| What is autism? Assessing Autism Spectrum Disorders Bright Tots information on child development |
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| Assessing Autism Spectrum Disorders |
Initial detection of autistic spectrum disorders (ASD) is a two-step process: developmental surveillance and screening
that begins at infancy with the child’s primary care provider.
Developmental surveillance is the routine monitoring and tracking of specific developmental milestones at well-child
visits. This includes the gathering of information through reliable standardized instruments combined with parent and
professional observations and tracking developmental progress, compared with children of similar age. All professionals
responsible for the care of the child should perform routinedevelopmental surveillance to identify children with atypical
development.
Evaluation
Major advancements in the sciences of early identification and treatment of ASD have increased public awareness and
focused more attention on this class of neuro-developmental disorders. It has been clearly demonstrated that ASD are
identifiable and relatively stable in very young children. Evaluations, the identification of risk factors for a disorder using
specific tests. By screening the population of children from birth through age 5 for ASD, seeks to identify those
children most at risk of developing an ASD and/ or developmental delay.
Historically, it has been difficult to reliably detect ASD before the age of 3. In part, this is due to lack of awareness of
health care providers about the presentation of ASD in young children (including their more limited skill development,
particularly in language, cognitive, social behaviors). For example, it would be difficult to judge developmental deviation
in peer relationships in children of 18 months, an age at which these skills would not be expected to have developed.
Identifying Behaviors Before Age 2
Advances have been made in identifying behavior indicators as well as atypical development in children less than 2 years
of age who are later diagnosed with ASD. It has been demonstrated that autism can be reliably diagnosed by an
experienced clinician in children between the ages of 24 and 30 months. Since ASD early intervention services are
dependent upon early detection and formal diagnosis, it is imperative that young children be screened for ASD,
identified as being at risk and referred for comprehensive evaluation and assessment in an efficient and timely manner.
Recently, researchers have begun to focus on the developmental precursors of communication, language and social
development in the first two years of life. Children with disorders on the autistic spectrum consistently seem to
demonstrate deficits in social-cognitive and social-communicative behaviors early in life.
These include failures of joint attention, nonverbal and pre-verbal communication, social reciprocity, affective
understanding and imitation.
The majority of parents report atypical behaviors in their young children with autism during the first two years of life.
Parents of children with autism noted several features that were markedly deficient in their child during the first two
years of life. These included: poor eye contact and poor coordination of eye gaze with vocalization or gesture, no
pointing to or showing of objects and an inability to follow another’s focus of attention through eye gaze or gesture.
Children with autism also displayed less pre-verbal babbling and no reciprocity in vocalizing and imitation. They also
attended less to voice and had difficulty understand and using nonverbal gestures.
The detection of young children with developmental and behavioral problems can be difficult due to the variety of
disorders and their manifestations at different ages. This is particularly apparent in young children with ASD whose
communicative and social difficulties are often poorly understood and are therefore frequently attributed to normal
variations in typical development. Many studies have demonstrated that early detection and early therapeutic intervention
are associated with the best developmental, behavioral and adaptive outcomes.
Early Diagnosis
Most parents of children with autism expressed concerns regarding their child’s development before 18 months of age.
Until recently, a considerable gap existed between the time parents first reported concerns and subsequent referral and
definitive diagnosis. A lengthy referral and diagnostic process contributes to considerable parental anxiety, places
unneeded stress on parents and families and squanders valuable intervention time. Research has supported the notion of
parental accuracy with regard to developmental concerns with their child. With the documented efficacy of early
intervention in achieving optimal outcomes for young children and their families, it is imperative that all concerns be
taken seriously and addressed appropriately.
Parents’ concerns about their child’s development and behaviors are discussed at every health care provider contact,
including well and ill child visits. Some noteworthy clinical sings, or “red flags,” exist that can help identify children at
risk for developmental delay and/or ASD within a routine office or other health facility visit. These indicators typically
are tracked through routine developmental surveillance procedures, which should occur at all well-child visits. The
most powerful indicators is degree of language development. Any child not using single words by 16 months of age or
some two-word phrases by 2 years of age should be further evaluated. Children who do not use gesture (i.e., pointing,
waving, etc) or who cannot follow nonverbal communication by 12 months should also be referred. Finally, any loss of
skills at any age is a serious red flag and warrants immediate referral to an appropriate diagnostic team.
Developmental Concerns
Primary care providers are generally the first point of contact for parents with concerns and questions regarding their
child’s development. Parents expect their pediatricians and family physicians to offer guidance regarding developmental
issues; if no help is forthcoming, these parents may turn to other sources. Well-child visits are the logical time and
place for developmental surveillance and screening for specific disorders to occur.
