Tweaking Clinic Protocols Improves Autism Screening Rates
Angie Voyles AskhamScreen time:
Pediatric clinics can boost their rates of autism screening and diagnostic referrals by way of sensitive tests, electronic notifications and secondary screens, according to a new study.
Clinicians are advised to screen toddlers for autism during regular check-ups at 18 and 24 months of age and to refer those who screen positive to a specialist for a diagnostic evaluation. But less than half of autistic children in the United States are screened for autism by age 3, some studies estimate which leads to inequities in diagnosis, advocates say. And the standard screening tool, the Modified Checklist for Autism in Toddlers, Revised , may fail to identify more than 60 percent of autistic children, who then miss out on early intervention.
The new study assessed how often autism screenings took place at two clinics at the University of Utah in Salt Lake City. About half of the children who visited the clinics from 2014 to 2017 had been screened, a figure in line with national estimates, the researchers found. But only 0.5 percent were eventually diagnosed with autism about one-third the rate recorded at other sites, suggesting the clinics screening and referral practices were ineffective.
We thought we might be delaying diagnosis by not being up to date with universal screenings, says lead investigator Kathleen Campbell, a pediatric resident at the University of Utah.
Diagnostic Assessment Criteria For Children With Autism
There are two sets of autism spectrum diagnostic criteria commonly used throughout Australia:
The main criteria used is the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders . The DSM-5 requires professionals to assess for the symptoms of autism and the impact these have on your childs life. Symptoms are identified in two domains social communication and social interaction, and restricted and repetitive behaviours. It requires consideration to co-occurring diagnosis. This information can help clinicians in their diagnostic decision-making and identification of support needs.
The World Health Organisations International Classification of Diseases . The ICD-11 requires clinicians to specify the presence and extent of intellectual and language impairment, along with the impact on numerous areas of functioning.
How Do You Assess Autism
There is no specific test or one single tool to assess whether the person has autism or not. The assessment and diagnosis actually comes from interdisciplinary collaboration.
The involvement of the family and caregivers is actually essential.
This interdisciplinary team will most likely include the childs pediatrician, a pediatric neurologist, a developmental pediatrician as well as the Speech-Language Pathologists.
They will use screening tests, talk with the child, observe their behaviors and talk with the parents about the childs life to get an idea.
The assessment of the child aims to identify as well as describe certain characteristics of the child to better understand the situation.
The following factors are assessed during this screening:
- Impairments in the body structure and function of the child
- Limitations in activity and participation
- Comorbid deficits or conditions
- Environmental and personal factors
Screening tools that are appropriate in terms of age and culture are used to identify whether the person shows symptoms of autism.
These tools will provide an idea if the child needs any further assessment or intervention.
After the screening test, the individual that is suspected to have ASD is referred to a professional if needed to conduct a comprehensive assessment.
In the comprehensive assessment, the following will be included:
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Different Types Of Screen Time
Active: Active screen time allows the person to interact with the media. For example, any games on phones or iPads/tablets through apps, or video games on the computer, XBox, Wii and PlayStation or other console.Passive: Passive means it does not get the person to actively engage in the media. Passive use is watching an item such as watching television, movies, music videos or YouTube videos.Educational: Educational screen time can be either active or passive and relates to the amount of learning which takes place during screen time.
Active educational screen time could be in the form of the many apps out there designed to develop a specific skill such as reading, comprehension or numeracy. There are also many games which give children opportunities to build confidence, creativity and problem solving skills.
Some games may unintentionally teach numeracy or literacy through instructions and game play and therefore count as educational. Some passively consumed TV shows and movies can also be educational, for example documentaries which expose children to nature, animals and different cultures which children may not be exposed to otherwise. Screen time which is not associated with learning is considered just for entertainment value.
Autistic people may be drawn to screens because they provide a repetitive and predictable interface that is easily customised to the specific interests of an individual.
Is There Anything Else I Need To Know About Autism Spectrum Disorder Screening
There is no one single cause of autism spectrum disorder. Research suggests that it is caused by a combination of factors. These may include genetic disorders, infections, or medicines taken during pregnancy, and an older age of one or both parents .
Research also clearly shows that there is no link between childhood vaccines and autism spectrum disorder.
If you have questions about ASD risk factors and causes, talk to your child’s health care provider.
Hybrid Asd Screening Methods
2.3.1. Asperger Syndrome Diagnostic Scale
2.3.2. Gilliam Aspergers Disorder Scale
2.3.3. Autism Spectrum Screening Questionnaire
The ASSQ is also a hybrid screening questionnaire developed by to identify the characteristics of high functioning developmental disorders, including autism and Asperger syndrome. It has 27 different questions, with three possible rating responses ranging from 02 as yes, somewhat, and no. The questionnaire is administrated by the parents or the teachers of the 7 to 16-year-old child or adolescent, and the result is interpreted based on the overall score gained by the individual. An overall score exceeding the threshold indicates that the individual has many characteristics of the autism spectrum and other high functioning syndromes. An accuracy of 90% is shown in the accurately attributed positive results generated by the tool at a cut-off threshold of 13 . A recent study performed to validate the ASSQ screening tool reported that it has 91% sensitivity and 86% specificity .
