Early Identification Is Best

Best practices in both the United States and the United Kingdom support early identification. It is this that guides the policy and service development in both countries. A child can be diagnosed as young as 18 months of age. When we consider the formative years of learning, early identification and early intervention becomes paramount to provide children with the best possible opportunity to catch up on skills to support their successful integration into school as well as the community.

When You Should Seek Out A Diagnosis

If your child meets any of the following red flag behaviours:

Red Flag Behaviours

National Institute of Child Health & Human Development (NICHD)
  1. No babbling or cooing by 12 months.
  2. No gestures (finger point, wave, grasp) by 12 months.
  3. No single words by 16 months.
  4. No 2 word phrases by 24 months.
  5. Any loss of language skill at any age.

Red Flag Behaviours

Robins, Fein, Barton, & Green, 2001
  1. Does not point to show interest in something.
  2. Does not respond when name is called.
  3. Does not show interest in other children.
  4. Does not bring objects to adults.
  5. Does not look at objects when adults point to them.
  6. Does not imitate adult’s movements.

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.

download the m-CHART-R NOW

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:

Diagnostic Criteria Based On The 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. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history:
    •  Deficits in social-emotional reciprocity.
    •  Deficits in nonverbal communication.
    •  Deficits in developing, maintaining and understanding relationships.
  2. Restricted, repetitive pattern of behaviour, interests or activities, as manifested by at least two of the following, currently or by history:
    • Stereotyped or repetitive motor movements, use of objects, or speech.
    • Insistence of sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behaviour.
    • Highly restricted, fixated interests that are abnormal in intensity or focus.
    • Hyper or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment.
  3. Symptoms must be present in the early developmental period.
  4. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

Diagnostic Criteria Based On The DSM-5

It is important to remember that Autism is a spectrum disorder in which their symptoms and severity may vary widely across the core characteristic symptoms. Remember, Autism is a spectrum disorder and they can roughly be divided into 3 categories (mild, moderate or severe) or according to learners (early, intermediate or advanced learner).

EARLY LEARNER
INTERMEDIATE LEARNER
ADVANCED LEARNER
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)
Reference

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.