In the first phase of the diagnostic evaluation, you will give your doctor background information about your child’s medical, developmental, and behavioral history. If you have been keeping a journal or taking notes on anything that concerned you, turn over that information. The doctor will also want to know about your family’s medical and mental health history.
The medical evaluation includes a general physical, a neurological exam, lab tests, and genetic testing. You child will undergo this full screening to determine the cause of his or her developmental problems and to identify any co-existing conditions.
Since hearing problems can result in social and language delays, they need to be excluded before autism can be diagnosed. Your child will undergo a formal audiological assessment where he or she is tested for any hearing impairments, as well as any other hearing issues or sound sensitivities that sometimes co-occur with autism.
Direct Behavior Observation
Developmental specialists will observe your child in a variety of settings to look for unusual behavior associated with the autism spectrum disorders. They may watch your child playing or interacting with other people.
Because lead poisoning can cause autistic-like symptoms, the National Center for Environmental Health recommends that all children with developmental delays be screened for lead poisoning.
Depending on your child's & symptoms and their severity, the diagnostic assessment may also include speech, intelligence, social, sensory processing, and motor skills testing. These tests can be helpful not only in diagnosing autism, but also for determining what type of treatment your child needs:
- Speech and Language Evaluation - A speech pathologist will evaluate your child's speech and communication abilities for signs of autism, as well as looking for any indicators of specific language impairments or disorders.
- Cognitive Testing - Your child may be given a standardized intelligence test or an informal cognitive assessment. Cognitive testing can help differentiate autism from other disabilities.
- Adaptive Functioning Assessment - Your child may be evaluated for their ability to function, problem-solve, and adapt in real life situations. This may include testing social, nonverbal, and verbal skills, as well as the ability to perform daily tasks such as dressing and feeding him or herself.
- Sensory-motor Evaluation - Since sensory integration dysfunction often co-occurs with autism, and can even be confused with it, a physical therapist or occupational therapist may assess your child's fine motor, gross motor, and sensory processing skills.
Learn more about the different autism spectrum disorders: Exploring the Autism Spectrum
Related medical conditions
There are several medical conditions which occur more frequently in people with autism than in the general population. Because of the increased risk, it is a good idea to familiarize yourself if your child has autism or other developmental delays.
Mental Retardation – Some children on the autism spectrum may suffer from mental retardation. While it is commonly stated that up to 75% of autistic individuals are cognitively impaired, new studies are challenging this statistic. This includes the latest autism population survey from the Centers for Disease Control. One of the reasons that mental retardation may be over-reported in autistic kids is that traditional IQ tests require strong verbal skills. Verbally-based tests don’t accurately measure intelligence in autistic children with speech problems. For further info: Utah Dept. of Health
Seizures – One in four autistic children develop epileptic seizures, typically during adolescence. It is believed that the seizures are triggered by hormonal changes. The seizures may be noticeable, with clear symptoms such as convulsions, blacking out, or odd body movements. However for some, the seizures are not quite so obvious. In these cases, tantrums, self-injury, little academic progress during the teen years, or a loss of previously-acquired behavioral skills may be subtle signs of a subclinical seizure disorder. For further info: Epilepsy Ontario
- Fragile X Syndrome – Children with autism are at a higher risk for the genetic disorder Fragile X syndrome. Fragile X syndrome is the most common cause of mental retardation and results from a defect on the X chromosome. The syndrome affects approximately 2-5% of autistic individuals. For further info: The National Fragile X Foundation
- Tuberous Sclerosis – Tuberous sclerosis is a rare genetic disorder that causes benign tumors to grow in many different organs, including the brain, eyes, heart, lungs, and skin. Around 3-4% of children with autistic disorder also have tuberous sclerosis. For further info: Tuberous Sclerosis Alliance
Autistic Children and IQ Tests
If your child’s intelligence is being assessed, ask for an IQ test that doesn’t require language abilities, such as the Test for Nonverbal Intelligence (TONI).
When it comes to autism treatment, there are a dizzying variety of therapies and approaches. Some autism therapies focus on reducing problematic behaviors and building communication and social skills, while others deal with sensory integration problems, motor skills, emotional issues, and food sensitivities.
