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A comprehensive guide on how what Autism screening is, and how you can go about it as a parent or guardian.
What is an Autism Screening Test?
Autism screening test is a developmental screening that can be done for the child by a number of healthcare professionals, professionals in the community or at school settings.
This developmental screening is a short test. In this test, the healthcare professionals try to determine if children have delays or are learning basic skills at the appropriate age.
The doctor asks parents and caregivers a series of questions. They also play and talk with the child to see if they have any problems with speech, behaviors, and movement.
Autism Screening Test for Toddlers
Autism Spectrum Disorders can be detected as early as 18 months. The diagnosis made by an experienced professional by age 2 is considered very reliable.
This may not be the case for all children, and some could receive a final diagnosis when they are much older.
It is recommended by the American Academy of Pediatrics (AAP) that all children should be screened for developmental delays during their well-child doctor visits. These visits happen at:
- 9 months
- 18 months
- 30 months
If the child is determined to be at high risk for developmental issues, additional screening could be needed.
There are many tools available for developmental screening. According to CDC , some of them are as follows:
This is a general developmental screening tool. Parent-completed questionnaire; series of 19 age-specific questionnaires screening communication, gross motor, fine motor, problem-solving, and personal adaptive skills; results in a pass/fail score for domains.
Standardized tool for screening of communication and symbolic abilities up to the 24-month level; the Infant Toddler Checklist is a 1-page, parent-completed screening tool.
This is a general developmental screening tool. Parent-interview form; screens for developmental and behavioral problems needing further evaluation; single response form used for all ages; may be useful as a surveillance tool.
Parent-completed questionnaire designed to identify children at risk for autism in the general population.
This is an interactive screening tool designed for children when developmental concerns are suspected. It consists of 12 activities assessing play, communication, and imitation skills and takes 20 minutes to administer.
How Do They Test for Autism in a 2 Year Old?
Children should also be screened especially for ASD during their regular doctor visits when they are aged 18 months and 24 months.
There are specific tests developed for toddlers, including 2-year-olds. Depending on what type of screening tool is used, generally, the parents are asked questions about their child’s behavior and speech.
Anything that gives a clue about developmental milestones is discussed from communication to fine and gross motor skills.
Since many of the screening tests available are completed by parents, they may need to consult their healthcare provider if the results indicate.
The aim is to determine whether the child needs further evaluation. The healthcare professional will then talk and play with the child to see if they have symptoms of ASD.
ASD symptoms in a 2-year-old:
- Lack of meaningful speech
- Lack of imitation
- No response to name when called
How Do They Test for Autism in a 3 Year Old?
It is important for doctors to screen all children for developmental delays. Generally speaking, children can be diagnosed with autism as early as 2 year old.
However, sometimes the symptoms are not noticed maybe until the child turns 3.
Similar to the case in screening of 2-year-old children, there are screening tests available for 3-year-old children.
Namely the Screening Tool for Autism in Toddlers and Young Children (STAT™) is used to screen children between the ages of 24 months to 36 months of age.
It is important to select the tool that is age-appropriate for the child. This particular test is designed for the use of community service providers who work with children in terms of assessing their developmental level or intervention options.
They have to be administered by those who have experience with ASD.
In this interactive test, the child’s core social and communication skills and behaviors are assessed.
These include imitation, play, attention direction as well as requesting behaviors.
Once a conclusion is reached, further assessment by healthcare providers could be needed to get a final diagnosis.
ASD symptoms in a 3-year-old:
- Lack of eye contact
- Avoiding physical contact
- Delayed speech
- Restricted and repetitive behavior
- Tendency to be alone
Autism Screening Test for Adolescent
As we mentioned earlier, it is possible to diagnose ASD in children really early on. However, for some, signs might not be as clear in their early ages.
Some of the children with autism may not be diagnosed until they begin school. These are the times when the social and behavioral differences become more obvious as the child is in school.
