His mother suspected that there was something wrong, almost from the start. As an infant, Joshua Huffman kept to himself, didn't babble like most babies do, didn't respond to his name when called.
Three years later, Joshua is a whirlwind of activity who can put together puzzles with ease, race around his Clarksville house with older brother Zachary and even tell his brother, in very clear language, to go to timeout.
Joshua was part of a study at Baltimore's Kennedy Krieger Institute that revealed that half of children with autism can be diagnosed not long after the first birthday - nearly two years earlier than it has been reliably diagnosed before. Researchers, who still don't know exactly what causes autism, know this much: Early diagnosis leads to earlier intervention, which they hope can change the course of an autistic child's life, as happened with Joshua.
"It's a very significant finding, a very significant study," said Dr. Lisa Gilotty, chief of the social behavior and autism program at the Rockville-based National Institute of Mental Health which funded the research. "It speaks to the importance of early intervention ... before a child's development gets too far off course.
"She's showing us what to look for."
She is Dr. Rebecca Landa, the study's lead author and director of Kennedy Krieger's Center for Autism and Related Disorders. Landa has been conducting autism research for more than 20 years. She has been able to use her keen eye to spot the disorder earlier and earlier - this study showing the earliest yet. When Landa first started studying autism, she was working with children as old as 12. Then she realized she had to back up. "Where does it begin?" she wondered.
Autism is really a spectrum of disorders marked by impairment in social development and communication as well as by repetitive behaviors such as flapping arms or jumping up and down. Autistic children usually exhibit language delays and often have difficulties relating to people, failing to read basic social cues in the faces of others.
The study, whose findings were published this month in the Archives of General Psychiatry, looked at 125 children from the age of 14 months until 36 months, most of whom were siblings of autistic kids.
Landa told her fellow researchers to make their best guesses at whether the 14-month-olds they observed were autistic or not, something they were reluctant to do. Half of those who were eventually diagnosed with autism could not be diagnosed that early because they appeared to be functioning like typical children. Only later did their development slow or regress.
In a conference room at Kennedy Krieger's Greenspring Avenue campus on a recent morning, Landa narrated a series of video clips taken of the children she studied. One showed a typically developing 14-month-old giggling away as he played with a toy and a therapist across the table. The boy was interested in the toy, to be sure, but seemed more enthralled with the woman, trying to get her to laugh with him.
Another showed Joshua at 14 months. A researcher tried to get him to play peek-a-boo with a blanket, but the boy was having none of it. He actually tried to get as far away as he could from the blanket and the person behind it.
Landa and her team can now spot many cases of autism from 14 months. The key now, she said, is to devise some guidelines for what parents and pediatricians should look for at that age to get the treatment started, trying to retrain the brain while it is at its most malleable. Researchers caution that not all children are equally successful with therapy. Specific therapies for this young age also need to be developed.
Up until now, Landa said, many pediatricians have pushed a wait-and-see approach if children don't meet milestones, thinking that they would grow out of their symptoms. This reassures many parents who don't want to believe the worst about their little ones.
Landa said parents with suspicions that something is wrong should insist on seeing an autism specialist. Sometimes it is difficult to get an appointment, she conceded, but she said Kennedy Krieger makes sure to see children under 2 within four weeks.
One in 150 children is estimated to have autism. This year, according to Kennedy Krieger, more children will be diagnosed with autism than AIDS, diabetes and cancer combined. Yet there is a dearth of professionals who can diagnose it and who can treat it, despite the surge of children who need help.
"We see an epidemic, but we don't yet have the resources to handle the epidemic," said Dr. Anthony L. Rostain, an associate professor of psychiatry and pediatrics at the University of Pennsylvania School of Medicine who studies developmental disorders. "We can't afford to wait."