Pediatricians and Primary Care Doctors: How to Screen for Autism

By Nancy Wurtzel

Most children with Autism Spectrum Disorder (ASD) or autism for short are now identified and diagnosed by age three. Yet, some researchers believe the first signs of the disorder could be detectable as early as 12 months.

Everyone agrees early intervention will lead to the best outcomes for the child and his or her family.

The American Academy of Pediatrics (AAP) recommends that children be screened for autism during regularly scheduled well-child visits at 18 months, and then again at 24 months of age. However, screening can begin from the very first well-child visit, with clinicians making note of a baby’s first reactions to touch and sound.
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During well-child visits, pediatricians or family practitioners should do the following:

1) Assess typical milestones, especially in behavior and learning

2) Ask parents about any family history of ASD other risk factors

3) Inquire if parents have any developmental concerns they want to share, keeping in mind that first-time parents may be unaware a child is not meeting standard developmental markers.
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Clinicians are encouraged to be ready with ASD facts as parents may have questions about why the screening is necessary and encouraged:

• One in 68 children are now estimated to be on the autism spectrum
• More boys than girls have autism, a ratio of about five males for every female
• There is no definitive test, nor is there a cure for autism
• Early screening and intervention will produce the best outcomes
• Autism affects everyone differently, from very slight social challenges to severe cognitive impairment
• The Autism Society estimates that 3.5 million Americans are now living with a diagnosis of autism spectrum disorder (link to article #5)
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A 23-point questionnaire called the Modified Checklist for Autism in Toddlers (M-CHAT) has been developed for pediatricians, primary care doctors, and other clinicians who treat babies and children. The free checklist is also available as an online evaluation on the Autism Speaks website.

The screening takes only a few minutes and can help determine if an ASD professional should evaluate a child.
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Some common ASD markers or “red flags” in the infant to toddler stage include:

• Preference for not being held or cuddled
• Failure to make eye contact
• No response to his or her name
• A lack of babbling, pointing, reaching or waving by 12 months
• No speech by 16 months
• The lack of two-word phrases by 24 months
• Loss of abilities, at any point, such as babbling, smiling, laughing, or general interaction
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For toddler age and above, here are some signs to look for:

• Highly focused and even obsessive interest in objects and/or subjects
• Reactions or triggers to sensations
• Lack of verbal and/or nonverbal communication
• Experiencing echolalia, a tendency to repeat words or phrases
• Impaired physical coordination and/or physical behaviors such as rocking
• Inability to decipher social cues or engage in easy back-and-forth communication
• Lack of empathy, failure to establish successful interpersonal relationships
• Rigidity and a need or preference for routine

Since autism is a highly complex disorder, parents should be advised that well-visit office screening is only an assessment, not a diagnosis. In fact, office screening can miss identifying babies and toddlers with mild- or high-functioning autism.

Autism is a highly complex disorder, and our understanding of how to best treat those that have this condition is constantly evolving. It’s important to note that parents be advised that well-visit office screening is only an assessment, not a diagnosis. In fact, office screening can miss identifying babies and toddlers with mild- or high-functioning autism.

Parents who are troubled about their child’s development must be encouraged to trust their instincts. After all, parents spend the most time with their children.

Even if they do suspect a problem, it can be devastating for parents to hear their child may be at risk for autism. Parents may express shock, denial or anger. Clinicians can emphasize that “knowing is better” and early intervention can make a huge impact.

The next step is for the family is to seek a comprehensive ASD evaluation usually conducted by a multidisciplinary team of professionals, such as a psychologist, pediatric neurologist, child psychiatrist, developmental pediatrician, and speech therapist.

ASD diagnostic testing must be age-appropriate and should follow the criteria outlined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association and reprinted on the Autism Speaks website.

Many changes occurred when the DSM-5 was published in 2013, most notably it created one umbrella term – autism spectrum disorder (ASD).

The DSM-5 also laid out the specific criteria that must be met for diagnosis of autism, and it established a numerical level for diagnosis: Level 1, Level 2 and Level 3, with 1 considered on the low or mild end of the autism spectrum and 3 being the most severely affected. Additionally, the DSM-5 eliminated the terms autistic disorder and Asperger’s syndrome.

Some of these modifications proved to be controversial, and clinicians can learn more information on the changes in the DSM-5 here.

The DSM-5 also stipulated that a child with autism may also experience other co-morbid health conditions. These can include: epilepsy, allergies, asthma, as well as sleep, eating, and digestive disorders.

The medical community agrees that early intervention leads to the best outcomes for the child and his or her family, so if you suspect autism, speak to your family doctor.