Advice From the Experts: Navigating Autism Screening and Diagnosis

04.19.2023 | 5 min read

Amy Barczy is a former brand journalist who authored...

Rates of autism diagnosis are on the rise in children in the U.S.

One in 36 children in the U.S. have autism spectrum disorder (ASD), according to the U.S. Centers for Disease Control and Prevention. Experts attribute these increases to improved screening for autism.

ASD is a complex developmental condition that involves challenges with social communication, restricted interests and repetitive behavior.

Many children on the spectrum will show developmental differences at an early age as their social and language skills develop as infants and toddlers. While children on the autism spectrum may sit, crawl and walk on time, other developmental delays may be more subtle.

Navigating autism screening and diagnosis may feel overwhelming – but there are professionals available to help families and caregivers through each step. Experts say the earlier a child can get connected to therapies, the better.

Early signs of autism in children

Every child develops at their own pace. The best thing parents and caregivers can do are to be aware of developmental milestones, and to monitor their children as they learn and grow, said Dr. Kristyn Gregory, medical director of behavioral health at Blue Cross Blue Shield of Michigan.

According to the American Academy of Pediatrics, some of the earliest developmental differences between children on the spectrum and children without ASD is a “delay or lack of joint attention” – which means looking back and forth between an object or event and another person and connecting with them. These back-and-forth social interactions are building blocks for future social skills.

Using pointing gestures to communicate is a milestone to watch:

By 12 months, most children can look at an object a parent is pointing at, and then look back at the parent and mimic their expression. Children on the autism spectrum may appear to ignore the parent.
By 15 months, most children will point to an object that they want. A child on the autism spectrum may take a parent’s hand and lead them to the object without much eye contact.
By 18 months, most children will point to an object they find interesting and look back and forth to the parent to see that they are engaged. Children on the autism spectrum will point to an object because they want it, not because they want the parent to see it and enjoy it together.

Another milestone to watch is nonverbal communication and language. A child on the autism spectrum may develop language skills that they gradually stop using – typically between the ages of 15 and 24 months, and become more socially withdrawn.

If your child isn’t hitting the milestones or seems behind in activities like playing, learning and speaking, talk to your doctor about your concerns. One or two symptoms does not mean a child has autism, but it is important to get your doctor’s opinion as some symptoms may be more subtle and difficult to detect.

Screenings for autism

The American Academy of Pediatrics recommends all children should be screened for autism during the well-child visit children have with a pediatrician or family doctor when they are 18 months and 24 months old.

During a screening, the provider will often use a questionnaire that is filled out by the parents and caregivers to start conversations about the child’s language, behavior or any risk factors. If they notice there is an area of concern, they will then recommend the child undergo a diagnostic evaluation, which occur outside of the doctor’s office at an autism evaluation center.

In addition to screening at the doctor’s office, Gregory recommends parents continue to monitor their children to see if they are hitting their developmental milestones – and talk to their doctor if they have concerns.

“Parents know their kids best,” Gregory said. “Make sure your children are meeting their milestones, and make sure you bring it up during their well-visits with their doctor. Early diagnosis has the best outcomes if you can deliver interventions.”

Diagnostic evaluation for autism

Following a screening, a pediatrician or family doctor may recommend a child undergo a diagnostic, multidisciplinary evaluation for autism spectrum disorder.

During this evaluation, professionals will interview the parents, spend time with the child, test their skills and evaluate their speech and language as a part of a comprehensive diagnostic evaluation.

Multidisciplinary evaluations are provided at approved autism evaluation centers within the state of Michigan. Blue Cross Blue Shield of Michigan and Blue Care Network members can call the number on the back of their card to find an in-network center near them.

Common treatment options for autism often include applied behavior analysis (ABA) therapy, speech therapy, physical therapy and occupational therapy.

Blue Cross and BCN members can check to see what autism treatment services are covered through your plan by logging in to your member account on bcbsm.com or to the Blue Cross mobile app.

Advice for parents

Navigating the next steps of a child’s diagnosis of autism and discussing treatment options can feel overwhelming – but professionals are ready to help with support and solutions.

Sarah Sorise is the director of autism services at Judson Center in southeast Michigan, a nonprofit organization that provides human services to children and families – including for individuals with ASD. Sorise said professionals start the conversation with families by focusing on the child’s strengths and use that as motivation to treat any deficits.

For young children, early therapy interventions can make a significant difference. Sorise said it’s important that families and caregivers understand there is great promise for future success.

“Maybe in the past, parents have been told, ‘Your child is never going to talk,’” Sorise said, explaining autistic children can learn to speak vocally and using other means to communicate, including American Sign Language, a Picture Exchange Communication System or an Augmentative and Alternative Communication Device. “Parents need to know there is no limit on what your child can do.”

Finding treatment centers that offer speech therapy, occupational therapy and ABA therapy is often the first step after a diagnosis. Sorise encourages families and caregivers to find providers that are the best fit for them – and to stay diligent in conversations with care teams.

“Request a tour, meet the team and get to know them. You should feel good about entering a new relationship,” Sorise said. “The more involved a parent can be with the providers, and keeping expectations consistent across environments; and selecting the best provider for your family – there’s no end to the skills autistic children can gain.”