Dr. Choueiri

Piloted at UMass, RITA-T cuts wait time for at-risk toddlers.

Currently, the average age of diagnosis of Autism Spectrum Disorder (ASD) in the U.S. is close to 4 years old, though signs can be seen as early as 12 months. But a groundbreaking new screening test being piloted at UMass Memorial Health Care in Worcester could shave years off that diagnosis time, allowing the screening and identification of toddlers as early as 18 months.

The RITA-T, or Rapid Interactive Screening Test for Autism in Toddlers, is new system for identifying early ASD. A Level 2 screening test, it is to be administered on young children identified at risk for autism, or who scored positive on a Level 1 screening test, or who providers are worried about.

This new Level 2 test can be administered to children to differentiate between ASD and other delays, identifying children at-risk for ASD at a younger age than ever before -- 18-36 months -- and thus referring them in a faster way for more appropriate ASD evaluations.

RITA-T is an interactive test, which is preferred in this age group as it triggers directly early signs professionals look for, rather than relying on history or observation, as they may be hard to recognize.

Research commenced four years ago when Dr. Roula Choueiri M.D., who specializes in neuro-developmental disabilities, collaborated with Dr. Sheldon Wagner, Ph.D. to create a new and improved screening tool for earlier identification of autism. Inspired by their findings and collaborative publication, Dr. Choueiri continued to delve into this project with a community of her colleagues at UMASS Memorial Health Care.

One major change between the RITA-T test and other testing is that this new exam can be administered by a variety of early childhood providers -- not just limited to specific specialists. It is fast in its administration and scoring, easily accessed and reasonably priced.

"Before the arrival of the RITA-T, the previous Level 2 screening test was the only one on the market and it was more expensive. This new test can be completed within ten minutes," Dr. Choueiri explained. "It requires no preparation and since it is based entirely on games, the children seem to like it."

A marker, a toy phone, a mirror, a photo, and other child-friendly components are included in the RITA-T kit and employed to create a play-like, stress-free experience for the children, while assessing for early signs of autism. The RITA-T includes nine semi-structured play-based presses that examine constructs that have been described to be delayed in children with Autism Spectrum Disorders (ASD). With this new system integrating Early Intervention Providers, very young children can be screened earlier than with other testing.

With earlier diagnosis comes earlier intervention.

"It is exciting to be able to make a difference in a child's life and it is much better to see it early. While there is hope at any age of diagnosis, early intervention changes the trajectory as the brain is developing," said Dr. Choueir.

Jackie Gryska is a mom whose son, Jack, started showing signs of autism at 12 months of age and was later diagnosed at 18 months. "He went through a series of tests all day for multiple hours. Most of them, due to his age, were all play-based testing. The final results took about a week to get back. The wait times for children to get these tests done now have increased to wait lists of up to a year or longer due to the increase in autism," the Wayland mom said.

Gryska is pleased to learn about the RITA-T screening. "I feel the RITA-T training will be helpful to families, especially to first-time parents like we were," she said. "As a first-time parent you are not quite sure what symptoms to look out for and what could be concerning."

Grysak feels fortunate that her 2-year-old son was diagnosed with ASD early. "The early diagnosis and interventions opened doors for us to get Jack occupational therapy, speech therapy and ABA therapy 30 hours a week in our home from amazing teachers and therapists. It has allowed him to be integrated into a public preschool setting and has allowed him to continue his therapies at school within his classroom setting."

UMass Medical School offers an on-site training course to administer RITA-T, and online training is available as well, making the tool accessible to people all over the world. The three-hour training program is geared to a wide range of early intervention specialists such as teachers and day care providers who work with children age 3 and younger.

Some developmental delays or behaviors that could indicate a high risk for ASD could include a toddler not responding to his name, a language delay or a loss of language, difficulty with eye contact, aversions to touch or loud noises, or repetitive behaviors.

However, Dr. Choueiri cautions that it is important not to be alarmed by one of these behaviors, and said that parents with concerns should contact an early intervention specialist, as early intervention providers can start working with the family even without a diagnosis, and can make appropriate screenings and referrals.

"RITA-T will really help providers identify high-risk children earlier, which means that intervention and treatments can also start earlier," Dr. Choueiri said.

For information about RITA-T, including how to get trained in its administration, go to www.umass.edu/AutismRITA-T/about-the-test.