How Do Doctors Screen For Autism?

Pediatricians, nurse practioners, and family doctors start screening your baby or toddler for signs of developmental or communication challenges like autism from the very first visit. As a pediatrician, how your baby responds to you (and to me) during the various visits during infancy and toddlerhood guide me in their screening. In the office I get to observe how a baby giggles, how they look to their parents for reassurance, how they try to regain their mom’s attention during our conversation, how they point or wave, how they respond to their name, and even how and why they cry when I’m around. Those observations in combination with family history, health exams, and parental perspectives remain extremely valuable for me in helping identify children at risk for autism.
However, more formalized screening is recommended at both the 18 month and 24 month well child check. In most offices, clinicians use the M-CHAT, a 23-point questionare parents fill out. Often, I have to help parents answer one question in particular, (“Does your child make unusual finger movements by their face”) but other than that, most families find it easy to fill out. Using this standardized screening, pediatricians can pick up children at risk for autism 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.
It’s important to note that screening isn’t diagnosing. If your child has a positive screen for autism, it doesn’t mean they will be diagnosed on the spectrum. And further, if your child screens normally but you continue to worry about autism, don’t be shy. Screening tests are just that—screening—and don’t identify all children with autism. The rate of success for the M-CHAT for example isn’t 100% so we use it in combination with health and family history to identify children at risk. In my opinion, your opinons as a parent are irreplaceable and of the most importance.
If you are concerned your child has autism and your child hasn’t been formally screened, talk with the clinician about doing a formal screening. Many screening tools are available for general doctors. But know this, if you are concerned about your child’s communication or behavior due to a family history of autism, the way they talk or express themselves, or other people’s comments about their behavior, DON’T WAIT to talk with the clinician about doing more.
How were your children screened? Did you feel the M-CHAT was easy to fill out? What questions about screening do you have?