On average, half of the families of children with autism spectrum disorder are aware of children’s unusual behavior after 18 months of age. At this point, the autism test performed at an early stage is of great importance. Think about that your child is behaving in a disturbing manner and obviously you want to know what the problem is. Autism spectrum disorder can be recognized from some specific behavior.
One of the most important steps in child health monitoring is the evaluation of development. For this reason, in the assessment of child evaluation; the child’s gross motor, fine motor movements, understanding what is said, expressing their wishes, speaking and social communication skills should be evaluated whether they are appropriate for their age.
During the examination, the development process should be evaluated in detail by taking into consideration the observations of the doctor about the child, history and physical examination findings and the concerns of the family about the development of the child. However, there is no specific screening test in routine use for early detection of autism spectrum disorder.
In some tests, experts and parents can compare the child’s behavior with the typical behavior of children with autism. The result of the test is not diagnostic. On the other hand, thanks to this test, parents can see if there is a reason to do more detailed research.
Children with autism do not have good relations with the people around them. These children who have difficulty in speaking compared to their peers experience communication problems. Early diagnosis is of paramount importance, especially in the case of autism, which is manifested itself by the lack of eye contact.
Because autism has no definitive treatment. However, as a result of early diagnosis, autism effects can be reduced by up to 70% thanks to the education that children with autism get.
The attention of families is very important for the diagnosis of autism. Let’s think that there is a family with 12 months old child, there are some points that a family with a child of 12 months should pay attention to. For example, The fact that the child never rips, does not have any hand signals, does not say a single word when the child is 16 months, cannot speak two words spontaneously when he/she comes to 24 months, etc.
When such cases occur, parents can go to an expert in order to ensure the early diagnosis of autism spectrum disorder. Therefore, parents should observe the different behaviors that exist in their children.
Types of Autism Test
It can be difficult to diagnosed autism because there is no medical testing. Experts are going to ask parents about children’s behaviors, thus, parents need to observe look at the child’s behavior in order to help experts for a diagnosis.
Autism spectrum disorder screening tests are developed based on the symptoms of autism and the characteristics of the child with autism. In the first step, the parents need to have the expert opinion and evaluation as well as the tests they have filled. All behaviors of a child with suspected autism should be observed first.
Screening tests for autism spectrum disorder are indicated as two levels. Level 1 is aimed at identifying those who are at risk for autism in the community, and level 2 is intended to differentiate autism from other developmental disorders in high-risk children.
Autism tests are CHAT (Checklist for Autism in Toddlers), M-CHAT (Modified Checklist for Autism in Toddlers), ESAT (early screening for autistic traits), CSBS DP (Communication and Symbolic Behavior Scales Developmental Profile), PDDST (Pervasive Developmental Disorders Screening Tests-Stage I and II), TIDOS (Three-item Direct Observation Screen), Rapid ABC Test and ASAS (Australian Scale for Asperger’s Syndrome).
Among these, CHAT and its modified form, M-CHAT, are the most frequently used screening tests in the early diagnosis of autism spectrum disorder.
Autism Spectrum Disorder Awareness Test
It is a test that parents should fill it at the beginning of the diagnosis. It means if parents have any suspicion about a child’s condition, they should fill it first. And then, according to results they can go to the specialists. This test consists of some basic questions that should be answered as yes or nor. For example;
• The child has established close eye contact.
• The child has established distant eye contact.
• The child is able to talk.
• The child is turning around on his/her own.
• The child is rotating objects.
• The child is pointing objects.
• The child has stereotypical movements such as flapping, hands pounding or hands rub.
• The child has the habit of looking up.
• The child walks at his/her fingertips.
• The child repeats a word or makes the same sound constantly.
• The child uses his/her right hand.
• The child uses his/her left hand.
• The child uses both hands.
• There are stains on any part of the body.
• There is shaky walking.
• The child has intriguing curiosity and order.
• The child always insists on using the same path or wearing the same clothes.
• If the child uses a pen, he/she tends to draw around.
• If the child uses a pen, he/she tends to draw straight and square.
• There is a tendency to memorize everything.
• The child makes optical reading. (such as reading logos, signs, etc.)
• The child has a sense of disgust.
• The child does not like raw and soft objects.
• The child is disgusted with raw and soft objects.
• His/her hand, fingers, various objects are constantly in his/her mouth.
• The child shows a dependence on the mother.
• The child wants to sleep with the mother.
• The child does not like water, bath or pool.
• The child likes songs and makes musical noises.
• There are self-injury behaviors. (biting, hitting own chin and forehead, pulling own hair, etc.)
• The child hits the person around them.
• The child masturbates.
• The child is not comfortable with sounds.
• The child gets disturbed by crowded environments.
