Experts point out that it is very important to screen for developmental delays at regular well-child visits. Screening should start when your child is an infant and continue through school age.
A common way that pediatricians screen young children is by evaluating their age-appropriate skill development. This refers to skills or milestones that a child is expected to have because most children their age have them. When interviewing the parents of a child suspected of autism, the doctor should ask about loss of speech or a significant decrease in the child’s vocabulary or nonverbal communication skills such as pointing or grabbing.
The doctor should inquire about any change in social skills, inattentiveness, or an apparent loss of interest in parents or siblings at any age. When evaluating children for autism, specialists utilize several screening instruments that have been developed to quickly gather information about a child’s social and communicative development within medical settings. Some screening tools are based on the examiner’s observations of the child. Some evaluations rely solely on parental responses to a questionnaire while others rely on a combination of a parental report and observations.
A screening tool is like a checklist: It lists certain behaviors and abilities of the child and asks the physician to evaluate them. After each evaluation, the physician “scores” that behavior or ability. For example, if “eye contact” were an item on the screening tool, it might be scored like this:
0 = no eye contact,
1 = infrequent,
2 = intermittent, or
3 = full/appropriate eye contact.
At the end of the evaluation, the final score is calculated. Certain scores are associated with a diagnosis of autism. Experts validate these screening instruments by using them to evaluate hundreds of children who have been previously diagnosed as autistic and hundreds who are nonautistic children. When the screening instrument can correctly identify the autistic children from the nonautistic children, it is thought to be useful. It is important to note that the results of a screening tool are not sufficient to make a diagnosis of autism. A clinician who is experienced in evaluating children will not make a diagnosis of autism until after completing the following:
1. The parents have been interviewed about the child’s medical history, attainment of developmental milestones, and current behavior
2. The child has undergone a thorough physical examination
3. The child has been tested for other diseases that mimic autism
A screening tool only tells the examiner that the child responds in the same way as an autistic child responds. It does not tell the examiner why the child responds that way. For example, a child who is hearing impaired may be scored the same as an autistic child. A physician alerted to the results of the screening tool would have to make the appropriate diagnosis after the examination.
A screening tool only tells the examiner that the child responds in the same way as an autistic child responds. It does not tell the examiner why the child responds that way.
Term:
Checklist for Autism in Toddlers (CHAT) – A checklist to be used by general practitioners at 18 months to see if a child has autism.
