Is Autism Routinely, Radically Misdiagnosed?

In this, the first in a series of articles about supposedly mistaken diagnoses of children allegedly confronting autism, the Hughes Brothers say loudly and right up front here, “We are making no judgments. We’re not qualified to make judgments. We’re reporting. We’re gathering information on every side, the top and the bottom, every last nook and cranny of medical research into Autism Spectrum Disorder (ASD), by whatever name shall ye call it.”

And so please. Please, please use our discussions, our reportage as grist for your own personal investigation into the various clinical issues swirling about the rapidly increasing instance of diagnosed autism in our children. Draw your own conclusions, we beg of you.

In the meantime, we will do our non-professional very best to uncover the nuances of current medical thinking – pro, con, up, down, and all around –the behavioral and developmental patterns surrounding a child you love. As always, we will try to help you make some sense of the daily challenges you face as a parent, a sibling, a guardian, a teacher, a relative, a friend who cares so very deeply about a little one whose little life refuses to conform to any number of societal, of clinical, of individual norms.

Read on, please.

Together, we might make some sense of all this.

Autism by the numbers

The numbers, their multiplication, their seeming random aggregation toward an epidemic

In the past thirty years, diagnosis of autism in children has skyrocketed from, back then, one in five thousand to one in just over a hundred, these numbers the calculations of the Centers for Disease Control and Prevention. Elsewhere in these pages, the Hughes Brothers have documented incidence of diagnosis but seventy percent of that last CDC number: one child in sixty-eight now determined to be somewhere along the autism spectrum.

Kindly forgive the vulgarity.

But what the hell is going on here?

That problematic, that slapdown nowhere word “epidemic.”

Here comes bedrock fact, indisputable dictionary-definition truth about the spread of a physical illness, the sad collective state of infection we call an epidemic.

Know this.

The rapid proliferation, by whatever means, of any developmental or genetic disorder is – yesterday, today, tomorrow – scientifically impossible.

Genetics, the manifestation of at least nine months of one-on-one-on-one progression, simply cannot produce the sweeping, all-at-once phenomenon of what qualifies as an epidemic.

It just can’t happen.

Autism Epidemic

So, what if it’s not an epidemic at all?

In some articles immediately forthcoming, we’ll barge into the turgid waters surrounding specific scholarship proving, maybe, that autism just cannot be genetic. Rather, the learned doctors, the investigative geniuses we are about to trot before you, will argue with some scope and some heft that what we call autism, for the most part, remains a symptom of a treatable neurological disease attacking the brain’s immune system. Autism, they will argue, comes forward as a medical problem, a disease, not by any means a psychological or developmental issue.

Rather, occurring as a result of a dysfunction in the neuro-immune system, autism rides along with, oh, AIDS, ADD/ADHD, and chronic fatigue syndrome as examples of secondary neurotropic viruses. And the damage, the deep-down damage, they can do.

Meet Dr. Michael J. Goldberg.

In no, no way might the Hughes Brothers better begin our discussion of alternative diagnoses of autism than with the overpowering, the all-inclusive credentials of Dr. Goldberg.

· Received his medical degree from UCLA and trained at LAC-USC Medical Center

· President of the Neuro-Immune Deficiency (NIDS) Medical Advisory Board

· On the clinical teaching staff at both UCLA and Cedars-Sinai Hospitals

· Seventeen years’ experience in evaluating and treating autism, ADD/ADHD, and chronic fatigue syndrome

Hang on. The ride might bump around a bit.

Signs of Autism in Girls, Part 2

The criteria described here below and in our preceding article should serve as potential indicators, and nothing much more. No singly symptom alone can suggest autism. If a symptom or two become more pronounced as the years pass, parents or guardians should be able to look back and see there a pattern of behavior enduring from the toddler years onward. And crucially, always and always, look for limitations of daily functioning. If, the presence of symptoms aside, your daughter is progressing with her school work, enjoying her life, making and keeping friends, then not to worry overmuch.

Regardless, if you believe that some of these signs, collectively, describe your loved one, then evaluation by an expert clinician is probably in order. Be certain, however, that the evaluator, or team of evaluators, you select has specific experience with girls on the autism spectrum.

Some more signs then

· The young lady is typically described as “shy” or “quiet” by her teachers and classmates. Diffidence, in and of itself, does in no way indicate autism, not at all. At the same time though, difficulties with language – either receptive or expressive, or both – could be inhibiting a more active role in conversations, a quicker and more natural response to unfolding social situations or to engagements in the classroom.

