ASSESSMENT OF AUTI
ASSESSMENT OF AUTISM SPECTRUM DISORDERS
Early identification is a key to early intervention, which has been shown to have a significantly positive effect on long-term outcomes for children with ASD. Early signs of autism are often noticed by 18 months of age, or even earlier. Some early signs or “red flags” that a child may have an ASD include the following:
Lack of or delay in spoken language
Repetitive use of language
Little or no eye contact
Lack of interest in other children
Lack of spontaneous or make-believe play
Persistent fixation on parts of objects
Poor response to his/her name
Fails to imitate caregivers
Motor mannerisms (e.g., hand-flapping)
Fails to point or show joint attention
Appropriate treatment of ASD should begin with a careful assessment to determine the child’s specific strengths and needs. There are no specific medical tests for diagnosing autism although there are genetic tests for some disorders that may be associated with behaviors on the autism spectrum. An accurate diagnosis is based on systematic interviewing, observation, and assessment of the child's communication, social interaction, behavior, and developmental level. In addition to assessing the key symptoms of autism, a review of sleep, feeding, coordination problems, and sensory sensitivities is often recommended. Medical factors that may be causing pain or irritability should be recognized and treated whenever possible. Seizures are found in 11-39% of individuals with ASD, and electroencephalography (EEG) should be considered if there is a concern about possible seizures. Although neuroimaging is not currently used routinely as part of diagnostic evaluation, an MRI can be conducted if concerns about identifiable neuropathology in brain structure are present. A metabolic workup and genetic testing for syndromes with autism-like features (e.g., Fragile X, neurofibromatosis, tuberous sclerosis, velocardiofacial syndrome, 15q duplications, and Angelman syndrome) is often appropriate. Consultation with specialists may be necessary to assess for neurological (neurologist), genetic (clinical geneticist), gastrointestinal (gastroenterology), speech (speech/language pathologist), or motor concerns (physical or occupational therapist).
Several screening and assessment tools have been developed to specifically assess for the presence of ASD in children and adolescents. Use of brief autism screening checklists such as the Modified Checklist for Autism in Toddlers (M-CHAT) at ages 18-8
24 months can be very helpful in early identification of an ASD by health care providers or early educators. Although ASD screenings may be completed by a number of different professionals (e.g., primary care physicians, speech pathologists, teachers, etc.), the diagnosis of ASD should typically be made by a psychologist, psychiatrist, or developmental-behavioral pediatrician who has been trained in the diagnosis of ASD. Observation tools such as the Autism Diagnostic Observation Schedule (ADOS) and structured diagnostic interviews such as the Autism Diagnostic Interview – Revised (ADI-R) are often used to provide additional rigor to the assessment of ASD
