Methods for the diagnosis of of early childhood autism

• Methods for diagnosing early childhood autism 

• M-CHAT

• Questionnaire for parents

Methods for the diagnosis of early childhood autism.

The main method for diagnosing early childhood autism is dynamic observation of behavior, which is carried out either directly or indirectly by interviewing loved ones. In addition to the main method, psychological, physical, neurological and other examinations are carried out.

Observing a child’s behavior is the most important source of information. Because the behavior of a child with autism varies greatly depending on the situation and place, it should be observed in both a specially organized and normal everyday environment. For children, you need to create, if possible, relaxed play and educational situations. A number of requirements are imposed on the organization of direct observation of a child with early childhood autism:

• presence of parents;

• clear order and structure of actions;

• limited range of environmental stimuli;

• using familiar material;

• the use of materials with a high motivating character; 

• prevention of dangers;

• clear and unambiguous communication, if necessary using additional communication means (objects, photographs or drawings, pictograms, gestures);

• the use of material enhancers depending on the needs (favorite food, drink, object).

During the survey of close people, information is collected in the following areas:

the presence of autistic symptoms in the behavior of the child in various life situations;

developmental history and medical history, functional level of the child;

family health problems;

Family situation, social data and previous experience associated with the diagnosis and provision of medical and psychological-pedagogical assistance.

Diagnosis of early childhood autism includes three stages.

The first step is screening.

Developmental deviations are revealed without their exact qualification.

Screening is a quick collection of information about the social and communicative development of a child to isolate a specific risk group from the general population of children, assess their need for further in-depth diagnostics and provide the necessary corrective assistance. Since screening is not used for diagnosis, it can be done by educators, pediatricians and parents themselves. Let’s list the main indicators of early childhood autism, the observation of which requires further in-depth diagnosis of the child.

Indicators of early childhood autism:

• lack of single words at the age of 16 months;

• lack of a two-word phrase in 2 years;

• lack of non-verbal communication (in particular, pointing gesture) at 12 months;

• loss of speech or social ability.

Preschool Autism Indicators:

• lack of speech or delay in its development;

• special eye contact: not frequent and very short or long and motionless, rarely direct to the eyes, in most cases peripheral;

• difficulties in imitation of actions;

• performing monotonous actions with toys, lack of creative play;

• lack of social reaction to the emotions of other people, lack of behavior change depending on the social context;

• unusual reaction to sensory stimuli;

• any concern about the social or speech development of the child, especially if there are unusual interests, stereotyped behavior.

Indicators of autism at school age:

• lack of interest in other people, contacts with peers;

• great interest in inanimate objects;

• lack of need for comfort in situations of psychological necessity;

• having difficulties with waiting in social situations;

• inability to maintain dialogue;

• passion for one topic;

• performing activities filled with little creativity and imagination;

• strong reaction to changes in the usual daily schedule;

• any concern about the social or speech development of the child, especially if there are unusual interests, stereotyped behavior.

The following standardized screening instruments have long been developed and widely used in the world: CHAT – Scale for early recognition of autism, STAT – Autism screening test, ADI-R – Diagnostic interview for parents.

For example, CHAT is a short screening tool designed for the initial assessment of the development of a child between the ages of 18 and 36 months.

The first part of the test includes nine questions for parents, which record whether the child exhibits certain types of behavior:

Social and functional play, social interest in other children, joint attention, and some motor skills (pointing, unusual movements).

The second part of the test contains observation questions for five short types of interactions between the researcher and the child, which allow the analyst to compare the actual behavior of the child with the data obtained from the parents.

A positive screening result should be accompanied by an in-depth differentiated examination.

The second stage is the actual differential diagnosis, i.e. in-depth medical, psychological and pedagogical examination of the child to determine the type of developmental disorder and the corresponding educational path. It is conducted by a multidisciplinary team of specialists: psychiatrist, neurologist, psychologist, teacher-defectologist, etc. This stage includes the medical examination, parent interviews, psychological tests, pedagogical observation. The differential diagnosis is made by a clinical psychologist.

The ADOS Diagnostic Observation Scale for Autistic Disorders, CARS – the Rating Scale of Childhood Autism, are used as the main tools for the differential diagnosis of autism. For example, CARS is a standardized tool based on direct observation of the behavior of a child aged 2 years and older in 15 functional areas (relationships with people, imitation, emotional reactions, communication, perception, anxious reactions and fears, etc.).