With so many choices, it is extremely important to do your research, talk to autism treatment experts, and ask questions. But keep in mind that you don't have to choose just one type of therapy. The goal of autism treatment should be to treat all of your child's symptoms and needs. This often requires a combined treatment approach that takes advantage of many different types of therapy.
Common autism treatments include behavior therapy, speech-language therapy, physical therapy, occupational therapy, nutritional therapy, and medication.
Behavior management therapy uses rewards, or positive reinforcement, to teach autistic kids desirable behaviors and reduce ones that cause problems. Although there are many behavioral therapies for autism, applied behavior analysis (ABA) is the most widely accepted approach. ABA can help children with autism learn how to interact with others, play with toys, and improve their verbal and nonverbal skills. ABA is also effective for eliminating problem behaviors such as self-injury or stimming (repetitive, self-stimulatory behaviors such as twirling, finger flicking, and rocking).
While behavioral therapies such as ABA can be very successful in treating autism, they require time and commitment. As ABA therapist Megan Kenny writes in Maximizing Autism Therapy, “ABA is not two hours three times a week -- it is a frame of mind.” To get the most benefit out of behavior therapy, autistic kids need intensive one-on-one training. The general recommendation is 25 to 40 hours of therapy per week with a skilled behavior modification specialist. Parents should also learn the basic techniques of behavior therapy so they can work with their kids at home.
Speech, physical, and occupational therapies
Depending on your child’s needs, you may want to seek speech-language therapy, physical therapy, or occupational therapy. These therapies can address many of autism’s challenges:
- Speech and language therapy – Speech and language therapy addresses the communication difficulties that children with autism often struggle with. The focus in speech therapy is usually on improving verbal skills and language ability. However, speech and language therapy is also used to teach nonverbal communication skills and social skills that will help autistic kids communicate better with others.
- Physical therapy – Physical therapy helps children with autism improve their posture, balance, coordination, and strength. Physical therapists can work with young autistic children on basic motor skills such as sitting independently, walking, running, and jumping. They may also help older autistic kids learn more complex movements such as throwing, catching, or kicking a ball in order to participate in sports, recess, and other play activities.
- Occupational therapy – Occupational therapy helps children with autism spectrum disorders learn the skills they need for living. An occupational therapist may teach kids basic self-care skills such as getting dressed, brushing their teeth, or feeding themselves. Occupational therapy is also used to increase sensory integration in kids who underreact or overreact to stimuli such as noise or touch.
Assistive technology is any item or equipment that helps a disabled person function better. In autism treatment, assistive technology is commonly used as a part of speech therapy, physical therapy, and occupational therapy. Occupational therapists in particular often incorporate assistive technology into their work.
Assistive technology for an autistic child could include low-tech items such as a weighted vest to reduce stimming and increase focus, or picture cards to encourage nonverbal communicate. At the high-tech end of the spectrum, assistive technology for autism may use educational software or computers that are controlled by a special touch screen.
Autism and Computers
Many kids with autism spectrum disorders enjoy using computers. This may be because computers, unlike people, are predictable and straightforward.
Computers can be used to teach autistic kids many behaviors and skills, and they can also lead to increased focus and attention span—all while the children are having fun!
Nutritional therapy and diet changes
Nutritional therapy for autism is a controversial area. Some alternative doctors recommend specialized diets and supplements to treat autism, but at the present time there is little scientific evidence to support their effectiveness. On the other hand, many parents of autistic children believe that dietary interventions have helped their kids.
The bottom line is: while nutritional therapy and dietary restrictions may not cure autism or its core symptoms, they can be a helpful complementary treatment. Many autistic children have chronic gastrointestinal problems such as diarrhea, stomach aches, gas, and constipation. The pain and discomfort of these gastrointestinal problems can naturally lead to irritability, anger, and other challenging behavior. Eliminating certain foods and adding vitamin supplements may improve digestion in some kids. If an autistic child feels better, he or she is less likely to act up.
