Early Diagnosis.

“It does not have to be about tragedy or pain or loss. Bearing an autistic child is not losing that child. It’s gaining a very special new son or daughter”

Jasmine Lee O’Neill, a mute autistic savant who is a poet, writer, illustrator and musician. 

As yet there are no medical tests to diagnose Autism, an accurate diagnosis must be made on observation of the child’s communication, behaviour and development levels.

It has been proven worldwide that early, accurate diagnosis coupled with early, intensive intervention increases the child’s opportunity for positive development and success.

What should a parent do if they have concerns?

Frequently parents don’t suspect a problem with the development of their child until 18 months to 2 years or older.

Initially, if a child is still being seen by the Child Development Team at their local Health Centre, the parent should express concerns to them and ask for a referral to a Developmental Paediatrician.

If the child is older, the parent can go to a GP and ask for the same referral.

If deemed necessary, the child may firstly be referred to a hearing specialist to rule out other developmental delays associated with language and communication disorders including deafness.

M-Chat: The Modified Checklist for Autism in Toddlers (M-CHAT) is a validated developmental screening tool for toddlers between 16 and 30 months of age. It is designed to identify children who may benefit from a more thorough developmental and autism evaluation. The M-CHAT can be administered and scored as part of a well-child check-up, and also can be used by specialists or other professionals to screen for developmental delay and autism.

M-CHAT website. 

Developmental Milestone Checklist:

Developmental Milestone Checklist. 

Where parents are concerned and would like to seek assessment, parents can refer their child for the Assessment of Need process.

What happens after a referral is made?

Once seen by the Paediatrician or Educational Psychologist and they agree that there are areas of the child’s development which warrant further investigation, the  child will be referred again to an Autism Team, sometimes located within the Health Service Child and Family Centres, or sometimes within a hospital.

This team is typically made up of a Clinical Psychologist, Speech and Language Therapist, Occupational Therapist and Social Worker. The Psychologist and Therapists will then conduct an assessment of the child using recognised diagnostic assessment tools coupled with their observations of the child’s behaviours.

How long does the assessment process take?

Currently the waiting lists in Ireland are anything from 9 to 18 months before a child can be seen by the Autism Team.

When seen, the diagnostic procedure can take another few months with the Therapists wishing to work with the child on several occasions.

Can a private assessment be done?

If families wish to obtain a diagnosis privately, a Clinical Psychologist or Educational Psychologist can reach a diagnosis using recognised diagnostic assessment tools.

The Autism Research Institute (ARI) in the USA have produced a diagnostic checklist (Form E2) which is available free. Parents can complete the form, return it to ARI and receive a computerised rating of where their child appears on the autistic spectrum.

Although parents can find this useful, please be aware that this is not a recognised diagnostic assessment tool as defined below.

What are ‘recognised diagnostic tools’? Why are they important?

Autism is a condition that is diagnosed based on a cluster of behavioural symptoms. These behavioural symptoms are outlined in the Diagnostic Statistical Manual 5, and serve to guide diagnosis; however, it is extremely important that this criteria be implemented consistently.

Diagnostic assessment tools are checklists or rating scales used to try to more objectively (without bias) measure the characteristics of Autism and to ensure an accurate and reliable diagnosis, meaning that any two practitioners will come to the same decision. This is why only certain diagnostic assessment tools are recognised by the HSE.

While there are a number of validated assessment tools, presently the HSE requires that diagnosis be made using the Autism Diagnostic Observation Scale (ADOS). This is to ensure a consistent and universal ‘definition’ and diagnostic criteria.

What happens after a child gets a diagnosis?

One of the most important sections of the child’s diagnostic assessments are the recommendations which are made by the Autism Team, Educational or Clinical Psychologist.

The recommendations outline their areas of skill or deficiency and will define their educational and therapeutic needs. As well as including the type of educational environment best suited to the child, they will state if the child needs Speech and Language, Occupational or other therapy.

With this report, the family is able to register their child with the relevant bodies providing services and claim State Entitlements.

As always, there are long waiting lists for all services for those on the Autism spectrum and a shortage of therapists in all disciplines. However Irish Autism Action provide support and advocacy to help a family secure the services the child requires.

Addressing children’s needs early:

• Intervention is likely to be more effective and cost less when it is provided earlier in life.
• Early Intervention can change a child’s developmental path and improve outcomes for the child and the whole family.

• Connections in the brain for the foundations for learning and behaviour are more adaptable before the age of three. Early intervention takes advantage of this brain plasticity.
• Families benefit by being better able to meet their child’s needs.