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What should you do if you suspect your child is autistic, and how do you go from suspicion to diagnosis?

Autism is, as everything you'll read about it will emphasize, a lifelong neurodevelopmental condition. Its core features, which include differences in social communication and interaction, a strong need for routines and distress when faced with change, very intense passions for certain topics, and sensory sensitivities, will become apparent to anyone who interacts with an autistic person — even if they can't quite put their finger on what makes the person different. 

Did you know, though, that the signs a child may be on the spectrum can appear really quite early on in life? While research demonstrates that symptoms often show up by 12 to 18 months, many parents will look back and report that they've noticed differences even before that. They may include such things as not smiling back at a caregiver, not looking up when the child's name is called, and not checking what someone is pointing at. They may also include strong attachments to a certain toy or object. 

Despite the fact that the signs of autism manifest when children are very young, many aren't diagnosed until after age three, with the American Psychological Association reporting that the average age at which autism is diagnosed is four and a half. How do you go from those early suspicions that your child may be autistic to holding the diagnosis in your hands?

What should parents do if they suspect autism?

When parents notice behavioral differences in their children that they believe could point to autism, talking to their family doctor or pediatrician about their observations is an excellent first step. A pediatrician, especially, will be familiar with the wide range of possible paths typical development can take — and also with what kind of things are out of the ordinary. 

Many pediatricians will actually screen for disabilities and developmental delays quite automatically, whether or not you raise concerns. Such screenings usually take place when a child is nine months old, and then again at 18 months and either at 24 or 30 months — all during regular well-child visits. Some will also automatically screen for signs of autism, whether or not parents have reported any behaviors that could indicate that their young child may be on the spectrum. 

Awareness of autism is always increasing, more so in some countries than others. It's also entirely possible that you have a school-aged child, perhaps even a teenager, whom you've always noticed differences in, often right alongside relatives, teachers, and peers. If you come to suspect that your older child is on the spectrum, you can still talk to your family doctor, pediatrician, or school psychologist to discuss your reasons for believing your child may be autistic and to get their opinion. In a few cases, parents will bypass primary care providers and go straight to psychologists or autism specialists in their area. 

Autism diagnosis in children: What's next?

During assessments for autism, clinicians will ultimately seek to determine, using a variety of tools, whether the child meets the diagnostic criteria for autism spectrum disorder. This means they will show marked struggles in social interaction and communication — such as a lack of eye contact, trouble having back-and-forth conversations in ways expected for typically-developing children, and difficulties in maintaining friendships. They'll also show "repetitive and restricted" behaviors, which could include a strong insistence on routines and anxiety when faced with change, as well as strong interests in a few subjects and an oversensitivity to certain stimuli, like bright lights, crowds, and sounds. 

Autism can be diagnosed with or without language delays and with or without intellectual impairment. The severity of the symptoms are also determined, on the basis of how much support a person needs to be able to function optimally. 

The diagnostic process will differ slightly from place to place, and may also depend on whether you are relying on socialized medicine or are going private. You may or may not need a referral. There may or may not be a waiting list. Regardless of these bureaucratic factors, autism should be diagnosed by a psychologist, neuropsychologist, neurologist, or in some cases a pediatrician — and it's important that the diagnosing doctor has a lot of prior experience with autism and its diagnosis. The diagnostic team will also often include a speech-language pathologist

The diagnostic process for autism in children is thorough, and includes these steps:

  • Informative reports from adults in the child's life, such as teachers, grandparents, and tutors. 
  • An interview with the parents — here, you'll be asked about your child's development (including early development) and behaviors, but also whether you have a family history of autism spectrum disorder. 
  • A physical examination. 
  • Observing the child, where possible often in multiple contexts, like at school, home, and at a psychologist's office. Here, the diagnosing professional seeks to get a clear picture of the child's natural behaviors. 
  • Tests for linguistic, social, and cognitive skills. 

If other conditions are also being explored, an evaluation for those conditions will also be part of the process. Some children initially suspected of being autistic instead end up having ADHD, language delays, or neurological problems, for instance. In other cases, children teachers believe are showing signs of abuse instead end up being on the spectrum. 

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