Georgia autism project looks to early detection

Sept. 18, 2013: Clinical specialist Catey Funaiock sits with 5-year-old Brandon Dreher before their session in the pediatric feeding disorder program at the Marcus Autism Center. (AP)

ATLANTA – In a small room similar to a doctor's office, Marlaina Dreher broke into applause as her 5-year-old son, Brandon, grabbed a red plastic spoon filled with pureed lasagna and fed himself.

"Good job taking a bite, buddy," she said, joining in as her son banged his hands on a nearby table. "Good job putting your spoon back."

Brandon is autistic, and he's come a long way in his seven weeks in the pediatric feeding disorder program at the Marcus Autism Center. He used to eat only crackers and McDonald's fries, but meal time is no longer a constant battle.

"I couldn't have imagined being here seven weeks ago," Dreher said. "My husband, Sean, and I have said, `What if we had come here two years ago? Where would we be now?"'

That's the heart of a partnership between the center and the Georgia Department of Early Care and Learning. It aims to train a small group of state and contract employees to work with day care operators and pre-K providers throughout Georgia to identify the early warning signs of autism and support parents. Those involved in the effort point to research that shows that symptoms of the autism spectrum disorder, which affects some 1 in 88 children nationwide, can be detected as early as the first two years of life and that early intervention is key.

"Today, if I get a phone call and someone says they've got an 8-year-old who is unable to speak and is in need of our help, I know we can help that child. But we cannot help that child nearly as much as we could have if we got that same phone call when that child was 2," said Don Mueller, executive director of the Marcus Autism Center. "The associated disabilities of autism are not inevitable. They don't have to happen in many kids. We can intervene and change the course."

Marcus Autism Center, which operates under the umbrella of Children's Healthcare of Atlanta, is one of three institutions designated as an Autism Center of Excellence by the National Institutes of Health. The center's effort with the state Department of Early Care and Learning is part of a broader goal to enhance community outreach and build community resources for children with autism and their families. Center officials hope to eventually expand the partnership to other states and are working with federal officials to bring their work to Head Start programs nationwide.

Recently, a group of 15 state and contract employees who work with child care and pre-K providers gathered at the autism center to begin a yearlong training course. Another group began training in August. To start, each participant will identify at least two day care or pre-K programs to work with. They'll work with teachers on how to detect red flags, share concerns with parents and develop lesson plans tailored to a child's needs.

"We don't want to see a whole generation of children coming to the Marcus Autism Center," Dr. Jennifer Stapel-Wax, the center's director of infant and toddler clinical research operations, said during the training.

Research has shown intervention has the greatest impact if it begins before the age of 3, and experts estimate that a child with autism needs at least 25 hours per week of intensive work on behavioral issues. And treatment can be costly.

Jennie Couture, who oversees the training program for the Georgia Department of Early Care and Learning, said treatment goes beyond therapists: "It's families, the community, teachers, the other folks the child comes into contact with. When you start with a very early diagnosis and identification, you can get all those folks up to speed to support that child for all those hours of engagement."

At the core of autism are developmental disabilities that affect the ability to communicate, understand language, play and relate to others. Research has identified a number of genes associated with the disorder, but diagnosis is based on behavioral evaluations -- no medical test is available.

That's part of why the Georgia program focuses on warning signs. In the recent training, Stapel-Wax presented videos of two children, each about 16 months old. One demonstrated normal social development, the other early signs of autism. In the first video, the child interacted with the clinician, looked frequently at his mother, pointed to bubbles being blown in the air and set aside the bottle after trying to twist off the top. The second child looked at his mother but then ignored her and the clinician, becoming fixated on the bottle and flipping it over. Researchers say children with autism can tend to focus more on objects than people.

"Children who can't make eye contact, who spin or twirl or rock, and who can't make their needs known -- that is why some people feel that having autism is a death sentence because it's so devastating," Stapel-Wax said in an interview. "But we're saying that is not the case. If you intervene early, you can make a difference."

Mandy Smith, an inclusion coordinator with Quality Care for Children, said the training will go a long way to helping her and her counterparts across Georgia supports pre-K teachers and day care providers.

"A lot of child care providers don't have a lot of education and background working with children with autism," Smith said. "I feel like it will give us more tools to educate them to be better able to work with our children and to practice early intervention."

The Georgia early learning program is being funded in part with $199,500 in federal grant money. Commissioner Bobby Cagle, who oversees the Department of Early Care and Learning, said it's a good investment in the community.

"It's devastating to hear that your child has an autism spectrum disorder, but it's even more devastating to hear that and not have anywhere to go," Cagle said, noting that access to specialists in rural areas can be a challenge. "For those people, it is even more important that we work on developing these resources and developing a network of professionals around the state that can help once the disorder is diagnosed."