How young can a child be diagnosed with autism

Screening and Diagnosis of Autism Spectrum Disorder

Diagnosing autism spectrum disorder (ASD) can be difficult because there is no medical test, like a blood test, to diagnose the disorder. Doctors look at the child’s developmental history and behavior to make a diagnosis.

ASD can sometimes be detected at 18 months of age or younger. By age 2, a diagnosis by an experienced professional can be considered reliable ^[¹^]. However, many children do not receive a final diagnosis until much older. Some people are not diagnosed until they are adolescents or adults. This delay means that people with ASD might not get the early help they need.

Diagnosing children with ASD as early as possible is important to make sure children receive the services and supports they need to reach their full potential ^[²^]. There are several steps in this process.

Developmental Monitoring

Developmental monitoring is an active, ongoing process of watching a child grow and encouraging conversations between parents and providers about a child’s skills and abilities. Developmental monitoring involves observing how your child grows and whether your child meets the typical developmental milestones, or skills that most children reach by a certain age, in playing, learning, speaking, behaving, and moving.

Parents, grandparents, early childhood education providers, and other caregivers can participate in developmental monitoring. CDC’s Learn the Signs. Act Early. program has developed free materials, including CDC’s Milestone Tracker app, to help parents and providers work together to monitor your child’s development and know when there might be a concern and if more screening is needed. You can use a brief checklist of milestones to see how your child is developing. If you notice that your child is not meeting milestones, talk with your doctor or nurse about your concerns and ask about developmental screening. Learn more about CDC Milestone Tracker app, milestone checklists, and other parent materials.

When you take your child to a well visit, your doctor or nurse will also do developmental monitoring. The doctor or nurse might ask you questions about your child’s development or will talk and play with your child to see if they are developing and meeting milestones.

Your doctor or nurse may also ask about your child’s family history. Be sure to let your doctor or nurse know about any conditions that your child’s family members have, including ASD, learning disorders, intellectual disability, or attention deficit/hyperactivity disorder (ADHD).

Developmental Screening

Developmental screening takes a closer look at how your child is developing.

Developmental screening is more formal than developmental monitoring. It is a regular part of some well-child visits even if there is not a known concern.

The American Academy of Pediatrics (AAP) recommends developmental and behavioral screening for all children during regular well-child visits at these ages:

9 months
18 months
30 months

In addition, AAP recommends that all children be screened specifically for ASD during regular well-child visits at these ages:

18 months
24 months

Screening questionnaires and checklists are based on research that compares your child to other children of the same age. Questions may ask about language, movement, and thinking skills, as a well as behaviors and emotions. Developmental screening can be done by a doctor or nurse, or other professionals in healthcare, community, or school settings. Your doctor may ask you to complete a questionnaire as part of the screening process. Screening at times other than the recommended ages should be done if you or your doctor have a concern. Additional screening should also be done if a child is at high risk for ASD (for example, having a sibling or other family member with ASD) or if behaviors sometimes associated with ASD are present. If your child’s healthcare provider does not periodically check your child with a developmental screening test, you can ask that it be done.

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Developmental Diagnosis

A brief test using a screening tool does not provide a diagnosis, but it can indicate whether a child is on the right development track or if a specialist should take a closer look. If the screening tool identifies an area of concern, a formal developmental evaluation may be needed. This formal evaluation is a more in-depth look at a child’s development and is usually done by a trained specialist such as a developmental pediatrician, child psychologist, speech-language pathologist, occupational therapist, or other specialist. The specialist may observe the child give the child a structured test, ask the parents or caregivers questions, or ask them to fill out questionnaires. The results of this formal evaluation highlight your child’s strengths and challenges and can inform whether they meet criteria for a developmental diagnosis.

A diagnosis of ASD now includes several conditions that used to be diagnosed separately; autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. Your doctor or other healthcare provider can help you understand and navigate the diagnostic process.

The results of a formal developmental evaluation can also inform whether your child needs early intervention services. In some cases, the specialist might recommend genetic counseling and testing for your child.

References

Lord C, Risi S, DiLavore PS, Shulman C, Thurm A, Pickles A. Autism from 2 to 9 years of age. Arch Gen Psychiatry. 2006 Jun;63(6):694-701.
Hyman SL, Levey SE, Myers SM, Council on Children with Disabilities, Section on Developmental and Behavioral Pediatrics. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics. 2020 Jan;145(1).

