Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder.  All of the diagnoses classified as neurodevelopmental disorders have the onset of symptoms during the early developmental years, usually before reaching school age.  Symptoms of ASD are most often recognized between 12 and 24 months but can be seen earlier than 12 months, especially if they are more severe symptoms.  They can also be recognized later than 24 months if the symptoms are more subtle.  While symptoms must be present during the developmental years, they sometimes are not recognized and diagnosed until later.  Many first-time parents do not have a comparison to know that their child may not be developing as they should.  There are also many professionals who do not have experience with ASD and might not recognize it as easily as those with expertise in ASD.  The good news is that there have been many improvements in professional training about appropriately identifying and diagnosing ASD.  It is much more common for professionals to have an understanding and experience with ASD than it was years ago.

In addition to providing training and experience, another factor that complicates accessing a diagnosis before the age of 3 is the possibility of regression of skills.  A subset of individuals with ASD develop typically and then regress rapidly or gradually between 12 and 36 months of age.  Parents will report a child was talking using multiple words and then stopped talking suddenly as if they no longer could say the words they were previously saying.  They may also report the baby was socially engaged, played reciprocal games, such as peekaboo, and then stopped looking or engaging socially with parents.

In Utah, training has been provided to the majority of pediatricians to help them understand early signs and symptoms.  They have also been trained on how to use the M-CHAT to screen for signs and symptoms of ASD in toddlers.  Many pediatricians now have the parent fill out the very brief questionnaire at 18, 24, and 36-month well-child checks.  If the checklist indicates symptoms, pediatricians refer to a psychologist for further assessment and determination of a diagnosis.

If your pediatrician does not have you complete the M-CHAT and does not have experience with children with ASD, you can go to the CDC website to see if there are any signs or symptoms your child is exhibiting https://www.cdc.gov/ncbddd/autism/signs.html.  Some of the possible early signs of ASD are listed below.

This is a sample of some symptoms, but not an exhaustive list:

  • Poor eye contact
  • Not pointing at things to show interest (e.g., animals, an airplane or helicopter flying, etc.)
  • Not engaging in reciprocal games (e.g., peek-a-boo, tickling, etc.)
  • Not appearing to understand the feelings of others
  • Not responding to their name by the time they are 1 year old
  • Not playing pretend play (e.g., dolls, superheroes, etc.) by a year and a half
  • Having an oversensitivity or under sensitivity to sensory stimuli
  • Has not achieved language milestones during expected ranges
  • Having obsessive interests
  • Having rigid routines
  • Flapping their hands or having other repetitive behaviors

 

If you have concerns after reviewing the possible symptoms, it is important to find a professional who has training and experience in diagnosing ASD.  It can be difficult to know where to go and who to see, but there are some guidelines you can use to help select the correct person.  There is a book that is published by the American Academy of Pediatrics, Autism Spectrum Disorders: What Every Parent With Autism Needs to Know (https://ebooks.aappublications.org/content/autism-spectrum-disorders) that I often recommend this to parents when they first receive a diagnosis of ASD or are considering pursuing an assessment for their child.  If your child is diagnosed with ASD and you want to pursue services covered by insurance or Medicaid, you will need specific testing to get the services paid for.  Most payors require the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2).  This is a test usually administered by a psychologist, but there are other professionals that can do the ADOS-2 with appropriate training.  It would be important to make sure whoever you are seeing for a potential diagnosis can complete the ADOS-2.  The Health Department has a list of providers who can provide this assessment which includes our Psychological Services and Carmen B. Pingree Autism Center of Learning programs at Valley Behavioral Health.  The following link is where you can find the list of providers who can provide the ADOS https://health.utah.gov/cshcn/pdf/Autism/Autism%20Evaluations.pdf.

If the person you suspect of having ASD is an adult, they can pursue a similar process.  Many adults, particularly those who have higher language and cognitive skills, have gone undiagnosed.  Often, their more subtle symptoms are not as easily identified.  Prior to the last few decades, there was also a misunderstanding or complete lack of knowledge of ASD for many professionals.  They were not trained properly to assess and diagnose ASD so many people went without a diagnosis until they decided to pursue a diagnosis in adulthood.  Many people report that they always felt “different” or struggled socially so they now want to find out why.  Adults pursuing a diagnosis are often able to identify that they struggle with eye contact or social situations and that is what is the catalyst for pursuing an assessment.  While the individual would experience similar symptoms to those listed above, it would need to be confirmed that those symptoms were also present during the developmental years.  It would still be important to see someone who has experience and training with ASD specifically, but there may not be the need for an ADOS-2 since many in this group do not require intensive services covered by insurance or Medicaid as adults.

One of the more difficult conversations to have is when you suspect a family member, a friend, or a friend’s family member has ASD.  Many people struggle with how to talk to them about it and help them navigate the next steps.  It can be very intimidating and scary for parents to hear that there is a suspicion of ASD, but it is also important for ASD to be identified as early as possible so the child can get the treatment that can make significant impacts for them long-term.

If you suspect you or a family member has ASD and you would like additional information, contact us today.