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By scanning the brains of babies whose siblings have autism, researchers say they have been able to make reasonably accurate forecasts about which of these high-risk infants will later develop autism themselves. The findings raise the prospect of diagnosing autism spectrum disorder (ASD) months before children develop symptoms, a goal that has proved elusive. Nature looks at the new study and its implications.

Why has it been so tough to diagnose autism in infants?

Children typically show symptoms of ASD, such as difficulty making eye contact, after the age of 2. But researchers believe that the brain changes underlying ASD begin much earlier — possibly even in the womb.

“Children who end up with autism at 2 or 3, they don’t look like they have autism in the first year, so behavioural assessments and behavioural studies haven’t been helpful in predicting who’s going to get autism,” says Joseph Piven, a psychiatrist at the University of North Carolina (UNC) in Chapel Hill, who co-led the study, published online in Nature1.

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