• Her/his body or head tilted in one direction while walking.
• The child opens his arms.
• The child stands with his/her arms up.
• The child runs all the time.
• The child tends to produce various or uniform sounds when running.
• Collecting, aimless accumulation, excessive order of interest, obsessive behaviors are observed in family members.
• The child always carries an object in his/her hand.
• The child likes liquids like cleaning agents, cream, shampoo.
• Moods are observed on two constantly changing ends (excessive laughing – crying, etc.).
• The child always cries
• The child always laughs.
• He/she either scratches his/her eyes or grinds his/her teeth.
• The child eats or licks photo, newspaper, earth, glass, battery, and pencil.
• Family members have a history of schizophrenia, bipolar disorder, and paranoia.
• Family members have a history of neurological disease.
This test was created and developed to raise awareness about Autism Spectrum Disorder. It is important for parents if they suspect that their child has autism. After evaluating by experts, necessary guidance and treatments are made.
Rapid ABC Test
While the standard autism spectrum disorder test that has been used so far takes between 2 and 4 hours, a new test developed by Emory University can understand whether small children are in the risk group or not in just 5 minutes.
Autism is one of the biggest nightmares of parents to be. The diagnosis of this disorder, which has been increasing in our lives for the last 15 years, is very easy to diagnose but impossible to treat. Even if a certain level of improvement cannot be achieved with early diagnosis, treatment methods are provided in order to improve the child’s life quality.
Diagnosis before treatment is a very complicated area for parents. There are such cases that parents cannot be sure of the situation. Even experts from time to time may have difficulty in making these diagnoses. The experts of the American Pediatric Academy recommend that all children who are 18 to 24 months old age undergo routine autism screening.
The test, which is a very simple practice, has implemented 10,500 families with doubts about the child so far. The hit rate in the diagnostics revealed the reliability of the test which is 75%. It aims to measure attention, mutual interaction and communication in infants aged 15 to 17 months. When the 5-minute test is over, the results are loaded into the computer program. Depending on the results achieved by the computer, the baby is referred to a further scan or not. Research shows that this 5-minute test is very effective in the diagnosis.
The 5-minute test consists of 5 parts. The aim is to identify the babies who are in the risk group as early as possible and start to intervention.
1. Gesture and body language
2. Attention level
3. Body language
4. Eye contact
There are some questions asked to parents. They are as follows:
1. Do you have any definite knowledge about when your child is happy and unhappy?
2. Does your child try to attract your attention when you are not interested in your child?
3. Does your child point to objects around?
4. Does your child use sound and words in order to draw attention or help?
5. Does your child show a desire to play with different objects?
Studies on diagnosis and treatment will surely come to better points, but what concerns parents is what causes this disorder! All known is that autism spectrum disorder comes from the genetics of the mother and father. It is not necessary that parents should have autism for their child has autism.
If there is anxiety, depression, alcoholism, obsession in genetics, they can lead to small genetic mutations and the child may be born with an autism spectrum disorder. In addition to the genetic infrastructure, scientists claim that there are also environmental factors.
Pesticides, viruses, and chemicals that we use in our homes show the negative effects of the baby in the mother’s womb. For example, babies exposed to thalidomide (a substance used to strengthen the immune system), valproate substance or rubella are at high risk. In addition, researchers have found that insecticides, food containers used at home, and chemicals found in everything from plastics are also effective.
There is a study suggests that children living in close to busy highway areas have a higher risk of autistic birth than those who do not live in such places. In that study, researchers examined 304 children with autism. When they were born, babies who were living close to busy highways revealed that two times more autism was diagnosed. According to these results, researchers believe that air pollution is one of the reasons that triggered autism spectrum disorder.
M-CHAT (Modified Checklist for Autism in Toddlers)
M-CHAT consists of 23 items developed to be directed to the child’s parent or child’s primary caregiver. Each item in the scale is answered as yes or no. The first 9 of these items were taken from CHAT; the remaining items were prepared by those who developed the scale. The second section based on the observation in CHAT was removed. There are 6 critical items related to autism in M-CHAT.
The M-CHAT screening test is the most recent screening test in the literature among level 1 screening tests because it is easy to apply, relatively short duration, can detect autistic findings between 18 months and 3 years of age, can be filled by families and has higher sensitivity. The reliability value of M-CHAT test was found to be 0.69 with 23 items. This value is quite reliable. As a result, the MCHAT test in children aged 18-30 months can be used.
In order to determine the definitive diagnosis in autism, M – CHAT test which is one of the most applied autism tests is applied to children. M – CHAT test is applied to detect symptoms of autism on 18 – 30/36 month old children. This test, which consists of 23 items in total, lasts 15 to 20 minutes on average.
