By: Robin Blitz, MD, FAAP & Sara Swoboda, MD, FAAP
Your child's pediatrician may start checking your child for signs of developmental or communication differences like
autism spectrum disorder (ASD) at their very first
well-child visit.
They observe how your baby giggles, for example, or looks to you for reassurance. They note how your little one tries to regain your attention during a conversation; how they point, waves or respond to their name or cry.
All these ongoing observations―combined with family history, health examinations and parents' perspectives―help identify children with potential autism. Pediatricians
Formal autism screening at well-child visits
In addition to this regular developmental surveillance and screening, the American Academy of Pediatrics (AAP) recommends screening all children for autism at the 18- and 24-month well-child visits. This type of screening can identify children with significant developmental and behavioral differences early, when they may benefit most from early supports and services.
Why screen all children?
For screening to be effective, it must be applied to all children―not only those showing features of autism or developmental disabilities. If you are unsure about what developmental and autism screening your child has received, ask your pediatrician.Screening should also be done whenever you a parent or caregiver shares concerns about their child's development. If you have questions about your child's development or autism, don't hesitate to talk with your pediatrician and ask for a developmental screen.
Autism screening tools
There are various tools your provider can choose to screen for autism. While the AAP does not endorse any specific screening tool over another, here are some your child's provider may use:
Ages and Stages Questionnaires SE-2 (ASQ-SE2)
Communication and Symbolic Behavior Scales (CSBS)
Parents Observations of Social Interaction (POSI)
Modified Checklist for Autism in Toddlers – Revised with follow-up (M-CHAT-R/F)
Which is the most used screening tool for autism?
The M-CHAT-R/F is the most common autism screening tool used in pediatric offices. It is a 23-point questionnaire filled out by parents.
Using this standardized screening tool, pediatricians start conversations about
language delays, concerns about behavior, or possible next steps for a child with additional
genetic, neurologic or developmental testing.
Does a positive autism screen always lead to a diagnosis?
Keep in mind that screening for autism is not the same as diagnosing autism.
If your child has a positive screen for autism, it doesn't mean they will be diagnosed with autism. Your pediatrician may talk to you to get more information about how your child is developing. They may also recommend or refer your child for autism testing. (See
If Autism is Suspected, What's Next?)
If your child does not have a positive autism screen, but you continue to wonder if they have autism or other developmental differences, speak up. Screening tests are just that—screening—and don't identify all autistic children.
Keep in mind that children change as they grow. Some children who screen positive for autism may not ever be diagnosed with autism. While other children may not have a positive screen when they are young, but will have more obvious autism features as they get older and developmental and social expectations increase.
The rate of success for the M-CHAT -R/F, for example, is not 100%. So, it is used in combination with health and family history to identify children who may have autism and need more testing. Your opinions as a parent are irreplaceable and of the most importance.
If you are concerned and your child has not been formally screened:
Talk with your pediatric primary health care provider about doing a formal screening.
But remember this: If you think your child needs more evaluation because autism in the family, how they talk or act, or comments from others, trust your instincts. Don't wait to talk with your child's doctor about doing more. Before the visit, fill out a
free developmental milestone checklist, and read these tips about "How to Talk with the Doctor."
You know your child best and your knowledge and concerns are important. If the first doctor doesn't respond to you or take you seriously, get a second opinion.
Acting early can make a big difference in your child's development!
More information
About Dr. Blitz
Robin K. Blitz, MD, FAAP is a board-certified developmental pediatrician and a fellow of the American Academy of Pediatrics (AAP) and Society for Developmental and Behavioral Pediatrics. For 30 years, Dr. Blitz provided care for children with special health care needs, educated providers, students and families and directed patient-centered programs such as the Down syndrome clinic at Phoenix Children’s Hospital prior to joining UnitedHealthcare (UHC). She serves as medical director with the Special Needs Initiative (SNI)/Family Engagement Center of UHC. Dr. Blitz has served in organizations and committees, locally and nationally, including the AAP Council on Children with Disabilities and Autism Subcommittee, the Bureau of Indian Education Advisory Board for Exceptional Children, among others.
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About Dr. Swoboda
Sara Swoboda, MD, FAAP, is a primary care pediatrician and member of the AAP Council on Children with Disabilities. Her clinical and advocacy work emphasize supporting autistic youth and their families to thrive.
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