Sometimes parents have a “gut” reaction that something is different about their child. Some children seem more fussy and disagreeable, even when in no apparent distress from hunger, tiredness, or evident discomfort. Parents of these children may be more likely to seek early help from their child’s pediatrician.
Other times, a child seems “easy,” making few demands of caregivers and not requiring a lot of attention. Some children with ASD appear more advanced than their peers, displaying amazing academic skills or attentiveness beyond their years. Yet what seems like independence or precociousness may be masking an underlying developmental problem.
Red Flags and Risk Factors for ASD
Knowing what to look for is important for early identification of ASD. Early identification is important because the earlier ASD or signs of ASD are noted, the sooner treatment can begin. High quality early intervention services can change a child’s developmental trajectory and can improve outcomes.
Some of the early signs of ASD include:
- Does not respond to name
- At times, appears to be deaf
- Speaks with an unusual tone or rhythm
- Repetitive motions, such as rocking, spinning, or hand flapping
- Easily upset with change of routine
- Walks on toes
- Unusual attachments to objects or schedules
- Doesn’t know how to play with toys
- Doesn’t return a smile
- Doesn’t respond to cuddling
- Doesn’t reach out to be picked up
- Doesn’t look at mom when being fed (infants)
- Poor eye contact
- Prefers to play alone or with adults
- Lines up toys or other objects; ordering of materials
- Does not speak
Some children are at a higher risk for developing ASD, and these children should be monitored closely. In particular, if another family member has ASD, your child may be more likely than others to have it too. Genetic and family research studies have shown that ASD is heritable, increasing the likelihood of other family members having a diagnosis. Much research attention has been given to younger siblings of children with ASD, who are 10 – 20% more likely to develop ASD than the general population. Additionally, children born with low birth weights and children with certain genetic conditions have a higher risk for ASD.
Having one or even a number of these symptoms or risk factors does not mean that your child will be diagnosed with ASD. It is important to remember that children develop at different rates. However, do take note of any warning signs and bring them to your pediatrician’s attention as soon as possible.
Visiting Your Pediatrician
When you visit your pediatrician (make a special appointment if you have concerns and a routine visit is not in the near future), come prepared with examples of behaviors which concern you. This is important because your child may not exhibit the same concerns during a short office visit. If your child is between 16 and 30 months of age, your pediatrician should ask you to complete a developmental questionnaire to determine if your child exhibits red flags for ASD or other developmental problems.
The questionnaire usually used to screen for ASD is called the Modified Checklist for Autism in Toddlers, Revised (M-CHAT). The M-CHAT is a screener only, designed to identify children whose symptoms put them at risk for an ASD diagnosis. Depending on your child’s score on the M-CHAT, your doctor may recommend that your child receive further testing to determine if he or she has ASD.
ASD can only be formally diagnosed by a trained clinician after conducting formal diagnostic tests. Most pediatricians do not have this expertise. To be evaluated for ASD, your child may visit a developmental pediatrician, psychiatrist, psychologist, or other trained and experienced professional.
Tools created for the purpose of diagnosing ASD, including the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview, Revised (ADI-R), rely on observing the individual with suspected ASD in structured settings and asking caregivers about the individual’s history and behavior. A clinician may also suggest a neurological evaluation or genetic testing, metabolic testing, and electrophysiologic testing. There is no definitive medical test for a diagnosis. Instead, a medical diagnosis of ASD will be based on whether the individual meets the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).
What You Can Do
- Monitor your child’s development. Children with ASD tend to hit key developmental milestones a bit later than other children. Make note of when your child rolls over, sits up, stands, talks, etc. so that you can share these important timeframes with your pediatrician. However, missing milestones doesn’t mean your child has ASD, nor does hitting them on target mean your child does not.
- Talk to your child’s doctor if you have concerns. Your child’s doctor is there not only to help your child, but to support your family as well. Your child’s doctor can help you understand typical development and help you determine if your child is off-pace. Don’t wait for a routine appointment if you suspect a problem; visit your child’s doctor right away.
- Don’t “wait and see.” Too many concerned parents are told not to worry and to “wait and see” if their child grows out of the behaviors in issue or a delay. However, waiting is the worst thing you can do because it deprives your child of valuable time when he or she could be getting help. Regardless of whether the delay is caused by ASD or some other factor, children with developmental delays don’t usually grow out of them without appropriate intervention.
- Consider getting a second opinion. Ideally, your child’s doctor will take your concerns seriously. But sometimes, even well-meaning doctors miss red flags or underestimate problems. Follow your instincts if you feel that something is wrong, and be persistent. Schedule a follow-up appointment with your child’s doctor, seek a second opinion, or ask for a referral to a developmental pediatrician. You should also contact your local Early Intervention agency or school district and ask for an evaluation. Evaluations are provided free of charge by your local intermediate unit or school district and can identify if your child is in need of special education services. Your child does not need a diagnosis of ASD to qualify for these services, and you should proceed with a special education evaluation even if your child is waiting to be seen by a developmental pediatrician or other ASD specialist.