And, finally, the third stage is developmental diagnostics: identifying the individual characteristics of the child, characterizing his communication capabilities, cognitive activity, emotional-volitional sphere, working capacity, etc. The identified features should be taken into account when organizing and conducting individual correctional and developmental work with him. The development of a child with early childhood autism is diagnosed by a teacher-defectologist. For this purpose, the standardized test PEP-R is used abroad – the Profile of the Development and Behavior of a Child. PEP-R

Consists of two scales: development and behavior. In particular, the developmental scale assesses the level of a child’s functioning in relation to his peers in seven areas (imitation, perception, fine motor skills, gross motor skills, hand-eye coordination, cognition; communication and expressive speech).

M-CHAT Modified Autism Screening Test for Young Children

(The Modified Checklist for Autism in Toddlers (M-CHAT); Robins, Fein, & Barton, 1999)

Instructions

M-CHAT was created in the USA and is an enhanced version of the CHAT screening questionnaire created in the UK. M-CHAT contains 23 questions (the original version contains 9 questions). The use of the questionnaire began in the states of Connecticut and New England, and 33,000 children took part in the study by the authors of the questionnaire.

M-CHAT is designed to provide screening tests for autism spectrum disorders (ASD) in children aged 16 to 30 months. The M-CHAT can be done as part of the child’s routine health check-up. It can also be used to assess the risk of having autism and by representatives of non-medical specialties.

The main purpose of using the M-CHAT is to identify the risk of autism and ASD, however, not all children who are detected using this method are actually diagnosed with ASD. In addition to the M-CHAT, a diagnostic interview was also created. However, even with the use of interviews, children are often identified in whom the diagnosis is not subsequently confirmed, but some of these children are at risk of developmental delays.

M-CHAT data processing takes less than 2 minutes. Children who have received more than 3 points on the general scale, or who have scored 2 critical points, should be referred for diagnostic examination to specialists whose competence includes the diagnosis of NAS in young children.

No screening instrument is 100% reliable.

Please rate how the following statements describe your child. Try to answer each question. If the behavior is rare (you’ve only seen it once or twice), point out that this is not typical for the child.

No	Questions	Answers
1	Does the child like it when she/he is rocked in his arms, on her/his knees, etc.?	Yes	No
2	Does the child show interest in other children?	Yes	No
3	Does the child like to climb objects like stairs?	Yes	No
4	Does the child like to play hide and seek?	Yes	No
5	Has the child ever pretend play, such as talking on the phone or swinging a doll or something else?	Yes	No
6	Does the child use the index finger to point or ask for something?	Yes	No
7	Does the child use the index finger when showing or showing interest in something?	Yes	No
8	Can the child play appropriately with small toys (such as toy cars or bricks), other than just putting them in their mouth, twirling them, or throwing them around?	Yes	No
9	Have you ever brought you (your parents) objects to show you something?	Yes	No
10	Can a child look you in the eyes for more than 1-2 seconds?	Yes	No
11	Has the child ever been hypersensitive to sound (for example, covering his ears)	Yes	No
12	Does the child smile at you or in response to your smile?	Yes	No
13	Does the child imitate what you are doing (for example, mimics your facial expression)	Yes	No
14	Does the child respond to his/her name when you call him?	Yes	No
15	If you point to a toy in the room. Is the child looking at her?	Yes	No
16	Can a child walk?	Yes	No
17	Does the child look at the things (objects) that you are looking at?	Yes	No
18	Does the child make unusual finger movements around his face?	Yes	No
19	Is the child trying to draw your attention to what he is doing?	Yes	No
20	Have you ever felt like your child has a hearing impairment (deaf)?	Yes	No
21	Does the child understand what other people are saying?	Yes	No
22	Does it happen that the child is carried away by something, does not exist, or wanders aimlessly around the room?	Yes	No
23	Does the child look at your face to check your reaction when faced with something unfamiliar?	Yes	No

Scoring:

Attention! Scoring is not done by the parent, but by a professional.

