When to seek an evaluation?

Parents may have questions about what behaviors to look for if they are concerned with Autism Spectrum Disorders (ASD). As the name entails, ASD is a spectrum where no 2 children are the same. It is often said that “If you meet one child with Autism, you’ve met one child with Autism.” But this becomes confusing for parents, as the typical picture of a child with an ASD is the severely impaired child who flaps (aka stims), has minimal communication skills, and may even demonstrate severe behaviors. Yet, a child who may appear to be like a typically developing child who may have some “quirks,” “oddities,” or maybe social awkwardness may also be a child with an ASD.

Unlike a child with Down’s Syndrome (for example) where a chromosomal defect is known, there is no known cause for an ASD. There is no blood test or one specific evaluation tool that can tell with certainty that a child may develop an ASD. A comprehensive evaluation is required to determine the presence of an ASD and rule out any other factors.

School Psychologists, Developmental Pediatricians, Clinical Psychologists, and many other professionals have training in tools and assessments that can help determine the presence of an ASD. The question I usually hear is “How do I know if my child has Autism?” The only way to know with certainty is to have them assessed by a qualified professional who incorporates a variety of tools. This means that the professional does not use just one assessments and make a determination one way or the other. Rather, the trained professional uses a variety of tools including parent input, teacher or other childcare provider input, observations, assessments, rating scales, and direct assessments with the child.

The next question I hear is “Does my child have Autism?” This is usually based on observations of behaviors by parents or other individuals who work with the child. Sometimes, other people provide (sometimes unsolicited) advice suggesting that the child may have Autism. Parents also tend to do a lot of research on the internet. When should a parent be concerned and seek out an evaluation specific to Autism? What behaviors or characteristics typically prompt a parent to seek an evaluation?

Before getting into some possible signs to be concerned about, parents must remember that just because a child may exhibit a characteristic noted here, that does NOT mean their child has Autism. There is usually a preponderance of symptoms, not just one or 2. Yet, parents are encouraged to seek an evaluation as it is often better to rule out than assume there are no concerns. Early intervention is most beneficial, so the earlier a possible ASD is diagnosed the earlier interventions can be implemented.

So, what characteristics can parents or other caregivers look for to determine the need for an evaluation?

Does your child engage in eye contact with you to enjoy something together? For example, if your child is playing, do they look back to you to show you something they accomplished, looking near your eyes or generally at your face? If you were to point across the room to something of interest, would they follow your point or your gaze to look as well? If your child is asking for something or getting their needs known, do they look up at you while communicating? If the answer is no to these questions, your child may be demonstrating difficulty with joint attention and is one characteristic in many children with an ASD. This is one of the usual early signs parents note or look back to after their child is diagnosed and is often a sign seen in very early development.

Does the child show a preoccupation with a specific topic? Maybe they gear every conversation to their interest even if the conversation started on something completely different? Does the child insist on watching the same TV show or movie and is unable to watch anything else without a meltdown? This preoccupation or restricted interest may be a characteristic of an ASD.

Have you noticed your child always lines up toys, puts things in a specific order, or maybe flaps their hands or flicks their fingers? Maybe they look very intently at the wheels of cars or other objects that turn, but not to see how it works? Are there concerns with high or low reactivity to sounds or visual stimuli (e.g. Does the child appear to overreact to a sound that is not that loud, or under-react to a sound that is extremely loud)? These could be signs of a possible ASD.

Are changes in routines difficult for your child? If they typically anticipate a snack immediately after coming home from school and that is not possible today, do they have a meltdown? If you take a different way to visit relatives, does your child scream or is otherwise unable to engage once at the relative’s house? Or maybe the bedtime routine changed with a story first before bath rather than after and this caused a meltdown that kept your child from going to bed at their usual time? Significant difficulty with changes in routines are often associated with an ASD.

Does your child have difficulty playing with their siblings or peers at school? Do they seem to have trouble understanding social communication that is typical for their age? Does your child seem to engage physically with a peer because they want to play, but typically peers use words to enter or initiate play? Social communication difficulties can be associated with an ASD.

While no single one of these characteristics suggests your child has an ASD, if multiple characteristics are noted, it might be wise to have an evaluation.

Parents also wonder about Asperger’s versus Autism. Asperger’s Syndrome is a part of the Autism Spectrum and is usually considered to be another term for “High Functioning Autism.” However, Asperger’s was considered to be a different disorder. Within the past few years, the medical community published the most recent version of the Diagnostic and Statistical Manual (DSM-5), which includes the diagnostic criteria for many mental health disorders, including Autism. With this publication, all Autism Spectrum Disorders, including Asperger’s Syndrome, were included under ASD.

After reading through these symptoms, some people will remark “Well that sounds like everyone” or “That sounds like me” or “That sounds like me kid, but he/she isn’t Autistic!” Many people even as adults can demonstrate some of the characteristics but are not considered to have an ASD. I recommend that parents and families seek an evaluation to rule it out If there are any concerns. It does not hurt the child to go through an evaluation, and it often provides a wealth of great information.

If you want to know more, have questions about your child, or would like to seek an evaluation, please contact me!