M – CHAT Test determines whether a child has a suspicion of autism or not. As a result of this test, children who are diagnosed with autism spectrum disorder are started to be educated as soon as possible. This leads to a decrease in autism symptoms with early diagnosis. All children who fail in either of the 23 items included in the scale or any of the critical items of 6 are at risk for autism spectrum disorder.
M – Chat test should be administered by the child’s mother or the child’s primary caregiver. 23 questions asked in the test should be answered by taking into consideration of the general situation of the child. If a certain behavior is very rare, the answer should be answered as if it is not done at all.
• If you point at something across the room, does your child look at it?
• Have you ever wondered if your child might be deaf?
• Does your child play pretend or make-believe?
• Does your child like climbing on things?
• Does your child make unusual finger movements near his or her eyes?
• Does your child point with one finger to ask for something or to get help?
• Does your child point with one finger to show you something interesting?
• Is your child interested in other children? Does your child watch other children, smile at them, or go to them?)
• Does your child show you things by bringing them to you or holding them up for you to see – not to get help, but just to share?
• Does your child respond when you call his or her name?
• When you smile at your child, does he or she smile back at you?
• Does your child get upset by everyday noises? Does your child scream or cry to noise such as a vacuum cleaner or loud music?)
• Does your child walk?
• Does your child look you in the eye when you are talking to him or her, playing with him or her or dressing him or her?
• Does your child try to copy what you do, such as wave as bye-bye, clap, or make a funny noise when you do?
• If you turn your head to look at something, does your child look around to see what you are looking at?
• Does your child try to get you to watch him or her?
• Does your child understand when you tell him or her to do something?
• If something new happens, does your child look at your face to see how you feel about it?
• Does your child like movement activities?
(Robins, D. L., Fein, D., & Barton, M. L. (1999). The modified checklist for autism in toddlers (M-CHAT) follow-up interview. Publisher: Author. Find this author on.)
After the answers to these questions, it is determined whether the child shows signs of autism. This autism test is very important for early diagnosis. At the end of the test, the child who has autism symptoms starts an intensive education at home and at school.
LOW-RISK: If the total score is between 0 and 2. If the child is less than 24 months of age, the test should be repeated after the second birthday. If there is no risk for autism in screening, no further action is required.
MID-RISK: If the total score is between 3 and 7. To obtain additional information regarding risk-indicating responses, the observation part of the test should be completed. If the M-CHAT score is again 2 or higher, the child is considered having autism on screening. Refer the child for diagnostic and early intervention compliance assessments.
If the score is between 0 and 1, the child is considered to be autism negative in the scan. If there is no risk for autism in screening, no further action is required. The child should be re-screened for subsequent child examinations.
HIGH-RISK: If the total score is between 8 and 20. By skipping the observation part, the child can be referred for diagnostic and early intervention assessment.
Early Screening of Autistic Traits (ESAT)
It is a primary screening checklist that was designed and developed for infants who are aged 0 to 36 months old. It is based on prominent early signs of autism and also symptoms of Autism Spectrum Disorder. It should be completed by parents or primary caregivers during well-baby visits. It indicated that if there are failures on 3 or more items, it means there is a need for further evaluation.
The original publication of the Early Screening of Autistic Traits described 19 items. However, the experts used the first 14 items only. Even though it was developed to be used for infants 0-36 month(s) old, primarily targets are infants who 14-15 months of age.
The researchers and experts related to this area report that the ESAT has high specificity to differentiate normally developed children from children with autism spectrum disorder and less specificity in distinguishing between autism spectrum disorder and other types of abnormal development.
This test should be answered by yes or no. If parent or primary caregivers of the child answer 3 or more questions as “no” then the child is eligible for continued screening and should take to the experts.
• Is the child interested in different sorts of objects, and not for instance mainly in cars or buttons?
• Can the child play with toys in varied ways?
• When the child expresses his/her feelings is that mostly on expected and appropriate moments?
• Does the child react in a normal way to sensory stimulation, light, sound, pain or tickling?
• Can caregivers easily tell from the face of the child how he/she feels?
• Is it easy to make eye contact with the child?
• When the child has been left alone for some time, does he/she try to attract people’s attention around them?
• Is the behavior of the child without stereotyped repetitive?
• Does the child, on his/her own accord, ever bring objects over to someone or show something?
• Does the child show to be interested in other children or adults around them?
• Does the child like to be cuddled or be in intimate relation?
• Does the child ever smile at the primary caregiver or at other people in the environment?
• Does the child like playing games with others?
• Does the child react when spoken to, for instance, by looking, listening, smiling, speaking or even babbling?
• Does the child speak a few words or utter various babbling sounds?
• When someone is pointing at something, does the child follow the gaze to see what someone is pointing at?
• Does the child ever use his/her index finger in order to point and in order to indicate interest in something?