· In the same vein, unusual passivity, a sign that your loved one doesn’t know what to say or do. She may be playing it safe, sitting silently, choosing to say nothing out of fear saying something wrong, something inappropriate. Know too that some people with autism are anything but passive, displaying self-assertion, if not outright aggression, at every turn. This conflicting sets of indicators again demonstrate the difficulties of diagnosis.

· You notice changes in her behavior as she enters the teenaged years, a tumultuous time in everyone’s life, with autism or not. The changes will usually come in her social communication, easy and forthright as a young girl, but now troubled, increasingly hard for her. The Hughes Brothers have read accounts of young girls with high-functioning autism coping with the difficulties of social interaction, masking their feelings, allowing even encouraging others to speak in their place. Even the best adaptors, the brightest of young girls, find that this strategy disappoints them amid the whirlwind of social expectations as a teenager. The old tactics of darting and feinting in social encounters no longer work.

· And, finally, a dramatic, inescapable indicator – epileptic seizures. Again, while these seizures may arise from all sorts of disorder in the brain, studies show that seizures are more common among girls with autism than among the male counterparts.

The Hughes Brothers give all the credit, all the sympathy in the world to a young lady who has confronted her difficulties, has found away to function amid those challenges. Should you discover that your daughter is, in fact, autistic, take comfort in the depth and scope of treatments, of potential responses to the disorder. Most public school systems can create a plan appropriate for her particular needs. And many parents consider charter or private schools, where smaller classes, more individual attention can serve her well.

Another alternative perhaps

At the Children’s National Health System, and specifically the Center for Autism Spectrum Disorders there, clinicians have developed a cognitive behavioral intervention program called “Unstuck and on Target”, a complete program created to teach autistic kids flexibility, goal setting, and planning. Early trials show the program to be especially for children of elementary-school age placing somewhere on the autism spectrum. Meanwhile, further testing is going forth on the program’s effectiveness for middle- and high-school-aged kids, who face many more challenges each day to their decision-making skills.

Autism in Girls

The Hughes Brothers report these numbers with sadness.

One American child in sixty-eight is affected by autism, with boys included in that fraction at a rate five times that of girls.

New research suggests, however, the diagnostic methods currently recognized as best medical practice often overlook girls, a distressing thought meaning that even more young people may find themselves on the spectrum of autism disorder.

Three principal reasons for this newfound disparity

· Findings – from both behavioral analysis and preliminary neuroimaging – manifest themselves differently in girls, most specifically in that young females with autism are closer in their social skills to males developing typically.

· Almost all of the criteria for diagnosing autism have been built around boys, including behaviors that in girls might heretofore have been diagnosed as obsessive-compulsive disorder or attention-deficit/hyperactivity disorder or, even, anorexia.

· Until recently, prevailing clinical opinion held that, if autism were to manifest itself in girls, the symptoms would be far more severe than in boys, particularly in intellectual disability. Not necessarily so, the new research says.

Compensation and clinical bias, unintended, of course

Autism’s skewed gender ratio may arise, first of all, from girls ability to hide or to compensate somehow for the symptoms of ASD. The abilities in social situations cover for some of the underlying behavioral symptoms of the disorder. Further, ongoing research tells us that biological factors – girls and boys are indeed different – might prevent the development of the condition, beginning at birth.

The bias, based on all best thinking at the time, has historically called for more, and more serious, behavior problems or more troubles intellectually, or both, in girls before a diagnosis of autism might be made.

The unfortunate conclusion researchers are coming to, then: clinicians are missing many young females appearing on the less disabling end of the autism spectrum, what has traditionally been called Asperger’s syndrome.

“Restricted interests,” as an indicator of autism in girls

Tightly focused, repetitive all day long, and peculiarly personal, the intense fixation on a particular subject or objects can be a key indicator of autism at its less severe. (The Hughes Brothers have already reported on our little buddy Charley, up in Minneapolis, whose passion in life involves cassette tapes. No CDs. No vinyl, thank you very much. Just audio cassettes, the music thereon not much of a concern but, man oh man, the individual tape must, must, must be in its proper case.) Now, the studies referenced earlier reports that girls exhibit far fewer of these restricted interests. Could it be, however, that this differential might arise from the examples used in the diagnosis being more oriented toward boys. That is, the diagnostic factors might involve dinosaurs or toy trains far more than stereotypically female interests, dolls for instance, or pretty shoes. This weighted value of typically boyish interests contributes as well to the frequent failure of diagnosis of ASD in girls.

