A diagnosis of autism requires a sensitive and experienced doctor/clinician to observe the individual carefully, ask the family members about the development of the individual, and then objectively follow internationally recognized criteria for diagnosis.
There are no medical or genetic tests that can detect autism. These can only rule out other conditions. Autism may occur alongside conditions such as mental retardation and hyperactivity, but the autistic traits in the person are typically what require attention.
Onset of autism occurs at birth and the disorder can very often be detected as early as 12-18 months. Many children seem to be developing normally, followed by a deterioration of verbal and social skills around 1 ½ -2 ½ years.
At AFA children as young as 16-20 months old are routinely screened for autism using a combination of tools and techniques. The team develops an individualised early intervention plan for those who screen positive and seem at risk for autism. Targeted to minimise loss of time of opportunities, the intervention is focused on developing the skills that are pivotal to child development and are often the primary concerns for parents and professionals alike. A follow-up diagnostic assessment at the age of 30 – 36 months is strongly recommended for these children.
It is equally common to become aware about a child's differences at a later age, for example once s/he is in school or even later. Given the increasing awareness about autism, more and more adults are now requesting a diagnostic assessment for themselves. There are several diagnostic tests available where an adult can be assessed by answering a few questions.
Although autism may manifest differently in each child, some commonly seen symptoms are listed below.
• Is late to smile or does not smile
• Does not demonstrate attachment behaviour especially towards his/her primary caregiver
• Avoids peoples gaze
• Does not reach out, even in anticipation of being picked up
• Does not seek to be comforted or may be difficult to soothe
• Prefers to be alone
• Does not cuddle
• Exhibits simple repeated actions with their body, such as flapping their hands or rocking
• Exhibits simple repeated action with objects, such as the wheels of a toy car
• Has an intense dislike towards any changes in routine or the surroundings
• Nonverbal communication is not present, inappropriate or limited: - no gestures to communicate - no response to body language - not copying facial expressions or gestures, such as pointing, clapping or waving
• Does not respond to communication attempts by others
• Prefers to be alone
• Does not come for comfort, even when ill, hurt or tired
• Does not imitate or has impaired imitation
• Avoids peoples gaze
• Seems to be unaware of other peoples’ presence
• An older child may fail to greet people or take turns while playing or interacting
• Has delayed language development
• Has weak language comprehension
• Fails to develop language for communication, e.g. the child does not use language to ask for something
• Lacks appropriate gestures
• Has unusual first words
• Tends to repeat what is said to him or her
• Has an unusual manner of talking, e.g. with unusual tone, off-rhythm, squeaky, or sing-song voice
• Manipulates objects in odd ways e.g. spinning them or aligning them
• Has unusual body movements, e.g. hand-flicking or hand twisting, spinning, head-banging, or whole body movements
• Is persistently preoccupied with parts of objects
• Shows an attachment to unusual objects
• Shows marked distress over changes in trivial aspects of the environment
• Shows unreasonable insistence on following routines in precise detail
• Has difficulty in toilet training
• Has extreme fears
Children with autism may:
• Not imitate others
• Treat people like objects
• Lack an awareness of the existence or feelings of others
• Not play with other children
• Lack or have unusual emotional responses
• Be socially unresponsive
• Be indifferent or respond negatively to physical affection
• Show no interest in making friends
• Not understand conventions of social interaction, such as turn-taking
• Not initiate interactions
• Be socially awkward
• Show little expressive language
• Have delayed language development
• Rarely or never use appropriate gestures
• Show improper use of pronouns, statements and questions
• Fail to initiate conversation
• Say strange things
• Have unusual tone or rhythm of speech
• Not use speech in a meaningful way
• Repeat remarks made by others
• Frequently make irrelevant remarks
• Have great difficulty with abstract language
• Be preoccupied with one or very few narrow interests
• Have an excessive need for sameness
• Show an attachment to unusual objects
• Show marked distress over changes in trivial aspects of the environment
• Show unreasonable insistence on following routines in a particular and rigid way
• Twirl sticks, or flap pieces of paper
• Be fascinated with spinning objects
• Rigidly adhere to routines
• Be very good at rote memory tasks such as repeating lists of items or facts
Modified Checklist for Autism in Toddlers, Revised with Follow Up (M-CHAT-R/F)
(M-CHAT-R/F; Diana Robins, Deborah Fein, & Marianne Barton, 2009)
The Modified Checklist for Autism in Toddlers, Revised (M- CHAT- R) and the Modified Checklist for Autism in Toddlers, Revised with Follow up (M-CHAT-R/F) are a two stage parent report screening tool for toddlers between 16 and 30 months of age, to assess a risk for Autism Spectrum Disorders (ASD). The M-CHAT-R has 20, ‘yes’ and ‘no’ type questions that parents can answer themselves in about 5-7 minutes. The M-CHAT has been recently revised with a set of follow up questions. The M-CHAT-R/F is designed to be used with the M-CHAT-R.
