| What is autism? Assessing Autism Spectrum Disorders Bright Tots information on child development |
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| Assessing Autism Spectrum Disorders |
The diagnosis of autism spectrum disorders (ASD) is a two-step process: a developmental surveillance and screening
that begins at infancy with the child’s primary care provider. In screening for autism spectrum disorders 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 routine developmental surveillance to identify children with atypical
development.
Autism Spectrum Disorders and Evaluation
Early detection of autism spectrum disorders has increased public awareness and has focus more attention on this class
of developmental disorders. It has been clearly demonstrated that autism spectrum disorders are identifiable and
relatively stable in very young children. For the identification and risk factors of autism spectrum disorders specific
tests are used during the evaluation. By screening children early from birth through age 5 for autism, helps to identify
those children most at risk of developing an autism spectrum disorder and/ or developmental delay.
Autism spectrum disorders have shown difficult to reliably detect before the age of 3. In part, this is due to lack of
awareness of health care providers about the presentation of autism spectrum disorders 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 Autism Spectrum Disorders Before Age 2
Children with autism spectrum disorders are now being identified before the age of 2 years old thanks to advancements
in the autism diagnosis process. It has been demonstrated that autism can be reliably diagnosed by an experienced
clinician between the ages of 24 and 30 months. Since early intervention services are dependent upon early detection
and formal diagnosis, it is imperative that young children be screened for autism, identified as being at risk and referred
for comprehensive evaluation and assessment in an efficient and timely manner.
Children with autism spectrum disorders consistently seem to demonstrate deficits in social-cognitive and social-
communicative behaviors early in life. Recently, researchers have begun to focus on the developmental direction of
communication, language and social development in the first two years of life. These include failures of joint attention,
nonverbal and pre-verbal communication, social reciprocity, affective understanding and imitation.
The majority of children on the autism spectrum present autistic behaviors 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. Autistic children
have 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.
Detection of autism spectrum disorders in young children with developmental and behavioral problems can be difficult
due to the variety of disorders and their symptoms at different ages. This is particularly apparent in young children on
the autism spectrum 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
of autism and early therapeutic intervention are associated with the best developmental, behavioral and adaptive
outcomes.
Early Diagnosis Of Autism Spectrum Disorders
Parents of children with autism spectrum disorders have 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 the
time frame of referral and an autism diagnosis. A lengthy referral and diagnostic process contributes to considerable
parental anxiety, places unneeded stress on parents and families and wastes 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 with autism and their families, it is
imperative that all concerns be taken seriously and addressed appropriately.
Parents’ concerns about autism spectrum disorders and their child’s development and behaviors should be discussed at
every health care provider appointments, including well and ill child visits. There are some noteworthy sings, or “red
flags,” of autism exist that can help identify children at risk for developmental delay and/or autism 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 of autism is the 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.
Autism Spectrum Disorders and Developmental Concerns
Autism spectrum disorders and development concerns are generally discussed with primary care providers they are the
first source parents with concerns and questions regarding their child’s development seek. 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.
Studies have shown children with autism spectrum disorders and developmental delays, have been examined by primary
physicians and some physicians will wait to see if the delays will resolve spontaneously. 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 children require early intervention either on a temporary or
ongoing basis to function within their family and community environment.
Children suspected of having an autism spectrum disorder are being referred for evaluation regarding concerns at earlier
ages. Although many trained professionals are able to make a definitive diagnosis at a young age, the stability of
diagnosis within the autism 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 autism spectrum disorder at age 2 and then be described at age 3 or 4 as PDD-NOS. Autism 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 autism should be reexamined at least annually to
confirm the diagnosis and plan treatment.
Autism Spectrum Specific Domains
In diagnosing autism spectrum disorders developmental and behavioral history of the child and current functioning are
important. Developmental information such as developmental milestones, motor skills, eating and sleeping patterns etc.
are critical in the evaluation process.
Specific autism spectrum diagnosis criteria:
∙ First concerns about the child’s development.
∙ Characteristics of the child's temperament.