A nationwide, prestigiously academic effort in the study of women and girls with autism

The Hughes Brothers know of a major study of girls with autism, and adult women as well, being conducted in collaborative research at Harvard University, the University of California, Los Angeles, and the University of Washington. This study, a far-reaching and ongoing search for clinical information, will follow participants through their childhood and on to early adulthood. The researchers are spending time with, asking pointed questions of families of these girls, these women because they know firsthand the most problematic behaviors, the most troublesome symptoms of ASD. And the most helpful solutions thereto.

The study goes far beyond autism: brain scans, genetic testing and other such measures will tell us much about developmental differences in girls and boys attributable to autism, as opposed to gender. But also raising questions about whether autism affects sex differences in the brain and, ultimately how genetic and environmental factors come together in the production of gender-particular behaviors.

The Hughes Brothers have much more to say on the subject.

Please stand by.

The telltale signs then, the key indicators of a need for evaluation

As promised in the article just previous, the Hughes Brothers have gathered these most frequent, strongest signs that a girl – your daughter perhaps — should see an expert clinician.

We’ll try to be succinct, as academically accurate as we can. Serious business here. You should be concerned if the following behaviors assert themselves repeatedly, unavoidably.

· Your daughter depends on other children for help through her day, friends who guide her social interaction, who sometimes even speak for her. These friends, almost always other girls, take her through the school day and on into those hours of free time when their influence may change, but remain strong and present nonetheless.

· A particularly poignant and altogether predictive behavior here, as she turns to very specific, very limited, very focused interests, interests for which she shows intense, passionate, ongoing and enduring enthusiasm. Look especially for a subset of interests, her gathering of information about the details of a book or a movie or a television show; that is, the overreaching scope of the plot, the development of main characters prove less absorbing to her than the minutiae behind them – the props in the production, perhaps, or its locale, maybe the actors themselves far apart from the roles they play. Listen here for her talk. Is it repetitive, seemingly endless? Does she seem uninterested in the larger story involved, focusing instead on these restricted, almost obsessive details so very important to her?

· Your daughter demonstrates unusual sensitivity to intrusive sensory inputs – a sudden burst of loud music maybe or the sudden turning on a light in a darkened room or the odor of fried foods coming from a nearby hamburger stand. This sensitivity goes far beyond surprise or momentary discomfort. We’re talking over-the-top reaction to sensory stimuli that should present no more than a momentary, a fleeting response. The Hughes Brothers advise that these sorts of challenges are by no means restricted to autism. They remain, however, an indicator of the possible presence of the disorder.

· Her conversation concerns herself only, her interests alone. On the topics of her fascination, she may talk at length, with verve and humor. On the other hand, she seems uninterested in, even dismissive, of other people’s topics of conversation. This standoffishness may very well be interfering with her friendships, her ability to function in groups of her peers.

· Frustration is not her friend. She has no “medium” setting. Her feelings, and their expression, fly out of control at the first sign of frustration. She may melt down, reverting to the raging tantrums of a three-year-old. Unfortunately, such episodes may likely occur at school or in another setting where such behavior will lead to quick disciplinary action, further compounding her heartache.

· Watch for indications of anxiety or depression. While such feelings are far from unusual in teenagers, her symptoms may run much deeper, much more painful than the expectable angst of being an adolescent.

· Her friendships come and go. The longevity of her relationships with her other girls just disappears. And then, so sadly, when she loses a friend, she remains clueless, utterly unable to recognize her role in the damaged relationship. Sometimes, these difficulties arise – in the competitive, peer-pressurized environment of middle school – because of her inability to fit into the cultural norm of the moment, whether in choice of clothing, styling of one’s hair, or the vocabulary of the clique. She has just such a very hard time keeping pace with the demands of fitting in, however nonsensical and fleeting those demands might be.

More to come on this subject from the Hughes Brothers. Excuse us while we regroup.

Might a little girl you love be autistic?

A parent might confront few questions more troubling than this determination of if, and where, a loved one might place of the spectrum of autism disorders. And the answers do not come easily: the signs of autism in girls and women differ significantly from those in boys – a difficulty compounded by the fact that these signs, these indicators of a diagnosis, can be so often missed, overlooked, especially in cases of high-functioning autism.

Autism Under-diagnosis in girls

Only very young girls exhibiting overt, severe, obvious symptoms are, typically referred for evaluation. These behaviors include repeated and exaggerated self-stimulation (“stims,” as discussed in another Hughes review of chewable objects), major challenges with speech and language, little or no social communication, or significant learning disabilities and cognitive inabilities.