2.3.4. Autism Spectrum Quotient
In terms of validity, AQ-child has the highest sensitivity and specificity out of all the versions of AQ. However, overall sensitivity and specificity of AQ are reported as 77% and 74% respectively at a cut-off score of 32 .
2.3.5. Developmental Behaviour Checklist-Autism Screening Algorithm
2.3.6. Krug Asperger Disorder Index
2.3.7. Social Communication Questionnaire
2.3.8. Social Responsiveness Scale
2.3.12. Child Behaviour Checklist
How Do They Test For Autism In A 2 Year Old
Children should also be screened especially for ASD during their regular doctor visits when they are aged 18 months and 24 months.
There are specific tests developed for toddlers, including 2-year-olds. Depending on what type of screening tool is used, generally, the parents are asked questions about their childs behavior and speech.
Anything that gives a clue about developmental milestones is discussed from communication to fine and gross motor skills.
Since many of the screening tests available are completed by parents, they may need to consult their healthcare provider if the results indicate.
The aim is to determine whether the child needs further evaluation. The healthcare professional will then talk and play with the child to see if they have symptoms of ASD.
ASD symptoms in a 2-year-old:
- Lack of meaningful speech
- No response to name when called
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Children With Autism Are Vulnerable To The Negative Effects Of Screen Time
Children with autism spectrum disorders are uniquely vulnerable to various brain-related impacts of screen time. These electronic side effects include hyperarousal and dysregulationwhat I call Electronic Screen Syndromeas well as technology addiction, to video games, internet, smartphones, social media, and so on.
Why? Because a brain with autism has inherent characteristics that screen time exacerbates. In truth, these impacts in occur in all of us, but children with autism will be both more prone to experiencing negative effects and less able to recover from them their brains are more sensitive and less resilient.
As a framework for understanding these vulnerabilities, its helpful to know that screen timeparticularly the interactive kindacts like a stimulant, not unlike caffeine, amphetamines, or cocaine. Also know that children with autism are often sensitive to stimulants of all kinds, whether pharmaceutical or electronic. For example, children with autism and attention issues often cant tolerate prescribed stimulants, a standard treatment for ADD/ADHD. Stimulants tend to make children with autism irritable, weepy, over-focused, more obsessive-compulsive, and unable to sleep. Stimulants can also exacerbate tics, self-injurious behaviors, aggression, and sensory issues.
Needless to say, education in this arena is sorely needed.
11 reasons children with autism are extra vulnerable to screen time effects and tech addiction
If You Are Concerned And Your Child Has Not Been Formally Screened:
If you are concerned your child has an ASD and your child hasnt been formally screened, talk with your clinician about doing a formal screening. Many screening tools are available for general doctors.
But know this: If you are concerned about your childs communication or behavior due to a family history of ASD, the way he talks or expresses himself, or other peoples comments about his behavior, dont wait to talk with the clinician about doing more. If the first doctor doesnt respond to you or take you seriously, get a second opinion.
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Work With A Professional
Several websites offer self-diagnosis tests or quizzes for autism, but these are not definitive or even approved by medical practitioners who understand autism spectrum disorder. Reading information about autism, and the experiences of people who were diagnosed as adults, can be more helpful. This information can guide you into a discussion with your doctor, so you can get therapeutic support.
Screening And Diagnosis Of Autism Spectrum Disorder
Diagnosing autism spectrum disorder can be difficult because there is no medical test, like a blood test, to diagnose the disorder. Doctors look at the childs developmental history and behavior to make a diagnosis.
ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable . However, many children do not receive a final diagnosis until much older. Some people are not diagnosed until they are adolescents or adults. This delay means that children with ASD might not get the early help they need.
Early signs of ASD can include, but are not limited to
- Avoiding eye contact,
- Having little interest in other children or caretakers,
- Limited display of language , or
- Getting upset by minor changes in routine.
CDCs Learn the Signs. Act Early. program provides free resources to help families monitor developmental milestones and recognize signs of developmental concerns, including ASD.
As children with ASD become adolescents and young adults, they might have difficulties developing and maintaining friendships, communicating with peers and adults, or understanding what behaviors are expected in school or on the job. They may also come to the attention of healthcare providers because they have co-occurring conditions such as attention-deficit/hyperactivity disorder, obsessive compulsive disorder, anxiety or depression, or conduct disorder.