∙ Social-emotional milestones. This includes engagement in typical early childhood 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 autistic symptoms such as loss of skills or deterioration of behavior.
that begins at infancy with the child’s primary care provider. In screening for autism spectrum disorders 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 routine developmental surveillance to identify children with atypical
development.
Autism Spectrum Disorders and Evaluation
Early detection of autism spectrum disorders has increased public awareness and has focus more attention on this class
of developmental disorders. It has been clearly demonstrated that autism spectrum disorders are identifiable and
relatively stable in very young children. For the identification and risk factors of autism spectrum disorders specific
tests are used during the evaluation. By screening children early from birth through age 5 for autism, helps to identify
those children most at risk of developing an autism spectrum disorder and/ or developmental delay.
Autism spectrum disorders have shown difficult to reliably detect before the age of 3. In part, this is due to lack of
awareness of health care providers about the presentation of autism spectrum disorders 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 Autism Spectrum Disorders Before Age 2
Children with autism spectrum disorders are now being identified before the age of 2 years old thanks to advancements
in the autism diagnosis process. It has been demonstrated that autism can be reliably diagnosed by an experienced
clinician between the ages of 24 and 30 months. Since early intervention services are dependent upon early detection
and formal diagnosis, it is imperative that young children be screened for autism, identified as being at risk and referred
for comprehensive evaluation and assessment in an efficient and timely manner.
Children with autism spectrum disorders consistently seem to demonstrate deficits in social-cognitive and social-
communicative behaviors early in life. Recently, researchers have begun to focus on the developmental direction of
communication, language and social development in the first two years of life. These include failures of joint attention,
nonverbal and pre-verbal communication, social reciprocity, affective understanding and imitation.
The majority of children on the autism spectrum present autistic behaviors 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. Autistic children
have 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.
Detection of autism spectrum disorders in young children with developmental and behavioral problems can be difficult
due to the variety of disorders and their symptoms at different ages. This is particularly apparent in young children on
the autism spectrum 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
of autism and early therapeutic intervention are associated with the best developmental, behavioral and adaptive
outcomes.
Early Diagnosis Of Autism Spectrum Disorders
Parents of children with autism spectrum disorders have 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 the
time frame of referral and an autism diagnosis. A lengthy referral and diagnostic process contributes to considerable
parental anxiety, places unneeded stress on parents and families and wastes 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 with autism and their families, it is
imperative that all concerns be taken seriously and addressed appropriately.
Parents’ concerns about autism spectrum disorders and their child’s development and behaviors should be discussed at
every health care provider appointments, including well and ill child visits. There are some noteworthy sings, or “red
flags,” of autism exist that can help identify children at risk for developmental delay and/or autism 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 of autism is the 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.
Autism Spectrum Disorders and Developmental Concerns
Autism spectrum disorders and development concerns are generally discussed with primary care providers they are the
first source parents with concerns and questions regarding their child’s development seek. 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.
Studies have shown children with autism spectrum disorders and developmental delays, have been examined by primary
physicians and some physicians will wait to see if the delays will resolve spontaneously. 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 children require early intervention either on a temporary or
ongoing basis to function within their family and community environment.
Children suspected of having an autism spectrum disorder are being referred for evaluation regarding concerns at earlier
ages. Although many trained professionals are able to make a definitive diagnosis at a young age, the stability of
diagnosis within the autism 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 autism spectrum disorder at age 2 and then be described at age 3 or 4 as PDD-NOS. Autism 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 autism should be reexamined at least annually to
confirm the diagnosis and plan treatment.
Autism Spectrum Specific Domains
In diagnosing autism spectrum disorders developmental and behavioral history of the child and current functioning are
important. Developmental information such as developmental milestones, motor skills, eating and sleeping patterns etc.
are critical in the evaluation process.
Specific autism spectrum diagnosis criteria:
∙ First concerns about the child’s development.
∙ Characteristics of the child's temperament.
∙ Social-emotional milestones. This includes engagement in typical early childhood 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 autistic symptoms such as loss of skills or deterioration of behavior.
| ________________________________________________________________________________________________________________________ Copyright © 2004 Bright Tots® Inc. - Educational Toys & Resource Guide to Child Development - All rights reserved. ________________________________________________________________________________________________________________________ |
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