How to diagnose autism early?
Great question.There is a lot of fear around an autism diagnosis.
I understand that, however, fearing something will not help the situation.
Your child’s pediatrician should be doing developmental screenings at nine months, 18 months and 30 months. They should also be doing specific autism screening at 18 months and twenty-four months.
Those screening forms that your doctor gives you – they are really important to fill up. And I know they seem kind of annoying and stressful and ‘Why I have to do this?’, but it’s important to do these screenings on your well-baby visits.
An autism diagnosis can be given at 18 months or younger, and by the age of two, a reliable diagnosis can be made.
You can find out below who makes an autism diagnosis. Many times this is where the most time is wasted.
Who diagnoses autism?
A critical aspect of having an optimal outcome with autism is a proper and timely diagnosis. Let me teach you how not to waste your time.
Autism is diagnosed based on observations. Therefore, it’s really important to have right experts on your child’s health care team make the actual diagnosis.
Otherwise you’re going to waste time!
Likely your pediatrician has been asking you screening questions during your well-baby visits.
If they’ve had concerns, they might have suggested you see a specialist. This is important to do because autism is diagnosed by observation. So you want to have the diagnosis made by a doctor who just lives and breathes autism.
That’s all they do. Autism. They have the experience. They can see it. That’s who you want to make the diagnosis.
The child psychiatrist or psychologist, pediatric neurologist or developmental pediatrician typically are the best types of doctors to go for an evaluation.
But remember, look for someone who only sees patients with autism. This is who you want to make the diagnosis, if it’s needed.
Don’t waste time with a doctor that does not specialize in autism.
How to test for autism?
Unfortunately, there is no blood test or any lab work that can diagnose autism.
Yes, this is frustrating because the way that autism is diagnosed is by observation. While there is no test to diagnose autism, there are many ways to accurately assess your child’s health.
Functional Medicine is the best way to get at the root causes of your child’s symptoms. There are several great lab tests to do to get a better understanding of your child’s overall health. And that’s what we want, right? A happy and healthy child. If you’d like to work with a great functional medicine doctor that has a focus on autism, please check out my book, The Lyon’s Report, Autism and Functional Medicine Doctors.
It’s important not to waste time because the earlier autism is addressed, the better for everyone.
How long does it take to diagnose autism?
This is a great question and has a few answers.
How long it takes to diagnose autism depends a whole lot on how you navigate the health care system. It depends on the specialists making the diagnosis too. Some specialists will make a diagnosis based on two hours of observation in their office or in their department, whereas other specialists will want assessments done from a speech therapist, occupational therapist, physical therapist, maybe even a school observation. Plus they will do their own office assessment.
You can see the more assessments that are done, the longer it will take to get a diagnosis. The reason some specialists want multiple assessments is that the autism diagnosis is based on observation and some specialists like to form a consensus before giving a diagnosis, while others are confident after two hours or so. But that also depends on the symptoms of your child. Sometimes these specialists have a long waitlist. I would recommend getting on the waitlist as soon as your child starts to show potential signs of autism.
Even if you have some doubts about if your child really has autism, just get an appointment because it could be four, six months, or even longer before you actually see a good specialist. And it’s better in the long run for your child to be seen by one of these expert specialists. Check out the section above on who makes the autism diagnosis, because this is where a lot of time gets wasted. And I want to make sure you don’t waste your time.
What are Assessments of Autism Spectrum Disorder (ASD)?
When a child has been flagged for autism through screenings, what does an assessment look like? It’s a great question.
Most autism diagnosis are made by a specialist. So when I’m talking about assessments for autism, it’s by a specialist overseeing it, not a general pediatrician.
Typically, the assessment is referring to developmental steps. Basically what age is your child functioning at? Which might be very different than their actual age.
This is typically done before the specialist makes the diagnosis. There are questionnaires such as the SCQ (Social Communication Questionaire) or the SRS (Social Responsiveness Scale). Other ways to assess a child for potential autism diagnosis are the Behavior Assessment System for children, the Diagnostic Interview for Social and Communication Disorders, and the Child Behavior Checklist. They are used to assess children for other behavioral health conditions, but they may also identify behavioral profiles that are consistent with autism.
There’s also the Autism Diagnostic Inventory-Revised Edition and Structured Observation is also another way to assess a child for autism. There are two validated observation tools used to provide structured data to confirm the diagnosis, and those two are the Autism Diagnostic Observations Schedule(second edition). It’s abbreviated ADOS – II and also the Childhood Autism Rating Scale (second edition as well). There’s no single observation tool that is appropriate for all clinical settings for all children. That’s why there are so many to choose from.
