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Autism Increased Autism Diagnoses Indicates Improved Standards for Recognizing Symptoms Despite the complexities of diagnosing autism spectrum disorders (ASDs), the number of reported cases has increased by more than 20 percent in recent years, an indication that clinicians have become better at recognizing symptoms of ASDs. “Early identification and intervention are critical,” says Amanda Gulsrud, PhD, clinical director of t he Chi ld a nd Adu lt Neurodevelopmental (CAN) Clinic at UCLA and a co-investigator in UCLA’s Autism Center of Excellence (ACE). “As we continue to learn more about how to enhance the benefits of behavioral therapies to maximize long-term neurodevelopmental outcomes, we know that one of the most universal and best indicators is the age at which the child enters that intervention.” Diagnosing ASD in children younger than 3 years of age is often difficult. There is no medical test, such as a blood test, to diagnose ASD. Instead, clinicians rely on behavioral observation and developmental history. The gold standard in the field is the use of the Autism Diagnostic Observation Schedule (ADOS) in conjunction with the Autism Diagnostic Interview-Revised (ADI-R) with the parent or caregiver of the affected child. From the behavioral standpoint, clinicians look for red flags related to the way a child interacts socially with others, including the use of coordinated eye contact with another person, and the way a child gestures or points when communicating. “We see a wide range of behaviors in children with ASD, and not all treatments will work universally for all children on the spectrum,” Dr. Gulsrud says. “It is important to provide differentiated treatments for children based on their needs and individual symptoms.” UCLA’s CAN Clinic provides multidisciplinary evaluation and individualized treatment for patients of all ages with suspected or diagnosed neurodevelopmental disorders, with a focus on ASD. Once a course of treatment is prescribed, results should be consistent and measurable, says James McCracken, MD, medical director of the CAN Clinic and director of the Division of Child and Adolescent Psychiatry at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA. “Physicians should expect to see concrete evidence of progress in their patients with ASD every three to four months,” Dr. McCracken says. “If not, they should start to ask questions about why the prescribed therapies are not working.” Dr. McCracken is principal investigator of a $9-million award from the National Institute of Mental Health to create and lead a network of U.S. academic centers that will carry out early “high-risk/ high-reward” studies of promising new drugs that may help restore normal development and brain function in children and adults with ASDs. Diagnosing ASD in children younger than 3 years of age is often difficult. There is no medical test, such as a blood test, to diagnose ASD. Instead, clinicians rely on behavioral observation and developmental history. “Current medical treatments for ASD help to manage difficult behaviors but do not have much impact on the core problems of ASD, despite its known genetic and biological basis,” Dr. McCracken says. “This initiative has the potential to vastly accelerate our progress in this area.” As part of UCLA’s ACE Center, researchers are also involved in studies focused on a variety of issues related to ASD. They are investigating the genetic and biological underpinnings of ASD, working to improve clinical interventions for 12-to-21-month-old children at-risk for the disorder, using functional magnetic resonance imaging (FMRI) technology to examine infant and child brain development, striving to understand gender differences in symptom presentation and evaluating new treatments for patients with the most severe forms of ASD. “One-in-three children affected by an ASD never develops the ability to speak in phrases,” says Dr. McCracken. “We are now conducting one of the first studies that tests medication in combination with intensive communication therapy as a way to accelerate uptake of language in these children.” 3 UCLA Physicians Update