Slideshow – From catching early signs till a confirmed diagnosis of Autism–

what do you need to know as a parent?

Target audience: Parents of children between ages 1-4 years

Challenges: Autism diagnosis and assessment occurs around 2 years of age. Often families miss the early
signs and consult with a Pediatrician much later in the stage of the disorder. Early diagnosis can allow early
intervention which may help with better management of the condition in most cases.

Article Type: Basic (any parent with a high school degree must be able to comprehend this)

Tips: Sentences, visuals and voice over

Style: Slideshow article/Audio voice over, Toolkit, infographic

Learning Objective:
1. Understanding the basics of diagnosing a child with autism
2. Outlining the initial laboratory testing needed and multidisciplinary evaluations.
Autism: from early signs to
diagnosis
What do you need to know as a parent
 1 Early signs of
Autism Infographic

2 What to do, and

• Why an early assessment is essential whom to approach?
when parents notice signs of Autism?
• Noticing early signs for Autism– when
should parents be concerned? • Knowing what to do and whom to approach to discuss concerns
• Frequently asked questions about signs
of autism.
Toolkit – downloadable
PDF  How is the assessment for autism done? Risk assessment
 Standardized tools for risk assessment 3 Investigating
 A second opinion if in doubt Autism
 Read up and find resources on the web
• Other tests and investigations Investigating Autism further
• Excluding conditions that can mimic Autism
Slideshow video – voice
• Identify and understand conditions that can occur with Autism co-
over
morbidities

4 Living with Autism

• Coming to terms with Autism

Article with list of
Slideshow video – voice
content cross references
over

•Importance of early intervention 5 Early intervention

with Autism
Detecting Autism and knowing what to do at every step

1 Early signs of
Autism
Know the signs and act early on your concerns

• Many parents of children with autism had some concerns when their child was about 18 months
of age. But, for most of them getting a diagnosis was delayed till the child was 4 to 5 years of age
and precious time was lost that could have been used to help the child.
• Many children with autism can be diagnosed at about the age of 18 months. Some children,
however, do present later and are diagnosed when they are of school age.
• Parents can find out more about early signs of autism . Knowing these signs helps in noticing
indicators of autism.
• Many of the early signs of autism are also seen in children with developmental delay, hearing and
vision impairment. Simply noticing some signs does not meant that child will have autism. It does
mean that the parents must take the next step.
• If parents notice any of the early signs, they can use some ‘screening tests’ to help them.
• It is always best to ask for professional advice early; merely getting a developmental assessment
does not mean that there is something wrong with the child. It will help clarify concerns and the
child will get the help she/he needs early.
How do parents suspect that their child may have autism?
Parents know their child best. Observing the following abilities and behaviour can help in noticing
early signs of autism:
Does your child say any words to you?
Does your child look into your eyes when talking to you?
Does your child point to show you something at a distance?
Does your child respond when his/her name is called?
Can you and your child play together, taking turns and sharing? (in games such as clap hand/peek-
a-boo /hide and seek)
Does your child show interest in other children? (from 18 months children like getting close to
other children)
Does your child play in a pretend manner, for example, making or giving you pretend food or
feeding or sleeping a teddy or a doll? (children start doing this from 18 months to 2 years)
Is your child able to play together with other children, taking turn and sharing with them? (this
starts from about 3 years, children play alongside others before that)
If you have answered ‘No’ to any of the questions :
you may want to complete one of the screening questionnaires to help you decide the need for
further assessment.
Early signs noticed by early educators/teachers
Some early signs of autism are noticeable to early educators or teachers:
Not responding to name (children usually respond to their name well by 12
months of age; can also be due to hearing problems)
Wanting to be alone and not interested in other children
Not communicating with others, apart from asking for their needs
Late in talking and understanding language (can be due to language delay as well)
Not sharing their interest with others by pointing towards objects and then
looking at others to draw their attention
Not giving eye contact while communicating with others
Showing unusual sensory interest or reaction such as staring at light or covering
their ears even when there is no loud noise
Unusually strong or obsessive interest in objects or activities
Early signs of autism noticed by other practitioners -1

Speech and language therapists:

In some instances parents may first take the child to a speech language therapist due to
delay or inability to talk. Under those circumstances a speech and language therapist may
also spot early signs of Autism in your child.

