FREE DEVELOPMENTAL SCREENINGS
The American Academy of Pediatrics (AAP) recommends all children be screened for autism spectrum disorder (ASD) at 18 and 24 months.
Routine screening for autism is critical because of the prevalence and fact that children with ASD who receive an early and intensive treatment have the best possible outcome. Despite this, most children are never screened for autism. However, when a parent or has concerns, or a child is at risk for atypical development, an autism screening is imperative.
ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable. However, many children do not receive a final diagnosis until they are either transitioning from an early intervention program or have already been placed in a self-contained classroom. This delay means that children with an ASD might not get the help they need at a critical time in brain development.
An autism screening cannot provide a diagnosis, but it can help you and your doctor learn whether your child is showing delays or deficits in the two core areas related to ASD: (1) social communication and social interaction; and (2) restricted, repetitive patterns of behavior, interests, or activities.
During the screening the specialist will ask you a few questions and then spend a few minutes observing your child during free play and also while you are interacting with your child. Our specialists have extensive experience in early childhood and autism, and can help identify possible language delays, social skills, including engagement with others, how he plays with toys, and the scope of your child’s repetitive behaviors or limited, obsessive interests. A delay in any of these areas could be a sign of a problem that needs to be identified so treatment is not delayed any further.
If a professional sees any signs of a problem, a comprehensive diagnostic evaluation is needed.
In a national survey conducted in 2007, pediatricians and family physicians reported low self-perceived competency in providing care for children with ASDs and a desire for education (Golnik, Ireland, & Borowsky, 2009).
A Parent’s Value
Parents and caregivers are in the position of knowing the child much better than any professional. Although pediatricians may screen for developmental delays, it does not mean that they have screened for ASD. Parents should follow their instincts. It is difficult for any doctor to really know a child in a 10-15 minute doctor’s visit. Parents are the ones who spend the most time, so parents should not hesitate to bring up any concerns. If the doctor does not seem to have a solid understanding of your concern, get a second opinion. The worst situation to be in is a “wait and see” one. Timely intervention is critical to your child’s development.
Possible “Red Flags”
Not every child with ASD has deficits in all areas that are screened. Some children may have words, while others may not make many sounds at all. Some may always smile when having fun while others lack affect. After a screening, we will share results with you and give you examples of what was observed that may indicate further evaluation, including a formal psychological evaluation from a medical professional. According to the Center for Disease Control, Some children with ASD may:
- Not respond to their name by 12 months of age
- Not point at objects to show interest (point at an airplane flying over) by 14 months
- Not play “pretend” games (pretend to “feed” a doll) by 18 months
- Avoid eye contact and want to be alone
- Have trouble understanding other people’s feelings or talking about their own feelings
- Have delayed speech and language skills
- Repeat words or phrases over and over (echolalia)
- Give unrelated answers to questions
- Get upset by minor changes
- Have obsessive interests
- Flap their hands, rock their body, or spin in circles
- Have unusual reactions to the way things sound, smell, taste, look, or feel
Examples of social issues related to ASD:
- Does not respond to name by 12 months of age
- Avoids eye-contact
- Prefers to play alone
- Does not share interests with others
- Only interacts to achieve a desired goal
- Has flat or inappropriate facial expressions
- Does not understand personal space boundaries
- Avoids or resists physical contact
- Is not comforted by others during distress
- Has trouble understanding other people’s feelings or talking about own feelings
Typical infants are very interested in the world and people around them. By the first birthday, a typical toddler interacts with others by looking people in the eye, copying words and actions, and using simple gestures such as clapping and waving “bye bye”. Typical toddlers also show interests in social games like peek-a-boo and pat-a-cake. But a young child with an ASD might have a very hard time learning to interact with other people.
Each person with ASD has different communication skills. \ About 40% of children with an ASD do not talk at all. About 25%–30% of children with ASD have some words at 12 to 18 months of age and then lose them. 
Examples of communication issues related to ASD:
- Delayed speech and language skills
- Repeats words or phrases over and over (echolalia)
- Reverses pronouns (e.g., says “you” instead of “I”)
- Gives unrelated answers to questions
- Does not point or respond to pointing
- Uses few or no gestures (e.g., does not wave goodbye)
- Talks in a flat, robot-like, or sing-song voice
- Does not pretend in play (e.g., does not pretend to “feed” a doll)
- Does not understand jokes, sarcasm, or teasing
People with ASD who do speak might use language in unusual ways. They might not be able to put words into real sentences. Some people with ASD say only one word at a time. Others repeat the same words or phrases over and over. Some children repeat what others say, a condition called echolalia. The repeated words might be said right away or at a later time. For example, if you ask someone with ASD, “Do you want some juice?” he or she might repeat, “Do you want some juice?” instead of answering your question. Some people with an ASD can speak well but might have a hard time listening to what other people say.
People with ASD might have a hard time using and understanding gestures, body language, or tone of voice.
People with ASD might say “I” when they mean “you,” or vice versa. Their voices might sound flat, robot-like, or high-pitched. People with an ASD might stand too close to the person they are talking to, or might stick with one topic of conversation for too long. They might talk a lot about something they really like, rather than have a back-and-forth conversation with someone. Some children with fairly good language skills speak like little adults, failing to pick up on the “kid-speak” that is common with other children.
Unusual Interests and Behaviors
Many people with ASD have unusual interest or behaviors.
Examples of unusual interests and behaviors related to ASD:
- Lines up toys or other objects
- Plays with toys the same way every time
- Likes parts of objects (e.g., wheels)
- Is very organized
- Gets upset by minor changes
- Has obsessive interests
- Has to follow certain routines
- Flaps hands, rocks body, or spins self in circles
Repetitive motions are actions repeated over and over again. They can involve one part of the body or the entire body or even an object or toy. For instance, people with an ASD might spend a lot of time repeatedly flapping their arms or rocking from side to side. They might repeatedly turn a light on and off or spin the wheels of a toy car. These types of activities are known as self-stimulation or “stimming.”
Some people with ASD have other symptoms. These might include:
- Hyperactivity (very active)
- Impulsivity (acting without thinking)
- Short attention span
- Causing self injury
- Temper tantrums
- Unusual eating and sleeping habits
- Unusual mood or emotional reactions
- Lack of fear or more fear than expected
- Unusual reactions to the way things sound, smell, taste, look, or feel
People with ASD might have unusual responses to touch, smell, sounds, sights, and taste, and feel. For example, they might over- or under-react to pain or to a loud noise. They might have abnormal eating habits. For instance, some people with an ASD limit their diet to only a few foods. Others might eat nonfood items like dirt or rocks (this is called pica). They might also have issues like chronic constipation or diarrhea.
People with ASD might have odd sleeping habits. They also might have abnormal moods or emotional reactions. For instance, they might laugh or cry at unusual times or show no emotional response at times you would expect one. In addition, they might not be afraid of dangerous things, and they could be fearful of harmless objects or events.
- Lord C, Risi S, DiLavore PS, Shulman C, Thurm A, Pickles A.Autism from 2 to 9 years of age. Arch Gen Psychiatry. 2006 Jun;63(6):694-701.