Autism spectrum disorder 

Autism spectrum disorder (ASD) is a complex developmental condition involving persistent challenges with social communication, restricted interests and repetitive behavior. While autism is considered a lifelong condition, the need for services and supports because of these challenges varies among individuals with autism.  According to the Centers for Disease Control and Prevention, an estimated one in 36 children has been identified with autism spectrum disorder.  Early identification is crucial.  Early signs of this condition can be noticed by parents/caregivers or pediatricians before a child reaches one year of age. However, the need for services and supports typically become more consistently visible by the time a child is 2 or 3 years old. In some cases, the problems related to autism may be mild and not apparent until the child starts school, after which their deficits may be pronounced when amongst their peers.  

We can carry out early screening for ASD.  This evaluation involves using DSM-5 criteria, as well as interviewing the parent/caregiver, observing, and interacting with the child in a structured manner, and sometimes conducting additional tests to rule out other conditions. Generally 3 environments may be involved, such as the home, school and office.  An early diagnosis can greatly improve a child's functioning by providing the family early access to supportive resources in the community.

Social communication deficits may include:

• Decreased sharing of interests with others.

• Difficulty appreciating their own & others' emotions.

• Aversion to maintaining eye contact.

• Lack of proficiency with use of non-verbal gestures.

• Stilted or scripted speech.

• Interpreting abstract ideas literally.

• Difficulty making friends or keeping them.

Restricted interests and repetitive behaviors may include:

• Inflexibility of behavior, extreme difficulty coping with change.

• Being overly focused on niche subjects to the exclusion of others.

• Expecting others to be equally interested in those subjects.

• Difficulty tolerating changes in routine and new experiences.

• Sensory hypersensitivity, e.g., aversion to loud noises.

• Stereotypical movements such as hand flapping, rocking, spinning.

• Arranging things, often toys, in a very particular manner.

SCREENING TOOLS

There are many different developmental screening tools available:

Ages and Stages Questionnaires (ASQ®)

•  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.

Communication and Symbolic Behavior Scales (CSBS DP™ Infant-Toddler Checklist)

•  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.

Parents' Evaluation of Developmental Status (PEDS Tools®)

•  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.

Modified Checklist for Autism in Toddlers (M-CHAT™)

•  Parent-completed questionnaire designed to identify children at risk for autism in the general population.

Screening Tool for Autism in Toddlers and Young Children (STAT™)

•  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.