How soon can a child be diagnosed with autism?

Children may be diagnosed with autism by age two, but a more definite diagnosis may come several years later.

The American Academy of Pediatrics recommends all children be screened for autism between 18 and 24 months to possibly benefit from the option of early intervention therapies, like ABA therapy.

Autism spectrum disorder (ASD) may be diagnosed at an early age, about 14 to 16 months, though many parents do not receive a definite diagnosis till much later. Parents may notice atypical behaviors or developmental delays just a few months into a child’s life. However, many children are not diagnosed until they present more obvious symptoms around the age of two years old or older.

A study published in 2019 found that it was possible to diagnose autism as early as one year into a child’s life. However, this diagnosis was more likely to be overturned compared to one made around 14 to 18 months of age. The earlier intervention is applied to the child in question, the more positive outcomes come to pass.

Pay close attention to your child’s behaviors and development, even in infancy. While some signs of autism can be unclear, presenting several signs at once should prompt parents to seek a diagnosis as early as possible. Some early signs may include no interest in playing pretend, delayed speech and language skills, and/or quick upset to routine changes.

Most Parents and Caregivers Overlook Autism Until After Age Three

Even though the American Academy of Pediatrics recommends universal screening for autism around age two, how soon a child can be diagnosed with autism varies as many children aren’t diagnosed until they are more than three years old.

The National Institute of Child Health and Human Development states, “Research shows that early detection and early intervention greatly improve outcomes. So it’s important to look for these symptoms when a child is as young as possible.”

Earlier studies have shown that delayed diagnosis can be correlated with a number of common factors. Using the older classification system before the DSM-5 revision, children with “autistic disorder” had an average age of 3.1 years at their time of diagnosis, which increased to 3.9 years for a diagnosis of “developmental disorder not otherwise specified” (PDD-NOS).

In the past, children with Asperger’s disorder were diagnosed at an average age of 7.2 years. These findings indicate that children with more pervasive symptoms or who struggled with verbal communication were more likely to receive a diagnosis at a younger age due to parents recognizing their struggles more obviously versus their child having “quirks” or just assuming symptoms were a result of their personality.

Other correlative factors with an older age of diagnosis include living in a rural community, being near the poverty level, or having four or more primary care physicians.

How pervasively the ASD presents is the single largest factor in how soon a child can be diagnosed with autism, though. A 2013 study found that children with just seven of the 12 main behavior features were diagnosed at an average age of 8.2 years, whereas children with all 12 symptoms were diagnosed at an average age of 3.8 years.

Is An Early Diagnosis More Likely to Be Incorrect?

Multiple studies have confirmed that autism can be reliably diagnosed by age two with little risk of that diagnosis being invalidated later. Though early diagnoses may require a more definite diagnosis as the child grows older.

A 2006 study found that if children with autism were diagnosed at age two, that diagnosis was very likely to remain consistent by age nine.

However, the study noted that diagnostic stability was less reliable for children whose autism involved less severe presentations, meeting the older definition of PDD-NOS. This conclusion means that children with more typical presentations or who did not outwardly display multiple diagnostic criteria were more likely to affect how soon a child would be diagnosed with autism or have a missed diagnosis.

While medical knowledge has improved in the 14 years since that study was published, it is still possible for a child to delay presentation of ASD until age five or later.

One major factor that can prevent a missed diagnosis is input from parents. Because parents can observe some of the subtler signs or pervasive patterns that a single diagnostic test might miss, clinicians can perform a more thorough diagnosis or re-evaluate as the child ages.

Advances Lower Average Diagnostic Age

The possibility of a child being diagnosed with ASD at a young age and having that diagnosis overturned is low, while the possibility of an overlooked diagnosis is much higher. Parents concerned that their child has been misdiagnosed with ASD can always seek a second opinion or they can have the child re-evaluated after a few months.

But parents who disregard early symptoms could be limiting their child’s ability to progress, learn, interact with peers, and thrive. The opportunity for early intervention ABA therapy will equip them with the tools and knowledge to thrive alongside their peers instead of lagging behind.

For this reason, parents are urged to follow the American Academy of Pediatrics’ recommendation and have their child screened around 18 to 24 months. If they do not, they should still closely observe their child’s behaviors in preschool, during play, and when interacting with peers for signs of possible ASD.

Early diagnosis and intervention is crucial for helping the child develop skills that can help them lead a fulfilling life, and it can help parents provide the proper care. Therapeutic Pathways uses evidence-based and results-driven ABA therapy to help children with autism thrive while building skills in communication, self-help, social skills, language and speech skills, behavior management and more.

Get a diagnosis any time you suspect your child might have one or more signs of autism. If they do have ASD, visit an evidence-based autism treatment center that can help you and your child build a better life together.

Early Childhood Autism Exclusion

July 30, 2018

Voronin Nikolai

Neuropsychologist, Ph.D.

Autism is manifested by the lack of ability to interact with the outside world, communication disorders.

Most often, childhood autism manifests itself at 2.5-3 years. It is during this period that speech disorders and isolation in children are more pronounced. nine0003

However, the first signs of autistic behavior are often seen at an early age, before 1 year of age. It can be difficult for parents to independently distinguish the signs of autism, so it is no coincidence that children at the age of one year are recommended to consult a psychiatrist.

Do not be afraid to consult a psychiatrist! When parents of adolescents with behavioral problems come to us, we most often reveal that in childhood they could have had a developmental distortion of the autistic type, and with timely treatment, difficulties could have been avoided. nine0003

What should parents pay attention to? Symptoms of autism in children.

1. Violations of social contacts and interaction with others

The child practically does not ask to be held, it is more comfortable for him to lie in the crib.
The child does not assume a physiological position when breastfeeding.
The child is inactive, not as lively as peers. nine0003
The child does not respond to new toys, sounds, can stare at one point for a long time.
The child does not respond to his name (usually the first thing parents go to is an audiologist to check their hearing; if everything is fine with hearing, a psychiatrist should be consulted).
When adults or other children try to make contact with the child, he either removes his hands or moves to the side, or reacts aggressively, may throw something, cry. nine0003
The child throws the toy instead of handing it to avoid contact.
As the child grows older, he can go deeper into his inner world; he does not know how and does not want to communicate with family members, rarely seeks help, starts trying to serve himself early, does not use the word “give”, it is easier for him to take it himself or achieve his scandal.
Often children do not respond to discomfort, such as a full diaper; don't cry or draw attention to themselves. nine0003
There is no eye contact, the child does not fix his gaze on objects, toys.

2. Limited interests and features of the game

The child chooses one toy and plays only with it for a long time. Can choose as a toy something that is not intended for the game - ropes, rags.
The stereotypical nature of the game: placing toys in the same order, playing with a certain number of toys, and if one is lost, a scandal can occur. nine0003
Another example - a girl can not play with dolls, like the rest - not to change clothes, not to put her to bed, but simply carry her with her, maximum - iron her.
Games that require fantasy and imagination rarely captivate autistic children.
Children often prefer quieter games (eg puzzles, building blocks).

3. Tendency to repeat actions, the so-called stereotypy

Rocking the whole body from foot to foot, stereotypical head turn, stereotypical shoulder clamping.
Stereotypes observed in speech are called echolalia. It can be manipulations with sounds, words, phrases. At the same time, children constantly repeat words, cliches, cliché phrases that they heard from adults or on TV without realizing their meaning.
Stereotypical games - turning on / off the light, pouring water from glass to glass, pouring sand, cereals. It is difficult for a child to switch from this activity. nine0003
The child gets acquainted with the outside world not through interaction with others, but independently. He can lick, sniff objects.
Clothes: the child chooses certain things and wears only them, the sequence of dressing and undressing may be important for him.
Eating behavior: the child is selective in food, chooses only a certain range of products. In the most severe cases, this may be a complete refusal to eat. In mild cases - rituals: eats food in a certain order, at certain hours. He chooses dishes not by taste, but by shape, by color. Often, for example, a child only eats a certain shape of pasta. nine0003

4. Intellectual disorders

The main feature of the disease is selective intelligence. Autistic people may excel in math, art, and music, but lag far behind in other subjects. Savantism is a phenomenon where an autistic person is very pronouncedly gifted in one specific area. Some autistic people are able to play a tune accurately after hearing it only once, or to calculate the most complex examples in their minds. nine0003

5. Violation of the instinct of self-preservation

Autoaggression occurs in 1/3 of children with autism. Aggression is one of the main forms of response to what is happening, and since children are not inclined to communicate with others, they show this aggression towards themselves (they can beat themselves, bite, bang their heads against the crib).
Very often these children lack a "sense of edge". This can be observed even in early childhood, when the child hangs from the side of the crib, tries to get out of the stroller - the child has no fear. nine0003
Can run far from parents without looking back. If parents specifically hide in order to test the reaction, this reaction is often not.
Can climb a slide on a playground that is too old for him.
What is especially dangerous, children can run out onto the roadway, climb onto the windowsill with the window open.

6. ADHD

More often than other children, autistic children have hyperactive behavior. They are disinhibited and disorganized. Such children are in constant motion, they can hardly stay in one place, they do not respond to requests during classes, there are difficulties in controlling movements (“like on hinges”).

7. Verbal communication disorders

Speech disorders occur in all forms of autism. Speech may develop with a delay or not develop at all. Also, at the initial stages of development, speech may appear earlier than among peers, but at 1.5-2 years there is a regression - the child stops talking to others, but at the same time can fully speak to himself. nine0003
A peculiar intonation with a predominance of high tones at the end of a sentence, or the so-called "bird speech" or its own language, when the child talks to himself "under his breath."
Often children do not talk to others, but speech is present in the game. The reason is the unwillingness to interact with the outside world.

With delayed speech development, you can contact a speech pathologist. If a defectologist suspects autistic disorders, he refers to a psychiatrist. The main thing is to contact a specialist, and not be alone with this problem and not wait for everything to normalize by the age of three. It is better to immediately exclude the disease. nine0003

What to pay attention to in kindergarten? (symptoms of early autism in children after 1 year)

Aggression towards others, especially when the child's personal space is violated.
The child plays away from the others.
Children and caregivers complain about the child because he cannot interact with others, his play is destructive, he can interfere with other children's play. nine0003
Compulsive behavior - the intentional performance of actions according to certain rules, even if they go against the generally accepted ones.

Modern methods of diagnosing autism in children

Psychiatric consultation . This is a conversation with parents and observation of the child in free play. The doctor watches how the baby behaves, how it interacts with parents, whether it looks into the eyes, whether it puts objects in its hands, whether it throws it on the floor. If the child speaks, pay attention to speech, intonation, construction of phrases. The doctor carefully collects the history of the life and development of the child, the history of the mother's pregnancy. It is important when he began to utter the first sounds, when he stood up, crawled, began to walk, what was his gait. nine0003
Speech therapist consultation to rule out autistic speech. The doctor determines whether speech delay is related to autism or other disorders. Children with autism have a peculiar development of sound pronunciation, and an experienced speech therapist will immediately distinguish it.
Consultation with a neuropsychologist to identify which developmental milestones the child may have missed.
nine0002 Screening with tests (Autism Diagnosis Scales) :

D. Wexler intelligence test

Tests (cards, tasks for children) aimed at assessing general awareness, stock of knowledge and ideas about the world, the ability to assimilate and process information, and cognitive abilities.

Kaufman intelligence test

Tests to determine the strengths and weaknesses of information processing processes: visual and auditory memory, assimilation of instructions, planning a sequence of actions. nine0003

Raven Progressive Matrices

Allows you to determine the level of intellectual development of the child. Each series of tables contains tasks of increasing difficulty. Raven's progressive matrices are designed to determine the level of mental development in primary school children with any level of speech development.

Questionnaires for parents :

Sensorimotor Development Scales (ages 0-5)

To be filled in during the conversation with parents and observation of the child. They allow you to evaluate various aspects of motor and psychological development in accordance with age standards.

Vanderbilt ADHD symptom questionnaire

Allows you to assess the severity of symptoms of hyperactivity, inattention and impulsivity in various areas of the child's life.

nine0026

CARS Autism Rating Scale

One of the most commonly used tests for autism symptoms. The scale includes 15 categories.

