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The AAN’s practice parameter recommended that diagnosis of autism should include the use of standardized parent interviews regarding current concerns and behavioral history related to autism, and direct, structured observation of social and communicative behavior and play.
Recommended instruments for parental interviews include the Gilliam Autism Rating Scale, Parent Interview for Autism, Pervasive Developmental Disorders Screening Test–Stage 3, and Autism Diagnostic Interview–Revised.
Recommended instruments for observation include the Childhood Autism Rating Scale, Screening Tool for Autism in Two-Year-Olds, and Autism Diagnostic Observation Schedule-Generic.
The AAN practice parameter did not recommend that neuropsychological testing be used for the diagnosis of autism, but insteadshould be performed as needed, in addition to a cognitive assessment, to assess social skills and relationships, educational functioning, problematic behaviors, learning style, motivation and reinforcement, sensory functioning, and self-regulation.
A typical symptom of autism is absence of speech development, observed from infancy, taking the form of complete mutism at later stages.
Current screening methods may not identify children with milder variants of autism, those without mental retardation or language delay, such as verbal individuals with high-functioning autism and Asperger’s disorder, or older children, adolescents, and young adults.
There are relatively few appropriately sensitive and specific autism screening tools for infants and toddlers, and this continues to be the current focus of many research centers.
The Checklist for Autism in Toddlers (CHAT) for 18-month-old infants, and the Autism Screening Questionnaire for children 4 years of age and older, have been validated on large populations of children.
However, it should be noted that the CHAT is less sensitive to milder symptoms of autism, as children later diagnosed with PDD-NOS, Asperger’s, or atypical autism did not yield positive results on the CHAT at 18 months.
Because there are no biological markers for autism, screening must focus on behavior.