Autism Evaluations for Children

Autism spectrum disorder is also referred to as ASD or, simply, autism. Autism is not an illness or a disease.  Children with ASD have brains that work differently.  They display differences in the way they communicate, interact with others, and experience the world around them.  Children with autism may experience difficulties with social communication and reciprocal social interaction, show delayed or limited ability to form social relationships, insist on sameness, engage in repetitive behaviors, have restricted interests, and/or experience sensory processing differences.  

Autism is referred to as a spectrum disorder due to the wide variability in traits and characteristics, as well as the differing levels of severity of symptoms that people experience. Individuals of all genders, races, ethnicities, and economic backgrounds can be diagnosed with ASD.  When diagnosed with autism, the severity level is described in three ways: level 1 (requiring least amount of supports), level 2 (requiring substantial supports), and level 3 (requiring very substantial supports).   There is an additional categorization of “with or without language impairment” and “with or without intellectual impairment.”  The specifics of these categorizations are one of many reasons that a thorough autism evaluation is so important.  

Some common signs and symptoms of ASD include the following (but keep in mind that every child with ASD is unique and may display some or all of these traits): 

• Limited social exchanges such as pointing to objects, offering a social smile, showing objects to others
• Limited use of non-verbal communication strategies such as nodding and shaking head, using hand gestures, and directing facial expressions
• Difficulty developing and maintaining relationships with same-age peers
• Delayed expressive and receptive speech
• Limited use of eye contact when speaking or listening
• Loss of language skills
• Tendency to adhere to strict routines or rituals
• Becomes highly distressed in response to change or transitions
• Use of stereotyped phrases and/or repetitive speech
• Plays with objects in unusual ways, such as repetitively rolling wheels 
• Unusual or repetitive movements, such as rocking, flapping hands, toe walking, and picking at skin 
• Strong reactions to and avoidance of sensory input such as sounds, touch, lights, or textures
• Restricted or fixated interests in one toy or topic 
• Struggles with emotional and behavioral regulation resulting in frequent meltdowns or self-injurious behavior

Early intervention is critical.  When a toddler, child, or teen presents with any of the above signs and symptoms, they should be evaluated for ASD and related difficulties.  Often, a formal clinical/medical diagnosis is required before the child can access the needed supports, services, and therapies.   

ASD can be sometimes identified as early as 18 months of age or younger. By age 2 years, an experienced psychologist can evaluate and provide a reliable diagnosis.  Unfortunately, many children do not receive a final diagnosis until much older.  

Typically, a clinical psychologist (Psy.D. or Ph.D.), psychiatrist, or developmental pediatrician can diagnose autism.  Regardless of the provider’s license or credentials, extensive training and experience is necessary for assessing ASD.  Other key providers in the assessment process may include speech-language pathologists, occupational therapists, counselors, and social workers.  

While the first step of an autism evaluation may be a screener or check-list questionnaire, a thorough evaluation by a clinical psychologist should also include a clinical interview, review of records, IQ/cognitive testing or developmental testing, a measure of adaptive functioning, standardized direct assessment of autism symptoms, clinical observation, and parent report.  Typically, a clinical psychologist or neuropsychologist who specializes in autism assessment will have experience and training in gold-standard measures that should be included in the evaluation.  

Parents are often surprised to learn that a clinical/medical diagnosis of ASD does not automatically mean their child is eligible for an educational classification of autism.  Similarly, an educational classification (IEP) of ASD does not mean the child meets criteria for a medical/clinical diagnosis.  

The assessment process and criteria for a medical/clinical diagnosis vs. school-based classification (IEP) are different, as is how the diagnosis or classification can be used.  The primary differences are: 1) an educational classification cannot be used to access outside therapies or services, 2) an educational classification is based on a set of legal criteria as opposed to clinical criteria, and 3) an educational classification is heavily based upon needs that are specific to the classroom and learning.  If a child has an educational classification of autism, it is highly recommended that the family seek medical/clinical assessment by a clinical psychologist.  The need for a medical/clinical diagnosis will not likely be brought up by the school.

If you are concerned that your child exhibits traits and characteristics of autism spectrum disorder, a good first step is to consult with a clinical psychologist who specializes in ASD evaluation. This consultation should clarify the evaluation purpose and process, outline the scope and cost, and identify goals and potential outcomes. You should feel comfortable with the provider, understand their philosophy about child development and autism, and clearly understand the evaluation process and associated costs. This is also the time to ask questions. If you don’t feel good after the consultation, consider shopping around for other providers and options.

Treatment and intervention for ASD are unique for each child – this is why individualized evaluation is so important. Every child’s ASD profile is one-of-a-kind, just like their fingerprints.  When the process begins with a quality evaluation, you can be sure you are on the right track to helping your child.  Based on the findings from your child’s evaluation, you will be guided to the next steps and interventions.