Early screening can detect potential disorders

The kindergarten teacher and her aide were doing what they were trained to do. They did a great job introducing a roomful of little students to early reading and math skills. The duo was also on the lookout for any developmental issues they could help parents identify and address.

One of their little charges hated getting his hands dirty. Try as they might, the teacher and aide could not convince the 5-year-old to put his hands in shaving cream during science sessions or to dip his fingers in paint at craft time. The head teacher let the mom know of her developmental concerns. The mother, while a bit disturbed that her child was apparently exhibiting atypical behavior, thought to herself, “So my son doesn't like getting dirty and prefers clean hands. And that's a problem?”

Both the teacher and the mother had a point, since a particular sensory issue can raise a red flag for a more serious developmental disorder. But as a minor stand-alone finding, it is not always of real significance.

With still more emphasis being placed on early identification and intervention for children with autism and other neuro-developmental disorders, many pediatricians have incorporated various developmental screening tools during well-child toddler visits. One such tool, known as the M-CHAT, is a 23-question parental survey that includes questions such as, “Does your child enjoy being swung, bounced on your knee, etc.?” as well as, “Does your child ever seem oversensitive to noise (e.g. plugging ears)?”

As an example, a toddler would be considered to have “failed” the M-CHAT if his parents answered “no” and “yes” respectively to the above questions, in addition to noting one other atypical developmental feature, such as not using his index finger to point at something he desired. A failed survey does not give a diagnosis of autism but can lead a pediatrician to recommend a full developmental evaluation of the child.

Researchers Leslie Dowell and Mark Wallace of Vanderbilt University report that up to 90 percent of individuals with autism show abnormal reactions to sensory stimulation. These reactions can include both under- and overresponsiveness to a number of environmental sensory stimuli.

In their December 2009 Pediatrics in Review article, developmental pediatricians Lee Williames and Christine Erdie-Lalena note that there are various therapies used to address these abnormal sensory responses. One such approach, known as sensory integration therapy, involves individualized treatment “to guide controlled sensory inputs from activities … to facilitate organization of the brain so it may learn effectively from the environment.”

The authors find that, though sensory integration therapy has many supporters and is in widespread use, its “scientific legitimacy” has yet to be established in formal case-controlled studies and more research is needed. The two pediatricians conclude that, for the moment, SI therapy should be classified as a “potential adjunctive treatment,” as long as its use does not prevent the child from participating in school interventions and other “evidence-based therapies.”

More academic research is on its way, as a team of Vanderbilt University scientists recently received a federal grant to study the effect of sensory integration therapy in boosting language development in children with autism.

Ÿ Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.