Tests by defectologist and psychologist :

ADOS

The gold standard for diagnosing autism. Allows in a playful way to determine deviations in the communication skills of the child. The child is offered "communicative provocations" in which an ordinary child behaves in a "normal" way, a child with autism behaves differently. After the observation, a calculation is made of which behavior was more common or "autistic". According to the results of the calculation, a diagnosis is established. nine0003

ADI-r

A detailed survey that provides all the information needed to establish a diagnosis of autism and assess related mental disorders.

PEP scale

Identification of the child's individual characteristics, characteristics of his communication capabilities, cognitive activity, emotional-volitional sphere, working capacity, etc. The identified features are taken into account when drawing up an individual plan for corrective and developmental work with the child. nine0003

Autism Help at EMC

If the diagnosis is established, it is necessary to immediately start working with the child, and this work must be comprehensive:

The psychiatrist selects drug therapy (if abnormalities are detected before the age of 1 year, medications can often be dispensed with).
A psychologist, a neuropsychologist and a speech pathologist draw up an autism correction program and regularly work with the child, conducting various classes, tests, and games. nine0003

To achieve the best result, the complex work of specialists is important, and not just one psychiatrist. It is important not to waste time, but to correct autism at an early age.

Children of the rain. What you need to know about autism

11 April 2019 12:01

Behind the poetic expression "children of the rain" lies the daily feat of people who are faced with a diagnosis of autism. Children who will never be able to perceive themselves as part of the world around them, and parents for whom every day is a series of battles and victories. First, fighting with yourself, accepting and realizing that their child will never be cured, and then fighting the disease for every gesture, every smile, every look and word of the child - small, but such important victories. nine0003

Scientists have not been able to reliably establish the causes of the disease. It is known about the genetic predisposition: signs of autism are more often manifested in people whose family already has an autistic person. Pregnancy in mothers of such children proceeds normally, and the children themselves are often very attractive in appearance - autism, as a rule, does not affect the physical development of the child. However, the development of autism is still in some cases associated with the manifestation of other diseases:

cerebral palsy;
tuberous sclerosis;
impaired fat metabolism (the risk of having a baby with autism is greater in obese women).

All of these conditions can have a bad effect on the brain and, as a result, provoke symptoms of autism. However, what autism is, and what are the causes of its manifestation, is still not completely clear.

Early diagnosis plays an important role in the further development of an autistic child. Autism in children is manifested by certain signs. Early childhood autism is a condition that can manifest itself in children at a very early age - both at 1 year old and at 2 years old. What is autism in a child, and whether this disease occurs, is determined by a specialist. But you can independently figure out what kind of illness a child has and suspect him, based on information about the signs of such a condition. nine0003

Early signs of autism in a child

This syndrome is characterized by 4 main signs. In children with this disease, they can be determined to varying degrees.

Signs of autism in children are as follows:

impaired social interaction;
broken communication;
stereotyped behaviour;
early symptoms of childhood autism in children under 3 years of age.

The first signs of autistic children can be expressed as early as the age of 2 years. Symptoms may be mild when eye-to-eye contact is impaired, or more severe when it is completely absent. As a rule, autism manifests itself very early - even before the age of 1, parents can recognize it. In the first months, such children are less mobile, react inadequately to stimuli from the outside, they have poor facial expressions. nine0003

The child cannot perceive a holistic image of a person who is trying to communicate with him. Even in the photo and video, you can recognize that such a baby's facial expressions do not correspond to the current situation. He does not smile when someone tries to amuse him, but he can laugh when the reason for this is not clear to anyone close to him. The face of such a baby is mask-like, grimaces periodically appear on it.

Baby uses gestures only to indicate needs. As a rule, even in children under one year old, interest is sharply shown if they see an interesting object - the baby laughs, points with a finger, and demonstrates joyful behavior. The first signs in children under 1 year old can be suspected if the child does not behave like this. Symptoms of autism in children under one year old are manifested by the fact that they use a certain gesture, wanting to get something, but do not seek to capture the attention of their parents by including them in their game. nine0003

An autistic person cannot understand other people's emotions. How this symptom manifests itself in a child can be traced already at an early age. If ordinary children have a brain designed in such a way that they can easily determine when they look at other people, they are upset, cheerful or scared, then an autistic person is not capable of this.