Studies have shown that even when parents bring up developmental concerns, some PCPs respond by waiting to see if
the delays will resolve spontaneously or by discounting parental observations. They may be unaware of the degree of
accuracy often associated with parental concerns regarding their child’s development. While a small number of children
do “catch up” without formal intervention and achieve developmental milestones somewhat later than same-age peers,
this is the exception. A significant number of youngsters require early intervention either on a transient ongoing basis to
function within their family and community environment.
Presently, children are being referred for evaluation regarding suspicion of ASD at earlier ages. Although many trained
professionals are able to make a definitive diagnosis at a young age, the stability of diagnosis within the spectrum may
fluctuate. This is often the case with children who are very young (2 years and under) and for those at extreme ends of
the spectrum. It is not uncommon for a child to meet diagnostic criteria for autistic disorder at age 2 and then be
described at age 3 or 4 as PDD-NOS. Symptoms and behaviors may change considerably with intervention, particularly
as language and social skills progress. Because symptoms change over time, a young child with an early diagnosis of
ASD should be reexamined at least annually to confirm the diagnosis and plan treatment.
Specific Domains
Developmental and behavioral history of the child and current functioning are important in diagnosing ASD.
Developmental information such as developmental milestones, motor skills, eating and sleeping patterns etc. are critical
in the evaluation process.
The following are some specific domains in the diagnostic criteria.
∙ First concerns about the child’s development.
∙ Characteristics of the infant’s temperament.
∙ Social-emotional milestones. This includes engagement in typical baby games (pat-a-cake, peek-a-boo), eye
contact during feeding and games, shared attention, greetings and similar significant events. It is sometimes helpful to
provide a reference point (i.e., first birthday) to aid with recall.
∙ Sensory abnormalities. It is important for the clinician to provide examples to help discriminate atypical patterns
from typical development patterns. For example, arm flapping and jumping are common in many pre-verbal children.
For example, children respond to exciting stimuli such as the currently poplar children’s characters, Barney and Elmo.
∙ Feeding and sleep problems or patterns.
∙ Fine and gross motor development and milestones.
∙ Atypical interests and activities.
∙ Interest in other children and/or siblings.
∙ Patterns of attachment to care givers.
∙ Ability to use nonverbal communicative means such as gesture and facial expression.
∙ Communication, including both verbal and nonverbal intent.
∙ Preferred activities and play.
∙ Other notable characteristics such as loss of skills or deterioration of behavior.
that begins at infancy with the child’s primary care provider.
Developmental surveillance is the routine monitoring and tracking of specific developmental milestones at well-child
visits. This includes the gathering of information through reliable standardized instruments combined with parent and
professional observations and tracking developmental progress, compared with children of similar age. All professionals
responsible for the care of the child should perform routinedevelopmental surveillance to identify children with atypical
development.
Evaluation
Major advancements in the sciences of early identification and treatment of ASD have increased public awareness and
focused more attention on this class of neuro-developmental disorders. It has been clearly demonstrated that ASD are
identifiable and relatively stable in very young children. Evaluations, the identification of risk factors for a disorder using
specific tests. By screening the population of children from birth through age 5 for ASD, seeks to identify those
children most at risk of developing an ASD and/ or developmental delay.
Historically, it has been difficult to reliably detect ASD before the age of 3. In part, this is due to lack of awareness of
health care providers about the presentation of ASD in young children (including their more limited skill development,
particularly in language, cognitive, social behaviors). For example, it would be difficult to judge developmental deviation
in peer relationships in children of 18 months, an age at which these skills would not be expected to have developed.
Identifying Behaviors Before Age 2
Advances have been made in identifying behavior indicators as well as atypical development in children less than 2 years
of age who are later diagnosed with ASD. It has been demonstrated that autism can be reliably diagnosed by an
experienced clinician in children between the ages of 24 and 30 months. Since ASD early intervention services are
dependent upon early detection and formal diagnosis, it is imperative that young children be screened for ASD,
identified as being at risk and referred for comprehensive evaluation and assessment in an efficient and timely manner.
Recently, researchers have begun to focus on the developmental precursors of communication, language and social
development in the first two years of life. Children with disorders on the autistic spectrum consistently seem to
demonstrate deficits in social-cognitive and social-communicative behaviors early in life.
These include failures of joint attention, nonverbal and pre-verbal communication, social reciprocity, affective
understanding and imitation.
The majority of parents report atypical behaviors in their young children with autism during the first two years of life.
Parents of children with autism noted several features that were markedly deficient in their child during the first two
years of life. These included: poor eye contact and poor coordination of eye gaze with vocalization or gesture, no
pointing to or showing of objects and an inability to follow another’s focus of attention through eye gaze or gesture.
