Within the first few months of their baby's life, the parents of an autistic child may begin to feel that something is not quite right. They may notice that their child, who once seemed normal in every way, is acting strangely, refusing to make eye contact, point to toys or speak.
Even though the signs may appear before age 2, most children aren't diagnosed with autism until age 4 or 5, according to the Centers for Disease Control and Prevention. Part of the reason for this delay is that the symptoms of autism can look much like those of other conditions, which is why autism screening is a multistep process involving several different health and mental health professionals.
The first step to diagnosing autism begins with a developmental test administered by the child's pediatrician. If this test suggests an ASD, the next step is to bring in a team of experts, which may include a psychologist, neurologist, child psychiatrist, speech therapist, occupational therapist, physical therapist, and possibly other professionals. These doctors will evaluate the child for neurologic or genetic problems, as well as for cognitive and language skills. Evaluation may include observations, parent interviews, patient histories, speech and language assessments and psychological tests.
Screening tests for autism include:
- The Autism Diagnostic Observation Schedule (ADOS-G): An observational test used to identify delayed social and communication behaviors.
- The Autism Diagnosis Interview-Revised (ADI-R): An interview that assesses the child's communication and social skills.
- Childhood Autism Rating Scale (CARS): An observational test to determine autism severity that uses a 15-point scale to evaluate a child's verbal communication abilities, listening skills, body use, and social relationships.
- The Autism Screening Questionnaire: A 40-question scale used in children 4 and older to evaluate social and communication abilities
According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), children with autism meet at least six of the following criteria:
- Social impairments: Does not properly use nonverbal behaviors such as gestures and facial expressions Fails to develop age-appropriate peer relationships Does not spontaneously share objects or interests with others Lacks social or emotional reciprocity
- Communication impairments: Is slow to speak Has difficulty sustaining a conversation Repeatedly uses the same language Does not engage in age-appropriate make-believe or socially imitative play
- Repetitive behaviors: Is intensely preoccupied with one or more interests Is inflexible and unwilling to change set routines Repeats motions or mannerisms (such as waving arms, flapping, or twisting) Is preoccupied with parts of objects
Next, we'll look at conventional treatments for autism.