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Toddlers And Children Asd Screening Methods
2.1.1. Quantitative Checklist for Autism in Toddlers Based on Questionnaires
The Q-CHAT, one of the oldest methods of screening for autism, was developed by , as an efficient quantitative checklist to be administered by medical professionals coinciding with a report submitted by the childs parents based on observations of the childs behaviour. The earliest version of Q-CHAT was used to detect autism in toddlers aged between 18 and 24 months only. A screening study carried out to test the validity of Q-CHAT, based on 16,235 toddlers, revealed that the sensitivity of Q-CHATs initial version was as low as 38%. The M-CHAT, a modified version, was thus introduced by to enhance the sensitivity of the original CHAT method. A similar screening study was conducted for M-CHAT, and it was discovered that it had higher sensitivity and specificity on the referred sample population despite those of the M-CHAT method on the over-all population remained in question. However, both the CHAT and M-CHAT consisted of over 20 Likert Scale-type questions that needed to be completed in order to assist healthcare specialists in differentiating actual cases from the controls for further referrals. The Modified Checklist for Autism in Toddlers, Revised, with Follow-Up is a two-phase parent screening method to evaluate the risk of ASD. The M-CHAT-R/F can be used freely for research, educational and clinical purposes.
2.1.2. Autism Screening Instrument for Educational Planning3rd Version
How Early Can I Test My Child For Autism
The American Academy of Pediatrics recommends developmental and behavioral screening for all children during regular well-child visits at 9, 18, and 24 months. Screening specifically for autism begins at the 18-month visit. A diagnosis by a specialist can be considered very reliable once the child is 2 years of age.
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What Is The Difference Between Developmental Monitoring And Screening
Developmental monitoring is observing your childs growth as well as the changes over time. Through developmental monitoring, the aim is to see if your child is meeting the typical developmental milestones in terms of learning, speech, behavior, play and movements.
At the doctors office, the healthcare providers can also do developmental monitoring by asking questions about your childs development.
They could also talk and play with the child to see if they are meeting the milestones.
Developmental screening on the other hand is a bit more formal than monitoring. In this process, a closer look is taken at your childs development.
In this process, the child gets a brief test, or the parents or caregivers take a questionnaire about the child.
The tests or questionnaires used in developmental screening are based on research. They ask questions about the language, movement, behavioral, thinking and emotional development of the child.
Developmental screening can be done by various professionals such as a doctor or a nurse, other healthcare providers, community professionals or school staff that are experienced in the subject.
Moreover, developmental screening is done less often than developmental monitoring. The child should be scanned when there is a concern about the risk of ASD.
But developmental screening is also a regular part of well-baby visits for all children even when there is no concern about the risk, as recommended by the AAP.
Examples Of Asd Assessment Tools
Next, well briefly discuss the most common assessments for autism spectrum disorder. The most common assessments for ASD include:
The process of determining whether a child qualifies as having a diagnosis of autism spectrum disorder can be overwhelming. However, it helps to understand the whole system as well as how each step in the process supports the end goals that you have for your child. Understanding the screening and assessment process can help you to be more comfortable and more aware of how the system works which can help ease some of the stress and anxiety that you may experience.
ADOS-2: Autism Diagnostic Observation Schedule, Second Edition. Retrieved 5/21/2021 from
CARS-2: Childhood Autism Rating Scale, Second Edition. Retrieved 5/21/2021 from
June 3, 2021
Modified Checklist For Autism In Toddlers
In most offices, clinicians use the Modified Checklist for Autism in Toddlers , a 23-point questionnaire filled out by parents. Most families find it easy to fill out. Using this standardized screening, pediatricians can pick up children at risk for ASD and will be prompted to start conversations about language delay, concerns about behavior, or possible next steps for a toddler at risk with additional genetic, neurologic, or developmental testing.
Create A Screen Time Schedule
Creating a screen time schedule will ensure youre including a healthy mixture of activities for your child. Plus, it makes screen time predictable. But first create a family media plan to find your appropriate level of media use. Your digital media use will be specific to your family. Some families may need more screen time for homeschooling. Others may need less because they have more access to physical resources like parks and museums. Whatever your level, include a variety of interactive activities.
Limit screen time to moments when social interactions are less likely. For example, have your child watch a video while youre taking a shower or cooking dinner. If possible, combine the media with what youre doing Using digital media in conjunction with real life activities puts it in a useful context, not just as a source of entertainment.
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How To Tackle Screen Time For Kids With Autism
When it comes to tackling screen time for kids with autism, it is truly a balancing act. For many of our children, video games are a social outlet and apps are communication tools. Then to top it off, many children have begun schooling virtually. On the other hand, too much screen time for any child has been linked to behavioral issues, sleep problems, educational struggles, and so much more. So where is the fine line between enough and too much screen time for autistic children?
When out girls were little, tablets and phones for children were practically unheard of. Our television was constantly tuned to PBS every day in hopes to clean the house or make myself something quick to eat. Trips to the grocery store require a giant diaper bag of toys, snacks, and drinks to keep them occupied. The best invention I found at that time to ease my trips to the store was those carts with the additional two seats. While awful to push around, having all three children buckled in was amazing!
Looking back though, I still am not sure how I managed three neurodiverse little girls by myself. When meltdowns occurred, I had to learn very quickly how to help the child struggling while making sure the others needs were met at the same time. Once Netflix became an app that worked well on phones, it was life changing as a parent. I could get through the store or doctors appointments so much easier.