There is no specific or single test to diagnose ASD in adolescents. Diagnosis is really based on various assessments done by specialists and professionals.
The most probable people to catch the signs are actually the parents and caregivers, as well as the primary healthcare providers like the pediatricians.
There are ways to screen your adolescent for ASD. If you feel like your teenage child is showing symptoms of ASD, there are screening tests suitable for teenagers and adolescents.
Although they are just preliminary tests to indicate whether the person has ASD or not, it may be a good place to start.
Depending on where you live, you can also consult your healthcare provider.
They can assess the situation and if they are not experienced or specialised in ASD, they may refer you to a specialist to make a final diagnosis.
Autism Screening Test for Older Children
Sometimes children are not diagnosed with ASD early on due to many factors varying from socioeconomic backgrounds to access to specialized healthcare services.
That is why some children with ASD are not being diagnosed until later in their life.
However, there are ways to screen older children to see if they are at risk of having ASD. Many online tests and resources are available to give you an idea if your child has autism.
Autism Treatment Evaluation Checklist (ATEC) is one of the tests that can be taken. The rest of the process is similar to screening in other age groups.
It is important to remember that screening tools are not for diagnosis. They are only used to guide the individuals and inform them about the potential risk for autism.
After you have taken the test, consider consulting with your primary healthcare provider so that they can refer you to a specialist for final diagnosis.
Autism Screening Test for Adults
Since autism is a developmental disorder that presents in the early ages of children, the studies about the field were really focused on children with ASD.
However, recent studies have also been focusing on adults with autism who were not diagnosed or diagnosed really later in their life.
There are now screening tests available for adults. The questions in some of the tests are directed towards the person so they will be answering them rather than their parents or caregivers.
The reason why these tests are great tools for adults with autism is that they can provide clarity to the individual.
Those who have spent most of their adult life not understanding what is really going on with their life could really have a chance to understand and intervene in their diagnosis.
How Do You Assess Autism?
There is no specific test or one single tool to assess whether the person has autism or not. The assessment and diagnosis actually comes from interdisciplinary collaboration.
The involvement of the family and caregivers is actually essential.
This interdisciplinary team will most likely include the child’s pediatrician, a pediatric neurologist, a developmental pediatrician as well as the Speech-Language Pathologists.
They will use screening tests, talk with the child, observe their behaviors and talk with the parents about the child’s life to get an idea.
The assessment of the child aims to identify as well as describe certain characteristics of the child to better understand the situation.
The following factors are assessed during this screening:
- Impairments in the body structure and function of the child
- Limitations in activity and participation
- Comorbid deficits or conditions
- Environmental and personal factors
Screening tools that are appropriate in terms of age and culture are used to identify whether the person shows symptoms of autism.
These tools will provide an idea if the child needs any further assessment or intervention.
After the screening test, the individual that is suspected to have ASD is referred to a professional if needed to conduct a comprehensive assessment.
In the comprehensive assessment, the following will be included:
- Case history, child’s health, development and behavioral history, medical status
- Family’s medical and mental health history
- All assessments done to that date, including speech assessment, AAC assessment, etc.
- Medical evaluations like physical and neurodevelopmental examination
After the comprehensive assessment, a diagnosis of ASD could be reached. In addition, the SLP or the professional can also provide intervention recommendations.
At this step, this professional could refer the child and the parents to other specialists in order to confirm the diagnosis of ASD if further testing is needed.
Read more: Autism Spectrum Disorder - The Definitive Guide
How Do Pediatricians Screen for Autism?
Primary healthcare providers generally have regular contact with your children before they turn school age.
Your child’s pediatrician will start to screen your child for developmental and communication challenges such as ASD at their first visit.
Here, the pediatrician will be looking at the behavior of your child, seeing if they smile, giggle, babble, or try to get the pediatrician’s attention.
Certain behaviors like waving, responding to their name or crying are also examined.
