Specific social communication/interactions problems include avoiding eye contact, having difficulty using nonverbal gestures, using stilted or scripted speech, interpreting abstract ideas literally, having trouble recognizing one’s own emotions as well as the emotions of other people, and having difficulty making or keeping friends. 2
A child who shows restricted interests is extremely focused on a specific subject to the exclusion of other subjects and expects others to be just as interested in that subject. 2 A child with ASD has inflexible behavior and extreme difficulty dealing with change, particularly changes in routine or participating in new experiences. 2 Repetitive behaviors might include movements such as hand flapping, rocking, or spinning, being hypersensitive to stimuli such as loud noises, and arranging toys or other items in a very particular pattern. 1,2
Studies have shown that, with rare exceptions, a child with ASD will experience deterioration in their social and communication behaviors over the first 2 years of life. During the second year of life (aged 12 to 24 months) repetitive behaviors and abnormal play typically become more obvious. A small number of patients with ASD experience these behavioral declines in adolescence. Some people with ASD may not seek an evaluation for ASD until they are an adult, possibly prompted by an ASD diagnosis in a child in their family. 1,2
While parents can informally assess their child for signs and symptoms of ASD, they also can use tools designed for that purpose. While these tools generally are intended to be used by clinicians, they rely at least in part on input from parents, so parents may find it helpful to explore them before their child is evaluated by a specialist.
The Modified Checklist for Autism in Toddlers (M-CHAT-R; available at www.mchatscreen.com) is a screening tool intended to be used by primary care providers, specialists, or other professionals to determine a child’s risk for ASD. 7 It consists of 2 parts: the M-CHAT-R and the M-CHAT-R Follow-up (M-CHAT-R/F).
The M-CHAT-R consists of 20 yes/no questions about how a child usually behaves. Scoring of the M-CHAT-R is interpreted as follows 7 :
If a child screens positive on the M-CHAT-R, a clinician should administer the M-CHAT-R/F, which consists of 20 pass/fail questions and detailed instructions for how to interpret the results. 7 Because the goal of the M-CHAT-R is to detect as many cases of ASD as possible, it has a high rate of false positives, which means that not every child whose M-CHAT-R results suggest they are at risk for ASD will be diagnosed with the disorder. 7 However, children who screen positive on the M-CHAT-R are at risk for other developmental disorders and should be evaluated by an experienced clinician. 7
In addition to M-CHAT, several other tools that include input from parents can be used to screen children for development delays that might suggest a diagnosis of ASD 3 :
Screening tools such as these are used to help identify a child who might have a neurodevelopmental delay such as ASD, but they do not provide conclusive evidence of a delay and they do not establish a diagnosis. 3 Parents who thinks their child might have ASD should express their concerns to their child’s pediatrician. The American Academy of Pediatrics recommends that pediatricians conduct general developmental screening of all children at 9, 18, and 30 months of age, and screening specifically for symptoms of ASD at 18 and 24 months. 8 If necessary, the pediatrician will refer parents to a specialist who will conduct a thorough evaluation using the appropriate diagnostic criteria.
In order to receive a diagnosis of ASD, a child needs to meet the criteria established by the American Psychiatric Association and published in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. 1 Those criteria can be summarized as follows 1:
A. Persistent deficits in social communication and social interaction as manifested by all of the following:
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least 2 of the following:
To meet these criteria, a child must not only have the required number of symptoms but the symptoms must have been apparent early in the child’s developmental period and must cause significant impairment in functioning. 1 These symptoms must not be better explained by an intellectual disability or global developmental delay. 1
To best help a child who they suspect might have ASD, parents can be better informed about the condition and diagnosis. Some checklist items for parents to address include:
An adolescent or adult who suspects they may have ASD can follow a similar checklist:
