ASD Diagnostic Tools

The three core domains of autism spectrum testing

1. Language deficits (communication)

This domain covers the inability to process words and their related meanings. Although many people  can create associations between sounds and ideas (such as the word “banana” and the fruit it represents), children with autism don’t independently make that connection.

Not creating a connection between words and concepts is often mistaken for hearing loss, because it almost seems like a child is unable to hear part of a word. Although they may hear it, they may not know how to properly process it.

How to identify language deficits

Words with dual meanings and colloquialisms are especially difficult for people with autism to understand. For example, if someone says that they’re “feeling blue,” a person with autism may translate the statement literally without associating the color blue with sadness.

This breakdown in communication is often the first step to identifying autism. Although this might seem like an intellectual impairment, it’s not a measure of intellect. Many who experience this aspect of autism are clear and eloquent on paper but not in conversation. This makes the inability to quickly form and process words, tones, and even pauses in speech excellent indicators of autism.

2. Social deficits (social)

Although it’s certainly possible for those with autism to have normal social skills and interactions, they’ll need additional steps to get it right. As with any skill, it requires practice and education. Many with autism want to be around others but aren’t sure how to properly engage with them or how to be comfortable in new, sometimes awkward situations.

How to identify social deficits

The misunderstanding of social cues can appear in many ways. For example, a person with autism might not understand the difference between blushing or flushing. They might see a red face, and assume a person is angry when they actually just finished an intense workout.

This, of course, doesn’t hinder a person on the autism spectrum from having full and meaningful relationships. They’ll likely need more preparation using concrete examples to successfully predict what’s coming. This can be practiced at home or with a professional at Integrity, Inc. who can assist with developing social skill-building activities.

3. Repetitive behaviors (physical)

This last domain of autism spectrum testing often presents in other domains as well. Repetitive behaviors, such as repeating a word or sound or rocking back and forth, can affect the social and communication aspects of their lives. However, these repetitive movements and sounds can help balance sensory input and emotion. This often allows someone with autism to organize their thoughts when they’re feeling overwhelmed by language or social stimuli. The repetitive sounds and behaviors may allow them to focus on their own thoughts, figure out how to proceed, or find a way to feel comfortable in a situation.

There are many tools to assess ASD in young children, but no single tool should be used as the basis for diagnosis. Diagnostic tools usually rely on two main sources of information—parents’ or caregivers’ descriptions of their child’s development and a professional’s observation of the child’s behavior.

In some cases, the primary care provider might choose to refer the child and family to a specialist for further assessment and diagnosis. Such specialists include neurodevelopmental pediatricians, developmental-behavioral pediatricians, child neurologists, geneticists, and early intervention programs that provide assessment services.

Selected examples of diagnostic tools:

  • Autism Diagnosis Interview – Revised (ADI-R)external icon[7]
    A clinical diagnostic instrument for assessing autism in children and adults. The instrument focuses on behavior in three main areas: reciprocal social interaction; communication and language; and restricted and repetitive, stereotyped interests and behaviors. The ADI-R is appropriate for children and adults with mental ages about 18 months and above.
  • Autism Diagnostic Observation Schedule – Genericexternal icon (ADOS-G)[8]
    A semi-structured, standardized assessment of social interaction, communication, play, and imaginative use of materials for individuals suspected of having ASD. The observational schedule consists of four 30-minute modules, each designed to be administered to different individuals according to their level of expressive language.
  • Childhood Autism Rating Scale (CARS)[9]
    Brief assessment suitable for use with any child over 2 years of age. CARS includes items drawn from five prominent systems for diagnosing autism; each item covers a particular characteristic, ability, or behavior.
  • Gilliam Autism Rating Scale – Second Edition (GARS-2)external icon[10]
    Assists teachers, parents, and clinicians in identifying and diagnosing autism in individuals ages 3 through 22. It also helps estimate the severity of the child’s disorder.

In addition to the tools above, the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition  (DSM-5) provides standardized criteria to help diagnose ASD.

See DSM-5 diagnostic criteria »