The Autism Checklist: How to Identify Signs in Your Child

Recognizing Signs of Autism

Identifying the signs of autism in children at an early stage is crucial for their development and growth. The signs can manifest in various ways and at different times, making it essential for parents and caregivers to stay vigilant and observant of their child's behavior.

Early Signs in Babies

Signs of autism can be observed in babies as early as 6 months old, with different signs manifesting by 9 months, 12 months, 16 months, and 24 months [1]. Some children show early signs of autism within the first 12 months, while in others, signs might not appear until 24 months of age or later.

One of the significant early signs of autism spectrum disorder in young children is a delay in or lack of joint attention, which is crucial for social and communication skills.

Moreover, it is important to note that some children with ASD may develop skills and meet milestones until around 18 to 24 months of age, after which they may stop gaining new skills or lose previously acquired skills [1].

Age	Possible signs of autism
6 months	Rare or no big smiles or other warm, joyful expressions
9 months	Little or no back-and-forth sharing of sounds, smiles, or other facial expressions
12 months	Little or no babbling and pointing, showing, reaching, or waving
16 months	Very few or no words
24 months	Very few or no meaningful two-word phrases (not including imitating or repeating)

Signs in Older Children

As children grow, signs of autism can continue to manifest in different ways. Older children on the autism spectrum may show delays in spoken language or differences in how they interact with peers, while still sitting, crawling, and walking on time. Subtler differences in gestures, pretend play, and social language often go unnoticed.

In older children, signs of autism might include:

Repetitive behaviors (like hand-flapping, rocking, jumping, or twirling)
Constant movement
Specific routines or rituals (and gets upset when a routine is changed, even slightly)
Not making eye contact or makes very little eye contact
Not looking at objects or events a parent is looking at or pointing to
Not bringing objects of personal interest to show to parents
Not showing appropriate facial expressions
Not picking up on other people's facial expressions, tone of voice, and gestures
Making odd movements
Difficulty understanding, or showing understanding, or other people’s feelings or their own
Not being interested in other people at all
Being very interested in people, but not knowing how to talk to, play with, or relate to them

Recognizing these signs is the first step towards seeking professional evaluation, which can lead to early diagnosis and intervention, crucial for children with autism.

Seeking Professional Evaluation

If a parent, caregiver, or teacher suspects a child is showing signs of autism, such as social communication difficulties, repetitive behavior, fixated interests, or sensory issues (NHS), it's critical to seek a professional evaluation.

Importance of Early Diagnosis

Although some children can be definitively diagnosed with autism by 2 years of age, many are not diagnosed until 4 to 5 years of age. Early diagnosis is crucial as it allows for prompt intervention which can significantly impact the child's developmental trajectory.

Diagnostic Process

The process of diagnosing autism typically involves multiple stages and is usually conducted by a team of specialists. According to the Canadian Paediatric Society, most clinical guidelines recommend multidisciplinary team involvement in the autism diagnostic process.

Children with suspected autism are often first identified by a pediatrician, family physician, parent, or another caregiver. In most provinces and territories, only physicians or psychologists are licensed to diagnose autism spectrum disorder (ASD). In some communities, appropriately trained nurse practitioners may also make this diagnosis.

The essential elements of an ASD diagnostic assessment include reviewing a child's previous records, interviewing parents and caregivers, assessing core features of ASD, conducting a physical examination, considering differential diagnoses and co-occurring conditions, establishing an ASD diagnosis, and communicating diagnostic assessment findings [3].

Autism evaluations usually start with a screening questionnaire. If the questionnaire indicates that a child might have autism, then it’s time for a more in-depth evaluation. A child should never get a diagnosis based on just the questionnaire.

The evaluation will include a set of tests in which the clinician watches how the child plays, behaves, and communicates. These tests include specific tasks and ways of evaluating the child, and they are backed up by research. One common version is called the Autism Diagnostic Observation Schedule (ADOS) test [4].