After these observations, the pediatrician combines the information obtained from the parents like the family history, for instance, if the child has a sibling with ASD.
They get the opinions and observations of the parents and caregivers into consideration as well. This way they can determine whether the child is at risk for autism spectrum disorders.
The American Academy of Pediatrics (AAP) recommends that all children be screened for ASD at their well-baby visits at ages of 18 and 24-month.
This will provide regular surveillance and screening of the child to determine whether or not the child has any significant developmental and behavioral challenges early on.
This surveillance should be applied to all children, whether or not they are at risk for ASD or not.
What Happens During the Screening?
There is no specific or single test to diagnose autism spectrum disorder. The screening generally includes a couple of steps.
These steps include a lot of parties like the healthcare professionals as well as the parents and caregivers.
The first thing is the questionnaire and the test completed by the parents and caregivers. These ask questions about the child’s development and behavior.
Another aspect in the screening process is the observation of the child’s plays, behaviors, speech, plays, and interactions. The healthcare provider will be looking at these behaviors.
The healthcare provider will also be conducting tests where the child will be asked to perform certain tasks, which will evaluate their thinking skills and decision-making abilities.
In addition to these steps, there may also be underlying physical problems that can cause symptoms that are similar to autism symptoms.
The healthcare provider may include tests to the screening process to determine this physical condition.
What are the Tools Used for Screening?
There are various types of tools that are designed for different age groups, languages and cultures. According to CDC, here are a couple of them:
- Ages and Stages Questionnaires (ASQ)
- Communication and Symbolic Behavior Scales (CSBS)
- Parents’ Evaluation of Developmental Status (PEDS)
- Modified Checklist for Autism in Toddlers (MCHAT)
- Screening Tool for Autism in Toddlers and Young Children (STAT)
How Do Schools Test for Autism?
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the Individuals with Disabilities Education Improvement Act of 2004 (IDEA) are the two systems used to diagnose and classify children with autism spectrum disorder.
DSM-5 is used in clinical diagnoses as the primary resource, while IDEA is more regarding the eligibility decisions in terms of special education.
So IDEA is not really a diagnostic system. It is a federal legislation that is specifically designed to ensure children with special needs get appropriate education in public schools in the US.
Your child can get evaluated to obtain special education services. Parents and caregivers can request that their child be evaluated for eligibility.
Or the schools system could determine that an evaluation might be necessary. Before they conduct the evaluation, they will receive permission from the parent.
A team consisting of individuals from multiple disciplines gets together to conduct the evaluation.
This team must include a teacher or a specialist with specific knowledge in ASD. As mandated by IDEA, no single criterion can be used to determine an appropriate education program.
It is also required that the child should be assessed in terms of their hearing, communication skills, motor skills, social and emotional status, as well as vision.
This team evaluates your child to determine their eligibility for Individualized Education Program (IEP).
Parents and caregivers can also get independent evaluation at public or private institutions, where a list of professionals will meet the requirements of the state and the school.
Is Screening the Same Thing as Diagnosing?
No. Screening is NOT diagnosing. A positive screening test result does not mean that your child will be diagnosed with an autism spectrum disorder.
Also, you may get a negative result from the screening test and still worry that your child may have ASD.
Screening tests are just that - they screen for characteristics of the disorder. However, ASD is such a unique disorder on everyone that the screening may not be able to touch on everything.
This process is conducted in collaboration with professionals as well as parents and caregivers.
That is why by itself, the screening results are not diagnosis. They are just indicators. You should consult professionals after the test to get a proper and correct diagnosis.
Why Does My Child Need Autism Spectrum Disorder Screening?
As we mentioned, the American Academy of Pediatrics (AAP) recommends that all children, whether or not they are thought to be at risk for ASD, be screened at their 18-month and 24-month well baby appointments.
At these visits, the early signs of ASD could be identified. Screening at an earlier age would give the advantage of early intervention if your child is determined to have autism.
