Most recently, the Centers for Disease Control and Prevention (CDC) stunned the world with the latest data on the prevalence of children diagnosed with autism spectrum disorder (ASD) in the United States. Autism spectrum disorder is a neurodevelopmental disorder diagnosed in children who display deficits in social interaction and communication skills and demonstrate repetitive and stereotyped behavior, interests, and activities. There are other behavioral and medical conditions that also may occur in those diagnosed with ASD, and other neurodevelopmental conditions may also include ASD.
In 2000, the CDC funded the Autism and Developmental Disabilities Monitoring Network (ADDM) to monitor the prevalence of children diagnosed with ASD (and other developmental disabilities). The ADDM network is composed of 14 communities across the United States, representing approximately 8% of the population. The latest data collected in 2008 from special education and health records of 8-year-olds resulted in a reported prevalence of 1 in 88 children as having been diagnosed with ASD. In comparison with the 2002 data collection that was released in 2007, the prevalence rate of children diagnosed with ASD has increased by 78%! This rapid increase has been called the largest public health and special education crises of our time.
Most of those diagnosed with ASD are boys (five times more than girls), and most children with ASD do not have intellectual disabilities. The age of diagnosis of ASD has also been rapidly dropping to below the age of 3. This is because of increased awareness of the importance of early screening and diagnosis, as recommended by national campaigns such as the Learn the Signs, Act Early, which was also initiated by the CDC.
As could be surmised, the growing incidence of ASD has resulted in an abundance of theories on the causes behind such an increase. This has, in turn, spurred scientific research on a wide range of both biological (including genetic) and environmental variables that may contribute to a diagnosis of ASD. At this time, it has been reported that there is most likely some type of genetic predisposition for ASD, as well as additional complexities that compromise development of the brain of those diagnosed with it.
The increase in prevalence of children with ASD has had a profound impact on the field of early childhood intervention. One reason for this has been the finding that a small number of children do demonstrate a “recovery” from the initial diagnosis of ASD after they receive intensive and intentional interventions. Another is the fact that initial intervention recommendations for this population have focused on very specific treatment models implemented by certified interventionists at a higher intensity than traditional early childhood interventions. Most recently, however, recommendations for interventions for those with ASD have begun to reflect the need to match interventions to individual child and family characteristics as we develop evidence on the efficacy of specific intervention protocols. This should not surprise any of us in the field of early childhood intervention!
As we continue to advocate for earlier identification of, and effective intervention for, children with ASD, I hope that the field of early childhood intervention will take advantage of the momentum and focus on quality created by the surge in children diagnosed with ASD. This momentum should facilitate an increased awareness about all children who need and are served in early childhood intervention programs. I am not suggesting that the increased incidence of infants and young children with ASD should not continue to be in the spotlight of our service and research networks. On the contrary, I would like to broaden these national efforts to all children who demonstrate a deviation from typical development.
The CDC has recently reported that one in six children was diagnosed with a developmental disability (2006–2007 data). It would be safe to assume that there are additional children without such a diagnosis who may have biological and/or environmental risk factors that contribute to developmental delays. I suggest that we build on the successes achieved for those children and families with ASD to advocate for the same level of attention for all infants and children with delays and disabilities. As an early childhood interventionist, I feel we must create a national awareness of (all) disability and risk factors that contribute to disability as we build improved and effective early childhood intervention systems for all those who will benefit.
Our first article is extremely appropriate to this topic of the growing prevalence of ASD in children. In particular, the article highlights the importance of pediatricians in identifying children who may show signs of ASD. Wirongrong Arunyanart and colleagues, surveyed pediatricians as to their compliance with the American Academy of Pediatrics recommended actions for scheduled developmental screenings on their patients. Although their sample of 406 pediatricians across six states did demonstrate improved rates of screening from surveys of 5 years ago, only 17.8% of pediatricians were compliant on all screening recommendations. The authors discuss these findings and provide recommendations for practice, in particular screening practices among pediatricians.
Our second article presents a thorough review of the early childhood professional development literature. Patricia Snyder and colleagues used the framework from the National Professional Development Center on Inclusion to conduct a review of 256 professional development studies for providers serving young children. The studies characterized the recipients, the focus, and the type of learning experiences offered as professional development, including follow-up support. The authors' conclude with their recommendations for future studies on professional development, in particular studies that focus on the effects of professional development on improvements in intervention practices and child outcomes.
Tierney K. Popp and M. Jeanne Wilcox authored our next article that describes a study on the quality of parent–provider relationships in an early intervention program as measured over 1 year. Thirty-seven toddlers with developmental disabilities, their mothers, and their early interventionists were the subjects of the study. An observational coding system was developed to describe the parent–provider relationship, which was measured at three points during the year. The authors discuss the importance of measuring and examining the interactions between the parent and the provider as part of the intervention process.
The next article focuses on parent perspectives of an infant toddler play group that was implemented as part of a preservice student practicum. Dolores J. Appl and colleagues describe how a family-centered practicum contributed to the skills and outcomes of practicum students. The play group was held at a university field site and was based on an inclusive interdisciplinary model called Parents Interacting with Infants. The article focuses on how the evaluation process impacted the practicum implementation, and how the parent perspectives about family-centered practices impacted student experience. Applications to preservice training are discussed.
Our last article is from the doctoral dissertation of Peggy Giannoni (deceased) and her doctoral advisor, Philip Kass. The study is a retrospective analysis of 8,987 children at high risk for disability enrolled in California Early Start Program. The analysis identified child, maternal, family, and community factors associated with the rate of developmental disability in the cohort of children. The study concludes with future direction for the field in regard to the identification of children with disability based on risk factors.
I thank the authors for their contributions to Infants & Young Children and the reviewers who assisted in the manuscript preparation. I particularly thank our novice authors and those from the AUCD network. Finally, I am pleased to announce that our next issue will include submissions from international authors who will present an application of Mike Guralnick's Developmental Systems Approach for Early Childhood Intervention to services and systems in their own country.
—Mary Beth Bruder, PhD