The child is not interested in peers. Already at the age of 2, ordinary children strive for company - to play, to get acquainted with their peers. Signs of autism in children of 2 years old are expressed by the fact that such a baby does not participate in games, but plunges into his own world. Those who want to know how to recognize a child 2 years old and older should simply look at the company of children: an autist is always alone and does not pay attention to others or perceives them as inanimate objects. nine0003

It is difficult for a child to play with imagination and social roles. Children 3 years old and even younger play, fantasizing and inventing role-playing games. In autistics, symptoms at 3 years old may be expressed by the fact that they do not understand what a social role in the game is, and do not perceive toys as integral objects. For example, signs of autism in a child of 3 years old can be expressed by the fact that the baby spins the wheel of a car for hours or repeats other actions.

Child does not respond to emotions and communication from parents. Previously, it was believed that such children are not emotionally attached to their parents at all. But now scientists have proven that when a mother leaves, such a child at 4 years old and even earlier shows anxiety. If family members are around, he looks less obsessed. However, in autism, signs in children of 4 years old are expressed by a lack of reaction to the fact that parents are absent. The autist shows anxiety, but he does not try to return his parents. nine0003

In children under 5 years of age and later, there is a delay in speech or its complete absence (mutism). The speech is incoherent, the child repeats the same phrases, devoid of meaning, speaks of himself in the third person. He does not respond to other people's speech either. When the “age of questions” comes, parents will not hear them from the baby, and if they do, then these questions will be monotonous and without practical significance.

Stereotyped behavior includes obsession with one activity, repetition of daily rituals, development of fears and obsessions. At the same time, if the sequence of the ritual is violated, the child becomes hysterical or may show aggression or self-aggression. nine0003

Can autism be cured and is it curable at all? Unfortunately, there is no cure. How you can help your child depends on each individual case. Drug treatment is prescribed only in case of destructive behavior of a small patient. But, despite the fact that the disease is not curable, it is possible to correct the situation. The best "treatment" in this case is regular practice every day and the creation of the most favorable environment for the autistic. Classes are held in stages:

To form the skills that are needed for training. If the child does not make contact, gradually establish it, not forgetting who it is - autistics. Gradually it is necessary to develop at least the rudiments of speech. nine0030
Eliminate forms of behavior that are non-constructive: aggression, self-aggression, fears, withdrawing into oneself, etc.
Learn to observe, imitate.
Teaching social games and roles.
Learn to make emotional contact.

The most common treatment for autism is practiced according to the principles of behaviorism (behavioral psychology). One of the subtypes of such therapy is ABA therapy. The basis of this treatment is to observe what the reactions and behavior of the baby look like. After all the features are studied, incentives are selected for a particular autist. Speech therapy practice is obligatory: if the kid regularly works with a speech therapist, his intonation and pronunciation are getting better. At home, parents help the child develop self-service and socialization skills. Since autists have no motivation to play, they get used to the daily routine, everyday affairs, cards are created where the order of performing this or that action is written or drawn. nine0003

Why is early diagnosis important? There are conditions that mimic autism that can be confused with its symptoms. But other methods are used to correct them.

ZPRR with autistic features

The symptoms of this disease are associated with a delay in psychoverbal development. They are in many ways similar to the signs of autism. Starting from a very early age, the baby does not develop in terms of speech in the way that existing norms suggest. In the first months of life, he does not babble, then he does not learn to speak simple words. At 2-3 years old, his vocabulary is very poor. Such children are often poorly developed physically, sometimes hyperactive. The final diagnosis is made by the doctor. It is important to visit a psychiatrist, speech therapist with the child. nine0003

Attention deficit hyperactivity disorder

This condition is also often mistaken for autism. With a lack of attention, children are restless, it is difficult for them to study at school. There are problems with concentration, such children are very mobile. Even in adulthood, echoes of this state remain, because it is difficult for such people to remember information and make decisions. You should try to diagnose this condition as early as possible, practice treatment with psychostimulants and sedative drugs, and visit a psychologist. nine0003

Hearing loss

These are various hearing impairments, both congenital and acquired. Hearing-impaired children also have speech delays. Therefore, such children do not respond well to the name, fulfill requests and may seem naughty.