Presently, we don't have a medical test that can diagnose autism. Instead, specially trained physicians and psychologists administer autism-specific behavioral evaluations.
Often parents are the first to notice that their child is showing unusual behaviors such as failing to make eye contact, not responding to his or her name or playing with toys in unusual, repetitive ways. For a description of early indicators of autism, see Learn the Signs.
The Modified Checklist of Autism in Toddlers (M-CHAT) is a list of informative questions about your child. The answers can indicate whether he or she should be further evaluated by a specialist such as a developmental pediatrician, neurologist, psychiatrist or psychologist.
We encourage parents to trust their instincts and find a doctor who will listen and refer their child to appropriate specialists for diagnosis. Unfortunately, doctors unfamiliar with diagnosing autism sometimes dismiss parent concerns, delaying diagnosis and the opportunity for early intervention therapies. Autism Speaks and other autism organizations are working hard to raise awareness of early signs among physicians as well as parents.
From birth to at least 36 months of age, every child should be screened for developmental milestones during routine well visits. When such a screening-or a parent-raises concerns about a child's development, the doctor should refer the child to a specialist in developmental evaluation and early intervention. These evaluations should include hearing and lead exposure tests as well as an autism-specific screening tool such as the M-CHAT. Among these screening tools are several geared to older children and/or specific autism spectrum disorders.
A typical diagnostic evaluation involves a multi-disciplinary team of doctors including a pediatrician, psychologist, speech and language pathologist and occupational therapist. Genetic testing may likewise be recommended, as well as screening for related medical issues such as sleep difficulties. This type of comprehensive helps parents understand as much as possible about their child's strengths and needs. (For local and regional centers specializing in the coordinated medical care of children and adolescents with autism, explore our Autism Treatment Network and visit our Resources page)
Sometimes an autism spectrum disorder is diagnosed later in life, often in relation to learning, social or emotional difficulties. As with young children, diagnosis of adolescents and adults involves personal observation and interview by a trained specialist. Often, a diagnosis brings relief to those who have long struggled with difficulties in relating socially while not understanding the source of their difficulties. A diagnosis can also open access to therapies and assistive technologies that can improve function in areas of difficulty and, so, improve overall quality of life.
DSM-5 (DSM-V)
Signs
One of the most important things you can do as a parent or caregiver is to learn the early signs of autism and become familiar with the typical developmental milestones that your child should be reaching.
The following "red flags" may indicate your child is at risk for an autism spectrum disorder. If your child exhibits any of the following, please don't delay in asking your pediatrician or family doctor for an evaluation:
No big smiles or other warm, joyful expressions by six months or thereafter
No back-and-forth sharing of sounds, smiles or other facial expressions by nine months
No babbling by 12 months
No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months
No words by 16 months
No meaningful, two-word phrases (not including imitating or repeating) by 24 months
Any loss of speech, babbling or social skills at any age
Treatment Options for Toddlers and Preschool Children
Scientific studies have demonstrated that early intensive behavioral intervention improves learning, communication and social skills in young children with autism. While the outcomes of early intervention vary, all children benefit. Researchers have developed a number of effective early intervention models. They vary in details, but all good early intervention programs share certain features. They include:
√ The child receives structured, therapeutic activities for at least 25 hours per week.
√ Highly trained therapists and/or teachers deliver the intervention. Well-trained paraprofessionals may assist with the intervention under the supervision of an experienced professional with expertise in autism therapy.
√ The therapy is guided by specific and well-defined learning objectives, and the child's progress in meeting these objectives is regularly evaluated and recorded.
√ The intervention focuses on the core areas affected by autism. These include social skills, language and communication, imitation, play skills, daily living and motor skills.
√ The program provides the child with opportunities to interact with typically developing peers.
√ The program actively engages parents in the intervention, both in decision making and the delivery of treatment.
√ The therapists make clear their respect for the unique needs, values and perspectives of the child and his or her family.
√ The program involves a multidisciplinary team that includes, as needed, a physician, speech-language pathologist and occupational therapist.
Do Children or Adults Diagnosed with Autism Ever Move Off "the Spectrum"?
Growing evidence suggests that a small minority of persons with autism progress to the point where they no longer meet the criteria for a diagnosis of autism spectrum disorder (ASD). Various theories exist as to why this happens. They include the possibility of an initial misdiagnosis, the possibility that some children mature out of certain forms of autism and the possibility that successful treatment can, in some instances, produce outcomes that no longer meet the criteria for an autism diagnosis.
You may also hear about children diagnosed with autism who reach "best outcome" status. This means they have scored within normal ranges on tests for IQ, language, adaptive functioning, school placement and personality, but still have mild symptoms on some personality and diagnostic tests.
Some children who no longer meet the criteria for a diagnosis of autism spectrum disorder are later diagnosed with attention deficit and hyperactivity disorder (ADHD), anxiety disorder or a relatively high-functioning form of autism such as Asperger Syndrome.
Currently, we don't know what percentage of persons with autism will progress to the point where they "lose their diagnosis." We likewise need further research to determine what genetic, physiological or developmental factors might predict who will achieve such outcomes.
We do know that significant improvement in autism symptoms is most often reported in connection with intensive early intervention-though at present, we cannot predict which children will have such responses to therapy.
We also know that many people with autism go on to live independent and fulfilling lives, and that all deserve the opportunity to work productively, develop meaningful and fulfilling relationships and enjoy life. With better interventions and supports available, those affected by autism are having better outcomes in all spheres of life.
