My child may have autism…

Throughout this website we use the term 'autism' to refer to all Autism Spectrum Disorders.

What are the early signs of autism?

Autism spectrum disorders (ASD) are a group of similar developmental disorders whose symptoms that appear in the first three years of life and are characterized by problems with reciprocal social interaction and communication, and the presence of restricted behaviors, interests and activities.

The table below displays the diagnostic criteria for autistic disorder, the most impairing diagnosis on the spectrum. Asperger’s disorder is characterized by impairments in social interaction and restricted and repetitive behaviors and interests, but language development is typical. Individuals with Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) do not meet criteria for autistic or Asperger’s disorders, but still exhibit many of these symptoms.

Individuals with ASD usually have difficulty interacting with other people and may not be interested in common childhood social interactions, like cuddling or sharing their interests with loved ones. They also may have trouble using language to express themselves. While strange or repetitive behaviors don’t occur in all individuals with ASD, many people with ASD insist on certain routines or patterns in everyday life or want to play with toys in odd ways, like lining them up in precise rows. The presentation of ASD can vary widely among affected individuals and within an individual over the lifespan.

Diagnostic Criteria for Autistic Disorder from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition

A. At least 6 items from (1), (2) and (3), with at least 2 from (1), and one each from (2) and (3):

(1) Qualitative impairment in social interaction, manifested as at least 2 of the following:

(a) marked impairment in nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture social interaction gestures

(b) failure to develop peer relationships appropriate to developmental level

(d) lack of social or emotional reciprocity

(2) Qualitative impairments in communication manifested as at least one of the following:

(a) delay or lack of development of language, not accompanied by an attempt to compensate through other modes of communication

(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others

(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(3) Restricted, repetitive and stereotyped patterns of behavior, interests and activities, manifested as at least one of the following:

(a) encompassing preoccupation with stereotyped and restricted patterns of interest that are abnormal in intensity or focus

(b) apparently inflexible adherence to specific, nonfunctional routines or rituals

B. Abnormal functioning, with onset prior to age 3, in social interaction, social communication, or symbolic or imaginative play

C. Not better accounted for by Rett’s Disorder or Child Disintegrative Disorder

(Diagnostic and Statistical Manual for Mental Disorders, 4th ed., 2000)

All children develop cognitive, emotional and physical skills at different paces. Minor differences in when children start to smile, walk or talk probably do not have much effect on their overall development. There are certain developmental milestones, however, that all children should reach by a certain age. If your child is not doing the things list below, you should contact a pediatrician for an evaluation.

No or few expressions of emotion by six months (i.e., smiling, attention shift, satisfaction)
No communication using sounds or facial expressions by nine months
No babbling by 1 year
No communicative gestures (i.e., pointing, showing, reaching, or waving) by 1 year
No words by 16 months
No two-word fluent phrases (without imitating or repeating) by 2 years
Any loss of speech or babbling or social skills at any age
For more information please visit the Centers for Disease Control website on Autism.

What do I do if I think my child has autism?

If you are concerned about your child’s development, see your child’s primary care physician for evaluation and referral to a specialist for evaluation. Write down your concerns before the visit as not to forget to share important information. If the doctor says that you shouldn’t worry, ask at what point you should start worrying. Ask questions about what the doctor is basing his or her decision on, and/or ask for a standardized developmental screening test.

Remember that it is important to act early! Contact your local Early Intervention providers for an evaluation if you are concerned. The PA Department of Public Welfare Bureau of Early Intervention Services can provide more information. Early intervention services can result in substantial progress for children with developmental delays.

Who should I talk to for a diagnostic evaluation?

