How are children screened for autism spectrum disorder (ASD)?

Updated: Sep 30, 2019
  • Author: James Robert Brasic, MD, MPH; Chief Editor: Caroly Pataki, MD  more...
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Screening well babies for signs predictive of autistic disorder is important. Baron-Cohen and colleagues observed that abnormalities in pretend play, gaze monitoring, and protodeclarative pointing noted in toddlers during well-child visits in the United Kingdom were useful in predicting the later diagnosis of autistic disorder. [111, 112]

Baron-Cohen and colleagues developed a set of valid and reliable tools to screen for autism spectrum disorders over the lifespan, [116] including the Checklist for Autism in Toddlers (CHAT) and its revisions, the Modified CHAT (MCHAT) and the Quantitative CHAT (QCHAT), for newborns and toddlers, [111, 112, 117] as well as the Autism-Spectrum Quotient (AQ), for children, [118] adolescents, [119] and adults. [120] The possible cultural limitations of these tools in different ethnic groups in various geographic regions remain to be demonstrated.

Pretend play

In screening for the presence of symbolic play, other make-believe play may be substituted based on cultural relevance. The child should respond appropriately to a pretend activity compared with most other children of the same culture.

Gaze monitoring

The assessment of normal gaze monitoring, suggested by Baron-Cohen and colleagues, consists of the following steps: (1) the clinician calls the child's name, points to a toy on the other side of the room, and says, "Oh look! There's a [name a toy]!"; [111, 112] (2) if the child looks across the room to see the item indicated by the clinician, then a joint attention is established, indicating normal gaze monitoring.

Protodeclarative pointing

Baron-Cohen and colleagues established the following protocol to assess for the presence of protodeclarative pointing:

  • Say to the child, “Where's the light?” or “Show me the light”

  • A normal response is for the child to point with his or her index finger at the light while looking up at the clinician's face [111, 112]

  • If the child does not respond appropriately, the procedure may be repeated with a teddy bear or any other unreachable object

Executive function

Deficits in executive function have been generally observed in people with ASD. [121]

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