The (Subtle) Screening Process
Autism can't be diagnosed with a brain scan, a biopsy, or another medical test. It's usually first suspected by a concerned parent or doctor. In 2007, the American Academy of Pediatrics (AAP) recommended that every healthy 18- and 24-month-old should be screened specifically for autism. (A handful of states, like Massachusetts and New Jersey, now mandate this.) As a result, pediatricians are much more attuned to autism and developmental delays than ever before. And yet there's still room for improvement: In a recent Pediatrics study, only 48 percent of pediatricians surveyed said they use formal screening tools to identify developmental delays, including autism.
The tools are fairly simple questionnaires that take parents only a few minutes to complete. Perhaps the most common one is the Modified Checklist for Autism in Toddlers (M-CHAT), which can be used on children starting at 18 months of age. It consists of two dozen Yes/No questions such as "Does your child ever use his finger to point, to ask for something?" If two or more answers indicate problems, the test usually is considered positive. (You can download it at www2.gsu.edu/~psydlr.)
A relatively new tool, the Infant-Toddler Checklist, helps determine whether a child from 6 months to 24 months is at risk for autism or a developmental or language delay. Its reliability hasn't been studied as extensively as other tools. As with M-CHAT, it does not diagnose; it's meant to help pediatricians decide whether they should refer a child for further evaluation. (See the tool at Brookespublishing.com/checklist.pdf)
Some of the questions might freak out parents needlessly. For example, the M-CHAT asks if a child seems "oversensitive to noise" or wanders "with no purpose," which are both normal behaviors for many toddlers. But for the purposes of the screening test, it doesn't count if the action has happened only once or twice -- it needs to happen regularly. If you feel uneasy as you answer the questions, try not to panic. But do talk to your pediatrician, who will help determine what you should do next.
Always remember: A positive test doesn't necessarily mean your child has autism, just as only a fraction of women with a positive mammogram will go on to have an abnormal breast biopsy. "It's very likely, though, that a child who tests positive has some kind of delay that can benefit from early intervention," says Geraldine Dawson, Ph.D., chief science officer of Autism Speaks, the country's largest autism science and advocacy group. This was the case with my son Jake. When his scores indicated an increased risk for autism back in 2003, he underwent a more detailed developmental test from our state's early-intervention program and was diagnosed with a mild speech delay, not autism. I was thankful the problem was found. He had speech therapy for a year, and soon met all his milestones. He's now a typical fourth-grader.