Speech therapists may notice:

Unusual features of communication, social interaction or play

You should give information to the therapist about what you have noticed so far about the
child and ask the therapist to:
Describe to you what they have seen and what that means
Give you information about ways of helping the child
 Guide you about where and how to arrange a full developmental or autism assessment
Early signs of autism noticed by other practitioners - 2
A paediatrician may want to check (screen) for early features of autism. They may
want to do any of the following:
Use the M-CHAT or Q-CHAT-10
Ask you questions about the child’s language, play and social interaction (give
information about what you have noticed)
Observe or assess the child’s:
General developmental abilities
Language and communication skills
Play and social interaction skills

You should ask the paediatrician about their findings, what they mean, who else
can help and what you can do next.
Knowing what to do and whom to approach to discuss concerns:
a. screening questionnaires
If there is a concern that a child may have autism, it is often helpful to complete a screening
questionnaire:
Screening for autism means looking for some relevant signs to help you decide whether or not the
next step of assessment is required. A screening questionnaire is not a test for diagnosis, it does not
make or exclude a diagnosis. It only indicates when getting an assessment will be most helpful.
Screening questionnaires are a set of questions to prompt you to look at some behaviours and
abilities.
M-CHAT is a valid screening questionnaire that can be used for children between the ages of 16 to
30 months. How to complete the M-CHAT?
1. You can complete M-CHAT online in English here: M-CHAT online English

2. You can download and print M-CHAT in other languages (Hindi, Tamil, Urdu and Gujrati are
available) from here: M-CHAT Translations

Once you have completed the questionnaire you will need to look at the instructions for scoring the
M-CHAT. Remember, you may need help from a developmental paediatrician or a therapist in
interpreting the results.
Screening questionnaires for autism (contd)
Q-CHAT-10
This is another screening questionnaire to help decide when to proceed to a full assessment. It can be
used for children between 18 to 24 moths of age.
You can download and print this questionnaire in English here: Q-CHAT-10 English
and in Hindi here: Q-CHAT-10 Hindi

AQ-10 Child: This is similar to Q-chat 10 and can be used for children aged 4 to 11 years.
AQ-10 Child English AQ-10 Child Hindi

AQ-10 (Adolescent): This is similar to Q-chat 10 and can be used for children aged 12 to 15 years.
AQ-10 Adolescent English AQ-10 Adolescent Hindi

Screening questionnaires do not make diagnosis. They only tell if a diagnostic assessment should be
done.
If you have concerns that your child may have autism, it is always best to get professional advice from a
developmental paediatrician or a therapist working with children with autism.
Knowing what to do and whom to approach to discuss concerns:
b. taking professional advice

Parents should seek early professional advice if:

The screening questionnaire is suggestive of autism
Parental concerns are high: they have definitely noticed some early
signs or there is another child with ASD in the family
Concerns arise from multiple sources e.g. parents, early educators or
teachers and therapist
In such a situation a thorough diagnostic evaluation should be
performed by a certified psychologist/child-psychiatrist , Pediatrician or
a developmental Paediatrician.
 Parents review child’s developmental milestones.

Parental concerns
Parents are concerned about child development &
and have identified red flags.
for Autism
Parents consult with care-givers, family members,
day care helper, special educators
What to do and
whom to approach?
Parents use M-Chat to check for signs of ASD, score
it themselves online.

Parents consult their pediatrician/Developmental

Pediatrician with the M-CHAT scores and raise
concerns about missed milestones.

Asks to come Does the Pediatrician

back for
review in the express a cause for concern?
future after
monitoring
development. NO YES

Child’s development is assessed, and counseling is provided.

Note to parents : Ask your Pediatrician/Developmental Pediatrician about a
suitable specialist you need to visit.
Pediatrician
recommends no
immediate action. Multidisciplinary What to do, and
Discusses possibilities therapies 2 whom to approach?

in diagnosis. Parents are referred to a multi-disciplinary team of early

intervention services for further assessment, therapies and
What happens in the diagnostic assessment? 1
Autism presents as altered behaviours and developmental abilities. Many of the behaviours seen in
autism are also seen in other conditions such as delayed language development, hearing or vision
impairment and ADHD. This makes diagnosing autism a challenging process.

A trained clinician has to make sure that the child’s behaviour and abilities meet the diagnostic
criteria.

To make a diagnosis the clinician has to look for difficulties in the following areas:
 The way a child communicates and socially relates with others
 The way a child uses gestures and expressions to communicate with others
 Play and imagination abilities of the child
 Any restricted interests and repetitive behaviours
 Any unusual sensory interests or aversions
 Any other difficulties that the child may have
 The impact these difficulties have on the child’s life
What happens in the diagnostic assessment? 2
The clinician relies on three types of information:

1. Observation: clinicians use tests (that may look like toys) to create situations to
observe the child’s behaviour and abilities. The commonly used tests are the
Autism diagnostic observation schedule (ADOS-2), Childhood Autism Rating
Scale (CARS-2) and the ISAA (Indian Version).
2. Getting information from parents: clinicians use a set interview questionnaire
to get information from parents. The commonly used tools are the Autism
diagnostic interview (ADI-R) and the Social communication questionnaire
3. Getting information from schools: this is often useful for school age children
and a questionnaire may be used for the school to provide the required
information.
Finally, clinicians use their clinical judgement to make sense of the information to
make a diagnosis. They also make a profile of the child’s strengths and needs to
inform the management plan. They may consider the child not to have ASD if the
diagnostic criteria is not met and suggest an alternative explanation.
What happens in the diagnostic assessment? 3

In an assessment, clinicians also make a profile of the child’s strengths

and needs to inform the management plan.

