Consulting & Evaluation
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There are a variety of screeners that pediatricians or other practitioners might employ as a first step to learning if a child might have autism, before beginning a formal evaluation. Some are questionnaires that parents fill out and others are assessments done by clinicians. The Modified Checklist for Autism in Toddlers, or M-CHAT, is one questionnaire that is used to identify red flags. The M-CHAT asks questions about behaviors that might indicate autism, but Dr. Epstein warns that the test purposefully “casts a very broad net,” so it often flags children who may or may not be autistic. Similar scales include the Childhood Autism Rating Scale and the Ages and Stages Questionnaire, which is more of a basic developmental screener.
The Screening Tool for Autism in Toddlers and Young Children, or STAT, is another screener that probes for autism symptom behaviors in more detail than the other screeners mentioned, but is still intended to be used as a tool to catch children who are candidates for further evaluation. Screener results alone should never be considered a diagnosis.
If a screener indicates that a child may have autism spectrum disorder, the child should receive a comprehensive evaluation from someone trained in diagnosing autism.
This evaluation will often begin with a diagnostic instrument such as the Autism Diagnostic Observation Schedule, or the ADOS-2. The ADOS is a test with different modules to accommodate a range of children. There is a version for toddlers that is play-based. For kids older than thirty months, there are modules that include more conversation, according to the child’s language level.
This isn’t the kind of test where there are right answers. The purpose of the ADOS is to evaluate the social skills and repetitive behaviors the child displays during the test. This means the evaluator is paying attention to things like if the child asks for help when he needs it, gives other people a chance to speak, and follows along with changes of subject.
The Communication and Symbolic Behavior Scales (CSBS) is another good diagnostic instrument for toddlers and young children. This play-based instrument is also backed by research, but is used less than the ADOS, which covers a broader age range.