DIAGNOSING ASD

ASD can usually be reliably diagnosed by the age of two. Diagnosis in young children is often a two-stage process.

Stage 1: General Developmental Screening During Well-Child Checkups

The American Academy of Pediatrics recommends that all children be screened for developmental delays at their 9-, 18-, and 24- or 30-month well-child visits and specifically for autism at their 18- and 24-month well-child visits. Additional screening might be needed if a child is at high risk for ASD or developmental problems. Those at high risk include children who have a family member with ASD, have some ASD behaviors, have older parents, have certain genetic conditions, or who were born at very low birth weight. Children who show developmental problems during this screening process will be referred for the second stage of evaluation.

Stage 2: Additional Evaluation

This second evaluation is with a team of doctors and other health professionals who are experienced in diagnosing ASD.

This team may include:

• A developmental pediatrician—a doctor who has special training in child development

• A child psychologist and/or child psychiatrist—a doctor who has specialized training in brain development and behavior

• A neuropsychologist—a doctor who focuses on evaluating, diagnosing, and treating neurological, medical, and neurodevelopmental disorders

• A speech-language pathologist—a health professional who has special training in communication difficulties

• The evaluation may assess:

• Cognitive level or thinking skills

• Language abilities

• Age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting

As ASD is a complex disorder that sometimes occurs along with other illnesses or learning disorders, the comprehensive evaluation may include blood tests and hearing tests.

ASD symptoms in older children and adolescents who attend school are often first recognized by parents and teachers and then evaluated by the school’s special education team. The school’s team may perform an initial evaluation and then recommend these children for additional testing.

These subtle communication issues may include problems understanding tone of voice, facial expressions, or body language. Older children and adolescents may have trouble understanding figures of speech, humor, or sarcasm.

Diagnosing ASD in adults is often more difficult than diagnosing ASD in children. In adults, some ASD symptoms can overlap with symptoms of other mental health disorders, such as anxiety or attention-deficit/hyperactivity disorder (ADHD).

Information about the adult’s developmental history will help in making an accurate diagnosis, so an ASD evaluation may include talking with parents or other family members. Getting a correct diagnosis of ASD as an adult can help a person understand past difficulties, identify his or her strengths, and obtain the right kind of help.

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TREATMENT AND REHABILITATION

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There is no single treatment for autism. Treatments can include intensive skill-building and teaching educational sessions, known as applied behavior analysis (ABA), and many more interactive, child-centered versions of behavior treatments. Treatment may also involve special training and support for parents, speech and language therapy, occupational therapy, and/or social skills training.

In addition to treatment, regular and special education classrooms can be changed to help students with autism. Many students with autism can function better if the day is consistent and predictable. It is also helpful if the information is presented so the student can learn by seeing as well as hearing and if students get to play and learn with non-disabled peers. A federal law — the Individuals with Disabilities Education Act, or IDEA — requires that special services be available to children identified with a disability. The services can include early intervention, support for birth to three years, and special education for children aged three to 21.

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DIAGNOSTIC TOOLS

Many clinicians are diagnosing ASD based on DSM-IV or DSM-V evaluation. Diagnostic tools include ADOS, ADI-R, and CARS. The available diagnostic instruments for ASD are patented and expensive, and ADOS-G and ADI-R use requires mandatory international accreditation. The tools are not available in different Indian languages, with the exception of ADOS, which has been translated into Hindi and Bengali, but the translations are not freely available. 

Indigenous Tools Developed In India: To overcome several of the limitations of internationally available tools, standardize diagnosis and thereby facilitate early intervention for children with autism, two tools have been developed in India- INCLEN Diagnostic Tool for Autism Spectrum Disorder and Indian Scale for Assessment of Autism (ISAA).