Autism Assessment and Diagnosis
There can be a lot of questions for a client, parents, guardians, and care-takers when thinking about how to have a loved one, or even yourself, assessed and possibly diagnosed with Autism Spectrum Disorder. This post will cover some information from screening recommendations to diagnostic tools that can help make the process a bit less confusing.
Developmental screening can be completed by a number of professionals in health care, community, and school settings. However, primary health care providers are in a unique position to promote children’s developmental health.
Primary care providers are a great resource as they have regular contact with children and can provide a more complete medical assessment when a screening indicates a child is at risk for a possible developmental problem, as well as referrals to a specialist for assessment and diagnosis.
Tools for screening
There are a lot of screening tools available, however, it is ideal to have other sources of information as well, such as parents’ or caregivers’ descriptions of their child’s development and a professional’s observation of the child’s behavior. Below are a few of the most popular screening tools for general development and ASD. These are usually completed at the direction of, or by, the provider.
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.
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.
When should screenings occur?
The American Academy of Pediatrics (AAP) recommends that all children be screened for developmental delays and disabilities during regular well-child doctor visits at:
9 months
18 months
30 months
Additional screening might be needed if a child is at high risk for developmental problems because of preterm birth or low birth weight.
In addition, all children should be screened specifically for ASD during regular well-child doctor visits at:
18 months
24 months
*Additional screening may also be needed if a child is at high risk for ASD (e.g., having a sibling with ASD) or if symptoms are present.
It is important for families to be involved in the screening process as they are a source of direct information regarding a child's behaviors, development, and language.
*It should also be noted that a screening and/or assessment can be done at any age.
Diagnostic Tools
There are a lot of assessment tools available, however, it is ideal to have other sources of information as well, such as 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, neurologists, and/or counselors who are trained in the specific assessment to be given. Below are a few examples of assessments, some of which require gathering information from sources, as well as observation of the client being assessed and are only completed by the provider assessing for the diagnosis. These assessments do require training to complete.
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 – (ADOS) 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. This has been updated with a Second Edition.
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.