LAUSR

By definition, autism spectrum disorder (ASD) emerges during early childhood. However, despite longstanding recommendations for earlier identification and intervention, there has been relatively slow progress in lowering the average age of diagnosis and enrollment in treatment for affected children. This has been due to several factors, including the inadequacy of behavioral risk markers and clinical practice entailing a "wait to see" or "wait to fail" approach to identification. Converging evidence now suggests that brain changes precede changes in behavior in children with ASD. This work has led to the discovery of potential biomarkers of presymptomatic or prodromal risk which may be used to accurately identify children at ultra-high risk during the first year of life. Such findings raise the possibility of intervention prior to the consolidation of core autistic features and during a period of substantial neural plasticity. While these avenues of research suggest strong potential for eventual clinical application, they also raise new questions regarding content, dosage, and timing of intervention as well as ethical, legal, and social considerations concerning presymptomatic identification and treatment.