Early intervention for autism, we hear over and over again, improves outcomes. For that early intervention to become possible, a child first has to be diagnosed. This happens through an intensive evaluation to determine whether a child meets the diagnostic criteria for autism spectrum disorder, but a much less intense screening precedes that.
What role does screening play in the process that may eventually end with a diagnosis?
Do routine developmental screenings and well-child checkups play a role in the diagnostic process for autism?
Yes. When you take your child to routine doctor's appointments, your family doctor or pediatrician isn't just keeping an eye out for their physical wellbeing or administering vaccines. They seek to get a picture of the child's development as well. Routine checkups include screening for disabilities — whether or not you or your doctor have concerns that there may be any. These screenings usually take place:
- When your child is nine months old
- Again when they are 18 months old
- Then between the ages of 24 and 30 months
With the prevalence of autism being on the rise, or at least with diagnostic processes being much more thorough, allowing more autistic people to be diagnosed, the United States Preventive Services Task Force actually recommended that all children be screened for autism spectrum disorder, as well, again regardless of whether parents suspect it. It's not currently clear how effective such a screening is, and not all doctors everywhere in the world will conduct it routinely. Some will.
When do the early signs of autism make an appearance?
The trouble is that the early signs are not always adequately recognized, even if parents are aware that there is something different about their child. Most autistic children don't receive a final diagnosis until they are four years old, while many wait much longer. Screening is meant to help bring this number down.
What are some of the early signs of autism a young toddler may display?
Autism is a lifelong neurological condition characterized by differences in social communication and interaction, as well as repetitive behaviors and a strong need for routine. Some of the "typical" signs of autism — the kinds of things looked for during the diagnostic process — that can be apparent early on in childhood include:
- Language delays. This may mean not using any words by 18 months, or not combining two words to make short phrases by two years of age.
- No social smiling. Babies start smiling at their caregivers for social reasons as early as six weeks. Autistic young people are less likely to do this.
- Typically-developing children will follow your gaze or your pointing finger to figure out what you are looking at. They will also start pointing things out themselves, and will bring things to parents and caregivers to show. Autistic children may not do this.
- Autistic children may not be able to make or sustain eye contact, and avoid seeking it out in social contexts.
- Autistic children may form strong interests in certain topics very early on, or develop strong attachments to comfort objects.
It is important to note that many of these things can also have completely different causes or even be quite normative. Multilingualism can cause language delays, for instance, and vision problems can lead to a lack of eye contact. Many toddlers will become attached to a favorite stuffed animal.
A screening will help rule autism in or out. If autism is ruled out but a child has some of the signs, other causes can then be explored.
What happens during an autism screening?
The family doctor or pediatrician will observe the child as they try to engage them, but will also ask parents questions. They may use the so-called Modified Checklist for Autism in Toddlers for this purpose. Parents can expect to be asked questions like:
- Is your child interested in other children?
- Does your child use their pointer finger to show you things?
- Does your child bring you objects to share or show?
- Does your child make eye contact for longer than a few seconds?
- Does your child engage in pretend play?
- Is your child sensitive to noise?
- Does your child respond to their name?
- Have you ever wondered if your child can hear properly?
- Does your child enjoy movement activities, like swinging and bouncing?
- Does your child check to see if you are watching?
All the questions asked during a screening for autism spectrum disorder serve to gain a more complete picture of their overall development. Should it indicate that your child is quite likely to be on the spectrum, you can then be referred for a diagnostic evaluation.
As parents, you see so much more of your child's development and behavior that your doctor, who only observes your child for short periods of time, ever can. You play a crucial role in facilitating early diagnosis.