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The Steps to an Autism Diagnosis
 From the April 2001 Early Childhood newsletter.Given the early intervention services that are available, it is more important than ever to make a proper diagnosis of autism as early as possible. But that diagnosis is sometimes challenging to make, according to Robert Nickel, an associate professor of pediatrics at Oregon Health Sciences University and author of The Physician's Guide to Caring for Children with Disabilities and Chronic Conditions. Warning Signs Children can be diagnosed with autism as early as 12 months of age, although some children will not show signs of autism until about 18 months. Signs of autism that would necessitate an evaluation include a lack of babbling or hand gestures by the time a child is 12 months old, the absence of a child using single words by 16 months, and the lack of usage of two words or phrases by the time a child is 24 months old. Any loss of language or social skills at any age is also a warning sign. Dr. Nickel notes that the number of children being diagnosed with autism has increased dramatically in the past ten years, an increase that remains largely unexplained. He acknowledges that there are now better diagnostic tools than in the past but admitted that some children with developmental delays, language disorders, or mental retardation are occasionally misdiagnosed with autism. He also notes that screening tests are not 100% accurate and that children who do have autism are not always correctly diagnosed with the condition. "It is not an easy diagnosis for young children," affirms Dr. Nickel. "It is important for primary care physicians to do regular developmental screening." Screening is the first step to identify a possible problem once warning signs are present. The next step would be a comprehensive assessment to make a proper diagnosis. Collaboration is Essential Dr. Nickel, who is also the clinical director of the Regional Services Center of the Child Development and Rehabilitation Center in Eugene, Oregon, said it is important to organize a team of developmental professionals, composed of a speech pathologist, psychologist, occupational therapist, and other experts in the field to work together to make a diagnosis. He also recommends that multiple team members observe the child at the same time to avoid having the child experience excessive evaluations. For example, two team members might actually be in the room with the child while other team members watched through a one-way window. "We need to have a semi-structured observation of how the child plays and interacts," emphasizes Dr. Nickel. Dr. Nickel cautions that an autism diagnosis is "not a simple, straightforward thing. You have to look at the whole picture." That is why, emphasizes Dr. Nickel, that it is important to have professionals work together to observe different aspects of a child's behavior and development, and work together to make a diagnosis. He also recommends testing children for other conditions such as Fragile X syndrome or lead poisoning during the assessment process. It is also important, says Dr. Nickel, to rule out a simple developmental delay or mental retardation before making an autism diagnosis.
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