Here’s a thorough article on diagnosing autism in your child written by our director, Jochebed Isaacs. We’ve also had the honour of publishing this article in our very own Malaysian pediatric forum, Doktor Budak. We hope you find this article resourceful in seeking out a diagnosis for your child or someone you know.
Published in: DoktorBudak
Published on: 27th August 2014
The Diagnostic and Statistical Manual of Mental Disorders- Fifth Edition (DSM-5) describes autism spectrum disorder as a neurodevelopmental disorder that is characterized by impairment in reciprocal social communication and social interaction and restricted, repetitive patterns of behavior, interests or activities. These symptoms are present from early childhood and limit/impair everyday functioning.
With the most recent revision of the DSM-5 in 2013, autism spectrum disorder now covers all disorders previously referred to as: autistic disorder, high-functioning autism, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger’s Disorder.
Autism is a spectrum disorder with varying manifestations of the disorder depending on the severity of the autistic condition in the above-mentioned symptoms. Additionally, many individuals with autism have language delays, ranging from a complete lack of speech, delayed language, repetitive use of language, poor comprehension of language and overly literal language (American Psychiatric Association, 2013).
The Centers for Disease Control and Prevention (CDC) estimates that autism affects 1 in 68 children and is times more common in boys than girls.
CDC also highlights that there are likely many causes for multiple types of the autism Spectrum disorder. The factors that can contribute to a child having autism include environmental, biological and genetic factors.
CDC has identified the some risk factors which include: genes being one of the main risk factors, children with siblings with autism have a higher risk of having autism and children born to older parents are at greater risk for having autism.
Early symptoms of autism spectrum disorder are recognized with delayed language development accompanied by a lack of social interest or unusual social interactions, odd play patterns and unusual communication patterns. Sometimes parents may even wonder if their child is deaf and a hearing test will rule this out quite quickly. Parents will tend to observe odd and repetitive behaviours with the absence of typical play as well (American Psychiatric Association, 2013).
At EAP, we suggest that if parents answer “no” to more than 2 of the following questions regarding their child, they should contact a pediatrician or a psychologist for a diagnostic evaluation:
It is important to note that if you have observed your child doing any of the above once or twice, to check no.
Additionally, parents could complete the Modified Checklist for Autism, Revised (M-CHAT-R; Robins, Fein & Barton, 1999) which consists of 20 questions to identify if your child demonstrates symptoms of autism.
Both the above checklists of red flags are screening tools to identify if a child is demonstrating potential symptoms of autism. However, a parent needs to have a thorough diagnostic evaluation conducted for their child before the diagnosis of autism can be confirmed.
Children are able to be diagnosed by the age of 18 months and a diagnosis given at 2 years old is considered to be quite accurate. Unlike a medical condition, there are no medical tests that can be given to diagnose this disorder. Instead, doctors and trained clinicians will need to make diagnosis based on developmental delays observed and behavioural observations.
During routine doctor visits, a child’s development is monitored and if there are delays observed, a developmental screening should be conducted by a pediatrician. This is to ascertain the child’s developmental delay. If there are concerns in the child’s development, a comprehensive diagnostic evaluation needs to be conducted.
The diagnostic evaluation can be conducted by developmental pediatricians, child neurologists or child psychologists/psychiatrists (CDC, 2014). It is necessary that these clinicians have appropriate qualifications (minimum qualification would be a Masters’ Degree from an accredited university in the mental health or psychology field), appropriate accreditations as well as experience in the area of diagnosing children with autism accurately using the recommended diagnostic tools.
At present, the Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS; Lord, Risi, Lambrecht, Cook, Leventhal, DiLavore, Pickels & Rutter, 2000) are considered to be the ‘gold standard’ diagnostic procedure (Falkmer, Falkmer, Anderson & Horlin, 2013). Other tools typically used include the Childhood Autism Rating Scale (CARS; Van Bourgondien, Marcus & Schople ,1992) or the Gilliam Autism Rating Scale- 2 (GARS-2; Gilliam, 1995) however these screening tools need to be used together with the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5).
The diagnostic evaluation will cover two main areas, an interview with the parents/care givers to determine the child’s development as well as the clinician’s observation of the child’s behavior. The diagnostic evaluation will typically take between 2-3 hours long.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 2013 defines the Autism Spectrum Disorder (ASD) as neurological disorder with symptoms presenting in areas: