children 8-11 months old), 12 months (for 12-14 months old), 15 months (for 15-17 months old), 18 months (for 18-23 months old) and 24-36 months (for children 24 months and older). These ages were selected because of key social milestones, including social, emotional and cognitive development for each of these ages. For example, children by 8 months should engage in active eye contact and by 12 months should be engaging in babbling; that is using both consonant and vocal sounds with a rhythm particular to their parents’ language. By 18 months children should engage in pretend play such as “talking on a toy phone” or pretending to drink from an empty cup. By 24 months children should have the personal pronouns of me or mine and be able to engage in pretend play with other children or with their parents. The APP also screens for behaviors that are typical of children on the Autism Spectrum, such as repetitive behaviors, echolalia, and problem behaviors. The screening device contains questions and pictorial representations of these questions for each age level.
In addition to the parent questions, pediatrician input is also available. As part of this screening device pediatricians can assess children’s development and compare their assessment to that of the parents. The pediatrician can use this screening device in conjunction with the parents’ input to quickly scan the child’s development. Because it is parent friendly and can be filled out in the waiting room, the time it takes to complete makes it ideal for the busy practice as well as for parents who have little information regarding the milestones of development. This screening device has been used by over 8,000 parents and is currently being translated into Hindi and Chinese.