What is autism spectrum disorder screening?

Autism spectrum disorder (ASD) is a developmental disability caused by differences in a person's brain. ASD affects how people interact with others, communicate, learn, and behave. It can be diagnosed at any age, but symptoms usually show up in the first two years of life and can be life-long.

ASD is called a "spectrum disorder" because there is a wide range of symptoms and strengths in people with ASD. For example, some people with ASD may not talk at all, while others have strong language skills. The learning, thinking, and problem-solving abilities of people with ASD may range from severely challenged to gifted.

ASD screening is mainly used for young children. It helps find out whether a child has any early signs that could be ASD. But screening cannot diagnose ASD. If a screening shows that a child may have the disorder, more testing will be needed to find out for sure.

ASD screening in early childhood is important because early treatment for ASD can help reduce autism symptoms and improve quality of life. For this reason, health care providers routinely screen children for ASD before age two. Older children and adults may also be screened if they have symptoms of ASD but have never been diagnosed with the disorder.

Providers used to group ASD into different types of autism based on a person's symptoms. These were called Asperger syndrome, autistic disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS). There terms are no longer used to diagnose ASD.

Other names: ASD screening

What is it used for?

Autism spectrum disorder screening is most often used to check for signs of autism spectrum disorder (ASD) in children age 2 and under. It helps find out which children need more testing to see if they have ASD.

ASD can be hard to diagnose, and screening may not find milder cases in early childhood. So, ASD screening may also be used in older children and adults who have certain challenges with social life and/or behavior that could be signs of ASD.

Why does a child or an adult need an autism spectrum disorder screening?

The American Academy of Pediatrics (AAP) recommends ASD screening for all children at their 18-month and 24-month well-child checkups.

More ASD screening may be needed if your child has a higher risk for ASD. The risk for ASD is higher for children who:

• Have a sibling or other family member who has ASD
• Have older parents
• Have certain genetic disorders or chromosomal conditions, such as Down syndrome, Fragile X, Rett syndrome, or tuberous sclerosis
• Had problems during childbirth and/or were born with a low birth weight

Research studies have found no link between vaccines and ASD.

Your child may need ASD screening at any age if you, a teacher, or other caregiver notices possible autism symptoms. Some of the more common ASD symptoms in children and teens include:

• Problems with communication and social behavior, such as:
  • Making little or no eye contact with others
  • Not responding when people smile or talk to them
  • Rarely sharing their interests with others (for example, rarely showing you their favorite toy)
  • Trouble having conversations
  • Talking a lot about a favorite subject without noticing others aren't interested
  • Having an unusual tone of voice that's robot-like or sing-song
  • Having trouble making friends
  • Not understanding humor or sarcasm
• Having unusual behaviors and/or or narrow interests, called "restrictive/repetitive behaviors." For example:
  • Repeating words or phrases (called echolalia), or hand flapping and/or body rocking
  • Having a lasting, intense interest in specific topics, such as numbers, details, or facts
  • Showing unusual attachment to toys, objects
  • Becoming upset by slight changes in a routine and having difficulty changing from one activity to another
  • Being more sensitive or less sensitive than other people to sensory input, such as light, sound, the feel of clothing, or temperature

If you're concerned about your child or teen, talk with your child's provider even if your child had a normal ASD screening in the past.

Adults may need ASD screening if they have problems that could be signs of autism, but they were never diagnosed with ASD. Usually, their symptoms are mild, which is why they were not diagnosed earlier. Their challenges may include:

• Problems communicating and interacting with others, such as having trouble understanding other people's emotions
• Restricted interests and/or repetitive behaviors
• Trouble understanding what behavior is expected in school, work, or other areas of life

Adults with ASD may also have difficulty keeping a schedule and setting long-term goals. They often have other conditions such as anxiety, depression, or attention deficit hyperactivity disorder (ADHD).

What happens during an autism spectrum disorder screening?

For children: Screening for ASD is usually done by your child's pediatrician (a doctor who specializes in treating children) or nurse. Screening may also be done in school by trained professionals. The screening may have one or more parts, including:

• Questionnaires. You'll usually complete one or more questionnaires. The questions ask about your child's development and behavior, including speech, movement, thinking, and emotions. ASD often runs in families, so you may also be asked about your family health history.
• Observation. The provider will watch how your child plays and interacts with you and/or others. For example, the provider will check if your child responds to your laugh or looks at a person who tries to get their attention. Not responding may be a sign of ASD.
• Interactive screening tests. These tests are play activities, such as playing make-believe with dolls or other toys. These tests are designed to check your child's communication skills, social behavior, and other abilities.

For adults, screening tools for ASD are still being developed and tested. Your primary care provider may refer you to a specialist, such a psychologist or psychiatrist. The specialist may:

• Talk with you about the challenges you face in your day-to-day life
• Ask you to complete a questionnaire about your symptoms
• Ask to talk with family members who remember what you were like as a young child
• Do screening tests for depression, ADHD, and/or anxiety, which are common in people who have ASD

Will I need to do anything to prepare for an autism spectrum disorder screening?

There are no special preparations needed for this screening.

Are there any risks to screening?

There is no risk to having autism spectrum disorder screening.

What do the results mean?

The results of an ASD screening may be given as a score. The score may be described as low, medium, or high risk for ASD. If screening results do not find signs of ASD, but you have concerns, discuss them with your provider.

If the screening shows signs of ASD, it may mean that more testing is needed to confirm whether they are caused by ASD.

Children who show signs of ASD often need to see a specialist for more testing. Several types of specialists may be trained to diagnose ASD, including:

• Developmental pediatricians, doctors who have training in child development and treating children with special needs
• Child neurologists, doctors who specialize in diagnosing and treating conditions involving the brain, spine, and nerves
• Child psychologists or psychiatrists, providers who diagnose and treat children who have mental health, behavioral and/or developmental conditions. Psychologists usually have doctoral degrees (PhDs), and psychiatrists are medical doctors (MDs).

There is no one test that can diagnose ASD. So, a specialist will use a combination of methods, including:

• Detailed questionnaires and/or interviews with parents, teachers, or caregivers
• Watching the child's behavior
• Tests to evaluate the child's thinking, learning, and language abilities
• Exams to check for other conditions that can cause behavior and/or communication problems. These exams may check:
  • The nervous system
  • Hearing
  • Vision
• Genetic testing to look for inherited disorders that can cause ASD. If ASD runs in your family, these tests may be done to help make a diagnosis. Otherwise, they may be done after ASD is diagnosed to help guide treatment.

If your child is diagnosed with ASD, get treatment as soon as possible. ASD treatment involves a variety of services and support depending on your child's needs.

Adults who show signs of ASD may see a psychologist, psychiatrist, neuropsychologist, or other specialist with experience diagnosing ASD in adults. But it can be difficult to find a specialist with this experience. That's because adult testing to diagnose ASD is fairly new. If you would like to find out if you have ASD, ask your primary care provider to help you find a specialist. You might also try contacting an organization in your community that supports people with ASD.

Learn more about laboratory tests, reference ranges, and understanding results.

Is there anything else I need to know about autism spectrum disorder screening?

In early childhood, pediatricians do routine developmental and behavioral screening tests designed to catch other types of developmental problems. These tests may miss ASD, so make sure your child's provider does ASD screening, too.