Those with autism may have intellectual abilities, learning disabilities, ADHD, anxiety disorders or speech and language disorders, as well as many other different comorbidities. These conditions may influence the presentation of the symptoms of autism and also may influence the social and behavioral aspects of the child depending on their age. As you can see, this is why you want to work with the specialists. There can be many more aspects that a specialist might want to review before giving an autism diagnosis.
However, when someone refers to ‘Assessments for autism’, these are the typical observation-based assessments. And as you can see, there are many ways and types of assessments for autism. You don’t just want to pick one. It certainly can be frustrating. And this is why you want to work with an autism specialist.
Work with a doctor who is familiar with all of these assessments so that you get the correct diagnosis the first time.
Autism Versus Speech Delay
Is that autism or is it a speech delay? What’s the difference?
This is a great question and there certainly is a difference, and it’s important to note.
Let me explain. Let’s break down the differences by age in the critical time period where a diagnosis of autism can be made so that the amount of catchup time is on the minimal side. So let’s look at
- One year
- 18 months, and
- Two years
These are the milestones for a one-year-old in speech development:
- Response to simple spoken requests
- Use simple gestures like shaking their head no, or waving bye-bye
- Makes sounds with changes in tone -it sounds kind of like speech
- Says “mama” or “dadda” and goes “Uh-oh!”
- Tries to say words that you say – Try’s is the key point
So here are some other developmental milestones that if you just have a speech delay you’re not going to miss any of these milestones:
- Cries, when mom or dad leaves
- Has favorite things and favorite people,
- They might show fear in some situation
- They’ll hand you a book when they want to hear a story
- They can get to a sitting position on their own
- They’ll explore things in different ways, like banging and throwing things, shaking things just to see what happens.
- Finds hidden things easily
- Looks at the right picture for a thing when it’s named
- Another milestone is them copying gestures
- They might poke, or point with their index finger, and do similar stuff
- They can follow simple directions like “Pick up that toy.”
And so those are nonspeech-related milestones that you want to see your child achieving.
Milestones for an Eighteen-Month-Old
What are the milestones for an eighteen-month-old in speech development?
- They’re going to say several single words
- They’ll say and shake their head – “No”
- They’ll point to someone to show what they want
If your child is only missing some of those milestones, then likely it’s a speech delay.
Let’s look at other milestones for an 18-month-old. And this can help you determine if it’s a little more than a speech delay.
- They might be afraid of strangers
- They’ll show affection to familiar people
- They’ll play simple pretend games such as being a doll
- They may cling to the caregiver in new situations
- They’ll point to show others something that they find interesting
- They know what ordinary things are (for example: the phone, brush, spoon, fork, they know what they’re used for)
- They’ll point to get the attention of others
- They can point to different body parts when you name them, and
- They might start to scribble on their own
- They can follow one-step verbal commands without any gestures (for example, when you say sit down)
- They can walk alone, they can drink from a cup and eat with a spoon
So those are non-speech-related milestones. If your child is missing any of those milestones, it could be something more than just a speech delay.
Milestones for a Two-Year-Old
Gosh, the terrible twos!
Let’s look at the developments for speech in a two-year-old.
- There is a lot of pointing, and they point to things that they want or pictures.
- They know the names of familiar people and
- They know the names of different body parts
- They can say sentences with two to four words
- They can follow simple instructions.
- They’ll repeat words overheard in conversation (this is when parents have to be very careful with what they say) and
- They point to things in a book
Alright. So if your child has missed some of those milestones, let’s look at other developmental milestones for two-year-old to see, “Okay, could this be more than a speech delay?”
- They’ll copy others, especially adults and other children (Example: If you’re mopping the floor, they want to mop the floor) They just want to do whatever you’re doing.
- They get excited when other children show up and they want to play,
- They’ll also start to show more independence, like “I can do it!”
- They will also show some defiant behavior and especially doing something that they’ve been told not to do. (Terrible twos!)
- They can play mainly alongside the children, but they’re starting to play with kids, so they’ll start to do chase games, tag, and things like that
- They find things even when you’ve hid it say under two or three covers of blankets or they’re really good at finding things
- They begin to sort shapes and colors
- They can follow two-step instructions, such as pick up your shoes and put them in the closet.
- They can name items in a picture book such as a cat, a bird, a dog
- They can kick a ball
- They can make straight lines or circles when drawing and
- They’re beginning to run
So those are nonspeech-related developmental milestones.
With a speech delay, other aspects of development are on track.
With autism, many times there is some sort of speech delay, but not always. And with autism, it’s important to look at all the other developmental milestones.
So if your child is not meeting these milestones, it just means, OK, that’s a red flag. That’s a red flag. When you start to pay attention to this a little more.
