Autism Screening: Signs & Next Steps

As a parent, you know your child better than anyone. When you notice differences in how your child communicates, plays, or interacts with others, it's natural to wonder if these behaviors are part of typical development or if they might indicate autism spectrum disorder (ASD). Understanding the early signs of autism and knowing when and how to seek screening can make a significant difference in your child's developmental trajectory.

We Understand Your Concerns: When our son was diagnosed with autism at age 8, we experienced the same mixture of relief and fear that many parents feel. Relief that we could finally understand behaviors we had struggled to make sense of, and fear about what the future might hold. If you're having similar feelings right now, know that you're not alone—and that seeking answers is the best thing you can do for your child.

This comprehensive guide will help you recognize the early signs of autism, understand the screening process, and know what steps to take if you have concerns about your child's development.

Understanding Autism Spectrum Disorder

Autism spectrum disorder is a neurodevelopmental condition that affects communication, social interaction, and behavior. The term 'spectrum' reflects the wide range of symptoms, skills, and levels of impairment that individuals with autism can experience. Some children may have mild symptoms that don't significantly impact their daily life, while others may need substantial support.

Key characteristics of autism include:

Persistent challenges with social communication and interaction
Restricted and repetitive patterns of behavior, interests, or activities
Symptoms that are present in early development (though they may not fully manifest until social demands exceed capacity)
Symptoms that cause significant impairment in social, occupational, or other important areas of functioning

Early Signs of Autism by Age

While autism can be diagnosed as early as 18 months, signs may be apparent even earlier. Here's what to look for at different ages:

6-12 Months

Limited eye contact or avoiding eye contact
No big smiles or warm, joyful expressions by 6 months
No back-and-forth sharing of sounds, smiles, or facial expressions by 9 months
No babbling by 12 months
Unusual responses to their name being called

12-24 Months

No pointing, waving, reaching, or other gestures by 12 months
No single words by 16 months or two-word phrases by 24 months
Loss of previously acquired speech or social skills
Little interest in other children or caregivers
Repetitive behaviors like rocking, spinning, or hand flapping
Intense interest in specific objects or activities

2-3 Years

Difficulty with pretend play or imagination
Preference for playing alone
Difficulty understanding emotions or expressing their own feelings
Unusual reactions to sounds, textures, or other sensory input
Rigid adherence to routines and difficulty with changes
Repetitive speech patterns or unusual use of language

School Age and Beyond

Difficulty making and maintaining friendships
Challenges with nonverbal communication (facial expressions, gestures)
Intense, narrow interests that interfere with other activities
Difficulty with transitions and changes in routine
Sensory sensitivities that impact daily activities
Challenges with social rules and expectations

The Importance of Early Screening

Early identification of autism is crucial because:

Early intervention leads to better outcomes
Young brains are more adaptable and responsive to intervention
Families can access support and resources sooner
Children can develop coping strategies before challenges become more entrenched
Educational planning can begin early to support school success

The American Academy of Pediatrics recommends autism screening for all children at 18 and 24 months, in addition to ongoing developmental surveillance at every well-child visit.

Autism Screening Tools

Several standardized screening tools can help identify children who may benefit from further evaluation:

M-CHAT-R (Modified Checklist for Autism in Toddlers-Revised)

The M-CHAT-R is designed for children 16-30 months old. This parent-completed questionnaire includes 20 yes/no questions about your child's behavior and development. If your child scores above the cutoff, they should receive further evaluation.

Key areas the M-CHAT-R assesses include:

Joint attention and social engagement
Communication and language development
Play behaviors and imagination
Sensory responses and repetitive behaviors

CAST (Childhood Autism Spectrum Test)

The CAST is designed for children 4-11 years old and consists of 39 questions that parents answer about their child's behavior. It's particularly useful for identifying children who may have been missed in earlier screenings.

The CAST evaluates:

Social skills and peer relationships
Communication abilities
Repetitive behaviors and restricted interests
Sensory sensitivities

What Happens After Screening?

If screening tools suggest your child may be at risk for autism, the next step is a comprehensive diagnostic evaluation. This process typically involves:

Comprehensive Diagnostic Evaluation

A thorough evaluation should include:

Detailed developmental history
Direct observation of your child's behavior
Standardized assessment tools (such as the ADOS-2)
Medical examination to rule out other conditions
Input from multiple sources (parents, teachers, caregivers)

The ADOS-2 (Autism Diagnostic Observation Schedule-2)

The ADOS-2 is considered the gold standard for autism diagnosis. This semi-structured assessment involves play-based activities that allow trained clinicians to observe social communication, interaction, and play behaviors in a standardized way.

During the ADOS-2, your child will participate in activities designed to elicit behaviors relevant to autism diagnosis, such as:

Social interaction and communication tasks
Play-based activities that assess imagination and creativity
Tasks that evaluate response to social overtures
Activities that may reveal repetitive behaviors or restricted interests

Who Can Diagnose Autism?

Autism diagnosis should be made by qualified professionals with expertise in autism spectrum disorders. This may include:

Developmental pediatricians
Child psychologists or neuropsychologists
Child psychiatrists
Pediatric neurologists
Multidisciplinary teams at autism centers

Taking Action: What to Do If You Have Concerns

Trust Your Instincts

If you have concerns about your child's development, don't wait. Early intervention is most effective when started as soon as possible. Even if your concerns turn out to be unfounded, it's always better to err on the side of caution.

Start with Screening

Begin with our online screening tools:

Take the M-CHAT-R if your child is between 16-30 months
Complete the CAST if your child is 4-11 years old
Share the results with your pediatrician

Consult with Professionals

Discuss your concerns with your child's pediatrician and ask for a referral to a specialist if needed. Don't be discouraged if your pediatrician initially suggests a 'wait and see' approach—you know your child best, and you can advocate for evaluation if you have ongoing concerns.

Document Your Observations

Keep a record of specific behaviors or concerns you've noticed. Include:

Specific examples of behaviors that concern you
When these behaviors occur
How they impact your child's daily life
Any patterns you've noticed

What If Your Child Receives an Autism Diagnosis?

Receiving an autism diagnosis can feel overwhelming, but remember that it's the first step toward getting your child the support they need. Here's what to do next:

Connect with autism specialists and service providers
Learn about evidence-based interventions like ABA therapy
Connect with other families who have similar experiences
Explore educational options and support services
Take care of yourself and your family's emotional needs

Moving Forward with Hope

Whether you're just beginning to have concerns about your child's development or have recently received an autism diagnosis, remember that early identification and intervention can make a tremendous difference. Children with autism can learn, grow, and thrive with the right support.

At Buzz ABA, we're here to support you through every step of this journey. From initial screening to comprehensive intervention services, our team of experts is committed to helping your child reach their full potential.

If you have concerns about your child's development, don't wait. Take our online screening tools, consult with professionals, and remember that seeking help is a sign of strength, not worry. Your child's bright future starts with the steps you take today.

Start Your Child's Journey Today

Buzz ABA provides comprehensive, evidence-based ABA therapy in Concord, Manchester, Nashua, and surrounding NH communities. Our neurodiversity-affirming approach helps children thrive.

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Recognizing the Signs: Your Complete Guide to Autism Screening and Next Steps