The primary goal of the M-CHAT-R is to detect as many cases of ASD as possible. Therefore, there is a high ‘false positive’ rate, meaning that NOT all children who score ‘at risk’ for ASD after answering the questions M-CHAT-R, in will be diagnosed with ASD. To address this, the Follow-Up questions (M-CHAT-R/F) was developed.
It is important to note that even with the Follow Up; a significant number of children who screen positive on the M-CHAT- R may NOT necessarily be diagnosed with ASD; however, the child may be at risk for other developmental disorders or delays, and therefore, further evaluations with a specialist is extremely vital.
Designed to identify children who may benefit from a more thorough developmental and autism evaluation, the M-CHAT- R/F can be administered and scored as part of a ‘well-child’ check-up, and also can be used by specialists or other professionals to screen for developmental delay and autism.
Click here to take the test
Autism Diagnostic Observation Schedule (ADOS)
(ADOS; Lord, Rutter, DiLavore, Risi, 1999)
The Autism Diagnostic Observation Schedule (ADOS) is the ‘gold standard’ for assessing and diagnosing autism and pervasive developmental disorder (PDD) across all ages, developmental levels, and language skills. This semi-structured assessment can be used to evaluate almost anyone suspected of having autism - from toddlers to adults, from children with no speech to adults who are verbally fluent.
The ADOS includes four modules, each requiring just 35 to 40 minutes to administer. The individual being evaluated is given just one module, depending on his or her expressive language level and chronological age. Following the guidance provided in the manual, one would select the appropriate module for each person. Module 1 is used with children who do not consistently use phrase speech, Module 2 with those who use phrase speech but are not verbally fluent, Module 3 with fluent children, and Module 4 with fluent adolescents and adults. The one group within the autism spectrum that the ADOS does not address is, nonverbal adolescents and adults.
The activities provide a 30- to 45-minute observation period, full of opportunities for the trained administrator to observe social and communication behaviours related to the diagnosis of pervasive developmental disorders. As one administers the ADOS, one records the observations, then codes them later and formulates a diagnosis. Cut-off scores are provided for both the broader diagnosis of PDD/atypical autism/autism spectrum, as well as the traditional, narrower conceptualization of autism. Offering standardized materials and ratings, the ADOS gives a measure of the autism spectrum disorder that is unaffected by language.
Autism Diagnostic Interview, Revised (ADI-R)
(ADI-R; Couteur, Lord, Rutter, 2003)
The Autism Diagnostic Interview, Revised (ADI-R) is a structured interview used for diagnosing autism, planning treatment, and distinguishing autism from other developmental disorders. Used in research studies for decades, this comprehensive interview provides a thorough assessment of individuals suspected of having autism or other autism spectrum disorders. The ADI-R takes about 1 1/2 to 2 1/2 hours to administer and score.
To administer the ADI-R, an experienced clinical interviewer questions a parent or caretaker who is familiar with the developmental history and current behaviour of the individual being evaluated. The interview can be used to assess both children and adults, as long as their mental age is above 2 years, 0 months.
The 93 items of the ADI-R focus on three functional domains:
• Reciprocal Social Interactions
• Restricted, Repetitive, and Stereotyped Behaviours and Interests
Following highly standardized procedures, the interviewer records and codes the informant's responses. The interview questions cover eight content areas:
• The subject's background, including family, education, previous diagnoses, and medications
• Overview of the subject's behaviour
• Early development and developmental milestones
• Language acquisition and loss of language or other skills
• Current functioning in regard to language and communication
• Social development and play
• Interests and behaviours
• clinically relevant behaviours, such as aggression, self-injury, and possible epileptic features
Since the ADI-R is an interview rather than a test, and because it focuses on behaviours that are rare in non-affected individuals, it provides definite results rather than scales or norms. Results can be used to support a diagnosis of autism or to determine the clinical needs of various groups in which a high rate of autism spectrum disorders might be expected (e.g., individuals with severe language impairments or certain medical conditions, children with congenital blindness, and youngsters suffering from institutional deprivation).
The ADI-R has proven very effective in differentiating autism from other developmental disorders and in assessing syndrome boundaries, identifying new subgroups, and quantifying autistic symptomatology. Extensive use of the ADI-R in the international research community has provided strong evidence of the reliability and validity of its categorical results.