Autism Screening and Diagnosis

The American Academy of Pediatrics recommends that all children be screened for autism spectrum disorders at the 18- and 24-month well-child doctor visits, using autism-specific formal screening tests.

Screening tools include the Modified Checklist for Autism in Toddlers (M-CHAT), the Early Screening of Autistic Traits Questionnaire and the First Year Inventory. Initial data on M-CHAT and its predecessor, CHAT, on children aged 18 - 30 months suggests that it’s best used in a clinical setting and that it has low sensitivity (many false-negatives) but good specificity (few false-positives). It may be more accurate to precede these tests with a broadband screener that does not distinguish ASD from other developmental disorders.

If you suspect that your child is exhibiting symptoms of autism, schedule an appointment to talk with your doctor and follow these four crucial steps that follow emphasize the importance of a necessary “patient but persistent” approach.

Each well visit with your pediatrician provides an opportunity for your child to receive a routine developmental screening, but if you don’t request it, it may not be offered. As a parent, you are your child’s advocate and a “resident expert” regarding your child’s health and development. During a well visit, a physician may typically spend 15 minutes or less with your child, making it quite the challenge for both of you to cover the wide range of issues related to your child’s health.

If you have concerns, remember to take the following four crucial steps:

  1. Be prepared. Before your next well visit, print out a checklist of developmental milestones and note the expected milestones your child has met. Ask your doctor for a routine screening. If you have questions or concerns, write down some concrete examples. For example:
  2. • My son used to be so communicative, but now he hardly speaks at all.
    • He doesn’t look at me at all, and never makes eye contact.
    • My child spends most of his time lining up his toys.
    • My daughter hasn’t learned a new word in months.

  3. Express your concerns clearly. Try to focus on your concrete concerns, such as developmental milestones. If your physician doesn’t want to perform a screening, or isn’t responsive to your concerns, be persistent, keep asking why or why not. If you’re asked to “wait and see”, schedule a follow-up appointment or ask for a referral to a developmental pediatrician.

  4. Ask questions! If the pediatrician uses terms you don’t understand, ask him or her to explain. Following the screening, ask what the results indicate and what they mean. Inquire about referrals to specialists and ask about next steps.

  5. Follow up. For most parents, routine screenings indicate that a child is following a typical development pattern. If you learn that your child may be at risk of a developmental delay, follow up is crucial. Children at risk of atypical development are routinely referred to a developmental specialist. You may also want a referral to a developmental pediatrician, a psychologist, a neurologist, a psychiatrist and/or a specialist for further evaluation.

Remember, grief and disbelief can prove to be great hurdles. Empower yourself through education, just as you are here today. Proceed with confidence ... you know your child best. Only by pursuing your questions and concerns, forming a sharing relationship with your child’s physician and then by following up with him/her, can you ensure the best possible outcome for your child. Be patient with yourself and persistent for your child. Get the help your child needs.