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Autism prodrome 19 of 89

Overall these screening studies have shown that it is possible to
prospectively identify ASD, including in children about whom parents and
professionals did not have pre-existing concerns, from the age of 18 and even 14
months of age. The most common early signs captured by the screen are impairments
or delays in early emerging social communication behaviors such as response to
name, joint attention and play behaviors; although at least in the Netherlands study
there was a suggestion that sensory abnormalities or a restricted repertoire of play
activities might also be early indicators of later ASD. However, in none of the studies
that have included systematic follow-up of the screened populations to identify all
cases at outcome have the signs been universal. Scientifically such signs are
promising but neither universal nor necessarily specific markers of a later emerging
ASD presentation (as opposed to other neurodevelopmental disorders). Therefore, one
needs to be cautious about recommending universal screening.

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What can we learn about the prodrome of ASDs from prospective studies of
younger siblings?

As autism is amongst the most heritable of neurodevelopmental conditions, it
may have been assumed that autism would allow for one of the strongest tests of our
ability to identify risk factors and prodrome status and thus to test
neurodevelopmental theories regarding its underpinnings and influences, as well as
the effectiveness of preventative interventions. Furthermore, autism is one of the
earliest emerging neurodevelopmental conditions, with DSM-IV (1994) and ICD-10
(1993) requiring abnormality to be evident in the first 3 years of life to meet
diagnostic criteria for the ‘core’ disorder of childhood autism (ICD-10)/autistic
disorder (DSM-IV). Whilst some children, particularly some of those with average or

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