Diagnosis becomes much more uncertain, in some cases, impossible in young ladies whose symptoms present themselves with subtlety, with learned subterfuge. Girls with higher IQs may mask their symptoms, copying the behavior of peers, only to delay diagnosis to, at best, the pre-teen years.

Blame, in part, the culture.

Cultural assumptions, indeed some prevailing stereotypes, may further missed diagnoses in girls. For example, the politics of feminism notwithstanding, girls may be expected to be more reserved, quiet, far less assertive than boys. Femininity, to the popular mind, finds no quarrel with girls who seem shy and withdrawn, just that way little girls are. A boy showing forth the same characteristics – passivity, shyness, silence in social situation – will almost always, right now, be labeled atypical. In the same, a young girl who lives in a world of her own creation attracts little or no attention, even as a boy with the same behaviors will draw immediate scrutiny, much of it negative.

Some indications of autism in girls

The Hughes Brothers emphasize that a single, solitary symptom among the behaviors recounted below need suggest autism. On the other hand, some of these symptoms may become more visible, more easily recognized, as a little girl ages. In retrospect, parents may then be able to identify patterns of autistic behavior present since toddlerdom. Before you worry overmuch, the Brothers ask that you take concern only if one or more of these behaviors is interfering with events of daily life, with your loved little girl’s happiness and progress in school, at home, and in the usual social situations of being a kid. Not to worry, even if a couple of symptoms of autism appear, so long as the young woman seems to be enjoying life, demonstrates an ability to adapt to the situation of the moment and, particular, succeeds in school and in her other chosen endeavors.

Only when you notice the prevalence of these behaviors over the years, when they begin to interfere with functionality of any sort in the girl’s life, you might want to consider clinical evaluation. Time then for the experts to become involved, beginning – in our opinion – with your family doctor.

Not to rely too heavily on the Hughes Brothers, however, here are some scholarly references to give you detailed background on the behaviors of girls potentially somewhere on the autism spectrum. Remember, the more highly functioning your daughter or niece might be, the more difficult the diagnosis. A case in which her intelligence might be a bit of an obstacle to, at least, early indication of the disorder.

The bibliography, then.

DeWeerdt, S. Autism characteristics differ by gender, studies find. Simons Foundation, 27 March 2014.

Dworzynski K. et al. J. Am. Acad. Child Adolesc. Psychiatry 51, 788-797 (2012)

Nichols, Shana. A Girl’s-Eye View: Detecting and Understanding Autism Spectrum Disorders in Females. Interactive Autism Network at Kennedy Krieger Institute, December 2009.

Sarris, M. Not Just for Boys: When Autism Spectrum Disorders Affect Girls. Interactive Autism Network at Kennedy Krieger Institute, February 19, 2013.

Sleep Disorders in Children With ASD: A Primer

To the collective mind of the Hughes Brothers (and our sister Cindy), one of the great inequities that young people with Autism Spectrum Disorder must struggle mightily with daily life, its pressures and stresses and, yes, interactions with fellow human beings – the waking hours made more difficult by the lack of sleep that two of every three children with ASD endure. Their nightly woes worsen, in the worst possible way, the distress, the anxiety, the dysfunction that so sadly characterizes their days and ways. Depression can often follow as life looms out ahead inhospitable at best, threatening at worst.

Insomnia — difficulty falling and/or remaining asleep on a nightly or semi-nightly basis for a period of more than one month – stands alone as the most commonly reported sleep disorder among children (adults too) with ASD. In fact, insomnia can cripple up to ninety-percent of older people, wrecking their mornings with angst and exhaustion.

There’s more.

Children with ASD must often contend with nightmares, night terrors, and bedwetting — a set of horrors most widely found among children diagnosed with Asperger syndrome. And then. And then these children are frequently unable to describe the fears and the fright of the night before, a complication for certain in the treatment of these symptoms.

There’s more still.

Youngsters with ASD will wake in the middle of the night, only to engage in activities associated with waking hours: these children might play with a favorite toy or read out loud a favorite book.

Please read more on our Hughes Reviews site, as we explore – with you – potential responses to these sleep disorders capable of disrupting an entire family’s life.

Incidence of Sleep Difficulties in Children with ASD

Way back in 2009 came published a study in Sleep Medicine Reviews that addressed experiential evidence of sleep problems for children with ASD. A whopping eighty percent of parents of children with ASD reported at least some distress at bedtime. Among youngsters not diagnosed with ASD, but nine percent of them had recurrent trouble falling asleep and staying so.

