[Reviewed by:Shaguna Mathur, M.D.]
Autism Spectrum Disorder (ASD) is a complex developmental condition that often reveals itself during the first three years of life. Autism disrupts the normal development of the brain and impairs thinking, feeling and social functioning. It is considered a “spectrum" disorder because of the wide variation in the types and severity of symptoms.
ASD does not discriminate, as it occurs in all ethnic, racial and economic groups. While there is no cure for autism, early diagnosis and intervention can make a significant difference in a child's ability to function and thrive at home and in school.
Signs of autism can vary, but parents are usually the first to begin noticing changes in their child's social and communication behaviors. According to the Centers for Disease Control and Prevention, nearly half of parents who have a child with an ASD disorder observed problems before their child's first birthday and the vast majority of parents noticed problems by age 2.
Some of the “red flags" or signs parents may see can include…
Additional signs can include…
In very young children, signs can include…
The American Academy of Pediatrics recommends that all children be screened for autism at the ages of 18 and 24 months, in addition to regular developmental and behavioral observations at every well-child visit.
Early detection and intervention are important to ensure children receive the proper care. Boys Town Pediatrics encourages parents to schedule an office visit with their pediatrician if they are concerned about their child's developmental progress, or if their child is showing signs of autism.
Unfortunately, there is no lab test or simple blood test available to diagnose the disorder. Because the symptoms and severity of autism vary widely, diagnosis requires gathering and interpreting a lot of information. Typically, a diagnosis is based on criteria described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide created by the American Psychiatric Association and used by most healthcare providers.
A doctor will observe a child's behavior and review the child's development history when making a diagnosis. It is important that parents know what signs to look for in their child. Sometimes ASD can be detected at 18 months or younger, and by age 2, a diagnosis can be considered reliable. There are children, however, who do not receive a diagnosis until they are much older. This can happen for a variety of reasons, including being misdiagnosed or having a slow onset of symptoms.
There are several steps in the diagnosis process, including developmental monitoring and developmental screening.
Developmental monitoring involves observing how a child grows and develops and whether the child is meeting developmental milestones or skills, such as taking a first step, sitting without support, playing and moving. Missed milestones may suggest a potential problem, so a physician or specialist may conduct a more in-depth evaluation or screening.
Developmental screening is more thorough and can be done by a doctor, nurse or other qualified healthcare professional, as well as professionals in a school or community setting. Questionnaires and checklists that touch on a child's language, thinking, behavior and mobility are common screening tools. However, it is important to note that screening is not diagnosing. If a child tests positive after a screen, it does not automatically mean the child has autism.
There are a variety of screening tools a doctor will use in order to measure autism symptoms. They often include the following:
A screening is not a diagnosis, but if it shows areas for concern, a more comprehensive developmental evaluation is the next step. A trained specialist, such as a developmental pediatrician, will review your child's medical history and perform a developmental exam, specifically looking for several language milestones that include:
If additional testing is needed, the pediatrician may refer your family to a developmental behavioral physician who specializes in the diagnosis and treatment of developmental disorders.
In addition to screening measures (see “How is Autism Diagnosed), other tools and diagnostic instruments can be used as part of the comprehensive evaluation.
Diagnostic instruments may be used with different modules, or activities, to accommodate a child's age. For toddler s, a module will be play-based. For older children, the module will be conversation-based. The evaluation does not have right or wrong answers, but instead focuses on whether the child gives others a chance to speak, asks for help if it is needed and is able to follow a change in subjects.
Interviews are another insightful tool that is used. An interview is typically conducted with parents and consists of general development questions and what a parent's current concerns are. In addition, cognitive tests are often administered. This testing allows the individual conducting the assessment to examine the child's behavior in a socially loaded session with less structure. It also gives more understanding into how a child plans, solves and organizes problems.
Genetic testing and screening, while not intended to diagnose autism, can clarify the cause of some autism spectrum disorders or other developmental delays. The results of genetic testing can be used to enhance the therapies, interventions and medical care provided to children with specific genetic conditions, such as Fragile X syndrome.
The Boys Town Autism Clinic has a team of specialists, clinicians and genetic counselors who can provide evaluation, diagnosis, individual treatment and ongoing support for children who have developmental delays, learning and behavioral disorders and genetic conditions. The ability of genetic testing to identify a specific diagnosis is expanding, allowing our specialists to answer questions such as who else in the family may develop or be affected by neurological problems.
Children with autism have unique medical and clinical needs, and often have co-occurring medical conditions. The Boys Town Autism Clinic is staffed by clinicians and specialists who can provide everything from diagnosis and treatment to wrap-around services that address your child's physiological, social, emotional and co-occurring conditions.
School support is also available to help you navigate and encourage your child's academic success. Our specialists will work with your family and your child's school psychologists and counselors to help develop an individual education plan (IEP). You also can take advantage of virtual visits for follow-up care, medication checks and other specialty and clinical services.
At Boys Town, our child-focused and family-centered care targets the unique needs of each individual, so all treatment options can be explored, optimal care can be delivered and the best outcomes can be achieved. Our goal is your goal… to give your child the best opportunity to thrive and reach his or her full potential!
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