They may consider the child not to have autism if the diagnostic criteria
is not met and suggest an alternative explanation.

Having made a diagnosis of autism, they may also identify other

difficulties that the child may have in addition to autism.

They may also suggest for some tests or investigations to be done.

What investigations / tests should be considered during the assessment for autism?
A clinician may consider doing tests for 3 reasons:
1. To identify a genetic conditions that may present as autism, for example Fragile X syndrome,
Rett’s syndrome and tuberous sclerosis. Such conditions are rare and, combined together, only
contribute to about 1% of children with autism. These tests are not urgent and considerations
should be given to identify these conditions by clinical examination before ordering genetic
tests.
2. Conditions that can mimic or cause behaviour similar to autism, for example epilepsy. Sleep
EEG should be arranged, but only if there is a clinical suspicion of epilepsy, not as a routine.
Similarly, very rarely, degenerative conditions of the brain may cause autism. CT or MRI scan
should only be arranged if there is a strong clinical suspicion of such a condition. There is no
place for a routine CT/MRI scan in autism, and these tests may be harmful to the child.
3. Conditions that may co-exist with autism, for example some children with autism may be
anaemic or poorly nourished or my have a tendency to eat non-food items creating a risk for
lead poisoning. Blood tests are often arranged to confirm any clinical suspicion.

For all the reasons mentioned above, it is important that every child diagnosed with autism has a
thorough clinical examination by a paediatrician or a paediatric neurologist.
What further assessments are done after the diagnosis?
• Hearing evaluation – A hearing evaluation is done by an audiologist to a
identify any hearing problem, which may be causing or adding to
difficulties with speech and communication.
• Speech evaluation – One of the principle areas affected in children with
ASD is speech and communication. A qualified Speech and Language
therapist will asess your child’s speech, receptive and social interactive
abilities.
• Occupational therapy evaluation - An occupational therapist helps in
understanding your child’s gross & fine motor, sensory skills, and ability to
perform daily activities at home and school. An OT will evaluate both
physical and emotional factors that may be affecting your child’s everyday
life.
• Consultation with a pediatrician or a pediatric neurologist – they will do a
clinical evaluation to understand any physical, sensory or behavioral
difficulties. They will also help to integrate and interpret the information
gathered from different professionals.
Doing the best for your child
• First think, then discuss and plan and then act: your child is an individual
and has own strengths and needs. How to apply any approach to your child
needs planning; taking actions for your child without good planning can
often cause problems and make you and others frustrated.
• Children thrive on love and fun; intersperse all activities with fun
• Communicating and interacting with your child in daily activities of life is
the best way of helping. The whole family has to learn and change to make
it work.
• Don’t ignore other children. They have their own needs and need attention
too.
• Ensure a good amount of physical activities; making such activities fun,
such as dancing may be a good way to be active.
• Ensure some time for relaxation; over doing can cause exhaustion.
Doing the best for your child
All parents want to help their child. The following can help you do the
best for your child:
• Be better informed: most parents mention a journey of learning
about autism. Start with a good source of information and don’t
hesitate in asking questions.
• Be better connected: most parents mention the support and
information they received from other parents as the best source of
help. Find a local or an online way of connecting with other parents.
• Look after yourself and the family to do best for your child: don’t
ignore your own and other children’s well being. Share responsibility
in the family and appreciate each other’s efforts. Maintain good
relationships. Find time for your own interests and relaxation. Ask for
help and support from the wider family and friends.
Doing the best for your child
• Child’s frustrations = 10X ours – we are bringing up superheroes no matter how
hard we think our lives are. He is fighting a battle 10 times tougher than ours.

• What matters ultimately in our lives = dignity of independent life – don’t over
focus on grades and achievements

• It is not tolerance that we need, but acceptance. Acceptance creates equality of

relationship and gives it meaning. Your child doesn’t want pity, he wants respect.

• As a parent
 Don’t settle – remember to push what is best for your child.
 Be open, be vocal – talk about special needs to people around you. Help create awareness as
it is our responsibility. That will ultimately help you receive more support and acceptance.
 Act, participate – Pick any cause, support and engage in it. Creating a sensitive community.
 Think ahead – What future you can create for your child
Doing the best for your child: early intervention
Find out ways of helping the child and start he intervention as soon as ASD
diagnosis is considered rather than waiting until a definitive diagnosis is
made. A firm diagnosis is not necessary for early intervention.

Interventions work best when a good intensity is maintained; at least 25

hours a week of input is recommended. Plan to share the tasks where
appropriate.

The whole family’s involvement is required during intervention

• For more understanding of how early intervention may help your child’s
physical and emotional health, please consult the following links –