Nurses play a pivotal role in the early diagnosis of autism, which is why all Victorian Maternal and Child Health Nurses will undertake routine training to hone their skills in this area.

“The universal MCH system provides an ideal platform as children are already routinely monitored for their health and wellbeing – so it was an easy solution to incorporate the monitoring of early signs of autism within these routine checks,” says Professor Cheryl Dissanayake, Director, Olga Tennison Research Centre, who developed the training program along with Dr Josephine Barbaro.

“We use the 12, 18 and 24-month checks, and so the training was developed to equip nurses with the skills to monitor infants for signs of autism at these ages.

“Our ultimate focus in developing the program was and is to bring down the age of diagnosis of autism.”

Children can show signs of autism from the first year of life, with others beginning to show signs during their second year.

Research conducted by the Olga Tennison Research Centre shows that autism can be reliably identified during the second year, with diagnoses made at 24-months bring reliable and stable over time. 

“This research was undertaken in Victoria across two large studies with approximately 35,000 babies monitored by about 350 MCH trained nurses,” says Professor Dissanayake.

Professor Dissanayake says the key early signs involve social attention and communication behaviours and include inconsistent use of eye gaze, failure to point to shared interests, little use of imitation, a failure to use gestures socially, not responding readily when their name is called, little engagement in pretend play, amongst others behaviours. 

And while some parents may spot some of these signs, statistics show that only 50 per cent notice that something is amiss during their child’s first year of life.

“Parent’s aren’t exposed to the variety of children that nurses are, and many first time parents don’t know what to expect of their developing infant.

“The early signs of autism are often subtle as well, and it’s hard to see an absence of behaviours – which is commonly the case in autism – and so many parents miss the signs.

“MCH nurses see thousands of babies for their routine health and wellbeing checks, and are thus finely attuned to what typical development looks like; therefore they are receptive and sensitive to training on signs of atypical development - in our case, focused on the second year of life.”
The current early diagnosis training involves a 3-hour face to face delivery, but as part of the contract with the Department of Education and Training (DET), the research team is also developing online content to support the nurses learning of the early signs of autism.

Participants learn how to monitor the early signs of autism using the Social Attention and Communication Surveillance (SACS) approach, along with key learnings about autism and the early autism phenotype.

They also learn about the importance of the key early behaviours in the development of children, and how these go astray in autistic development, along with training on how to identify a child who is developing autism and how to raise concerns with parents and to empower them to seek a further referral for a developmental assessment of their child.

“The nurses often know, even before training, when the baby is not developing typically.

“Our training empowers them to operationalise what may be going on, and gives them the skills to hone in on this, to raise concerns in a timely fashion and to refer the family for a further developmental assessment of the child.

“The evaluations undertaken following the training of nurses in our two previous studies highlighted the positive impact of the training in SACS on their practice and the confidence it gave them to accurately monitor and refer children.”

Professor Dissanayake says 81% and 82% of children referred to as having a high likelihood of autism in the two studies, respectively, were diagnosed with Autism Spectrum Disorder at  24-months of age.

The mean age of diagnosis in Australia (in children under 7) is 4 years old (49 months) – two years later than what is possible.

“This makes a huge difference to children’s outcomes and parents lives, as the earlier children are identified and diagnosed, the earlier they are able to access services and supports.

“The remaining 18 – 19% of children who did not have an ASD were either language or developmentally delayed, meaning that they too were able to access services earlier than would otherwise have been the case.”

The training of MCH nurses on the SACS will impact the lives of between 1-2 % of Victorian children who develop autism and their families – who will have better outcomes as a result.

“But we need to make sure that once these children are referred by their MCH nurses, they have access to a timely assessment and diagnosis, and ready access into early intervention.

“We still have a lot of work to do.”