1. No               2. No               3. No               4. No               5. No               6. No

7. No               8. No               9. No               10. No             11. Yes            12. No 

13. No             14. No             15. No             16. No             17. No             18. Yes 

19. No             20. Yes            21. No             22. Yes            23. No

The Modified Checklist for Autism in Toddlers (M-CHAT); Robins, Fein, & Barton, 1999).

 -Adapted, Mirazova T., Demiralay D., 2019 –

Parents questionnaire

to identify disorders of mental (psychological) development, the risk of autism spectrum disorders in young children 

(under 2 years old)

No	Question	Yes	No	Find it difficult
1	Does your child fix his/her gaze on objects (toys) or the face of an adult?
2	Does the child look you in the eyes for 1-2 seconds? Does the child smile at the mother?
3	Does your child react to the speech addressed to him/her, does she/he follow the commands? (“Come to me”, “give me”, etc.)
4	Did you breastfeed your baby? If yes, then, did the child enjoy it, did he eat willingly?
5	Was your child “comfortable” in the first year of life (lay alone in the crib, did not react to the mother’s departure; occupied himself with objects (toys), his own fingers, etc.)?
6	Has your child experienced complex emotions (interest, curiosity, surprise, resentment, discontent, anger, etc.)?
7	Have you noticed that the child cries in her/his sleep, is afraid of toys, animals or certain objects?
8	Is the timing of your child’s motor development in line with the normative indicators? – holds the head – (2 months)- sitting – (6 months)- creeps – (7-8 months)- walks without support – (12 months)
9	Does the child walk on the socks?
10	Is the child using a pointing gesture?
11	Does the child know how to use a spoon?
12	Is the timing of your child’s speech development in line with the normative indicators? – humming (a, y, s, gu, ha) – 2-5 months.- babbling (ba, ma-ma, pa-pa, bo-bo, ta-ta-ta) – 6-10 months.- first words (targeting) – 10-12 months.- the first phrases (“mommy give”) – 18-24 months.
13	Does your child ask questions?
14	Do you notice multiple repetitions, “echoes of words, phrases”, speech stamps in your child?
15	Do you notice that your child is hypersensitive to external stimuli (noise from household appliances, fireworks, animals, increased voice tone, etc.)?
16	Have you ever thought that the child is “deaf”, “sees poorly” or has decreased sensitivity (sniffs, licks objects, etc.)?
17	Does the child touch his fingers in front of the chest, bring them close to the face, eyes?
18	Does the child play with household items (lids, cans, pots, etc.)?
19	Are there objects (things) with which the child does not part in everyday life, takes to bed (as “protection”, “help”)?
20	Does the child choose strings, laces, bags, sticks for games?
21	Does the child line up objects (toys) in rows (horizontal / vertical), carries them monotonously, rolls objects (toys)?
22	Does the child show interest in new toys?
23	Does the child shun other children on the playground, prefer to play alone?
24	Can a child experience fear or anxiety in a new situation, a change in situation (at a party, in a store, in a clinic, among unfamiliar children, adults, etc.)?
25	Can a child collect objects (pyramid, matryoshka) taking into account size, shape and color by the end of 2 years?

Calculation of results (method key):

No	Answer	No	Answer	No	Answer	No	Answer	No	Answer
1	No	6	No	11	No	16	No	21	Yes
2	No	7	Yes	12	No	17	No	22	No
3	No	8	No	13	No	18	No	23	Yes
4	No	9	Yes	14	Yes	19	No	24	Yes
5	Yes	10	No	15	Yes	20	No	25	No

If 4 or more answers match the key to the methodology presented above and parents are having difficulty answering one-third of the questions in the questionnaire, the child’s parents should be advised to consult a Dr. clinical psychologist or psychiatrist (the child).

The survey is carried out by clinical psychologists, pediatricians, neurologists, nurses, when interviewing the parents of children aged 18 and 24 months. The time for filling out the screening questionnaire is from 10 to 15 minutes.

The results are calculated by specialists (clinical psychologists, pediatricians, neurologists) with the aim of further referral to a consultation with a psychiatrist (children’s).

Reminder: Screening (survey) cannot be used to make a medical diagnosis. Diagnosis of childhood autism and other autism spectrum disorders is the responsibility and competence of a specialist child psychiatrist or Dr. clinical psychologist  with special professional training. The other course of a child with ASD is determined at a specialized medical institution licensed to provide psychiatric and psychological care, including assistance to minors.