So, how is Autism diagnosed? Until recently, autism spectrum disorders (ASD), including Aspergers Syndrome, have been understood as a range of complex neurodevelopment disorders—characterized by social impairments, difficulties in verbal and non-verbal communication, and restricted, repetitive, and stereotyped patterns of behavior.

Psychological therapy

Changes in definition have been proposed and accepted by different organizations and groups in the United States and other parts of the world. The changes have been discussed in other posts; meanwhile, I will address how autism is diagnosed.

At the present time, a single test to diagnose autism does not exist. We do know that a biological or single genetic marker has not been identified, thus, autism cannot be diagnosed with a blood test or imaging studies. It is rather a diagnosis that is primarily identified by behavioral and developmental differences.

As parents know their children better than anyone else, they are usually the first to suspect their child is following a different developmental trajectory.

Autism has its roots in very early development—many parents would report that they saw differences shortly after birth—however, signs of Autism are usually apparent between the first and second birthdays.

Children with high functioning abilities, such as those with Aspergers Syndrome, are often diagnosed later in life. This is partly because their signs and symptoms tend to be milder and partly because their above average cognitive skills allow them to perform well despite their social difficulties. It is not unusual that the Aspergers diagnosis is only suspected during adulthood.

Pediatricians, family physicians, nurse practitioners, physician assistants and other health professionals are in a position of privilege and great duty to notice concerning signs in the children under their care.

The American Academy of Pediatrics and other like-minded organizations, have established guidelines to direct health care providers in their diagnostic journey. It is therefore required that they perform developmental screenings in each and every one of their encounters with a child, and that they perform more in depth evaluations—and appropriate referrals—when necessary.

One of the most important contributions in the field of identification of autism spectrum disorders was made by a local physician, Dr. Chris Plauche Johnson.

Dr. Plauche is a neurodevelopmental pediatrician who, in 2007, led an effort in identifying, evaluating, and managing Autism. The result of this contribution was the catalyst behind the new directives requiring that children receive an autism-specific screening at the ages of 18 months and 24 months.

Amongst the better known Autism screening tools:

  • Modified Checklist for Autism in Toddlers (M-CHAT)
  • Screening Tool for Autism in Two year-olds (STAT)
  • Social Communication Questionnaire (SCQ)
  • High-Functioning Autism Spectrum Screening Questionnaire (ASSQ)
  • Childhood Asperger Syndrome Test (CAST)
  • Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist (CSBS-DP-ITC)

If a child is found to be at-risk for autism, the health provider is then expected to refer the child for a comprehensive autism evaluation, early intervention services and an audiologic evaluation. The provider will also provide education to the parents on their child’s development and schedule a follow up appointment.

Other efforts toward early identification and diagnosis is discussed the second part of this blog series.

by A. Patricia Del Angel, M.D., Clinical Director, Autism Community Network

Sources: American Academy of Pediatrics (AAP), American Psychiatry Association (APA), Mayo Clinic, Autism Speaks, National Institute of Neurological Disorders and Stroke (NINDS), National Institute of Mental Health (NIMH).

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  1. While the work to develop better diagnostic tools for children suspected of being on the autism spectrum continues, a tool for diagnosis of adult autism is still lacking. Answering the question of “why am I the way I am “ is important for adult people.

  2. The APA is a joke. For one, Autism is NOT Aspergers. First, the only reason Aspergers was lumped into the Autism DX is because clinicians were too lazy to investigate historical background of child. “Second, the criteria for Asperger syndrome in the DSM-IV are flawed and hard to implement in practice, as highlighted by a number of researchers. At least two problems exist: It is often difficult to establish whether single words were spoken before age 2 and phrases by age 3, as required for the Asperger diagnosis. Individuals receiving this diagnosis typically come into the clinic in middle childhood or later, and parental memory may be understandably vague. For the increasing number of people diagnosed in adulthood, the issue is even more problematic”…Hence, let’s make it easier on ourselves and just LUMP ASPIES AND AUTIES all together….wee…..dumb. Dumbest and intellectually lazy thing that has ever been seen in the history of the DSM. Shame on these people. Put it back to how it SHOULD be and get to work. Investigate someone’s background to see if they meet the criteria. Don’t be a LAZY psychologist or doctor and check the boxes. Disgusting! Lumping Aspies with people with autism has HURT people with autism because now the stupid media thinks everyone with Aspergers winning nobel prizes, joining baseball teams, etc…is autistic. NO!! This is wrong, wrong, wrong. Aspergers is the 2nd or 3rd cousin of autism, not the same as autism, not even like a sibling. And certainly not a twin. Get it together DSM you utter intellectually lazy folks. Seriously, this is so abusive, using your power to change DSM for your own convenience in the field. Wow. Crazy! You did this to for yourselves, not the autism or aspie population. It takes WORK to look at someone’s historical background. It takes WORK and analysis and critical thinking skills to ask the right questions, and discern whether or not someone stopped talking, but then suddenly did talk as a result of temporary speech disorder, etc…as opposed to Aspergers or autism. Yep, all this takes investigation, but we don’t see this anymore in the fast food psychology arena, nope, it’s in you go, mom tells us 5 minutes of history, we check a box and boom, we got autism. You idiots! You have HARMED thousands and and thousands of people with real autism with your phony, lazy change in the DSM. Get it right next time and change it. Put an espresso machine in your office if you can’t handle the workload, or better yet, quit and find another job. This is so disgusting what has happened. And even more shocking that more people aren’t aware or notice this. Distracted much?? Wake up. The DSM change to lump aspergers with autism was NEVER intended to help people with autism or aspergers, only to make it easier for lazy clinicians trying to make a quick buck and diagnosis. People w Aspergers and autism deserve BETTER than cattle cow diagnosis by these increasingly lazy professionals.
    Sources cited:
    Mayes S.D. et al. J. Abnorm. Child Psychol. 29, 263–271 (2001) PubMed
    Miller, J. N. and S. Ozonoff J. Abnorm. Psychol. 109, 227–238 (2000) PubMed

  3. Can anyone direct me to resources for my 19 yr old? She was diagnosed with PDD-NOS when she was 16. We pulled her out of school and homeschooled due to social, sensory and anxiety issues, so she has never had an IEP or any paper trail from school to follow her. She has gotten some OT and seen a therapist for her anxiety and was released. Her sensory issues in the last couple months have gotten SO much worse! Not sure why. Also, she also has a joint disorder which makes it hard for her to have more than a minor part-time job without suffering the physical consequences (daily pain, stumbling, knees giving out). If you are diagnosed high-functioning, can she be considered for getting financial help through the state? At this rate, she will never be self sufficient (although she is hoping otherwise). I’m not sure where to start. We live in Kentucky.

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