Getting an Autism Spectrum Diagnosis / The Diagnostic Process
Autism Spectrum Disorder (ASD) varies widely in severity and as it is a spectrum disorder, it will present differently from one child to another and from male to female. Signs and symptoms and may go unrecognized, especially in what may appear to be mildly affected children. Autism may also go unrecognized when it is masked by more prominent co-conditions.
The Process of Diagnosis
Getting an autism spectrum diagnosis is often a two-stage process. The first stage involves general developmental screening during well-child checkups with a pediatrician or an early childhood health care provider. Children who show some developmental problems are referred for additional evaluation. The second stage involves a thorough evaluation by a team of doctors and other health professionals with a wide range of specialties.
At this stage, a child may be diagnosed as having autism or another developmental disorder. Children with autism spectrum disorder (ASD) can usually be reliably diagnosed by age 2, though research suggests that some screening tests can be helpful at 18 months or even younger.
How is ASD diagnosed in children and teens?
Many people—including pediatricians, family doctors, teachers, and parents—may minimize signs of ASD at first, believing that children will “catch up” with their peers. While you may be concerned about labeling your young child with ASD, the earlier the disorder is diagnosed, the sooner specific interventions may begin.
Early intervention can reduce or prevent the more severe disabilities associated with ASD. Early intervention may also improve your child’s IQ, language, and everyday functional skills, also called adaptive behavior.
A well-child checkup should include a developmental screening test, with specific ASD screening at 18 and 24 months as recommended by the American Academy of Pediatrics Screening for ASD is not the same as diagnosing ASD. Screening instruments are used as a first step to tell the doctor whether a child needs more testing. If your child’s pediatrician does not routinely screen your child for ASD, ask that it be done.
For parents, your own experiences and concerns about your child’s development will be very important in the screening process. Keep your own notes about your child’s development and look through family videos, photos, and baby albums to help you remember when you first noticed each behavior and when your child reached certain developmental milestones.
Types of ASD Screening Instruments
There are a variety of instruments used when screening a child for autism spectrum disorder. Oftentimes the doctor will ask parents questions about the child’s symptoms to screen for ASD. Other screening instruments combine information from parents with the doctor’s own observations of the child.
Examples of screening instruments for toddlers and preschoolers include:
- Checklist of Autism in Toddlers (CHAT)
- Modified Checklist for Autism in Toddlers (M-CHAT)
- Screening Tool for Autism in Two-Year-Olds (STAT)
- Social Communication Questionnaire (SCQ)
- Communication and Symbolic Behavior Scales (CSBS).
To screen for ASD or Asperger syndrome in older children, the doctor may rely on different screening instruments, such as:
- Autism Spectrum Screening Questionnaire (ASSQ)
- Australian Scale for Asperger’s Syndrome (ASAS)
- Childhood Asperger Syndrome Test (CAST)
Comprehensive Diagnostic Evaluation
The second stage of diagnosis must be thorough in order to indicate whether other conditions may be causing your child’s symptoms.
For more information, see the section: What are some other conditions that children with ASD may have?
A team that includes a psychologist, a neurologist, a psychiatrist, a speech therapist, or other professionals experienced in diagnosing ASD may do this evaluation. The evaluation may assess the child’s cognitive level (thinking skills), language level, and adaptive behavior (age-appropriate skills needed to complete daily activities independently, for example eating, dressing, and toileting).
Because ASD is a complex disorder that sometimes occurs along with other illnesses or learning disorders, the comprehensive evaluation may include brain imaging and gene tests, along with in-depth memory, problem-solving, and language testing. Children with any delayed development should also get a hearing test and be screened for lead poisoning as part of the comprehensive evaluation.
Although children can lose their hearing along with developing ASD, common ASD symptoms (such as not turning to face a person calling their name) can also make it seem that
children cannot hear when in fact they can. If a child is not responding to speech, especially to his or her name, it’s important for the doctor to test whether a child has hearing loss.
The evaluation process is a good time for parents and caregivers to ask questions and get advice from the whole evaluation team. The outcome of the evaluation will help plan for
treatment and interventions to help your child. Be sure to ask who you can contact with follow-up questions.
Diagnosis for Adults
Diagnosis can help a person to better understand themselves and make better sense of their life history. Oftentimes adults on the autism spectrum have grown up with a variety of social and communication challenges and have not been able to understand why they are having challenges in some areas but not others. Diagnosis and subsequent education and support, allows for opportunities for families, friends, spouses and other loved ones to also better understand and provide better support based on improved knowledge.
Since autism spectrum disorder is a recognized disability, having a diagnosis may help an individual access accommodations and services. Some places where services might be useful could be during college or university, social and housing services, employment and other benefits agencies.
If you are an adult seeking diagnosis, the usual route to getting a diagnosis is to ask your primary care physician for a referral to a clinical psychologist or psychiatrist who has experience in diagnosing autism spectrum disorder or Asperger syndrome in teens and adults.
There will possibly be questions about your childhood and developmental years, questions you might not know the answer to. Answer to the best of your ability with as much detail as possible. Here is an article from the National Autistic Society which goes into more depth about this subject:
If you are concerned that your primary care physician or general practitioner does not have enough information about autism or Asperger syndrome to make a referral, the following hand-out from the National Autistic Society might provide useful:
Health-related material is provided for information purposes only and does not represent endorsement by or an official position of Autism Empowerment. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.