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Autism can be challenging to pinpoint. A range of signs and symptoms can differ from one child to the next. And because it is a spectrum, each child’s cognitive ability and level of functioning also vary. Then there is the overlap in symptoms that occur with other developmental disorders like ADHD or Sensory Processing Disorder.
This can be frustrating for parents, who usually know very little about autism at the beginning of their journey. They know their child is different and needs support but are looking for a why and how. Some parents may fear a formal diagnosis as it ‘attaches a label.’ But it is essential to know what you are dealing with as it empowers you and allows you to educate yourself to understand your child better and seek the best support available.
How Autism in Children is Assessed and Diagnosed
No scan or blood test can diagnose autism. Instead, when a child’s behavior points towards the possibility of autism, specialists get involved and use a variety of diagnostic assessments and screening tools to see if the child meets the criteria.
Developmental Screening
The American Academy of Pediatrics (AAP) recommends that pediatricians conduct a developmental screening for ASD during routine well visits in children between 18 months and two years of age. In addition, if there is a history of autism in the family, the child is at a higher risk of developing autism and will be screened more regularly.
When a doctor conducts a developmental screening, the parent is given a series of questionnaires regarding the child’s development. If the questionnaires identify signs that are cause for concern, the child will be referred for further evaluation.
Signs that indicate possible ASD include:
- Speech and communication delays.
- Not responding when their name is called despite not having any hearing issues.
- Struggling with changes to routine.
- Avoiding eye contact.
- Avoiding physical contact.
- Poor social interaction.
Again, it’s essential to understand that not all of these symptoms must be present. At the same time, other factors are considered over and above these. Further evaluation requires the expertise of a child psychiatrist or a physician specializing in child development.
Types of Developmental Screening Tools
Physicians use developmental screening tools to determine if autism is a possibility. Some are based on informal observation, while others take the form of more formal assessments. The developmental screening tools listed here are the most commonly used, but the list is not exhaustive. In addition, the CDC does not endorse any screening tools for autism, and physicians use them to determine whether further referral is necessary.
Ages and Stages Questionnaires (ASQ)
The Ages and Stages questionnaire comprises 19 questions specific to the child’s age and expected stage of development. It considers the child’s communication skills, fine and gross motor skills, problem-solving ability, and personal adaptive skills.
Communication and Symbolic Behavior Scales (CSBS)
The CSBS tool is designed for screening children under the age of two. It screens communication skills and symbolic abilities. The parent completes it in the form of a one-page checklist.
Parents’ Evaluation of Developmental Status (PEDS)
The PEDS assessment tool can be used for all ages and uses a parent interview form to screen for developmental delays and behavioral problems that require further evaluation.
Modified Checklist for Autism in Toddlers (MCHAT)
The MCHAT has been developed to identify young children who have a high risk of autism. Parents complete a questionnaire.
Screening Tool for Autism in Toddlers and Young Children (STAT)
The STAT is a more interactive screening tool that uses activities designed to asses communication, play, and imitation skills in children with developmental concerns.
Diagnostic screening
After the initial screening process, it’s determined whether the child needs further evaluation.
Diagnostic screening is more in-depth, and several formal testing methods are available. For the assessment, the professional will interview the parents and spend time with the child to observe him/her.
Diagnostic assessments can also check for or rule out other developmental, emotional, and behavioral, disorders.
Types of diagnostic screening tools
Autism Diagnosis Interview-Revised (ADI-R)
The ADI-R assessment tool can be used from about age 18 months right through to adulthood. It focuses on the core symptoms of autism, such as communication skills, social interactions, and repetitive behaviors.
Autism Diagnostic Observation Schedule – Second Edition (ADOS-2)
The ADOS-2 evaluates communication, social and play skills in those suspected to have ASD. It can also be used from 18 months through to adulthood. The ADOS-2 can be used to evaluate both verbal and non-verbal individuals.
Childhood Autism Rating Scale, Second Edition (CARS-2)
The CARS-2 diagnostic tool is used for children two years and up. It is suitable for both high and low cognitive abilities. The CARS-2 provides information about the severity level of not only autism but also the severity of each symptom.
Gilliam Autism Rating Scale (GARS-3)
The Gilliam Autism Rating Scale aims to determine the severity of autism in different individuals from the age of three to twenty-two. The broad autism spectrum can make diagnosis challenging. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) places the levels of autism under one umbrella, which can lack clarity.
The GARS-3 is a norm-reference tool that compares individuals to those in a norm group. A norm group considers age, race/ethnicity, socioeconomic status, etc.
The Autism Diagnosis
Autism is very complex. Many claim autism is on the rise, with the numbers going up, but there is a logical reason for the growing number of cases. Greater awareness has resulted in more high-functioning autism diagnoses. These were previously overlooked, and the behaviors were attributed to personality traits, upbringing, and other issues like ADHD and anxiety. In addition, more comprehensive tools are available for screening and diagnosis that factor in the fact that autism is a spectrum.