- Gluten-free, Casein-Free Diet (GFCF) — Some autistic kids are sensitive or allergic to gluten (a protein found in wheat and other grains) and/or casein (a protein found in dairy products). If medical tests reveal that your child suffers from these sensitivities, you may want to consider a gluten-free, casein-free diet. The GFCF diet is very restrictive (no bread, cereal, milk, ice cream, or cheese for starters) and can also have side effects, so it’s a good idea to consult with a nutritionist or a doctor before putting your child on it. A nutritionist can help you develop a diet plan that includes the essential vitamins, protein, and fiber your growing child needs. This is particularly important if your kid is a picky eater
- Vitamin supplements — Autistic children may have nutritional deficiencies that contribute to their symptoms. In these cases, vitamin supplements may help. Supplements used for autism treatment include vitamin B, magnesium, vitamin C, omega-3, and cod liver oil.
Medications for autism
There are no medications that can cure autism or treat its core symptoms. However, certain medications are sometimes prescribed to treat specific problems, such as hyperactivity, self-injurious behaviors, aggression, and tantrums. With these disruptive symptoms minimized, autistic children may be better able to focus and learn.
Medication for children with autism can cause significant side effects and problems with long-term use. Furthermore, as most of these drugs have not been well-tested in children, they should always be used with caution. If you'd like to look into drug treatment for autism, be sure to talk with your child's doctor about all the options, the risks involved, and what warning signs to watch for.
Related links for autism diagnosis and treatment
Autism Diagnosis and Evaluation
Diagnosing and Evaluating Autism Part I (PDF) – Learn about the medical tests involved in the diagnosis of the autism spectrum disorders. (Center for Autism and Related Disabilities)
Diagnosing and Evaluating Autism Part II (PDF) – Discusses direct observation and standardized tests used to diagnosis autism. (Center for Autism and Related Disabilities)
Autism Therapy and Treatment
Healing Thresholds – Organization dedicated to helping parents sift through the information about autism therapy. Includes therapy fact sheets, research summaries, and an online forum.
Autism Treatment – Helps parents understand the autism treatment options and how to evaluate approaches. Includes subsections on Treatment Guidelines, Learning Approaches and Biomedical Approaches. (Autism Society of America)
Treatments for Autism – Explore treatment options for autism spectrum disorders, including applied behavioral analysis (ABA), floortime, sensory integration therapy, and a gluten-free diet. (Autism Speaks)
Behavior Therapy for Autism
Behavioral Intervention for Children with Autism – Overview of how behavior therapy is used in autism treatment. (The Cleveland Clinic)
Maximizing Autism Therapy: An ABA Therapist's Perspective on Effective Intervention - Advice from an applied behavioral analysis therapist on how to get the most out of treatment. (Autism Speaks)
Ask a Therapist: A Trained ABA Therapist Answers a Parent's Most Common Questions – Covers the basics of ABA therapy and what parents need to know. (Autism Speaks)
Occupational and Speech Therapy for Autism
Increasing Expressive Skills for Verbal Children with Autism – Strategies for helping a child with autism increase their knowledge and understanding of social communication skills, as well as language skills. (Cooperative Educational Service Agency No. 7)
Developing Expressive Communication Skills for Non-verbal Children With Autism – Strategies for assessing a nonverbal autistic child’s communication abilities and building on them. (Cooperative Educational Service Agency No. 7)
Occupational Therapy's Role with Autism – Fact sheet on what occupational therapy for autism involves and how it can help. Includes tips for finding a good occupational therapist. (American Occupational Therapy Association)
Assistive Technology for Children with Autism – Learn about the different assistive technologies that can help children with autism spectrum disorders communicate and function better. (Cooperative Educational Service Agency No. 7)
Delving deeper into autism diagnosis and treatment
The Road Less Traveled: Charting a Clear Course for Autism Treatment (PDF) – Discusses the challenges of finding good autism treatment for a child and how parents can evaluate their options. (Organization for Autism Research)
Practice Parameter: Screening and Diagnosis of Autism (PDF) – In-depth recommendations on early screening for autism and the tests and assessments needed for diagnosis. (American Academy of Neurology)
The Pediatrician's Role in the Diagnosis and Management of Autistic Spectrum Disorder in Children – Explore the current guidelines that pediatricians are recommended to follow in order to identify autism in their young patients. (American Academy of Pediatrics)