Autism spectrum disorder (ASD) is one of the most common developmental disorders of childhood. The CDC estimates that 1 in 36 children eight years of age has ASD. It occurs in all races, ethnicities and socioeconomic groups. Boys are four times more likely than girls to be diagnosed with autism. People with autism have persistent deficits in social communication and interactions that occur in a variety of settings. They also show restrictive and/or repetitive behaviors or interests. These symptoms must also be causing impairment in their daily functioning and relationships. Children and teens may present differently depending on the age at which they are being evaluated.

Preschoolers and toddlers often have language delays or may even be nonverbal. When they do speak it is often repetition of speech they have heard, called echolalia, rather than meaningful speech. They also may not point to indicate their needs but may use their parents as a tool to help get what they want. Spinning, rocking, hand flapping and lining up of toys are common behaviors. Finally, they may resist cuddling and have minimal to no eye contact.

School-age children continue to have language delays and abnormal speech patterns. Girls may speak a lot but in a running monologue rather than a give and take conversation. They often prefer to be alone and have a hard time making friends. They may be very rigid in behaviors and not adapt well to change.
Teenagers continue to have social difficulties and many of the symptoms already listed are still present. They may find it difficult to interpret body language and other nonverbal communication from their peers. Higher functioning adolescents may be good at camouflaging their symptoms but this can cause significant anxiety. They may get overwhelmed easily by noises, crowds and even by their schoolwork.

The American Academy of Pediatrics recommends that all children be screened for autism between 18 and 24 months of age using the m-CHAT or other standardized screening tool. This is only a screening, however and not a diagnostic tool. As a parent, your first step if you are concerned that your child might have autism, at any age, should be to discuss this with your child’s pediatrician. If they are under three and have not already been screened, this would likely be the first step. If the screening is positive or they are too old for the m-CHAT your doctor may choose to refer your child for further evaluation by a specialist or may choose to schedule a longer appointment to do that evaluation themselves.

If your pediatrician will be referring you to a specialist for diagnosis, they should make referrals for appropriate services while you are waiting for that evaluation. The AAP is encouraging more pediatricians to complete these evaluations in the medical home if they feel comfortable with the DSM-5 criteria and have the time in their schedules to do so. A thorough diagnostic evaluation should include a DSM-5 criteria focused interview, a complete medical history including past medical history, developmental history, and social and family history. The evaluation should also include a complete physical examination including a neurological exam, hearing and vision tests if not already done, and a structured behavioral observation such as the ADOS-2 or the CARS-2.
Early identification of autism is important to access services that will optimize your child’s long term development. These may include speech therapy, occupational therapy, physical therapy and applied behavioral analysis (ABA) therapy. As I mentioned earlier, some of these services can be accessed as soon as you or your child’s doctor suspects a problem. Others, especially ABA therapy, require a formal diagnosis of autism.
Besides your child’s doctor, there are many resources for getting the help you need for your child. Readers in the Las Vegas area can contact FEAT or the Nevada chapter of the AAP for lists of providers that can do diagnostic evaluations. FEAT can also provide resources for getting ABA therapy or support groups. At my office, the Center for Psychiatry and Behavioral Medicine, we provide ADOS-2 evaluations as well as ongoing clinical trials for children and young adults with ASD. Finally, your child’s school should provide an appropriate educational environment based on your child’s diagnosis and unique needs and strengths.
Randi Lampert MD