• Does the child ever use his/her index finger in order to point and in order to ask for something?
• Does the child ever pretend or act something or someone?
(Dietz, C., Swinkels, S., van Daalen, E., van Engeland, H., & Buitelaar, J. K. (2006). Screening for autistic spectrum disorder in children aged 14–15 months. II: Population screening with the Early Screening of Autistic Traits Questionnaire (ESAT). Design and general findings. Journal of autism and developmental disorders, 36(6), 713-722.)
TIDOS (Three-item Direct Observation Screen)
The TIDOS scale makes it easier to apply and scans more children as a result of the increasing prevalence of autism spectrum disorder. This scale is based on direct observation of the child. The scale can be applied in clinical practice by health professionals such as physicians, psychologists, psychiatrists, pediatricians, nurses, pedagogues, neurologists.
In TIDOS; common attention (the person’s attention itself, the arrangement between the person and the object in which it interacts), eye contact and the answer to the name (in four different cases) are evaluated.
This test is based on the social and communicative link between the child and the physician and the child and his / her parents during the examination of the physician. The test is a simple, easy-to-apply and newly developed screening test that can be applied in any environment, without requiring any material.
The TIDOS observational screening test is based on the observation of the experts during the examination of the child. Before starting the observation, 2-3 toys will be placed in the environment to be evaluated. Experts during the examination observe the child’s behavior in three areas, which are responding to the name, taking part in common consideration and making eye contact, in approximately 15 minutes.
Responding to name; It is defined as the look of the child when he/she is called. The child calls by the name while not looking at the practitioner it and dealing with something else. No other word is said to the child than the name of the child. If the child does not respond, this is repeated 4 times.
Common attention; It means to collect the attention of the baby and the adult with a common point. With his/her forefinger, the practitioner points to an object in both the child’s reach and his/her reach that is not accessible and asks the child to look at it. In doing so, the practitioner first looks at the child, then looks at the object and then again at the child and observes the child’s gaze.
Eye contact; It is defined as the non-verbal communication form that occurs when two people look into each other’s eyes at the same time. Eye contact should be clear, variable, socially oriented and repeated several times in different situations. This is evaluated if eye contact is limited, rare and inappropriate. If the child looks embarrassed and his/her behavior varies, this parameter is evaluated after the child is used to.
Communication and Symbolic Behavior Scales- Developmental Profile (CSBS-DP)
In the beginning, this test was not developed for testing autism. However, because of the characteristics of autism, experts can use this test for diagnosis. There are two main aims of CSBS-DP. One is the identification of children who are at risk for developing a communication impairment. And the other is monitoring changes in a child’s communication, speech and symbolic behavior over time.
This is the first step in routine developmental screening for children who are 6 to 24 months old in order to decide whether a communication evaluation is needed or not. It should be filled by the primary caregiver who nurtures the child on a daily basis. It takes about 5 to 10 minutes to complete.
The Communication and Symbolic Behavior Scales Developmental Profile Infant/Toddler Checklist is developed in order to measure some language predictors. These predictors are collected under 3 umbrellas. First one is communication composite which consists of emotion and use of gaze, use of communication and use of gestures. The second one is expressive speech composite which consists of the use of sounds and use of words. The third one is a symbolic composite which consists of an understanding of words and the use of objects.
Pervasive Developmental Disorders Screening Tests – Stage I ve II (PDDST)
This test is designed and developed in order to identify children between 12 to 48 months old who may be on the autism spectrum. This test is completed by the child’s parent or the child’s primary caregiver. It consists of a 23-item questionnaire. The test identifies toddlers and young children who may be on the autism spectrum. And as a result, the tests help to identify who should be referred to experts for a more complete evaluation.
ASAS (Australian Scale for Asperger’s Syndrome)
This scale is designed and developed in order to identify behaviors and abilities indicative of Asperger’s Syndrome in children during their primary school years. It is mostly a Likert type scale. It consists of 24 questions, which should be answered from rarely to frequently, and 10 open-ended questions. It takes about 5 to 10 minutes to complete. It should be completed by parents, teachers or other caregivers who know the child very well.
Facts About Developmental Screening
- Although it is thought that there are no adequate screening tools for preschoolers, nowadays sound screening measures exist for them. Most of the screening measure have sensitivities. Their specifities are greater than 70%.
- Requirements for training and educatiın are not extensive for screening tools. Paraprofessionals can administer many of them.
- Contrary to popular belief which is screening test takes a lot of time, many tests take less than 15 minutes to complete. And even some of them takes only about 2 minutes to complete.
- Parent’s concerns are predictive of developmental delays. That’s why their concerns are generally valid and essential. According to some researches, parental concerns detect up to 80% of children with disabilities.