The problems followed an unsettling, unsettled pattern.

· Hyperarousal, heightened anxiety at bedtime

· Difficulty with sleep onset, or falling asleep

· Difficulty with sleep maintenance, or staying asleep throughout the night

· Fitful sleep of minimal duration

· Sleep fragmentation, characterized by erratic sleep patterns throughout the night

· Early morning waking

· Excessive daytime sleepiness

Meanwhile, the underlying causes for the above problems with sleep gather – both directly and indirectly — around the child’s diagnosis with ASD. In broad terms, the reasons cluster below.

· Irregular circadian rhythm: this splendid term (minus the “irregular”) refers to the twenty-four-hour biological clock that regulates our human, our daily cycle of time spent sleeping and waking. Based on sunlight, temperature, and other environmental factors, the circadian rhythm dances through the brain in a balanced and happy repetition of just what we need in terms of rest and activity, activity and rest. ASD intrudes on this wake-sleep cycle, inflicting irregularities of every sort. Throughout these pages, you’ll note that the Hughes Brothers discuss, over and over, the role of the hormone melatonin in good sleep, in the patterning of the circadian rhythm. In children with ASD, the production of melatonin is haphazard.

· Mental health disorders: The Hughes Brothers reel at the term “co-morbid,” but co-morbid is the case between ASD and such unhappy mental states as anxiety and depression. Such difficult conditions compound problems with insomnia and other sleep disorders. Further, recent studies suggest that many, if not most, children with ASD also exhibit the symptoms of attention-deficit hyperactive disorder (ADHD. Just leave it to ADHD to bring about elevated moods around bedtime.

· Other medical problems: Damn. Here comes that awful co-morbidity again, this time involving epileptic seizures accompanying ASD. The awful impact on sleep could not be more obvious. Further, gastrointestinal distress assaults children with ASD with relentless fervor – constipation, diarrhea, acid reflux, the whole ugly, painful ballgame.

· Side effects of medication: Doubly unfortunately, the medications prescribed for the symptoms of ASD can redound to significant interference with normal sleep patterns. Selective serotonin reuptake inhibitors (SSRIs), for example, may cause fretful agitation in the evening, harassing every attempt at a peaceful, productive bedtime. Any little child taking antipsychotics may anticpate excessive drowsiness during the day, a lethargy that drifts on down to sleep-onset and sleep-maintenance issues. (The Hughes Brothers will discuss in another article the ways and means of ASD medications. Please stand by.)

Little ones confronting ASD struggle day after day with the pressures confronting every child in a world built around stimuli, everywhere stimuli, electronic and otherwise. For children with ASD, the influx of stimulus leads to all the behaviors, the unavoidable behaviors implicit in the ASD diagnosis. Then, with a rough night just behind them, these poor youngsters must take on the following day with more distress, more anxiety, more frustration than is their usual distraught lot. “Vicious” does not begin to describe the cycle of sleepless night with painful, so very painful day.

And the struggles of the day, difficult for even the healthiest of children, impugn every attempt at education, at social interaction, at enjoyment of any kind.

Autism Spectrum Disorder: Levels of Severity

No knowledgeable person would argue with the contention that the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the most authoritative guide for evaluating and diagnosing mental health disorders in the United States.
And, after defining the characteristics — behavioral and otherwise — usually associated with ASD, the manual goes on to describe the three clinical levels of ASD according to their severity.

The Hughes Brothers hope that the following recap of the DSM’s discussion of those three levels will prove helpful to the extended family of young people dealing with ASD. The DSM uses social communication, restricted interests, and repetitive behaviors as the primary indicators of the severity of ASD in individual cases.

We begin with Level 3, the most troubling, and we quote the DSM’s precise language.

Level 3:
– Requiring Very Substantial Support
– Severe deficits in verbal and nonverbal social communication skills
– Severe impairments in functioning
– Very limited initiation of social interactions
– Minimal response to social overtures from others
– Preoccupations, fixated rituals and/or repetitive behaviors that markedly interfere with functioning in all spheres
– Marked distress when rituals or routines are interrupted
– Very difficult to redirect from fixated interest

Level 2:
– Requiring Substantial Support
– Marked deficits in verbal and nonverbal social communication skills
– Social impairments apparent even with supports in place
– Limited initiation of social interactions
– Reduced or abnormal response to social overtures from others
– Rituals and repetitive behaviors] and/or preoccupations or fixated interests frequent enough to be obvious to the casual observer and to interfere with functioning in a variety of contexts
– Distress or frustration apparent when rituals and repetitive behavior are interrupted
– Difficult to redirect from fixated interest

