Who diagnoses autism in a child? When do we diagnose autism in a child? How does the diagnosis of autism proceed? These questions are asked by almost all parents who suspect an autism spectrum disorder in their child.

The first signs of autism

Diagnosing autism spectrum disorders is a complex process. The clinical picture takes on a variety of forms, so that the symptoms and first signs of autism can look different for each child. In addition, the clinical picture is obscured by the co-occurrence of other diseases. However, the peculiarities of functioning of people with holistic developmental disorders allow us to quickly catch alarming signals and refer to a specialist.

Parents, after observing the first disturbing symptoms in their child (including lack of response to the name, difficulty in establishing relationships, slower development or loss of already acquired skills), most often report them to the primary care physician, although due to the diversity of the course and diversity of the various medical care systems in Poland, patients are referred to specialists in various fields. They may screen for autism and/or refer the child to a specialized clinic.

Where to get an autism diagnosis?

The primary care physician or specialist to whom the parents have gone, suspecting an autism spectrum, may refer the child to a Child Autism Clinic. At such a Clinic, a detailed psychiatric examination of the child is conducted. Depending on the situation (the child's age, functioning, etc.), it consists of several elements: an interview with the parents, an interview with the child, and information obtained from the facility the child attends. The diagnostic doctor may also use data obtained from standardized questionnaires and structured diagnostic interviews, a pediatric and neurological examination of the child, and (if necessary) other additional tests.

Tools for diagnosing autism

One of the world's most popular and most highly regarded diagnostic tools for diagnosing autism spectrum disorders is ADOS-2. Testing with this tool takes about 40-60 minutes and is conducted using a single module selected by the diagnostician. The system of modules makes it possible to tailor the protocol to the age and development of the person being tested. Each protocol includes a detailed list of tests to be performed and then interpreted accordingly. The T module makes it possible to test children as young as 12 months old.

Other additional tests, depending on medical indications, may include laboratory diagnostics (e.g., blood tests), genetic testing (e.g., when Rett syndrome or Angelman syndrome is suspected), diagnostic imaging (e.g., CT scan, MRI), EEG, among others.

In order to make a diagnosis, a psychiatrist must know the applicable diagnostic criteria-that is, the symptoms that must be observed in a given patient in order to make a correct diagnosis. In Poland, the criteria of the International Classification of Diseases ICD-10 are universally applicable. All mental and behavioral disorders in it have the letter symbol F and the corresponding number (e.g., childhood autism F84.0 and Asperger's syndrome F84.5).

The doctor may also refer the child to an interdisciplinary diagnostic team that includes specialists in various fields, including a psychologist, oligophrenopedagogue, speech therapist. They can give an opinion on the child-this is often a very important part of the diagnostic process.

However, a medical (nosological) diagnosis that allows access to highly specialized services can only be made by a doctor.

Parents in the diagnostic process

A very important aspect of the diagnostic process is an in-depth interview with the parents. Among other things, it includes gathering information about the course of the pregnancy, the child's past development, social contacts, illnesses in the family, and the family's relationships and functioning. In the case of parents or caregivers of individuals with autism, the interview can be conducted using the ADI-R tool.

The interview collected from the child is aimed at establishing a good relationship with the patient, identifying the problem and assessing the child's mental state. Among other things, the psychiatrist asks about functioning at home and school, family and friends, leisure activities, emotions, self-esteem and ways of coping with stress.

Obtaining information from the institution the child attends is possible only with the consent of the parent. A teacher, educator or other specialist can write an opinion, which often provides valuable information about the child's behavior in a particular institution.

The pediatric and neurological examination allows us to assess the child's somatic condition and detect possible comorbidities, such as epilepsy, endocrine or gastroenterological disorders.

Early and prompt diagnosis plays a key role in the effective realization of a child's potential, as it is followed by targeted therapeutic measures that provide a chance for optimal development. The chance is greater if the child's parents and social environment are involved in the therapeutic process.

Paulina Szymanska

Physician, postgraduate student of Clinical Sexology - opinion, education, therapy. Clinical diagnostician of ADOS-2. As a co-author, she developed two nationwide JiM Reports with the Foundation team. She has completed a Level III training in Applied Behavior Analysis.