For your child, whether it’s a speech delay or autism, have your child evaluated by a specialist. It’s important to get the right diagnosis the first time so that time is not wasted.
I have other videos about who makes the autism diagnosis and how to prevent autism and the autism app that the FDA approved to help with an autism diagnosis, along with videos on assessments for autism, and how long does it take to diagnose autism?
Autism Spectrum Disorder (ASD) Symptoms
This post is about Autism Spectrum Disorder symptoms. This is a complex topic, but I’m excited to share with you the data. So let’s do this.
Symptoms cluster in two domains:
- Social communication interaction and
- Restricted repetitive patterns of behavior
That is how autism symptoms are listed in the DSM-5, which is how autism is medically defined so that doctors use all the same definitions of autism. Autism is diagnosed based on observations.
If your child is not hitting their milestones developmentally, that’s when red flags should start to warn you. It doesn’t mean that a child, if they miss a milestone, then poof – it’s Autism. It doesn’t mean that.
Here are some milestones that are red flags for autism screening and or closer observation. I can’t go over every single milestone, but here are some of the major ones.
At two months old, the child should begin to smile at people and tries to look at the parents and they “Coo..” And they turn their head towards sounds and they can hold their head up. That’s important.
At six months they know familiar faces and begin to know if someone is a stranger. They like to play with others, especially parents, and they respond to other people’s emotions and often seem happy. They like to look at themselves in the mirror. That’s why those toys all have those little mirror things on them. And they also respond to sounds by making sounds.
They might string vowels together when babbling like “Aaaa…”, “Eeee…” or “Ooooo..”, and they like to take turns with the parent making sounds so back and forth like the Cooing, the little fun stuff back and forth. They respond to their own name and they make sounds to show joy and displeasure. They might look around at things nearby and they put things in their mouth quite often. They show curiosity about things and try to get things that are out of reach, right. Put something away and they’re like trying to get it and they begin to pass things from one hand to the other.
At one year they’re shy or nervous with strangers. They cry when mom or dad leaves. They notice – are you there or are you not? They might hand you a book when they want to hear a story. They could repeat sounds or actions to get attention and they can assist with getting dressed – they might put up an arm or their leg or put out their foot for the sock. They play games such as Peek-a-boo and Pattycake. That’s when those fun things start. And it’s just natural. It’s fun. They can easily mimic you and they use simple gestures like Headshaking for no or waving bye-bye. They say, “Mama ..” or “Dadda…” or “Uh – oh!..”.
And they try and say words that you say. It doesn’t sound right, but they’re trying. They’ll also explore things in different ways, like, shaking a toy or banging it, or even throwing it. They also find hidden things easily. So you might want to just put something in another room to get them to stop playing with it. And they’re going to go to the other room and try and find it.
They’ll also copy gestures and they’ll start to use things correctly, like drinking from a cup and maybe brushing their hair or brushing their teeth, trying at least, and they might start to bang things together, like, oh, what happens when I do this? And they’ll point! A lot of pointing, you know, with their index finger.
And they can follow simple directions, like pick up that toy and they can actually sit up without getting any help.
They like to hand things to others to play with. They may be afraid of strangers and they’ll show affection to people that they’re familiar with. They’ll play simple pretend games such as like feign-a-doll. They’ll also point to show others something interesting – Oh, look at the plane up there. Look at that bird.
They’ll say several single words and they’ll say and shake their head – “No!”
They’ll point to someone when he wants something and they’ll point to get the attention of others. Pointing is a big thing. Shows interest in a doll or some type of stuffed animal by pretending to feed it – (really cute ;))
They can point to a body part if you say, “Oh, where’s your arm?” They can point to it. “Where’s your head?” They can point to it.
They can follow one-step verbal commands without any gestures. So example, when you say sit down, they can sit down and you don’t have to kind of gesture for them what sitting down is.
They walk alone and they may walk up steps and start to run. They can help undress and they can drink from a cup and eat with a spoon.
So these are the milestones that if missed – are red flags to start monitoring for autism? You can talk with your doctor about your concern.
As I mentioned before, core autism symptoms cluster in these two special domains and it’s:
- Social communication interaction, and
- Restricted repetitive patterns of behavior
Those are the symptoms. So let me give you some examples as to what that looks like.
Social communication and social interaction characteristics related to autism
They avoid or do not keep eye contact. They do not respond to their name. They do not show facial expressions like happy or sad. It’s kind of just a stone face. They don’t play simple interactive games like patty cake and they use a few or no gestures by 12 months of age. So they might not be a lot of pointing.
