Early Identification and Diagnosis
EARLY SYMPTOMS OF AUTISM IN BABIES AND TODDLERS:
Doesn’t make eye contact (e.g. look at you when being fed).
Doesn't smile when smiled at.
Doesn't respond to his or her name or to the sound of a familiar voice.
Doesn’t follow objects visually.
Doesn't point or wave goodbye or use other gestures to communicate.
Doesn’t follow the gesture when you point things out.
Doesn’t make noises to get your attention.
Doesn’t initiate or respond to cuddling.
Doesn’t imitate your movements and facial expressions.
Doesn’t reach out to be picked up. Doesn’t play with other people
or share interest and enjoyment.
Doesn’t ask for help or make other basic requests.
The following delays warrant an immediate evaluation by your child’s
pediatrician:
By 6 months: No big smiles or other warm, joyful expressions.
By 9 months: No back-and-forth sharing of sounds, smiles, or other facial expressions.
By 12 months: Lack of response to name.
By 12 months: No babbling or “baby talk.”
By 12 months: No back-and-forth gestures, such as pointing, showing,
reaching, or waving.
By 16 months: No spoken words.
By 24 months: No meaningful two-word phrases that don’t involve
imitating or repeating.
Selected examples of screening tools for general child development and ASD:
Ages and Stages Questionnaires (ASQ)
This is a general developmental screening tool. Parent-completed questionnaire; series of 19 age-specific questionnaires screening communication, gross motor, fine motor, problem-solving, and personal adaptive skills; results in a pass/fail score for domains.
Communication and Symbolic Behavior Scales (CSBS)
Standardized tool for screening of communication and symbolic abilities up to the 24-month level; the Infant Toddler Checklist is a 1-page, parent-completed screening tool.
Parents’ Evaluation of Developmental Status (PEDS)
This is a general developmental screening tool. Parent-interview form; screens for developmental and behavioral problems needing further evaluation; single response form used for all ages; may be useful as a surveillance tool.
Modified Checklist for Autism in Toddlers (MCHAT)
Parent-completed questionnaire designed to identify children at risk for autism in the general population (www.mchatscreen.com).
Screening Tool for Autism in Toddlers and Young Children (STAT)
This is an interactive screening tool designed for children when developmental concerns are suspected. It consists of 12 activities assessing play, communication, and imitation skills and takes 20 minutes to administer.
Diagnostic Tools
There are many tools to assess ASD in young children, but no single tool should be used as the basis for diagnosis. Diagnostic tools usually rely on two main sources of information—parents’ or caregivers’ descriptions of their child’s development and a professional’s observation of the child’s behavior.
In some cases, the primary care provider might choose to refer the child and family to a specialist for further assessment and diagnosis. Such specialists include neurodevelopmental pediatricians, developmental-behavioral pediatricians, child neurologists, geneticists, and early intervention programs that provide assessment services.
The American Psychiatric Association's Diagnostic and Statistical Manual, Fifth Edition (DSM-5) provides standardized criteria to help diagnose ASD. See DSM-5 diagnostic criteria
Selected examples of diagnostic tools:
Autism Diagnosis Interview – Revised (ADI-R)
A clinical diagnostic instrument for assessing autism in children and adults. The instrument focuses on behavior in three main areas: reciprocal social interaction; communication and language; and restricted and repetitive, stereotyped interests and behaviors. The ADI-R is appropriate for children and adults with mental ages about 18 months and above.
Autism Diagnostic Observation Schedule – Generic (ADOS-G)
A semi-structured, standardized assessment of social interaction, communication, play, and imaginative use of materials for individuals suspected of having ASD. The observational schedule consists of four 30-minute modules, each designed to be administered to different individuals according to their level of expressive language.
Childhood Autism Rating Scale (CARS)
Brief assessment suitable for use with any child over 2 years of age. CARS includes items drawn from five prominent systems for diagnosing autism; each item covers a particular characteristic, ability, or behavior.
Gilliam Autism Rating Scale – Second Edition (GARS-2)
Assists teachers, parents, and clinicians in identifying and diagnosing autism in individuals ages 3 through 22. It also helps estimate the severity of the child’s disorder.
Courtesy of the Centers for Disease Control and Prevention, USA
KNOW THE
SIGNS
Early intervention can make a highly significant difference. Consult with your child's doctor if you notice the signs given and think your child might have autism or any neurological disorder.
If needed, your doctor can then refer you to a specialist to make a diagnosis. Relevant specialists include
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Developmental Pediatricians
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Child Neurologists
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Child Psychologists or Psychiatrists
