DIAGNOSIS QUESTIONS

SCREENING

Developmental Screening Tools 

Screening tools are designed to help identify children who might have developmental delays.

Screening tools can be specific to a disorder (for example, autism) or an area (for example, cognitive development, language, or gross motor skills), or they may be general, encompassing multiple areas of concern. Some screening tools are used primarily in pediatric practices (open to infographic – screening-chart), while others are used by school systems or in other community settings.

Screening tools do not provide conclusive evidence of developmental delays and do not result in diagnoses. A positive screening result should be followed by a thorough assessment. Screening tools do not provide in-depth information about an area of development.

Selecting a Screening Tool

When selecting a developmental screening tool, take the following into consideration:

  • Domain(s) the Screening Tool Covers
    What are the questions that need to be answered?
    What types of delays or conditions do you want to detect?
  • Psychometric Properties
    These affect the overall ability of the test to do what it is meant to do.
  • The sensitivity of a screening tool is the probability that it will correctly identify children who exhibit developmental delays or disorders.
  • The specificity of a screening tool is the probability that it will correctly identify children who are developing normally.
  • Characteristics of the Child
    For example, age and presence of risk factors.
  • Setting in which the Screening Tool will be Administered
    Will the tool be used in a physician’s office, daycare setting, or community setting? Screening can be performed by professionals, such as nurses or teachers, or by trained paraprofessionals.

Types of Screening Tools

There are many different developmental screening tools. CDC does not approve or endorse any specific tools for screening purposes. This list is not exhaustive, and other tests may be available.

Selected examples of screening tools for general development and ASD:

  • Ages and Stages Questionnaires (ASQ)
    • This is a general developmental screening tool. Parent-completed questionnaire; series of 19 age-specific questionnaires screening communication, gross motor, fine motor, problem-solving, and personal adaptive skills; results in a pass/fail score for domains.
  • Parents’ Evaluation of Developmental Status (PEDS)
    • This is a general developmental screening tool. Parent-interview form; screens for developmental and behavioral problems needing further evaluation; single response form used for all ages; may be useful as a surveillance tool.
DIAGNOSTIC TOOLS

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)
    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 – Generic (ADOS-G)
    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)
    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)
    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.
CRITERIA FOR DIAGNOSIS

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