When children are suspected of having autism or any other developmental delay they should be referred to a specialist for further evaluation. The following specialists commonly evaluate individuals suspected of having ASD:

Child psychiatrist- A medical doctor who is involved in the diagnosis and treatment of mental and emotional disorders in children. Child psychiatry training typically includes a preclinical phase and a clinical phase prior to graduate medical education, specializing in children. A child psychiatrist also has the ability to prescribe medication.
Clinical psychologist- Assesses mental health problems, conducts scientific research to understand mental health problems, and provides psychological care and interventions. A clinical psychologist should perform standardized, written psychological assessments to aid in making an appropriate and diagnosis and choosing treatment. A doctoral degree (PhD) is usually required for independent licensed clinical practice and counseling.
Developmental pediatrician- A medical doctor who conducts comprehensive developmental assessments for children. A developmental pediatrician typically assesses children suspected of having developmental delays, including language, motor or cognitive delays. Developmental pediatric training includes a preclinical phase and a clinical phase prior to graduate medical education, specializing in the development of infants and children. A developmental pediatrician also has the ability to prescribe medication.

What should I ask the specialists who evaluate my child?

It is important to get a referral to a specialist as soon as possible. Wait lists for appointments are often long. The purpose of the evaluation is to provide a diagnosis if needed, discuss child’s strengths/weaknesses, define needs, develop a treatment plan, and monitor high risk children. The diagnosis should be determined based on an examination of the child’s five developmental areas:

Social/emotional- understanding and interaction with adults and other children
Physical- gross motor skills like running and climbing, and fine motor skills like drawing and cuttin
Cognitive- puzzles, identifyin and counting things
Adaptive- important skills around the house (dressing, eating) and in the community
Communicative- using and understanding gestures and words to communicate with others

In addition to using their own clinical judgments when considering a diagnosis, clinicians usually use standardized tests along with reported observations. A full evaluation may take one or two visits. Be sure to ask whomever schedules your appointment if there is a follow-up visit as well. The evaluation may consist of the following elements:

A history of the child’s development including questions for the parent about when the child learned to walk and talk, habits and behaviors, likes and dislikes. Documentation such as medical records and baby books that may indicate exactly when the child first walked or talked will be helpful to the physician.
Specific questions about the mother's pregnancy
Family history of illnesses or disorders.
A physical examination, usually including a neurological examination
A general developmental assessment tool

Specific ASD testing tools may also be administered to determine a diagnosis. Examples of these ASD specific instruments/tests include:

Autism Diagnostic Interview-Revised (ADI-R)
Autism Diagnostic Observation Schedule (ADOS)
Checklist for Autism in Toddlers (CHAT)
Childhood Autism Rating Scale (CARS)
Social Communicatin Questionnaire (SCQ)
Modified Checklist for Autism in Toddlers (M-CHAT)
Aspergers Syndrome Diagnostic Scale (ASDS)

Ask lots of questions! To help you learn more about autism and your child, some helpful questions to ask include:

When do symptoms of autism typically appear?
What type of symptoms could appear?
What types of tests/assessments are given to diagnose autism?
Where are the tests done?
How reliable are the tests?
Does my child have autism? Mild or severe?

When the child’s evaluation is complete, you will be sent a doctor's note including a list of recommendations appropriate for your child's development and his or her behaviors. Ask questions following the evaluation as well. The following questions can help guide your discussion with the professional after the evaluation:

What does this diagnosis mean?
Where can I find reliable information about my child’s diagnosis?
Is there a wait list to see the specialist? How long? (ask when scheduling appointment)
Will my visit be covered by my insurance or Medical Assistance?
What kinds of interventions are available?
How will I know if the services and interventions my child is getting are working?
How can I reach you if I have questions after this visit?
Who else can you refer me to for a second opinion?
Can you refer me to any local support groups to my area?

Make an Appointment

There are many qualified centers in Pennsylvania to have children evaluated for developmental delays. Ask your pediatrician for a referral to a provider for an evaluation. For further resources, please contact us.

What if your child does not receive a diagnosis of autism, but you are still concerned with his or her developmental delay?

If your child does not receive a diagnosis for autism, but you are still concerned that their development is delayed, please contact Early Intervention services to see if they qualify for services. Contact the PA Department of Public Welfare Bureau of Early Intervention Services for more information.

*UPENN does not advocate or endorse any specific provider/organization. The providers and organizations listed on this website are intended for informational use only.