According to a survey conducted by Families for
Early Autism Treatment (FEAT), these are the five
most common concerns parents described prior to
diagnosis of autism by a qualified professional:
-
Lack of speech, and/or had words
and lost them.
-
Child seems deaf.
-
Child does not make eye contact
with parent or care giver.
-
Child has unusual, odd behaviors
including severe tantrums. The child may also
be self injurious, difficult to control, and engage
in self stimulation.
-
Child ignores or does not play
with other children.
(FEAT, 1997)
CHAT, the Checklist for Autism in Toddlers, has
demonstrated strong effectiveness in predicting
which children will ultimately receive a diagnosis
of autism (The British Journal of Psychiatry, 1996).
Parents, care givers and educators can ask themselves:
- Does your child enjoy being swung, bounced on
your knee, etc?
- Does your child take an interest in other children?
- Does your child like climbing on things, such
as up stairs?
- Does your child enjoy playing peek-a-boo, or hide-and-seek?
- Does your child ever pretend, for example, to
make a cup of tea using a toy cup and teapot, or
pretend other things (pouring juice)?
- Does your child ever use his/her index finger
to point, to ask for something?
- Does your child ever use his/her index finger
to point, to indicate interest in something?
- Can your child play properly with small toys (eg
cars or blocks) without just mouthing, fiddling
with, or dropping them?
- Does your child ever bring objects over to you
(parent), to show you something?
CHAT also includes more detailed observational assessment
that can be conducted by a professional. (See appendix
for complete CHAT screening tool.)
The Childhood Autism Rating Scale (CARS) is also a
useful instrument for children ages two and over that
can reliably distinguish children with autism spectrum
disorders from children with other developmental disorders,
as well as distinguish amongst levels of severity
within the autism range. This instrument can be used
through observation, reviewing charts and records,
and/or interviews. It is comprised of fifteen domains:
relating to people, imitation, emotional response,
body use, object use, adaptation to change, visual
response, listening, taste/smell/touch response and
use, fear or nervousness, verbal communication, nonverbal
communication, activity level, level and consistency
of intellectual responses, and general impressions.
A four-point scale provides ratings on a continuum
from within normal limits (1) to severely abnormal
(4). Total scores then lead to categorization from
non-autistic, to mild autism, to moderate autism,
to severe autism.
CARS is described by its authors as "an initial
aid in the classification process" (Schopler,
Reichler & Rochen-Renner, 1988). It is constructed
to be immediately useable with minimum training by
professionals from a wide variety of disciplines.
Reliability and validity are considered acceptable.
A constraint of this instrument is that it incorporates
a range of symptoms with no weighting, yet some symptoms
are clearly more diagnostic than others. Reliability
and validity data also need to be updated. CARS can
be obtained from Western Psychological Services, 12031
Wilshire Boulevard, Los Angeles, CA 90025-1251.
Parents and professionals who suspect a child may
have autism should immediately alert the child's physician.
Children under five should be referred to Child Development
Services. Children five and over should be referred
to local public schools. Based upon the results of
initial screenings, the child may be referred to a
psychologist, psychiatrist, or one of five developmental
evaluation clinics (DECs) throughout Maine for a definitive
diagnosis (see appendix for list).
Some children with autism have complex biobehavioral
issues including seizure activity, self injury, tantrums,
aggression, and property destruction. Combined with
severe deficits in functional communication, these
behaviors may require inpatient assessment.
Early diagnosis leading
to effective, early intervention is critical to the
child's outcome. If in doubt, refer!
References/Screening Children
for Autism
The British Journal of Psychiatry,
(1996), 168, 158 - 163; The British Journal of Psychiatry,
(1992), 161, 839 - 843.
"Doctor, My Child Doesn't Talk:" The Importance
of Early Autism Diagnosis. (Pamphlet)
Families for Early Autism Treatment (FEAT), PO Box
255722, Sacramento, CA 95865-5722 (916) 843-1536.
Schopler, E., Reichler, R. J., & Rochen-Renner,
B. (1988). Childhood Autism Rating Scale, Western
Psychological Services.
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