Your child may need to have autism spectrum disorder screening if you notice the following symptoms:
- Lack of eye contact
- Lack of response when their name is called
- Delayed speech
- Restricted and repetitive behaviors
Screening of ASD is not only done when the child is a baby. If you feel like your child is showing signs of the disorder and they were not diagnosed at an early age, screening could also provide a direction in terms of determining the path to intervention.
What is the Difference Between Developmental Monitoring and Screening?
Developmental monitoring is observing your child’s growth as well as the changes over time. Through developmental monitoring, the aim is to see if your child is meeting the typical developmental milestones in terms of learning, speech, behavior, play and movements.
At the doctor’s office, the healthcare providers can also do developmental monitoring by asking questions about your child’s development.
They could also talk and play with the child to see if they are meeting the milestones.
Developmental screening on the other hand is a bit more formal than monitoring. In this process, a closer look is taken at your child’s development.
In this process, the child gets a brief test, or the parents or caregivers take a questionnaire about the child.
The tests or questionnaires used in developmental screening are based on research. They ask questions about the language, movement, behavioral, thinking and emotional development of the child.
Developmental screening can be done by various professionals such as a doctor or a nurse, other healthcare providers, community professionals or school staff that are experienced in the subject.
Moreover, developmental screening is done less often than developmental monitoring. The child should be scanned when there is a concern about the risk of ASD.
But developmental screening is also a regular part of well-baby visits for all children even when there is no concern about the risk, as recommended by the AAP.
Here is a quick comparison of both method by CDC :
Benefits of an Early Autism Diagnosis
Although ASD can be detected as early as 18 months. By age 2, a definitive diagnosis could be made for certain by professionals.
However, some children may not receive a final diagnosis until they are much older. This delay would cause the child with ASD to not get the help they need.
Early diagnosis would mean that your child could get the necessary interventions to have a balanced, independent life.
Children could receive ABA (Applied Behavior Analysis) therapy to learn the necessary skills to enhance their quality of life.
The importance of early diagnosis comes from the fact that it happens really early on in the life of the child.
Children with autism could really reach their full potential by learning the skills needed for daily life.
Early intervention to the social communication skills of the child will enable them to have a social life in which they are comfortable and able to handle the conversation.
In terms of prognosis, early intervention tends to be more effective compared to interventions later in life.
Speech-Language Assessment
Speech-language assessment is where the child’s skills in language, speech, feeding and swallowing, and augmentative and alternative communication (AAC) are tested.
The speech-language pathologist can use both formal and informal assessment during these tests.
Through informal testing, it can be determined whether the child has met certain communication milestones. Communication skills in everyday life are also assessed.
In terms of language, the spoken, written, and social communication skills of the child are assessed based on their ages and abilities. These include:
- Language expression and comprehension
- Reading decoding, reading comprehension, written expression
- Joint attention, communication initiation, social reciprocity, understanding and use of facial expressions, conversational skills, etc.
Assessing speech abilities is important in terms of determining whether there is a speech disorder. This disorder may cause the individual to have difficulty in producing speech.
If this disorder is not accurately diagnosed, the symptoms and difficulties experienced may be wrongly attributed to ASD.
How do I Prepare My Child for the Autism Spectrum Disorder Screening?
There are no special preparations that are needed to be done before the autism spectrum disorder screening.
What are the Risks of an Autism Screening?
There is no risk in taking an autism spectrum disorder screening. The most important thing to remember is that screening does not equal diagnosis.
Therefore, the results of the screening should be taken as an indication that the child may be at risk for ASD.
What is the Next Step After Screening?
The next step to be taken after the screening is to assess the results with a professional. Depending on the results, more screenings and tests might be needed to better understand the situation.
If the individual is suspected to have ASD, they are referred to a specialist for a comprehensive assessment.
The results of the assessment are combined with other tests and the family history and observations of the parents and caregivers.
A diagnosis of ASD could be reached after conducting the comprehensive assessment.