They do not share interests with others. That’s called joint attention. So if you say, “Oh, look at the airplane!” It’s going to feel very difficult. They do not point or look at what you point at. They also might not notice when others are hurt or sad. That doesn’t mean that they don’t understand it. It’s just really that interaction back and forth. So this symptom is a little bit controversial. It doesn’t mean they don’t love you. They still do.
They might not pretend play and they show little interest in other peers. And your child does not have to be experiencing all of these. It might just be a few.
Examples of restrictive or repetitive interests and behavior
Here are some examples. They might line up their toys or other objects and get upset when the order is changed or if anyone touches it, they might repeat words or phrases over and over and over again. They might play with the same toy the same way and that’s how they always play with toys in that same particular way. So, not really much pretend, not really much creativity or imagination that is expressed with the toy play.
They are focused on parts of objects like spinning wheels, something like that. They might get upset by minor changes in schedule or routine and have an obsessive interest. They might flap their hands, rock their body or spin themselves in circles. And they have unusual reactions to things around them.
So like smell and taste and look. And a lot of times you might just be puzzled, like, “Why? Why is this bothering you?”
So a reliable diagnosis can be made at eighteen months. Those developmental red flags, if they’re not addressed, then the symptoms I described are what can be seen as the child gets older. Remember, diagnosis of autism is based on observed behaviors, and don’t feel bad if you’ve missed some of these red flags or didn’t even know that these were red flags.
My daughter wasn’t diagnosed until she was three and a half years old.
Yes, it is better to get a diagnosis early so that there is less catching up to do, but it doesn’t mean game over if your child is diagnosed later in life. I work with clients in their fifties and they’ve seen changes. Anything is possible. So don’t let your guilt stop you from taking action. And especially don’t let someone else tell you what kind of life your child can live.
Anything is possible!
So try and not to be scared of an autism diagnosis. I actually found that autism has been one of the greatest blessings in my life. It took me a while to get there, but there’s so much that you can learn about yourself and your child who has autism.
So try not to be afraid of it.
It really can turn into a beautiful life…
Levels of Autism
What level of autism does your child have? Seems like a simple question, but it’s a complicated answer because of diagnosis definitions. Let me explain.
Pre-2013 There were five types of autism spectrum disorders. Now there’s only one diagnosis – Autism.
Let me explain the five levels pre-2013:
The three most common forms of autism and the Pre-2013 classification system were:
- Autistic disorder (and that’s classic autism),
- Asperger syndrome, and
- Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS).
These three disorders share many of the symptoms, but they differ in their severity and impact.
The Autistic disorder was the most severe. Asperger syndrome sometimes was called high functioning autism, although that label is not descriptive enough to actually be useful. The label meaning ‘high functioning’, and I do have a separate video that goes into the details of the difference between Autism and Asperger’s. Nowadays the labels high-functioning and low-functioning – they’re controversial. Because someone could be low functioning in one area and high functioning in another area or vice versa.
And it’s just really not descriptive. It’s very limiting, but I know sometimes it’s hard to not use a term like that. PDD-NOS or Atypical autism – that was considered the less severe out of all the autisms.
Childhood Disintegrative Disorder and Red syndrome were also among the pervasive developmental disorders, but both are actually rare genetic diseases, so they are usually considered to be separate medical conditions that don’t truly belong on the autism spectrum. But there’s kind of some overlap and a little bit of a Gray area in there.
Now that there is only one diagnosis – Autism, the hopes were to focus less on the spectrum where the child was and to focus more on just actually helping the child.
How to prevent autism? How to test for autism? Who diagnoses autism? How to diagnose autism Early? Does autism get worse with age? All of these questions have been answered in my blogs and also on my YouTube Channel. These will help you really understand the initial part of an autism diagnosis.
Currently, there’s only one level of autism. In the past, there were different diagnoses, but currently, there is one level and one diagnosis.
Autism in Babies
An autism diagnosis can reliably be made as early as 18 months.
Let me go through some of the milestones that a typically developing child hits. If your child is not doing these things, it doesn’t automatically mean that it’s autism. Let’s go into these milestones:
At four months:
Turn towards sounds. Smile back at you, when you smile. Follow and react to bright colors, objects, movements and they show interest in watching people’s faces. They’re really kind of tuned in.
At six months:
They share moments of joy. Smile often while playing with you. They do a lot of cute stuff, little back and forth smiles, and plain fun things like that, noises as well, so they coo or babble when they’re happy.
At nine months:
There’s lots of social exchange, lots of back and forth, such as smiles and facial expressions, sounds, gestures, laughs. If you are starting to have concerns, don’t doubt yourself. You know what’s best for your baby. If you have any concerns about your child’s development, please see a specialist.