Children develop and grow quickly in the first few years of life. If there are questions about their development and if it's on track, it is important to seek answers. If
autism spectrum disorder (ASD) is considered as a possible reason for delays, talk with your pediatrician about getting a diagnostic evaluation.
Ways to support your child while waiting for an autism evaluation
You may have to wait for that evaluation appointment. But there are lots of steps that you can take to support your child even before a diagnostic evaluation:
1. Referral to programs in your state that support child development
If your child is under 3 years old: They should also be referred to your state's Early Intervention (EI) program.
If your child is 3 years old or older: They can be evaluated, and likely enrolled, in your local school district's special education services.
If your child is between 3 and 5 years old: They may be eligible to attend a developmental preschool program for children in need of more support. Contact your local school district.
2. Referral to outpatient therapy
Your child's pediatrician may prescribe medically necessary therapy to support skill development.
3.Get a hearing screen
Ask your pediatrician if your child had their hearing screened. If not, hearing screening is something many pediatrician offices can do. Or, they can refer you to another location to check your child's hearing.
4. Keep engaging your child in daily play that they enjoy
Connect with your child through play, following their lead with activities, objects or people that interest them. Consider enrolling them in a local preschool, daycare or play group where they can be around other children their age. Children learn important communication skills from being around each other. Even a few hours per week of peer interaction can have positive benefits.
5. Learn about autism and child development from trusted sources
Children learn and develop in many different ways. While many follow a similar path, it is important to take time to learn about how your child is developing and what they may need to thrive. Consider reading books, listening to podcasts or talking with other parents to explore what autism looks like. Gaining knowledge of autism and child development can help you better understand how to help your child.
The diagnostic evaluation for autism: what to expect
Your pediatrician will help guide you to the best place to help assess your child for a question of autism. The diagnostic evaluation will include detailed questions about your child's health and development. It will also include observations of your child playing and interacting.
Some diagnostic evaluations include a team of professionals like psychologists, speech therapists, occupational therapists and physicians.
The goal of the evaluation is to best understand your child and their needs. You can help by sharing how you see your child play, interact and communicate. If your child spends time with others like grandparents, teachers, neighbors, or others, it will be helpful to have them share what they see when spending time with your child as well.
An ASD diagnosis is based on all the information collected from your child's history, observation and testing. (See "How is Autism Diagnosed?") After the evaluation, your child's skills and needs will be compared to the criteria for autism along with other developmental delays and diagnoses. If your child meets the diagnostic criteria for autism, they will receive that medical diagnosis.
Some diagnostic evaluations will happen in one day, while other professionals may divide the evaluation across several days. Ask your pediatrician to help you know what to expect.
Tests for other conditions
Laboratory tests may be called for to check for other possible medical conditions or genetic syndromes that could cause ASD symptoms. This depends on findings from the child's history and physical examination. If these tests are appropriate, your child may be referred to other specialists, such as a
geneticist or
pediatric neurologist.
Medical tests may include:
Genetic tests. It is recommended that families be offered genetic testing, such as chromosomal microarray testing, to help identify potential reasons a child might have ASD. At present, up to 42% of children on the autism spectrum have genetic abnormalities that can be identified through chromosomal microarray testing.
Depending on findings from a child's history and physical examination, other types of genetic testing may be recommended to look for specific disorders. Examples include
fragile X syndrome,
Rett syndrome or
tuberous sclerosis complex.
Lead test.
Lead screening is an important component of well-child checkups. A child's blood lead level should be tested when they live in a high-risk environment, such as an older building, or continue to put things in their mouth.
Other tests. Depending on findings from the child's medical history and physical examination, electroencephalography (EEG), a magnetic resonance imaging (MRI) or tests for metabolic disorders may be requested. Children with ASD may be
picky eaters, so your child's pediatrician may recommend looking for evidence of
iron or vitamin deficiencies (especially vitamin D deficiency).
Medical tests not recommended:
There is not enough clinical evidence to recommend any of the following tests specifically for ASD:
Hair analysis
Routine measurement of multiple vitamin or nutrient levels
Intestinal permeability studies
Stool analysis
Urinary peptide analysis
Measurement of mercury or other heavy metals
Next steps after an autism diagnosis
It is important to read the diagnostic evaluation report. Ask for a copy of the report for your records. Every report will include a section with recommendations for your child. Be sure to talk with your pediatrician about these recommendations. They can help you with referrals to therapy and other community resources.
Many children on the autism spectrum need additional evaluation, treatment and support for other concerns. These may include issues related to sleep, nutrition and gastrointestinal problems (feeding problems, abdominal pain, constipation, diarrhea, and behavioral health (such as anxiety, ADHD, irritability, and aggression).
Take a moment to reflect on your child. Your child is amazing. Receiving a diagnosis of autism does not change who your child is. This diagnosis adds information about how your child communicates, interacts and learns. This information helps shape how the adults and professionals in our child's life can provide support and guide your child to their best potential.
Remember
If you have questions about your child's behavior or development, don't hesitate to talk with your pediatrician.
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