Although there are many concerns about labeling a
young child with an ASD, the earlier the diagnosis of ASD is made,
the earlier needed interventions can begin. Evidence over the
last 15 years indicates that intensive early intervention in optimal
educational settings for at least 2 years during the preschool years
results in improved outcomes in most young children with ASD.
In evaluating a child, clinicians rely on behavioral characteristics
to make a diagnosis. Some of the characteristic behaviors of ASD may
be apparent in the first few months of a child's life, or they may
appear at any time during the early years. For the diagnosis,
problems in at least one of the areas of communication,
socialization, or restricted behavior must be present before the age
of 3. The diagnosis requires a two-stage process. The first stage
involves developmental screening during "well child" check-ups; the
second stage entails a comprehensive evaluation by a
multidisciplinary team.
Screening
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.
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.
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 ASDs 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.8 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.
Recent studies have shown that there is
currently a worldwide autism epidemic. In fact, more than 1.5
million people are affected in the United States alone, with one in
every 250 children diagnosed.
It's true that early detection and early treatment are the two key
factors in improving prognosis -- but too often parents get bogged
down in denial or confusion about this still mysterious disorder,
and are unable or unwilling to take the necessary steps.
The Essential Guide to Autism contains advice and information that
will help you make the right treatment decisions for your child.
Today, many youngsters can be helped to attend school alongside
their peers. Some programs are demonstrating that with appropriate
support, many people with autism can be trained to do meaningful
work and participate fully in community life.
All of the materials on this site have been included for the purpose of
providing general information, and they should not be relied on as a
substitution for professional advice.