Autism is a subjective disorder that cannot be diagnosed with a blood test, scan, or physical assessment, but looking at development alone is not enough to diagnose autism. Young children can develop at different rates within an acceptable norm. However, sometimes children are way slower to hit developmental milestones. For example, in some children, communication skills can take a bit longer to develop, but they eventually catch up. We may notice delays in speech development, only to later discover that the child has a hearing loss. If doctors base their findings on delayed development alone, it can lead to a premature diagnosis.
Autism symptoms can also overlap with other disorders like ADHD. As a result, it can be incorrectly diagnosed or missed altogether. This is why an exhaustive diagnosis can take time. It requires extensive observation, development monitoring, and communication with the parents and adults involved with the child on a daily basis.
Who is qualified to conduct an autism assessment?
ASD can only be officially diagnosed by a medical or mental health professional with a thorough understanding of autism. There is a growing awareness of how critical specialized training is and the need for quality, trusted diagnostic tools.
Pediatricians
Developmental-behavioral pediatricians
Developmental pediatricians possess the necessary training and skills to diagnose autism and developmental disorders. They assess the medical and psychosocial elements of the child’s symptoms and problematic behavior.
Pediatric neurologists
Pediatric neurologists are specialized in treating conditions brought about by problems with the nervous system. Their understanding of problems that begin in the brain or within the nerves, spine, and muscles equips them with the ability to rule out developmental delays that are not related to autism.
Child and adolescent psychologists
Child psychologists specialize in children’s social, emotional, and mental development. They observe a child’s development from birth through to adolescence and can diagnose and treat developmental, emotional, and social challenges.
Child and adolescent psychiatrist
Child psychiatrists are licensed physicians who can diagnose and treat behavioral disorders in children. Unlike most psychologists, they are able to prescribe medication and create a treatment plan tailored to a child’s biological and psychological makeup. This could include behavioral therapy, medication, or both.
Recommended Autism Treatment and Therapy
Behavioral interventions
Behavioral approaches identify the specific cause behind unwanted behavior and implement strategies to reinforce positive behavior and reduce unwanted behavior. Scientifically proven data validates a behavioral approach, which is the most common form of treatment because it’s effective.
ABA Therapy
The most widely practiced behavior therapy for children with autism is Applied Behavior Analysis (ABA). The approach establishes the critical skills that are prerequisites for communication, social, adaptive, behavioral, and other life skills.
ABA therapy focuses on ensuring children with autism develop and master the skills to live meaningful, fulfilled lives.
Using positive reinforcement, ABA increases positive and appropriate behaviors while reducing or eliminating the behaviors that can create challenges that hinder the child’s quality of life. This includes deficits in communication, social skills, or inappropriate displays of behavior.
There are many benefits of ABA. It is effective throughout the child’s lifetime, and its goals address several skills, including cognitive, language, social, and self-help skills. ABA therapy also teaches the essential behaviors needed to function in home, school, and community environments.
ABA empowers parents as they are actively involved in the process and gain the tools needed to help them interact with their children in a meaningful way.
Psychological interventions
Psychological interventions deal with issues resulting from autism, like depression, anxiety, and other mental health issues. Cognitive-Behavior Therapy (CBT) is the most common and focuses on learning the connections between thoughts, feelings, and behaviors.
A CBT identifies the child’s thought patterns and behavior that create challenges for them. They then guide the child in adjusting their thought process and reactions to certain situations.
Educational interventions
These are treatments that are conducted within the classroom setting. The most notable of these approaches is the Treatment and Education of Autistic and Related Communication-Handicapped Children (TEACCH) approach.
TEACCH guides teachers on classroom strategies that will improve academic and other outcomes. The approach recognizes that people with ASD thrive on consistency and are visual learners.
Early Intervention For Autism is Key
Research has proven that the earlier a child with autism receives intervention, the more likely they are to experience long-term benefits and assimilate into society. However, this can be frustrating when getting a diagnosis is not always as straightforward as one would hope.
We can help you find a doctor in the New Jersey area to assess whether your child in fact has an autism spectrum disorder. We’ve done the research for you to find providers that accept insurance and are qualified. If you’re interested, just fill out our diagnostician form, and someone from our team will be in touch soon!
Therefore, ABA should happen as quickly as possible after a diagnosis of autism. Older children can still benefit, but the children who receive services at a younger age tend to be nearly indistinguishable from their peers as they age.
At Circle Care Services in New Jersey, we provide comprehensive ABA to help your family to start the right treatment plan for your child. We offer in-home services, and preschool readiness programs, and we work in school settings with our clients. If you are seeking ABA services and have questions about ABA, we are here to help.
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