Doctors checking babies for mental disorders

Some critics worry that the trend will trigger needless diagnoses in children with normal variations in behavior.

Dr. Michael Fitzpatrick, a London physician, said that while early recognition and treatment of true disorders are important, "the extension of these categories to include 20 to 30 percent of all children reflects a social trend of pathologizing and medicalizing children's lives, which seems to reflect difficulties of parents and teachers in dealing with familiar problems of childhood development."

Dr. Stanley Greenspan, a psychiatry professor at George Washington University who co-authored the CDC-Interdisciplinary group report, said the idea is not to slap a label on babies and give them medication. Greenspan said the goal is to raise awareness about early warning signs and to encourage treatment to increase the chances that children can develop normally.

Research on identifying early clues and testing treatments is booming. For example:

• Dr. Fred Volkmar at Yale University is studying potential ways to diagnose autism in the first months of life, including whether looking at objects rather than people is a sign. "I think we're on the verge of being able to do a much better job" of diagnosing autism in infancy, Volkmar said.
• Researcher Stephen Porges at the University of Illinois at Chicago is starting a five-year study of whether excessive crying past 6 months of age might be an early sign of autism, attention deficit or other behavior problems.
• Greenspan is launching a multimillion-dollar study involving parents and babies at risk for autism or attention deficit disorder. One group will receive intensive behavior training, the other will not; both will be compared through age 5.

While rigorous scientific evidence is needed to prove that early intervention succeeds, Greenspan said his work with patients has shown promise.

Jacob didn't say his first word, "more," until he was in treatment and almost 2 — about a year later than normal. He didn't say "mama" until he was 3.

He gets 33 hours of weekly home treatment with trained college students, including six hours most days. The tab is $70,000 yearly, paid for by California, one of the few states that pay, through state and federal funds, for early intensive autism treatment.

Repetition and rewards
Jacob's sessions involve lots of repetition, and rewards, including praise and treats, for a job well done. For example, to improve eye contact, teachers bounce him on a favorite giant ball, then stop. If he turns to look at them, he gets praise, maybe a piece of candy, and more bouncing.

To teach language, they use activities like swinging that get him excited enough to make sounds, then offer rewards for sounds like vowels or consonants rather than humming. Then they name objects, encourage mimicking, and offer more rewards.

Now he knows the alphabet, understands commands like "Bring me the cow and the horse toy," and can say simple sentences like "I want juice," his mother said.

"We definitely hope to mainstream him. We hope that he will have a job and have a life where he can take care of himself and be happy," Day said. "Everyone has given us reason to believe that's not an outlandish expectation."

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