People diagnosed with autism may behave, interact, and learn in ways that are different from other people. There is often nothing about how they look that sets them apart from others.

*Citation: Hyman, S. L., Levy, S. E., Myers, S. M., Kuo, D. Z., Apkon, S., Davidson, L. F., … & Bridgemohan, C. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1).

According to the American Medical Association (2013), a qualified healthcare professional is “an individual who is qualified by education, training, licensure/regulation (when applicable), and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service.”

At ASD.me, all of the evaluating clinicians are state-licensed psychologists who are trained to evaluate and diagnose autism.

Symptoms of autism are often present before the age of 3 years and can last throughout a child's life. The American Academy of Pediatrics recommends that all children be screened for autism at 18 and 24 months of age. Children can be diagnosed as young as 18 months of age by an experienced professional.*

*Citation: Hyman, S. L., Levy, S. E., Myers, S. M., Kuo, D. Z., Apkon, S., Davidson, L. F., … & Bridgemohan, C. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1).

Every child with autism is unique, but parents and healthcare providers may request an evaluation if a toddler has delayed language skills, unusual emotional reactions, or shows unusual play behaviors.

According to the Center for Disease Control and Prevention (CDC), social concerns may include: the child has difficulty making eye contact, does not respond to his/her name, show facial expressions that match the situation (happy, sad, surprised), use gestures (pointing out objects),look where others point, or play interactive games like peek-a-boo.

Concerns about repetitive behaviors may include: repeating certain words or sentences over and over, unusual focus on parts of objects (hinges or wheels), lining up objects, becoming upset when a routine is disrupted, or unusual interests in the way things taste or feel.

Every child with autism is unique, and it is impossible to predict how one child may grow and change. However, over 80% of children who are diagnosed with autism after a comprehensive evaluation at less than 3 years continue to meet the criteria for autism into adulthood.* According to a recent peer-review study**, most children with autism show improved communication and social functioning as they age, but not all do. The level of improvement is often linked to how early and how often the child received medical and behavioral services.

Citations:
* Hyman, S. L., Levy, S. E., Myers, S. M., Kuo, D. Z., Apkon, S., Davidson, L. F., … & Bridgemohan, C. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1).
**Fountain, C., Winter, A. S., Cheslack-Postava, K., & Bearman, P. S. (2023). Developmental Trajectories of Autism. Pediatrics, 152(3).

When a diagnosis of autism is given, the psychologist will specify a level of 1, 2, or 3. This level refers to the difficulties the child has, and how significant these difficulties are. The American Psychiatric Association* describes the “levels of severity” as follows:

Autism consists of three levels:

• Level 1: “Requires Support”
• Level 2: “Requires Substantial Support”
• Level 3: “Requires Very Substantial Support”

The level of severity provides guidance to the child's medical providers, therapists, and educators in deciding which kinds of therapies will be most helpful.

*Citation: American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

Telehealth improves access to care by connecting families with autism evaluations quickly, without long wait lists or the difficulties of arranging transportation and childcare., Rather than interacting with a stranger in an unfamiliar environment such as a doctor's office, the child is evaluated with a trusted caregiver in a familiar environment. This allows the psychologist to see what the child's day-to-day behavior is. ASD.me considers the child's caregiver to be a partner and an important source of information. Licensed psychologists complete the evaluations and interact directly with you and your child. The psychologists will provide several opportunities to speak directly to them and ask questions. Following the COVID-19 public health crisis, several scientifically-validated autism assessment tools were developed specifically for telehealth platforms*, and those are what we use in our evaluations.

Citation: Micheletti, M., Brukilacchio, B. H., Hooper-Boyle, H., Basiru, T., Brinster, M. I., Ravenscroft, S., & Shahidullah, J. D. (2023). Evaluating the Efficiency and Equity of Autism Diagnoses via Telehealth During COVID-19. Journal of Autism and Developmental Disorders, 1-7.

• ABA therapy: Applied behavioral analysis (ABA) is “the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree, and to demonstrate that the interventions employed are responsible for the improvement in behavior.”* ABA therapy focuses on improving desirable behaviors while discouraging negative or undesirable behaviors.
• Developmental-relations focused therapy: This type of therapy is designed to promote social development in children with autism by focusing on the relationship between the child with autism and their caregiver (for example, mom or dad) through coaching to help the child respond to the adult. The adult helps the child by joining in child-initiated play activities and encouraging imitation.
• Parent Management Training: Parent management training focuses on giving caregivers knowledge about how to manage their child's symptoms and undesirable behaviors, as well as how to navigate medical treatment, education, and care coordination.
• Speech therapy: Speech therapy can help children with autism use and understand both verbal and non-verbal communication.
• Occupational therapy: Occupational therapy can help children with autism improve their motor skills, as well as help them process sensory information and accomplish tasks of daily living (e.g., washing their hair or putting on socks).
• Social skills instruction: Social skills training (done with adult therapists or with other children) can help children with autism learn to pick out and focus on social cues (e.g., , someone's facial expressions) and learn social rules.

*Citation: Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of applied behavior analysis, 1(1), 91.

Of course, you want the very best for your child. But before you start a new therapy process, make sure that there is some scientific or peer-reviewed evidence supporting its effectiveness. The American Academy of Pediatrics states: “Ideally, the evidence supporting or refuting a treatment should include peer-reviewed studies with appropriately diagnosed, well-defined homogeneous study populations; a randomized, double-blind, placebo-controlled design; and an adequate sample size to support the statistical analysis presented. It should also control for confounding factors and use appropriate, validated outcome measures.”*

* Hyman, S. L., Levy, S. E., Myers, S. M., Kuo, D. Z., Apkon, S., Davidson, L. F., … & Bridgemohan, C. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1).

* Citation: Mutluer, T., Aslan Genc, H., Özcan Morey, A., Yapici Eser, H., Ertinmaz, B., Can, M., & Munir, K. (2022). Population-based psychiatric comorbidity in children and adolescents with autism spectrum disorder: a meta-analysis. Frontiers in Psychiatry, 13, 856208.

There is no simple answer. We don't know the exact causes of autism; however, experts suspect that it is influenced by a combination of genetic and environmental factors. Studies suggest that genetic factors play an important role*. Genetic researchers estimate that approximately half of people with autism have chromosome deletions or duplications.** Studies focused on identical twins found that if one twin is diagnosed with autism, the other twin is likely to have autism, as well.***. Having one child with autism does increase the risk that later-born siblings will also have autism.****

Chaste, P., & Leboyer, M. (2022). Autism risk factors: genes, environment, and gene-environment interactions. Dialogues in clinical neuroscience.
**Genovese, A., & Butler, M. G. (2023). The Autism Spectrum: Behavioral, Psychiatric and Genetic Associations. Genes, 14(3), 677.
*** Sandin, S., Lichtenstein, P., Kuja-Halkola, R., Hultman, C., Larsson, H., & Reichenberg, A. (2017). The heritability of autism spectrum disorder. Jama, 318(12), 1182-1184.
****Ozonoff, S., Young, G. S., Carter, A., Messinger, D., Yirmiya, N., Zwaigenbaum, L., … & Stone, W. L. (2011). Recurrence risk for autism spectrum disorders: a Baby Siblings Research Consortium study. Pediatrics, 128(3), e488-e495.