Level 1:
– Requiring Support
– Without supports in place, deficits in social communication
– Noticeable impairments
– Difficulty initiating social interactions
– Demonstrates clear examples of atypical or unsuccessful responses to social overtures of others
– Decreased interest in social interactions
– Rituals and repetitive behaviors with significant interference with functioning in one or more contexts
– Resists attempts by others to interrupt these behaviors or to be redirected from fixated interest

Comprehensive Diagnostic Evaluation for Children at Risk for ASD

If your child is manifesting symptoms consistent with Autism Spectrum Disorders, this second phase of evaluation simply could not be more important, with family participation the critical element of it. You’ll be able to give the doctors anecdotal evidence of the symptoms, the behaviors in question. What’s more, your presence at the evaluation will soothe your child.

This second part of your toddler’ evaluation will call for at least two of the four diagnostic tools described immediately below.
Autism Diagnosis Interview-Revised (ADI-R): Used to evaluate children eighteen months or older (and, interestingly, adults as well), the ADI-R interview relies on very specific questions, honing in on social communication, social interaction, restricted interests, and repetitive behaviors.
Autism Diagnostic Observation Schedule-Generic (ADOS-G): Your child’s ability to express herself/himself using the spoken word becomes the sole subject of this test. Expect four thirty-minute modules of evaluation.

Childhood Autism Rating Scale, Second Edition (CARS2): This scale designed for children two and older offers more precise diagnoses in two principal ways: it distinguishes the symptoms of ASD from other disabilities, and it gauges the severity of those symptoms. Your child’s level of functioning will determine the specific form of the test to be administered, wherein there will come an assessment of the frequency, duration, and intensity of each ASD diagnostic criterion.
Gilliam Autism Rating Scale – Second Edition (GARS-2): Designed for teachers and clinicians, this scale may be used to evaluate anyone between the ages of three and twenty-two. The forty-some items on the scale fall into three categories: stereotyped behavior, communication, and social interaction.
Naturally, once the comprehensive diagnostic evaluation is complete, you can discuss the outcomes with your physician and — if your child should receive a diagnosis of ASD— you can explore possible treatment options.

The Hughes Brothers are honored to offer you some thinking about these treatments, most especially those addressing the difficulties that so often occur at bedtime in children with ASD. Kindly read on.

Developmental Screening Tools

The Centers for Disease Control have identified these developmental screening tools as the most commonly employed. Parents may expect for their child to be tested using one or more of the following tools.

According to the CDC, the most commonly used developmental screening tools include the following.
Ages and Stages: A series of nineteen questionnaires, this test addresses the child’s ability to communicate, motor skills, and other expectable areas of early development. Because the questionnaires are age-specific, doctors can be completely focused in their evaluations of very young children.
Communication and Symbolic Behavior Scales (CSBS): Sometimes referred to as the Infant-Toddler Checklist, this test evaluates children in their demonstration of emotion, their eye gaze, their ability to communication using gestures, sounds, and words, their understanding of spoken words and phrases, and their ability to determine an object’s usefulness.

Modified Checklist for Autism in Toddlers (MCHAT): Short and straightforward, this questionnaire features about twenty ‘yes or no’ questions referring to the toddler’s interests, motor skills, speech, and behavior. It’s scored on a scale of zero to twenty, with twenty ensuring an extremely high risk of ASD.
Parents’ Evaluation of Developmental Status (PEDS): The Hughes Brothers promise that this screening is not as difficult as its targeted information might indicate. Entirely based on evidence gathered in the home, the tests evaluate children based on their skills and their behaviors indicative of good mental health as made manifest in their expression of emotion and social interaction, or lack thereof.Screening Tool for Autism in Toddlers and Young Children (STAT): Designed for children two to three years old, STAT uses a dozen separate segments (requiring less than half an hour in total) to determine early indication of ASD.

Should the tests yield results consistent with the symptoms of ASD, a comprehensive diagnostic evaluation really ought to follow. The details of such evaluations will be forthcoming in the next article from your friends at Hughes Reviews.

If developmental screening yields results that are consistent with ASD symptoms, then a comprehensive diagnostic evaluation may be recommended. Family participation during this second phase is vital. Parents can describe symptoms and behaviors to the evaluation provider, who can then take these statements into account when conducting the diagnosis. The presence of at least one parent can ease the evaluation process for the child, as well.