A full evaluation should also include interviews with parents, teachers, and other adults who know the child. Structured cognitive tests should be part of the evaluation as well. These tests show how the child thinks and provide important information about what kinds of support at school would be helpful.

It's crucial to work with a mental health professional who has experience diagnosing people on the autism spectrum. This ensures that the child receives an accurate diagnosis and appropriate intervention strategies.

Autism Screening and Evaluation

The journey to uncovering if a child is demonstrating signs of autism often begins with a screening process followed by a more in-depth evaluation if required.

Screening Questionnaire

Screening for autism is a crucial first step in identifying children who might have autism. It typically starts with a screening questionnaire. If the questionnaire indicates that a child might have autism, then it’s time for a more in-depth evaluation. A child should never get a diagnosis based on just the questionnaire [4].

The American Academy of Pediatrics (AAP) recommends screening all children for autism at ages 18 months and 24 months, along with developmental and behavioral screenings during well-child visits at 9 months, 18 months, and 30 months. This is because research indicates that an autism spectrum disorder (ASD) diagnosis by an experienced professional by age 2 is reliable.

In-Depth Evaluation

If the initial screening questionnaire indicates potential signs of autism, a more comprehensive evaluation is conducted. This evaluation includes a set of tests in which the clinician observes how the child plays, behaves, and communicates. These tests include specific tasks and ways of evaluating the child and are backed up by research.

A well-rounded evaluation should also involve interviews with parents, teachers, and other adults who know the child. Incorporating structured cognitive tests into the evaluation process is also beneficial. These tests provide insights into how the child thinks and supply valuable information about what kinds of support at school would be helpful [4].

One common test used during this comprehensive evaluation is the Autism Diagnostic Observation Schedule (ADOS). This test evaluates the behavior and social skills of children who may have autism.

It's essential to work with a mental health professional experienced in diagnosing individuals on the autism spectrum. The age of autism diagnosis and the early signs of autism can vary widely from child to child, with some children showing signs within the first 12 months of life, while in others signs may not be apparent until 24 months of age or later.

The process of autism screening and evaluation is a critical step in understanding if a child is demonstrating signs of autism. Recognizing these signs early can lead to timely interventions, which can significantly improve a child's development and quality of life.

Diagnostic Tools and Tests

When it comes to identifying signs of autism in children, several diagnostic tools and tests are employed by professionals. These tests, which include the Autism Diagnostic Observation Schedule (ADOS) and various cognitive tests, are used to assess the child's behavior, social skills, and cognitive abilities.

Autism Diagnostic Observation Schedule (ADOS)

The Autism Diagnostic Observation Schedule (ADOS) is a test used to evaluate the behavior and social skills of children who may have autism. During the ADOS test, the clinician observes how the child plays, behaves, and communicates. The test includes specific tasks and ways of evaluating the child, all of which are backed up by research.

The essential elements of an Autism Spectrum Disorder (ASD) diagnostic assessment include reviewing the child's previous records, interviewing parents and caregivers, assessing the core features of ASD, conducting a physical examination, considering differential diagnoses and co-occurring conditions, establishing an ASD diagnosis, and communicating the diagnostic assessment findings.

Cognitive Tests

Cognitive tests are another crucial component of the evaluation process. These structured tests provide insights into how the child thinks and offer important information about what kinds of support would be beneficial at school. For instance, they might reveal specific learning styles or areas where the child might struggle, allowing for the creation of a more tailored educational plan.

A full evaluation should also include interviews with parents, teachers, and other adults who know the child well. Their observations and experiences can provide valuable context and supplement the findings from the ADOS and cognitive tests.

In most regions, only physicians or psychologists are licensed to diagnose autism spectrum disorder (ASD). However, in some communities, appropriately trained nurse practitioners may also make this diagnosis.

These tools and tests are essential for diagnosing autism and determining the most effective strategies for support and intervention. They are part of a comprehensive approach to understanding and addressing the unique needs of each child.

