Developmental Screening for Autism Spectrum Disorder
Autism spectrum disorder (ASD) is a serious developmental nervous system disorder, and symptoms begin before the age of 3 years and last throughout a person’s life, although some symptoms may improve over time. According to the last survey by Centers for Disease Control and Prevention in the United States in 2020, the overall ASD prevalence was 27.6 per 1,000 (one in 36) children aged 8 years and was 3.8 times as prevalent among boys as among girls (43.0 versus 11.4). Some children with ASD show some problems within the first few months of life, but parents do not detect them because they think those symptoms for neonate and toddlers are natural, and they hope their children will gradually grow up like others. In some other children, symptoms may not show up until 24 months or later. Also, there is a group of children with an ASD that develop normally until around 18 to 24 months of age, but they stop learning new skills while losing previously acquired skills which had been learned. According to survey study, one third to half of parents of children with an ASD noticed a problem before their child’s birthday, and nearly 80%–90% saw problems by 24 months of age, but unfortunately, the average age of diagnosis in the United States is about 5 years old (California 36 month and Minnesota 59 month). Therefore, early screening evaluation by professionals is critical, and it makes a huge impact on children’s lives as intervetion treatment plans can be started earlier.
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 doctor visits at 18 and 24 months.
Additional screening might be needed if a child is at high risk for ASD or another developmental problem. For example, having a sister, brother or another family member with an ASD or another delayed developmental disease, preterm or low birth weight, lead exposure, or other factors, the doctor and your healthcare provider may also discuss additional screening tests for diagnosis of ASD from other diseases. Parents must be considered that the golden age for treatment and the greatest result is under age of 5, so early intensive intervention programs can substantially improve children’s development and provide a significant difference in their lives.
Tips for Parents
If your child exhibits any of the following symptoms, immediately ask pediatrician, family doctor, or professional person for an evaluation:
By 6 Months
• No eye contacts
• No big smiles or laughing or joyful expressions
By 9 Months
• No interesting to share back and forth smiles, sounds or other facial expression
By 12 Months
• No responding to his/her name
• No pointing to or showing objects
• No providing sounds such as babbling
By 16 Months
• No or few vocabularies and words
By 24 Months
• Limited to make a two-words phrases (e.g., I want, Give me, Green Car)
• Very limited or none meaningful communication
At Any Age
• Loss of previously acquired speech, babbling or social skills
• Avoidance of eye contact
• Persistent preference for being alone
• Difficulty understanding other people’s feelings
• Delayed language development
• Persistent repetition of words or phrases (echolalia)
• Resistance to minor changes in routine or surroundings
• Restricted interests
• Repetitive behaviors (flapping, rocking, spinning, etc.)
• Unusual and intense reactions to sounds, smells, tastes, textures, lights and/or colors
M-CHAT TEST
The M-CHAT (Modified Checklist for Autism in Toddlers) as a screening test can help family and teachers to determine if a professional should evaluate the child. This test has recently revised (M-CHAT-R) and consists 20 questions about child’s behavior, and parents are required to respond “yes” or “No” to each question. This screening test is used for toddlers from 16 months to 30 months.
Score interpretation:
1. Total score is 0-2: the score is LOW risk. No follow- up needed.
2. Total score is 3-7: the score is MODERATE risk. Child must be evaluated by professionals.
3. Total score is 8-20: the score is HIGH risk. Child must be evaluated by professionals.
Notice that this test is a screening test and the rate of success is not 100%, so this test is used in combination with health and family history as well as conducting other developmental assessment tests, genetic or neurologic tests for the final diagnosis. If parents have any concerns or questions, even without tests, they must contact to a primary care physician or child’s health provider to be checked and refer to a specialist such as psychiatrist, doctor psychologist, or other person who has been qualified to diagnose ASD or other developmental disabilities.
Related Link:
1. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Pages/autism-initiatives.aspx
2. https://www.healthychildren.org/English/health-issues/conditions/Autism/Pages/How-Doctors-Screen-for-Autism.aspx
3. http://dx.doi.org/10.15585/mmwr.ss7202a1.
4. https://stacks.cdc.gov/view/cdc/124397