How do I know if my child is developing typically?

To identify any possible developmental delays, your child’s development could be compared to what most children his/her age are doing, formally called developmental milestones. Developmental milestones are accomplishments expected by certain ages (talking, walking, sharing social experiences, etc.). If delays are present, early intervention can have a significant and lasting impact. To help parents determine if their child is progressing typically, www.cdc.gov/actearly has lists of developmental milestones from 2 months to 5 years. They also provide a free Milestone Tracker app for documenting a child’s development. Early diagnosis and treatment is critical. Please discuss any questions or concerns with your healthcare providers.

Many parents of children ultimately diagnosed with ASD became concerned when their child did not reach developmental milestones, such as responding to their name, making eye contact, imitating sounds or actions, or starting to talk.

Some have significant delays in many areas, but others may be ahead of their age in certain areas yet behind in others. For example, a child with ASD may be able to complete a jigsaw puzzle with ease but show no interest in sharing that accomplishment with others. Another may have had no language delay but difficulty having conversations or playing with others. While most children later diagnosed were determined to have been behind on their milestones all along, 25-30% had typical skills at 12-18 months but then significantly regressed.

According to the CDC, caregivers should be alert to the following red flags.

Children with ASD might not:

  • Respond to their name by 12 months of age

  • Point at objects to show interest by 14 months

  • Play pretend (such as feeding a doll) by 18 months

Additionally, they may:

  • Avoid eye contact

  • Have trouble understanding other people's feelings or expressing their own

  • Have delayed speech and language skills

  • Excessively repeat words or phrases (called echolalia)

  • Give unrelated answers to questions

  • Become very upset by minor changes

  • Have obsessive interests

  • Flap their hands, rock their body, or spin in circles

  • Have unusual reactions to the way things sound, smell, taste, look, or feel

There are specific research-based and effective ways to teach these skills to children with ASD. While there is no “cure”, early diagnosis and appropriate intervention can greatly improve abilities and quality of life. Caregivers are encouraged to reach out right away if they have any concerns. The first step is to ask their pediatrician for a developmental screening to see if an autism-specific evaluation is warranted.

What does the diagnostic process entail?

The American Academy of Pediatrics recommends that pediatricians screen for ASD during well visits at 18 and 24 months and at any time a parent raises a concern. This involves asking the parent about their child’s progress toward typical milestones. They may use a screening instrument, such as the Modified Checklist for Autism in Toddlers (M-CHAT) or the Childhood Autism Rating Scale (CARS). If the screening indicates red flags for autism, the pediatrician may recommend that the child participate in a multidisciplinary evaluation.

There are currently no medical tests to diagnose autism, so specialized diagnosticians (neurologists, psychologists, developmental pediatricians, or psychiatrists) use specific observational tools to determine if the individual meets the criteria. The gold standard assessment is the Autism Diagnostic Observation Schedule/Autism Diagnostic Interview-Revised (ADOS/ADI-R). These tools assist the diagnostician in observing the individual in different scenarios and extensively interviewing the caregiver. Though most are children, individuals can be diagnosed at any age. Some diagnoses include a level 1, 2, or 3 notation to describe the level of support needed (level 3 denotes the most significant support needs).

To qualify for a diagnosis of ASD, the individual must meet the criteria established by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In 2013, ASD became the formal diagnosis, replacing these previously used terms: autistic disorder (autism), Asperger’s Disorder, Pervasive Developmental Disorder, Pervasive Developmental Disorder Not Otherwise Specified, and Childhood Disintegrative Disorder.