Throughout this website we use the term 'autism' to refer to all Autism Spectrum Disorders.
What is autism?
What are the early signs of ASD?
What do I do if I think my child has autism?
Who should I contact for a diagnostic evaluation?
What should I ask specialists who evaluate my child?
Make an appointment
What if my child does not receive a diagnosis of autism, but I am still concerned with his or her developmental delay?
Autism spectrum disorders (ASD) are a group of similar developmental disorders whose symptoms appear in the first three years of life. They are characterized by problems with reciprocal social interaction and communication, and the presence of restricted behaviors, interests and activities. The most severe diagnosis on the spectrum is autism. For more information on autism, please click here.
Other autism sprectrum disorders include:
Asperger’s disorder -symptoms include impairments in social interaction and restricted and repetitive behaviors and interests, but language develops at a normal rate. For more information about Asperger’s disorder, please click here.
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. For more information about PDD-NOS, please click here.
Rett’s Disorder (also known as Rett Syndrome) – symptoms include normal early development followed by a loss of acquired motor and social skills between 6-18 months and a slowing of head growth, primarily found in girls. It often is misdiagnosed as autism. For more information about Rett’s Disorder, please click here.
Childhood Disintegrative Disorder - characterized by normal early development followed by a loss of language, cognitive, and/or social skills at around age 3 or 4. For more information about Childhood Disintegrative Disorder, please click here.
What are the early signs of ASD?
In general, individuals with ASD usually have trouble interacting with others 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 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.
Autism
Included below are some of the symptoms of classic autism. Keep in mind that all children develop cognitive, emotional and physical skills at different paces. Minor differences in when children start to smile, walk or talk probably will 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 listed below, you should have a pediatrician evaluate him or her.
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No or few expressions of emotion by six months (i.e., smiling, attention shift, satisfaction)
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No communication using sounds or facial expressions by nine months
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No babbling by 1 year
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No communicative gestures (i.e., pointing, showing, reaching, or waving) by 1 year
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No words by 16 months
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No two-word fluent phrases (without imitating or repeating) by 2 years
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Any loss of speech or babbling or social skills at any age
Although the symptoms of autism are similar at different ages, there are some subtle variations in noting when an individual may be on the spectrum. For a more complete list of signs of autism, please refer to this list. Additional important developmental milestones can be found here.
For a more formal understanding of what constitutes autism, refer to the table below which includes the diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. This manual was developed and is continually updated to ensure that mental health professionals are using the same criteria for diagnosis.
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): |
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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)
Asperger’s Syndrome
Although closely related to autism, the symptoms of Asperger’s are not exactly the same. Many people with Asperger’s are less affected than those with autism and can lead normal, productive lives. The main impairment in Asperger’s syndrome is an inability to interact with others in social situations. Individuals with Asperger’s typically have normal intelligence and (by definition) cannot have a significant cognitive deficit, according to diagnostic criteria.
Here are some additional general signs of Asperger’s:
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Inability to function in typical social situations or pick up on social cues
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Seems to lack empathy
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Appears uninterested in conversation or lacks appropriate eye contact
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Obsessive interest in specific activity
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Flat speech that lacks appropriate intonation or tone
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Lack of understanding of abstract concepts like humor or sarcasm
For a more complete set of warning signs of Asperger’s, please refer to this list. If you start to notice any of these warning signs, be sure to take action! Refer to the “What do I do if I think my child has autism?” section for more information.
For a more formal understanding of what constitutes Asperger’s, refer to the table below which includes the diagnostic criteria according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders). This manual was developed and is continually updated to ensure that mental health professionals are using the same criteria for diagnosis.
| Diagnostic Criteria for Asperger’s Syndrome from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition |
| A. Qualitative impairment in social interaction, as manifested by at least two of the following: |
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| B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: |
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| C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning. |
| D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years) |
| E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood. |
| F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia. |
PDD-NOS
This category is used for individuals that do not fit into the definition of another mental disorder as stated by the DSM. Often, children with PDD-NOS have the symptoms of autism as described in the DSM, but they may not follow the exact configuration presented or be just below the amount of symptoms needed to qualify. Late onset of symptoms or atypical symptoms also may qualify a child for this category. If a loved one exhibits many symptoms of autism but does not match the criteria as specified in the autism diagnostic table, they may still qualify as PDD-NOS and be entitled to services and support. For more information about PDD-NOS and an example case, please click here.
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 it appears someone you know may have autism or any other developmental delay they should be referred to a specialist for further evaluation. The following specialists commonly test individuals who may have ASD:
- Child psychiatrist- A medical doctor (MD) who diagnoses and treats mental and emotional disorders in children, and can also prescribe medication.
- Clinical psychologist- Assesses and conducts research to understand mental health problems and provides psychological treatment. . A doctoral degree (PhD) is usually required.
- Developmental pediatrician- A medical doctor (MD) who conducts developmental assessments for children, typically those who may have a delay, and can also prescribe medication.
- School psychologist – Conducts evaluations on students, consults with parents and teachers about students’ progress, and works with students on behavioral issues. States vary in license requirements and in whether or not they can make definitive autism evaluations
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
- monitor high risk children.
The diagnosis should be determined based on an examination of the child’s five developmental areas:
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 such topics as:
- when the child learned to walk and talk
- habits and behaviors
- likes and dislikes
- the mother's pregnancy
- family history of illnesses or disorders.
Be prepared! 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.
- 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 Scales (ASDS)
Other evaluations that could be done include:
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Gastroinestinal (GI) issues – Many children with ASD have co-occuring GI issues, such as diarrhea and constipation. Be sure to inform your doctor if you have experienced any of these issues and ask for an appropriate specialist.
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Neurological- a series of tests that will assess the neurological functioning of an individual. Such tests will likely include a discussion of the history of symptoms and physical tests such as an EEG or MRI which can reveal issues in the nervous system. Typically performed by a neurologist.
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Genetic Testing - Examines an individual's DNA to see if the individual has any autism-specific markers. These types of tests are still being studied to determine their reliability and validity.
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? Or, if you do not receive a diagnosis, what should my next step be?
- Where can I find reliable information about my child’s diagnosis?
- Will my visit be covered by my insurance or Medical Assistance?
- What kinds of interventions are available?
- Will these interventions be covered by my insurance or Medical Assistance?
- 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.