I do think we need better data. I think the issue of whether every child should be screened and at what age is an interesting one that evidence needs to be collected on.
The American Academy of Paediatrics suggested that all children should be screened at 18 months and 24 months. We've had a lot of talk about that, but it's not practical within our current health system. We have adopted a principle in Ontario called “developmental surveillance”, which means that physicians and nurse practitioners are being trained to screen for all developmental disorders during well-child or well-baby visits.
The key items for identifying autism at 18 months are now built into the Nipissing questionnaire, which the Ontario government has bought the licence for, so practitioners can just download it off the net. There is also the Rourke well-baby record, which was developed by Leslie Rourke, working with the Canadian Paediatric Society. We inserted the key questions for autism into it, and it's a point-of-care tool. It has been shown to improve the quality of care if the primary care physician or practitioner has to tick off the things they've asked about.
I think our 18-month surveillance visit, the enhanced visit that we got funding for this year, will pick up a lot of children at 18 months that would have been missed otherwise. But now we're trying to work with the services to see what we can do with all these kids who have red flags at 18 months. We're talking about a sea of red and where we go now.
That's a critical point, but we have to get the intervention ready to start. We can't just put them all on a waiting list. We're working hard on wait-list strategies, but the intervention has to be there once you do the identification.