Diagnosing Autism

Parents worry that any difference in their child's behavior or development could be a sign of a lifelong disability like autism. Sometimes these worries are unnecessary. Other times, careful observation can lead to early diagnosis, early treatment, and, with luck, a positive outcome.

Even if autism is diagnosed and treated later in childhood—or even in adulthood—treatments and support can make a big and positive difference.

 While it's never "too late" to be diagnosed with autism, it's never too early for a screening or evaluation. In some cases, autism can be treated early and intensively, which is the optimal approach. In other cases, while autism may be ruled out, other challenges may be caught and treated early.

Noticing the Signs

Often, early signs of autism are observed by parents or grandparents. If you think that you or someone you love may be autistic, you probably have noticed certain symptoms. Perhaps you've picked up on a lack of eye contact, difficulty with social relationships, speech delays, or odd physical behaviors such as rocking, finger flicking, or toe walking. 

It's important to remember that if your child has just one or two symptoms but are otherwise developing normally, chances are that they are not autistic.

That doesn't mean, however, that they have no challenges. A child who has speech delays but no other symptoms, for example, may benefit from speech therapy even if he/she is not autistic.

Older children and adults may have some or all of the symptoms described above. Most of the time, however, these symptoms are relatively mild—late diagnosis means that the individual has managed to compensate for autistic challenges.

Nevertheless, as individuals get older, it can be harder to manage the complex social and logistical demands of daily life.

Selecting a Health Professional

Once you've determined that something may be amiss, it's a good idea to seek a health professional to screen for autism. The "right" professional may be a psychologist, a developmental pediatrician, or a pediatric neurologist. Your choice will, to a large degree, depend on who is available in your local area. Whatever their specialty, be sure that the expert you choose has experience with and knowledge of autism spectrum disorders.

Remember that only an experienced professional practitioner can diagnose autism. Your child's teacher is not a diagnostician. And while they may see worrying signs, they cannot and should not make a diagnosis.

The same is true of friends and relatives who may believe they see signs of autism in your child.

While it's fine to take their concerns seriously enough to schedule a professional evaluation, their "diagnosis" should never be the final word.  Adults who are seeking an autism diagnosis will usually see a psychologist or psychiatrist who specializes in autism. That individual can administer appropriate tests and suggest treatments.

Diagnostic Testing

Because autism cannot be diagnosed with a medical test, testing involves interviews, observation, and evaluations. Screening may include:

  • IQ tests to check for intellectual challenges.
  • Speech evaluations to check your child's ability to understand and use spoken speech in an age-appropriate and meaningful manner.
  • Occupational therapy evaluations (tests to check for age-appropriate fine motor skills, visual and spatial awareness, sensory responses, and other neurophysical concerns).
  • Hearing tests (to ensure autistic symptoms are not caused by hearing loss).
  • Autism-specific questionnaires such as the ADI-R for parents to fill out about their child's developmental milestones, behaviors, sensitivities, challenges, and strengths.
  • Other tests such as the Autism Diagnostic Observation Scale (ADOS) and The Checklist for Autism in Toddlers (CHAT) which examine observations of children's behaviors based on norms

None of these tests are perfect and some can be misleading. IQ and speech tests, for example, are written for typically developing children. But children being tested for autism almost always have behavioral and speech challenges. These challenges can get in the way of the testing process, making outcomes difficult to interpret.

Even when a professional provides an opinion, the opinion may not be definitive. It's not unusual to hear (particularly of a very young child), "It could be autism, but he's still very young. Why don't you check in again in six months and we'll see how he's doing?"

While this kind of uncertainty can be extremely frustrating, it's sometimes unavoidable. In many cases, children have developmental challenges that resemble autism but which turn out to be simple delays or signs of other developmental issues like ADHD or apraxia of speech. Issues like these can and should be treated as soon as possible.  Older children and adults may be administered similar tests, though adults will complete their own questionnaires.

Next Steps

If your child has received an autism diagnosis, you'll want to take action. Your medical practitioner may or may not have practical suggestions. So, that puts the burden on you, the parent, to find and set up appropriate programs and treatments for your child.

Start by looking into services, treatments, and programs available through early intervention programs or your local school district. Connect with autism support organizations with local chapters, such as The Autism Society. Do an Internet search for "autism support" and "autism services" for your area. Ask questions about local autism centers, school programs, therapists, and support organizations.

While each family's journey will be different, local information and support will be your most important tool for success.

A Word From Verywell

For many families, an autism diagnosis can be overwhelming. It seems to change everything and it can affect your relationship with your spouse, your friends, and your child. But your child is still the person he or she always was and there's plenty of help, hope, and support available.

Sources

Allely, CS. Diagnosing autism spectrum disorders in primary care. Practitioner. 2011 Nov;255(1745):27-30, 3.

Anne Le Couteur, Catherine Lord, Michael Rutter. Autism Diagnostic Interview-Revised (ADI-R) Western Psychological Services, 2003

Ozonoff, S., Goodlin-Jones, B. L. , et al. Evidence-based assessment of autism spectrum disorders in children and adolescents. Journal of Clinical Child and Adolescent Psychology 34(3): 523-540, 2005.

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