Understanding the Diagnostic Evaluation Process for Autism Spectrum Disorder

According to the CDC, it is currently estimated that about 1 in 44 children are diagnosed with Autism Spectrum Disorder (ASD). In order for a child to receive a diagnosis, there are several steps that must be taken for you and your family. While it may seem overwhelming at times for parents who believe their child may have ASD, there is a clear process in place for diagnostic evaluations. 

The diagnostic process consists of a multidisciplinary approach which includes a review of medical records, developmental history, current behaviors, cognitive and language abilities, observations and evaluation. Once completed, findings will guide recommendations for your child’s developmental needs .

Below is an outline of what to expect to guide you on your journey to having your child evaluated for ASD:

Developmental Monitoring of Your Child

Diagnosing children with ASD as soon as possible is crucial to ensure they receive the services and support they need to reach their full potential. The first step for any parent is to monitor their child’s development. Parents, caregivers and other family members can collectively participate in monitoring a child’s growth and development. This includes ensuring that your child is reaching typical milestones at around the expected age in regards to speaking, playing, learning, behaving and moving. While monitoring your child’s development, it is crucial to share any notes or concerns you may have with your child’s physician during or outside of well visits.

Common signs of autism at any age to look out for include:

• Loss of previously acquired speech, babbling or social skills
• Avoidance of eye contact
• Persistent preference for solitude
• 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

Preparation for the Appointment

If you and your child’s primary care provider have determined that your child should be evaluated for ASD, an appointment will be made with a trained specialist. Once you have obtained a referral from your child’s physician as well as insurance verification for your child, the initial appointment can be scheduled.

Prior to the appointment, you will complete an intake form that outlines several questions about your child’s medical, developmental, social-emotional, and behavioral history. It is recommended to gather your child’s school records, Individualized Education Program (IEP) and any other evaluations or assessments your child may already have and to bring them with you. It is also beneficial to set aside time to review milestones and timelines of your child’s development and make note of their progress and any concerns you may have so they are fresh in your mind.

At the appointment, you will meet with the diagnostician, and a thorough understanding of your child’s developmental history will be obtained through the use of the Autism Diagnostic Inventory, Revised (ADI-R). ADI-R is a semi-structured interview with a child’s parents used by a trained specialist to help make a definitive diagnosis. At this time, any questions you may have about the evaluation process will be answered.

Screening and Diagnostic Tools

The time it takes to conduct the developmental evaluation varies from child to child depending on your child’s age and skill. The average time to conduct the assessment typically takes between 1.5-3 hours. You may accompany your child throughout the assessment should separation difficulties emerge.

The diagnostic tool used may also vary, as some insurance companies have specific requests for which diagnostic tool is used when assessing children for ASD. The primary assessment tool most commonly used is the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2).

ADOS-2 is a diagnostic instrument specifically determined to be empirically valid for accurately identifying autism, along with measures of adaptive behavior and social emotional functioning. It is considered the gold standard for a clinical diagnosis of ASD. Through a series of semi-structured observations, trained evaluators assess a child’s communication skills, social interaction, and imaginative use of materials.

Other diagnostic tools that may be used include:

• Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) is a brief checklist of yes/no items for early detection among children 16 to 30 months of age.
• Childhood Autism Rating Scale (CARS) observes a child’s behavior and uses a 15-point scale to evaluate a child’s relationship to people, body use, adaptation to change, listening response, and verbal communication.

Recommendation Meeting

Following the assessment and evaluation, you will meet with your child’s diagnostician. A comprehensive report will be provided to you at this time which outlines your child’s developmental history, test results, diagnostic impressions, and recommendations for future intervention services. The diagnostician will review these areas in detail and answer questions following the discussion. If your child is diagnosed with ASD, our diagnostician will then assist in identifying which intervention is most likely to enhance your child’s development.

Beginning a Path of Progress

We understand that an autism diagnosis for your child can be life-altering, and we are here to help you, your child, and your family move forward. There are a variety of interventions and programs that can help improve your child’s development and growth. Autism Learning Partners is here to provide the resources and support necessary for your child to lead their most fulfilling life.