Identification and Evaluation of Children With Autism Spectrum Disorders

Pediatrics

Johnson, C. P., & Myers, S. M. (2007).

Pediatrics, 120(5), 1183-1215.

This guideline provides recommendations for diagnosis, screening and assessment of children on the autism spectrum. The primary audience for this guideline is pediatricians. This document has been partially updated by Hyman et al. (2020). For more information, please see the Notes on This Article section.

American Academy of Pediatrics

This guideline was most recently re-affirmed in 2014, see the statement of reaffirmation at the <a href="https://doi.org/10.1542/peds.2014-2679" title="https://doi.org/10.1542/peds.2014-2679">Pediatrics Journal</a> webpage. The guideline below provides additional updated recommendations:

Clinicians "should be careful to differentiate between typical and autistic echolalia; usually, a formal evaluation by a speech-language pathologist (SLP) is needed" (p. 1192).

General developmental screening tools may be used with unselected primary care populations. These tools are likely to detect developmental disorders, including ASDs; however, they do not differentiate children on the autism spectrum from children with developmental disorders. Data are not available on the sensitivity of ASD identification (p. 1199). There are several tools currently being developed to screen children, younger than 18 months, who may be on the autism spectrum; however, no tools are currently available for clinical use (p. 1199). While many level 2 screening tools (i.e., tools that are used in developmental clinics and early intervention programs as opposed to primary care facilities) have been marketed for identification of older children who may be on the autism spectrum, these tools require further comparative research before one can be recommended over another (p. 1199).

"Other professionals, such as child psychologists, SLPs, pediatric occupational therapists, and social workers with expertise in ASDs, can be helpful by performing independent evaluations, often using standardized tools that can assist in the diagnostic process, especially when no team or pediatric 'expert' is available ... the American Speech-Language-Hearing Association published guidelines that stated that an SLP with expertise in ASDs can make the diagnosis independently when other resources are not available" (p. 1202).

Several tools are available for screening children, 18 months of age or older, who may be on the autism spectrum. "Some measures, such as the Checklist for Autism in Toddlers (CHAT), Modified Checklist for Autism in Toddlers (M-CHAT), and Pervasive Developmental Disorders Screening Test-II (PDDST-2) Primary Care Screener were designed specifically for early detection of ASDs in young children" (p. 1199).

An audiologic evaluation is recommended for all children with language delays, including children who are suspected to be on the autism spectrum, regardless of the result of the neonatal screening. If behavioral audiometry is unsuccessful, auditory brainstem or brainstem auditory evoked-response tests can be used. Sedation will likely be necessary (p. 1203).

"Factors associated with better outcomes include early identification resulting in early enrollment in appropriate intervention programs and successful inclusion in regular educational and community settings with typically developing peers" (p. 1206).

"Among the tools designed for screening the elementary school-aged population, only the Childhood Asperger Syndrome Test (CAST) has been assessed in a large, unselected population as a level 1 (i.e., general population) screening tool. The authors concluded that the CAST is useful as a screening test for ASDs in epidemiologic research but that there is not enough evidence to recommend it for routine screening in the general population as part of a public health program" (pp. 1201-1202).