A "well child" check-up should include a developmental screening test. If your child's pediatrician does not routinely check your child with such a test, ask that it be done. Your own observations and concerns about your child's development will be essential in helping to screen your child.
Reviewing family videotapes, photos, and baby albums can help parents remember when each behavior was first noticed and when the child reached certain developmental milestones.
"For healthcare providers, we have a message that's pretty direct about autism. And the message is: The 4-year-old with autism was once a 3-year-old with autism, which was once a 2-year-old with autism."
Dr. Jose Cordero, Director of the National Center on Birth Defects and Developmental Disabilities, part of the CDC
Several screening instruments have been developed to quickly gather information about a child's social and communicative development within medical settings. Among them are the Checklist of Autism in Toddlers (CHAT), the modified Checklist for Autism in Toddlers (M-CHAT), the Screening Tool for Autism in Two-Year-Olds (STAT), and the Social Communication Questionnaire (SCQ) (for children 4 years of age and older).
Some screening instruments rely solely on parent responses to a questionnaire, and some rely on a combination of parent report and observation. Key items on these instruments that appear to differentiate children with autism from other groups before the age of 2 include pointing and pretend play. Screening instruments do not provide individual diagnosis but serve to assess the need for referral for possible diagnosis of ASD. These screening methods may not identify children with mild ASD, such as those with high-functioning autism or Asperger syndrome.
During the last few years, screening instruments have been devised to screen for Asperger syndrome and higher functioning autism. The Autism Spectrum Screening Questionnaire (ASSQ), the Australian Scale for Asperger's Syndrome, and the most recent, the Childhood Asperger Syndrome Test (CAST), are some of the instruments that are reliable for identification of school-age children with Asperger syndrome or higher functioning autism. These tools concentrate on social and behavioral impairments in children without significant language delay.
If, following the screening process or during a routine "well child" check-up, your child's doctor sees any of the possible indicators of ASD, further evaluation is indicated.
Source: National Institute of Mental Health
Screening Guidelines and Diagnosis of Autism
Do you suspect your child may be developmentally delayed? There are developmental checklists which parents can use as a guideline to determine if their child has met certain developmental milestones.
The links below are recommended to pediatricians by the American Academy of Pediatrics for autism screening:
AAP Screening Guidelines and Diagnosis of Autism
The American Academy of Pediatrics endorses certain guidelines for the screening and diagnosis of autism.
Practice Parameter: Screening and diagnosis of autism.
American Academy of Neurology Guidelines
California Department of Developmental Services publishes New Best Practice Guidelines for Screening Diagnosis Assessment of Autism Spectrum Disorders.
Developmental Screening Resources
For free information on developmental milestones, tools to track your child's developments, and resources about developmental problems and developmental screening, visit www.cdc.gov/actearly
Click here for links to parent information on Developmental Screening Resources to national, foundations and private organizations.
Information on Developmental Screening
Information on Autism Screening
Information on Audiological Screening
Comprehensive Diagnostic Evaluation
The second stage of diagnosis must be comprehensive in order to accurately rule in or rule out an ASD or other developmental problem. This evaluation may be done by a multidisciplinary team that includes a psychologist, a neurologist, a psychiatrist, a speech therapist, or other professionals who diagnose children with ASD.
Because ASD's are complex disorders and may involve other neurological or genetic problems, a comprehensive evaluation should entail neurologic and genetic assessment, along with in-depth cognitive and language testing. In addition, measures developed specifically for diagnosing autism are often used.
These include the Autism Diagnosis Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS-G). The ADI-R is a structured interview that contains over 100 items and is conducted with a caregiver. It consists of four main factors—the child's communication, social interaction, repetitive behaviors, and age-of-onset symptoms. The ADOS-G is an observational measure used to "press" for socio-communicative behaviors that are often delayed, abnormal, or absent in children with ASD.
Still another instrument often used by professionals is the Childhood Autism Rating Scale (CARS). It aids in evaluating the child's body movements, adaptation to change, listening response, verbal communication, and relationship to people. It is suitable for use with children over 2 years of age. The examiner observes the child and also obtains relevant information from the parents. The child's behavior is rated on a scale based on deviation from the typical behavior of children of the same age.
Two other tests that should be used to assess any child with a developmental delay are a formal audiologic hearing evaluation and a lead screening. Although some hearing loss can co-occur with ASD, some children with ASD may be incorrectly thought to have such a loss. In addition, if the child has suffered from an ear infection, transient hearing loss can occur. Lead screening is essential for children who remain for a long period of time in the oral-motor stage in which they put any and everything into their mouths. Children with an autistic disorder usually have elevated blood lead levels.
Customarily, an expert diagnostic team has the responsibility of thoroughly evaluating the child, assessing the child's unique strengths and weaknesses, and determining a formal diagnosis. The team will then meet with the parents to explain the results of the evaluation.
Although parents may have been aware that something was not "quite right" with their child, when the diagnosis is given, it is a devastating blow. At such a time, it is hard to stay focused on asking questions. But while members of the evaluation team are together is the best opportunity the parents will have to ask questions and get recommendations on what further steps they should take for their child. Learning as much as possible at this meeting is very important, but it is helpful to leave this meeting with the name or names of professionals who can be contacted if the parents have further questions.
Source: National Institute of Mental Health
Early Autism Diagnostic and Evaluation Tools
Autism Treatment Evaluation Checklist (ATEC)
Checklist for Autism in Toddlers (the CHAT Screen)
Evaluations and other tests which may be recommended
Consult your pediatrician or family physician for a referral to a Developmental Pediatric Specialist, Neurologist, Psychologist or Psychiatrist.
Possible evaluations and tests your health care providers or School District may recommend are:
-Speech and Language Evaluation
-Developmental or Psychological
-Chromosomal Testing for Fragile X Syndrome
-Occupational Therapy (OT) Evaluation (Fine Motor Skills)
-Physical Therapy (PT) Evaluation (Gross Motor Skills)
-Sensory Integration Dysfunction
Autism Screening and
The late Dr. Rimland was founder and director of the Autism Society of America (ARI and editor of the Autism Research Review International. Dr. Rimland was highly regarded and fondly known in the autism community as the "Father of Modern Autism." ARI provides parents and professionals with useful diagnostic tools, the Diagnostic Checklist Form E-2 (autism) and E-3 (behavior) in the diagnosis process. Single copies of these forms are made available to parents free of charge. For more information on Autism Spectrum Disorders contact the Autism Research Institute
The Center for the Study of Autism is an affiliate of ARI and is noted for the working papers Advice for Parents of Young Autistic Children
: Spring (2004), written by Drs. James B. Adams, Stephen M. Edelson, Temple Grandin, and Bernard Rimland.
Dr. Edelson wrote a popular article, What I Would Do If I Were a Parent of An Autistic Child
: Recommendations Based on 25 Years of Research Experience.
For more information on the importance of early developmental screening click here.
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