DIAGNOSING A CHILD WITH AUTISM
EARLY IDENTIFICATION IS BEST!
The reasons why it is so important to identify red flags, symptoms and to get a diagnosis as soon as possible are due to the following reasons:
The brain is still developing and more malleable at a very young age. Therefore a child’s brain has higher potential to adapt, change and learn rapidly the younger they are.
The developmental delay is much smaller at a younger age (e.g. a 3 year old child demonstrating a 2 year delay versus a 7 year old child demonstrating a 5 year delay). The smaller the gap, the higher the likelihood of closing the gap.
The challenging behaviours a child with autism may demonstrate (e.g. repetitive or self-stimulatory behaviours, or self-injurious or aggressive behaviours) have only been practiced for a shorter amount of time the younger the child is.
WHEN TO SEEK A DIAGNOSIS?
If your child meets any of the following red flag behaviours:
- No babbling or cooing by 12 months.
- No gestures (finger point, wave, grasp) by 12 months.
- No single words by 16 months.
- No 2 word phrases by 24 months.
- Any loss of language skill at any age.
National Institute of Child Health & Human Development (NICHD)
- Does not point to show interest in something.
- Does not respond when name is called.
- Does not show interest in other children.
- Does not bring objects to adults.
- Does not look at objects when adults point to them.
- Does not imitate adult’s movements.
Robins, Fein, Barton, & Green, 2001
You can do a self-screening for your child using the M-CHAT-R:
The Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F; Robins, Fein, & Barton, 2009) is a 2-stage parent-report screening tool to assess risk for Autism Spectrum Disorder (ASD). The M-CHAT-R/F is an autism screening tool designed to identify children 16 to 30 months of age who should receive a more thorough assessment for possible early signs of autism spectrum disorder (ASD) or developmental delay.
The American Academy of Pediatrics (AAP) recommends that all children receive autism-specific screening at 18 and 24 months of age, in addition to broad developmental screening at 9, 18, and 24 months. The M-CHAT-R/F, one of the AAP recommended tools, can be administered at these well-child visits.
WHAT TO EXPECT FROM A DIAGNOSTIC EVALUATION
If your child shows any of the above red flags or fails the M-Chat, it is important that you schedule a diagnostic evaluation as soon as possible. Our diagnosing consultants from Wisconsin Early Autism Project (WEAP) have shared some useful points that you should look out for when receiving a diagnosis. They are:
- The diagnosis needs to be made by a psychologist, psychiatrist, neurologist, developmental pediatrician, or similar qualified medical professional.
- No medical tests, diagnosis based on history and symptoms.
- Golden standard for diagnosis:
– The Diagnostic and Statistical Manual of Mental Health (5th edition) (DSM-5).
- Gold standard assessment tools:
– Autism Diagnostic Observation Schedule (ADOS)
– Autism Diagnostic Interview Revised (ADI-R)
- A comprehensive diagnosis takes approximately 2 hours to complete and should include:
– Observations of your child
– A thorough interview with parents/caregivers
- It will entail a comprehensive discussion on developmental history of your child.
- You should receive a detailed report
- A diagnosis needs to be made as early as symptoms present clear diagnosis.
- It is also important to remember that as a Spectrum Disorder: may be higher functioning or more challenged.
DIAGNOSTIC CRITERIA BASED ON DSM-5
Autism Spectrum Disorders (ASD) are neurological disorders featuring delayed or abnormal development in “social communication and interactions”; and “restricted, repetitive patterns of behaviour, interest, or activities”. It is a spectrum disorder in which their symptoms and severity vary widely across the core characteristic symptoms. It is defined by symptoms that appear before the age of 3 years old.
According to the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) – the golden standard for diagnosis – ASD is characterised by 2 core areas:
1. Deficits in social-emotional reciprocity
2. Deficits in nonverbal communication
3. Deficits in developing, maintaining and understanding relationships
B) Restricted, repetitive pattern of behaviour, interests or activities, as manifested by at least two of the following, currently or by history:
1. Stereotyped or repetitive motor movements, use of objects, or speech
2. Insistence of sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behaviour
3. Highly restricted, fixated interests that are abnormal in intensity or focus
4. Hyper or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
C) Symptoms must be present in the early developmental period
D) Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning
REMEMBER, AUTISM IS A SPECTRUM DISORDER!
|EARLY LEARNER SKILLS||May not have much cooperation, imitation or attention.||Able to cooperate, imitate and attend in a one to one setting and possibly small group setting.||Able to cooperate, imitate and attend in a one to one setting and possibly small group setting.|
|COMMUNICATION & LANGUAGE||Child may be nonverbal, use hand-leading and tantrums to communicate or may have some sounds or few words.||Child has ability to receptively learn nouns, verbs, people’s names, may have some expressive language (e.g. 2-3 word phrases), answer simple conversation questions.||Fluent in receptive understanding & expressive language.|
|PLAY SKILLS||Very few play skills, may play repetitively or inappropriately with limited toys.||May be able to play with different toys and participate in simple preschool games.||May be able to play in group activities and sport.|
|SOCIAL SKILLS||May be unaware of other people, prefer to play on his own, little or brief eye contact.||May have learned to play with others, able to take turns, share and stay with peer.||May struggle with literal thinking, may demonstrate some socially inappropriate behavior due to lack of understanding more complex social rules.|
Jochebed Isaacs (2014)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
National Institute of Child Health & Human Development (NICHD) (2013). What are the symptoms of Autism Spectrum Disorder (ASD). Retrieved from: http://www.nichd.nih.gov/health/topics/autism/conditioninfo/Pages/symptoms.aspx
Jochebed Isaacs (2014). What is Autism? [Power Point slides].
Robins, D. L., Fein, D., Barton, M. L. & Green, J. A. (2001). The modified checklist for Autism in Toddlers: An initial study investigating the early detection of Autism and Pervasive Developmental Disorders. Journal of Autism and Developmental Disorders 2001, 31(2) 131-144.