Differential Diagnosis

Differential diagnosis allows healthcare professionals to distinguish one condition from another that may present similar symptoms. This process is crucial for autism, as its symptoms can overlap with other conditions, such as Social Pragmatic Communication Disorder (SCD).

Differentiating Autism from SCD

Children with autism often have difficulties with social communication and exhibit repetitive or disruptive behaviors. However, children with Social Pragmatic Communication Disorder (SCD) may not display these restrictive behaviors associated with autism.

SCD encompasses difficulties in communication where a child may have proper pronunciation and sentence formation but struggle to engage in two-way conversations, misunderstand others, or lack the use of language in the proper context. There are four key criteria for an SCD diagnosis:

Persistent difficulties in understanding and using communication cues.
Challenges in the ability to change communication to match the context.
Delayed language development milestones.
Difficulties not attributable to other medical or language disorders.

(Sarah Dooley Center)

On the other hand, children with autism repeat behaviors and have disruptive behaviors, which are not typically seen in those with SCD. Autistic individuals may have symptoms common to SCD but present additional distinct symptoms.

Red Flags for Misdiagnosis

When suspecting autism in a child, it's important to be aware of potential red flags for misdiagnosis. As mentioned, children with SCD struggle with tones, sharing thoughts, nonverbal communication, and understanding social cues. They may also find it challenging to understand the meaning of interactions [6].

However, if the child does not exhibit the restrictive or repetitive behaviors often associated with autism, it may be a sign that the child does not have autism but rather SCD or another condition.

A professional assessment and accurate diagnosis are crucial for children exhibiting signs of autism or SCD to ensure proper treatment and therapy. Misdiagnosis can lead to improper treatment, which may not be beneficial and could potentially exacerbate the child's difficulties.

In conclusion, understanding the key differences between autism and other conditions like SCD can help parents and healthcare providers make an accurate diagnosis and provide the right support and interventions.

Support and Interventions

Once a child has been diagnosed with autism spectrum disorder (ASD), the next step involves finding the right interventions and support to help them thrive. Early diagnosis and interventions can be pivotal in providing necessary support services for children with ASD, and can contribute to a child’s success at home, in school, the workplace, and community, making a positive impact on a child’s development and accomplishments well into adulthood.

Early Intervention Benefits

Early intervention for autism has shown significant benefits. It is important to monitor your child’s developmental milestones and bring up any concerns to your child’s pediatrician in case there are specific behaviors that can be indicative of a developmental disability such as autism. Parents should trust their instincts about their child's development and not hesitate to reach out for support if they feel something is different [7].

Treatment and Therapy

Treatment for Social Pragmatic Communication Disorder typically involves professional therapy with a licensed speech-language pathologist specializing in SCD, family support and involvement, education and tools for teachers and other adults in the child's life, as well as regular practice in real-life scenarios.

Supporting a child with Social Pragmatic Communication Disorder at home involves active participation in the child's therapy, reinforcing skills learned during sessions, practicing therapeutic activities together, and collaborating with the special education department to create an Individualized Education Program (IEP) or a 504 plan tailored to the child's needs. These plans may include speech therapy, social skills training, and other necessary supports [5].

Early diagnosis of Social Pragmatic Communication Disorder (SCD) or autism is encouraged for a head start in treatment. Speech and language therapy, along with various treatments focusing on functional communication skills in social situations, are beneficial. Social interactions should be encouraged for individuals with SCD or ASD. Training family members on strategies to aid engagement, involving school staff for children, and preventing bullying situations are recommended approaches to support individuals with these disorders [6].

It is crucial to obtain a professional assessment and an accurate diagnosis for children exhibiting signs of autism or Social Pragmatic Communication Disorder (SCD) to ensure proper treatment, therapy, and help. This is essential for providing children with the necessary tools to succeed in school, at home, and in life [5].