Parents are in the best position to monitor their young children, they observe them across settings and over time, and spend a great deal more time with their child than a practitioner may in any given appointment time. The most effective assessments are completed when parents and providers partner together- using tried and tested standardized assessment tools, proven on thousands of other children to be reliable, and partner to truly observe the child and the areas where he or she may be struggling.
Diagnosing autism spectrum disorder (ASD) can be difficult, since there is no medical test, like a blood test, to diagnose the disorders. Doctors look at the child’s behavior and development to make a diagnosis.
ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable. However, many children do not receive a final diagnosis until much older, which may delay the therapies or help that they need. A child who is being screened at an older age may also require the use of different screening tools in order to be valid.
Diagnosing an ASD takes two steps:
- Developmental Screening
- Comprehensive Diagnostic Evaluation
Developmental screening is a short test to tell if children are learning basic skills when they should, or if they might have delays. During developmental screening the doctor might ask the parent some questions or talk and play with the child during an exam to see how she learns, speaks, behaves, and moves. A delay in any of these areas could be a sign of a problem. A screening tool is a simple pass/fail type inventory where they are either put it an ‘at risk’ category or not. A screening alone can never confirm a diagnosis of autism, which requires a full diagnostic assessment.
All children should be screened for developmental delays and disabilities during regular well-child doctor visits at:
- 9 months
- 18 months
- 24 or 30 months
Additional screening might be needed if a child is at high risk for developmental problems due to preterm birth, low birth weight or other reasons.
In addition, all children should be screened specifically for ASD during regular well-child doctor visits at:
- 18 months
- 24 months
Additional screening might be needed if a child is at high risk for ASD (e.g., having a sister, brother or other family member with an ASD) or if behaviors sometimes associated with ASD are present
It is important for doctors to screen all children for developmental delays, but especially to monitor those who are at a higher risk for developmental problems due to preterm birth, low birth weight, or having a brother or sister with an ASD.
If your child’s doctor does not routinely check your child with this type of developmental screening test, ask that it be done.
If the doctor sees any signs of a problem, a comprehensive diagnostic evaluation is needed.
Parents can find free and downloadable screening tools online and bring them to their child’s doctor’s appointment if they have concerns. Parents should trust their instincts and avoid a ‘wait and see’ approach, and avoid waiting for the pediatrician to note red flags.
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.
If you and your physician agree that further screening is needed, you can request a free developmental assessment through your State Department of Health. We provide the contact information for your state’s local Early Intervention coordinator on your child’s M-CHAT-R/F report.
Early Intervention sites offer further evaluations of your child free-of-charge. These developmental assessments often vary from county to county and may involve a physical exam, a cognitive exam, a hearing assessment, and a speech assessment. In addition to these important components of a thorough evaluation, you may also consider genetic testing and/or specialized assessments provided by a medical geneticist, a clinical psychologist, a developmental pediatrician, a pediatric psychiatrist, or a pediatric neurologist.
Click here to view the AAP policy on developmental screening recommendations and guidelines. A statement of reaffirmation for this policy was published in September of 2010 and can be found here.