Surveillance, Screening, and Diagnosis for Early Identification of ASD

Surveillance, Screening, and Diagnosis for Early Identification of ASD

There is considerable need for further research, innovation, and improvement in early identification, given the gap between the age when ASD characteristics are first noticed and when a diagnosis is made, as Shattuck et al. (2009) suggested. There are several levels of recommended practices that lead to the early identification of ASD.

Surveillance is the ongoing process of identifying children at risk. Surveillance methods are often simply questions that primary care providers ask all parents at well-child visits about developmental milestones.

Screening is a brief assessment that uses standardized instruments to identify children at significant risk of having a disorder. The results of screening indicate the presence of risk characteristics for delay or disability, but do not provide a diagnosis.

Diagnostic assessment involves a detailed assessment process using standardized tools, observations, and clinical history to  define the child’s difficulties and determine the presence of a clinical diagnosis. A diagnostic assessment is the final step in early identification of a specific disorder.

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The American Academy of Pediatrics endorsed new practice parameters for ASD screening and evaluation to occur with primary care pediatric practices as summarized in Identification and Evaluation of Children with Autism Spectrum Disorder (Johnson et al., 2007).

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There are several new early identification guidelines laid out in this document, which represents a significant new milestone for the autism field. 

Among the most important recommendations are the following:

Primary care providers should become aware of early signs of ASD;

Primary care providers should routinely ask all parents about developmental milestones and behavior at each visit; If any concerns are identified by parents or professionals, an autism-specific screener should be administered and/or the child should be immediately referred for a diagnostic evaluation, depending upon the level of concern;

Primary care providers should screen all children, using an autism-specific screener, at 18 and 24 months of age.

These autism specific refinements follow previously established parameters for the universal screening of all children for potential developmental delays at 9, 18 and 24 (or 30) months during well-child visits.  This surveillance and screening algorithm can be found at the National Center for Medical Home Implementation website.

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