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Autism Coach

Does My Child Have Symptoms of Autism?

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Symptoms, Checklists and Diagnostic Tests for Infants, Toddlers and Young Children

We have below tools commonly used by clinicians to diagnose autism and more detailed information about the Autism Toddler Checklist which is used to identify young chlidren within the autism spectrum.

An diagnosis of autism is based on observation of the individual's communication, behavior, and developmental levels.  However, because many of the behaviors associated with autism are shared by other disorders, various medical tests may be ordered to rule out or identify other possible causes of the symptoms being exhibited.  Autism may also co-occur with other conditions such as Tourette's Syndrome, seizure disorders, ADD, ADHD, and depression. 

It is important to distinguish autism from other conditions, since an accurate diagnosis and early identification can provide the basis for building an appropriate and effective educational and treatment program.  (Autism Coach - In our opinion, it is important to identify and address underlying and related medical conditions. However, as a wise parent once said, "Labels are for cans, not for kids!"  Our children are not a collection of labels.  We must look beyond labels to the whole child we love, determine our child's strengths and areas of deficit, and then create an intervention program that allows that child to use his or her strengths to lay the groundwork for new learning and the acquisition of new skills and abilities.) 

Early Diagnosis

Research indicates that early diagnosis is associated with dramatically better outcomes for individuals with autism. The earlier a child is diagnosed, the earlier the child can begin benefiting from one of the many specialized intervention approaches.  (Autism Coach - We can't emphasize enough how important it is to begin treatment as early as possible!)

Diagnostic Tools

The characteristic behaviors of autism spectrum disorders may or may not be apparent in infancy (18 to 24 months), but usually become obvious during early childhood (24 months to 6 years).   The National Institute of Child Health and Human Development (NICHD) lists these five behaviors that signal further evaluation is warranted:

  • Loss of direct eye contact at any age - this is proving to be the definitive identifiable symptom
  • Regression in/loss of language or social skills at any age
  • Does not babble or coo by 12 months
  • Does not gesture (point, wave, grasp) by 12 months
  • Does not say single words by 16 months
  • Does not say two-word phrases on his or her own by 24 months
  • Any loss of language or social skills at any age

Having any of these five "red flags" does not mean a child has autism, but because the characteristics of the disorder vary so much, a child should have further evaluations by a multidisciplinary team that may include a neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant, or other professionals knowledgeable about autism.

While there is no one behavioral or communications test that can detect autism, several screening instruments have been developed that are now used in diagnosing autism.

CARS rating system (Childhood Autism Rating Scale), developed by Eric Schopler in the early 1970s, is based on observed behavior. Using a 15-point scale, professionals evaluate a child's relationship to people, body use, adaptation to change, listening response, and verbal communication.

The Checklist for Autism in Toddlers (CHAT) is used to screen for autism at 18 months of age. It was developed by Simon Baron-Cohen in the early 1990s to see if autism could be detected in children as young as 18 months. The screening tool uses a short questionnaire with two sections, one prepared by the parents, the other by the child's family doctor or pediatrician.

The Autism Screening Questionnaire is a 40 item screening scale that has been used with children four and older to help evaluate communication skills and social functioning.

The Screening Test for Autism in Two-Year Olds, being developed by Wendy Stone at Vanderbilt, uses direct observations to study behavioral features in children under two. She has identified three skills areas - play, motor imitation, and joint attention - that seem to indicate autism.

Autism Toddler Checklist

Autism, a developmental disorder characterized by social withdrawal and an inability to communicate, is usually diagnosed during the preschool years. But the disorder begins in infancy, and a group of British researchers have developed a behavior checklist that may help identify toddlers at risk for autism so they can get treatment earlier.

"There is some, although not uncontroversial, evidence of the benefits of early intervention programs," notes Dr. Tony Charman of the Institute of Child Health in London, and colleagues. "The possibility of early identification of autism merits investigation."

The researchers developed a questionnaire called the Checklist for Autism in Toddlers, or CHAT, that can be used by parents and health care workers to identify toddlers who are at risk for developing autism, pervasive developmental disorder, and language disorders. The checklist focuses on behaviors that are usually missing in children with autism: interacting or playing with others, showing interest in things around them, and communication through language or pointing.

Of the more than 16,000 children screened with the CHAT at 18 months, 38 were considered at high risk for autism, and 369 at medium risk. The researchers looked at whether the screened children had autism or another developmental problems at ages 3 1/2 years, 5 1/2 years, and 7 to 8 years

The team found that CHAT correctly identified 38% of the children who were later diagnosed with autism, and 32% of those later diagnosed with pervasive developmental disorder. Among the high-risk group, 27 of the 38 were not diagnosed with autism, but four of these developed language disorders and three had other developmental disorders.

The 38 high-risk children and half of the 369 medium-risk children were screened twice about one month after their first use of the CHAT. With these two screenings, the checklist's ability to predict later disorders went up: 83% of those identified as high risk were later diagnosed with either autism or pervasive developmental disorder. The researchers note, however, that this method of screening also missed a number of children who did later develop these disorders.

Writing in the June issue of the Journal of the American Academy of Child and Adolescent Psychiatry, Charman and colleagues concluded that "the CHAT can be used to identify cases of autism and related pervasive developmental disorder at 18 months of age." They note, however, that the checklist is a screening tool only, and children identified through the screening tool require more detailed examination by experts.

"It is emphasized that the CHAT is not a diagnostic instrument but can identify potential cases of autism spectrum disorders for a full diagnostic assessment," the researchers stated.

SOURCE: Journal of the American Academy of Child and Adolescent Psychiatry 2000;39:694-702.