Early Identification of Autism

Jennifer M. Zubler, MD


February 11, 2019

Editorial Collaboration

Medscape &

The Centers for Disease Control and Prevention's (CDC's) most recent report[1] from the Autism and Developmental Disabilities Monitoring (ADDM) Network shows that more work is needed to identify children with autism spectrum disorder (ASD) at a younger age and help them access early-intervention services. The report's findings include the following:

  • Fewer than half of the children identified in ADDM received their ASD diagnosis by the time they were 4 years old.

  • Although concerns about their development were noted in the health records of 85% of children with ASD by the time they were 3 years old, only 42% received a comprehensive developmental evaluation by that age. This underscores the importance of surveillance and screening for ASD, as recommended by the American Academy of Pediatrics (AAP), and timely referral for further evaluation of concerns.

Healthcare providers play a critical role in identifying children with ASD as early as possible to ensure timely and appropriate care.

  • The AAP recommends developmental surveillance at each health supervision visit, developmental screening at age 9, 18, and 24 months, and autism-specific screening at 18 and 24 months to identify children with ASD and other developmental disabilities. Surveillance involves eliciting parents' concerns; taking a developmental history; observing the child; identifying strengths, risks, and protective factors; documenting results; and communicating results and concerns with other providers and parents. Screening is done using a standardized screening tool, typically completed by parents, at the specific ages recommended by the AAP and whenever parents or providers have a concern. Surveillance and screening complement each other, and when done together they can improve early identification of children with ASD and other developmental disabilities.

  • However, a recent study[2] published in JAMA Pediatrics showed that only 37% of young children ages 9-35 months received developmental surveillance, 30% received developmental screening (including ASD-specific screening), and only 19% received both surveillance and screening as recommended by the AAP. The lack of surveillance and screening for ASD and other developmental disabilities can delay children's receipt of early-intervention services that have been shown to improve outcomes.

  • If surveillance or screening indicates a concern for ASD, a child should be simultaneously referred for:

  • Further evaluation by a specialist; and

  • Early-intervention services so that children can start to receive services while they await further evaluation.

CDC offers Autism Case Training (ACT), a free, Web-based continuing education course designed to help healthcare providers gain knowledge and skills to improve early identification of children with ASD. Each module contains case studies based on real-life situations.

  • Module 1 demonstrates how to recognize early warning signs of ASD and perform ASD screening.

  • Module 2 offers best practices for discussing concerning screening results with families and supporting a family whose child is diagnosed with ASD.

  • Module 3 offers strategies for primary care physicians to recognize and manage common developmental issues for children with ASD.

CDC's Learn the Signs. Act Early offers free, research-based, parent-friendly resources, such as the Milestone Tracker app, to assist healthcare providers with meeting the AAP recommendations for developmental surveillance from age 2 months to 5 years, along with guidance on how to integrate these resources into their practice.