Children with autism also displayed less pre-verbal babbling and no reciprocity in vocalizing and imitation. They also
attended less to voice and had difficulty understand and using nonverbal gestures.
The detection of young children with developmental and behavioral problems can be difficult due to the variety of
disorders and their manifestations at different ages. This is particularly apparent in young children with ASD whose
communicative and social difficulties are often poorly understood and are therefore frequently attributed to normal
variations in typical development. Many studies have demonstrated that early detection and early therapeutic intervention
are associated with the best developmental, behavioral and adaptive outcomes.
Early Diagnosis
Most parents of children with autism expressed concerns regarding their child’s development before 18 months of age.
Until recently, a considerable gap existed between the time parents first reported concerns and subsequent referral and
definitive diagnosis. A lengthy referral and diagnostic process contributes to considerable parental anxiety, places
unneeded stress on parents and families and squanders valuable intervention time. Research has supported the notion of
parental accuracy with regard to developmental concerns with their child. With the documented efficacy of early
intervention in achieving optimal outcomes for young children and their families, it is imperative that all concerns be
taken seriously and addressed appropriately.
Parents’ concerns about their child’s development and behaviors are discussed at every health care provider contact,
including well and ill child visits. Some noteworthy clinical sings, or “red flags,” exist that can help identify children at
risk for developmental delay and/or ASD within a routine office or other health facility visit. These indicators typically
are tracked through routine developmental surveillance procedures, which should occur at all well-child visits. The
most powerful indicators is degree of language development. Any child not using single words by 16 months of age or
some two-word phrases by 2 years of age should be further evaluated. Children who do not use gesture (i.e., pointing,
waving, etc) or who cannot follow nonverbal communication by 12 months should also be referred. Finally, any loss of
skills at any age is a serious red flag and warrants immediate referral to an appropriate diagnostic team.
Developmental Concerns
Primary care providers are generally the first point of contact for parents with concerns and questions regarding their
child’s development. Parents expect their pediatricians and family physicians to offer guidance regarding developmental
issues; if no help is forthcoming, these parents may turn to other sources. Well-child visits are the logical time and
place for developmental surveillance and screening for specific disorders to occur.
Studies have shown that even when parents bring up developmental concerns, some PCPs respond by waiting to see if
the delays will resolve spontaneously or by discounting parental observations. They may be unaware of the degree of
accuracy often associated with parental concerns regarding their child’s development. While a small number of children
do “catch up” without formal intervention and achieve developmental milestones somewhat later than same-age peers,
this is the exception. A significant number of youngsters require early intervention either on a transient ongoing basis to
function within their family and community environment.
Presently, children are being referred for evaluation regarding suspicion of ASD at earlier ages. Although many trained
professionals are able to make a definitive diagnosis at a young age, the stability of diagnosis within the spectrum may
fluctuate. This is often the case with children who are very young (2 years and under) and for those at extreme ends of
the spectrum. It is not uncommon for a child to meet diagnostic criteria for autistic disorder at age 2 and then be
described at age 3 or 4 as PDD-NOS. Symptoms and behaviors may change considerably with intervention, particularly
as language and social skills progress. Because symptoms change over time, a young child with an early diagnosis of
ASD should be reexamined at least annually to confirm the diagnosis and plan treatment.
Specific Domains
Developmental and behavioral history of the child and current functioning are important in diagnosing ASD.
Developmental information such as developmental milestones, motor skills, eating and sleeping patterns etc. are critical
in the evaluation process.
The following are some specific domains in the diagnostic criteria.
∙ First concerns about the child’s development.
∙ Characteristics of the infant’s temperament.
∙ Social-emotional milestones. This includes engagement in typical baby games (pat-a-cake, peek-a-boo), eye
contact during feeding and games, shared attention, greetings and similar significant events. It is sometimes helpful to
provide a reference point (i.e., first birthday) to aid with recall.
∙ Sensory abnormalities. It is important for the clinician to provide examples to help discriminate atypical patterns
from typical development patterns. For example, arm flapping and jumping are common in many pre-verbal children.
For example, children respond to exciting stimuli such as the currently poplar children’s characters, Barney and Elmo.
∙ Feeding and sleep problems or patterns.
∙ Fine and gross motor development and milestones.
∙ Atypical interests and activities.
∙ Interest in other children and/or siblings.
∙ Patterns of attachment to care givers.
∙ Ability to use nonverbal communicative means such as gesture and facial expression.
∙ Communication, including both verbal and nonverbal intent.
∙ Preferred activities and play.
∙ Other notable characteristics such as loss of skills or deterioration of behavior.
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