Screening & Diagnosis of Autism Spectrum Disorders

Instructor: Karin Gonzalez

Karin has taught middle and high school Health and has a master's degree in social work.

Pediatricians begin screening for developmental disorders like autism spectrum disorders (ASD) as early as a child's 9-month well visit. Learn about ASD and various screening and diagnosis methods in this lesson.

Definition of Autism Spectrum Disorders

Jessica and Jason have been worried about their son, John, since he was about 4-months-old as he has never really shown an interest in people. John, now 17-months-old hardly smiles, gives eye contact, or turns his head at the sound of his name. He can only say the word ''dog'' when the average vocabulary is 50 words for other kids his age. Jason and Jill decide to talk to John's pediatrician in his 18-month well visit about the possibility of autism spectrum disorder.

Autism spectrum disorder (ASD) is a social and communication neurodevelopmental disorder that is usually noticed when a small child has difficulty communicating and socializing with others. It is called a spectrum disorder because there is a large scale of severities and qualities of autism. To illustrate, some autistic children and adults may be academically high-functioning with high intelligence despite their social awkwardness. On the hand, other autistic children and adults are low-functioning in that they have an intellectual disorder, engage in repetitive self-harming behaviors (like head banging), and hardly talk at all.

If a young child is displaying symptoms of ASD, early screening can lead to early diagnosis which is great because it means that the child can get occupational, speech, cognitive, physical, mental health and social therapies as early as possible. Although there is no known cure for ASD, therapies can significantly lower the effects and improve communication and social skills for kids and adults with ASD.

Screening of ASD

Doctors begin asking parents questions about whether or not their children are meeting developmental milestones as early as the 9-month well visit. These questions are meant to be a way to detect any developmental concerns, including those associated with ASD. The American Association of Pediatrics (AAP) recommends that every baby should be screened for developmental disorders and specifically for ASD at the 18-month well visit.

Parents, like Jessica and Jason, can begin screening for ASD on the internet with the M-CHAT-R. The AAP recommends the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R™) that can be used with children that are between 18 and 30 months of age. This is a 20-question assessment and follow-up interview. Parents can complete the assessment from the comfort of their own home.

In the week before John's 18-month doctor's visit, Jessica searches the internet and finds the assessment. It takes her merely 10 minutes to answer the 20 questions. She is asked questions about John, like if he:

  • Points to signal that he wants something
  • Looks in the direction that she points to
  • Responds to his name
  • Returns smiles
  • Imitates her
  • Provides eye contact
  • Attempts to get her attention
  • Likes to play pretend

Jessica answers mostly ''no'' on the assessment and is given an immediate result that John is indeed a high risk for ASD.

Questionnaires for Older Children

Social Communication Questionnaire (SCQ) is for kids over the age of 4, and it, like the M-CHAT-R, takes about 10 minutes to complete to assess kids for ASD.

Autism Spectrum Screening Questionnaire (ASSQ) is a 27-question screening tool of children between the ages of 7 to 16. Parents who notice that their child, although smart and academically capable, has social, relationship and communication difficulties, can fill out this questionnaire to see if their child falls on the high end of the spectrum. It's essentially a screening tool for Asperger's Syndrome, but since the Diagnostic Statistical Manual of Mental Disorders 5th edition created an umbrella diagnosis of ASD, which includes Asperger's Syndrome, it is now just a screening tool for high-functioning ASD.

Diagnosis of ASD

There are a number of qualified professionals in the health care field that can diagnose ASD including a child's pediatrician, a child psychologist, neurologist and school psychologist, to name a few.

Jessica and Jason visit child psychologist, Dr. Brown, with John. Diagnosis of a child usually incorporates information obtained from parents and professional observations of the child.

Information obtained from parents/caregivers

Dr. Brown asks Jessica and Jason about the presence of autism-related symptomatic behavior, communication patterns, social skills, relationships, etc. with John. This is known as the Autism Diagnostic Interview- Revised (ADI-R). It's a structured 2-3 hour interview of 93 questions, and it is a key diagnostic tool for ASD.

The Childhood Autism Rating Scale (CARS) is a briefer 15 question scale that takes 5-10 minutes. It can only be used with children ages two and older, though.

The GARS-3: Gilliam Autism Rating Scale-Third Edition is intended for children and young adults ages 3-22. It's one of the most widely used scales to diagnose ASD and it contains 56 questions.

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