If you found this post, chances are you are concerned about your own child or a loved one and some of the behaviors this child has been exhibiting. Could it be autism?
Several years ago I also turned to the Internet to try to find answers—a definitive and resounding NO or YES (as it turned out)—so I would at least know what I was dealing with. (Or so I thought!)
Some of the behavioral “quirky-ness” my son demonstrated included:
· Walking on his tip-toes practically all of the time. He had extremely well developed calves for a toddler!
· Flapping his hands and jumping up and down, inexplicably
· Chewing on things constantly, things that a child should not be chewing on, such as furniture
· Poking himself in the eyes (this one terrified me)
· Extreme sensitivity to light and wind (making going outside very unpleasant)
· Fear of the vacuum cleaner and hair dryer—I’m talking real panic
· “Combat crawl”, as if he was in bootcamp going under a low row of barbed wire, rather than a typical on-all-fours-crawl
· Wanting to do the same thing over and over again for hours on end
· Not responding to me when I call his name
Oh, there were many other things, such as language delays and so on but the behaviors above really concerned me and started my quest (online at first) for answers. You can read all the details about our personal autism story and how we got the diagnosis of autism on my son’s website.
It was relatively quickly that I came across the CHAT, or the Checklist for Autism in Toddlers. While I must include the disclaimer that this is not medical advice and you should never diagnosis yourself or someone else, when I found the CHAT that pretty much sealed the deal for me and my husband.
As a rule, your pediatrician should do a cursory run-down of the CHAT for your child when he or she comes in for his or her 18-month old wellness visit.
The checklist is broken into two sections. The first is the list of questions that your pediatrician should ask you. The second section results come from your doctor’s observations of your child.
The content of the checklist is as follows:
Section A - Ask Parent:
Yes or No?
____ 1) Does your child enjoy being swung, bounced on your knee, etc?
____ 2) Does your child take an interest in other children?
____ 3) Does your child like climbing on things, such as up stairs?
____ 4) Does your child enjoy playing peek-a-boo/hide-and-seek?
____ *5) Does your child ever pretend, for example, to make a cup of tea using a toy cup and teapot, or pretend other things?
____ 6) Does your child ever use his/her index finger to point, to ask for something?
____ *7) Does your child ever use his/her index finger to point, to indicate interest in something?
____ 8 ) Can your child play properly with small toys (e.g. cars or bricks) without just mouthing, fiddling, or dropping them?
____ 9) Does your child ever bring objects over to you, to show you something?
Section B - GP’s observation
Yes or No?
____ i) During the appointment, has the child made eye contact with you?
____ *ii) Get child’s attention, then point across the room at an interesting object and say “Oh look! There’s a (name a toy)!” Watch child’s face. Does the child look across to see what you are pointing at?
NOTE - to record yes on this item, ensure the child has not simply looked at your hand, but has actually looked at the object you are pointing at.
____ *iii) Get the child’s attention, then give child a miniature toy cup and teapot and say “Can you make a cup of tea?” Does the child pretend to pour out the tea, drink it etc?
NOTE - if you can elicit an example of pretending in some other game, score a yes on this item
____ *iv) Say to the child “Where’s the light?” or “Show me the light”. Does the child point with his/her index finger at the light?
NOTE - Repeat this with “Where’s the teddy?” or some other unreachable object, if child does not understand the word “light”. To record yes on this item, the child must have looked up at your face around the time of pointing.
____ v) Can the child build a tower of bricks? (If so, how many?) (Number of bricks…)
* Indicates critical question most indicative of autistic characteristics
There is also another widely-used autism symptoms checklist called the M-CHAT, or Modified Checklist for Autism in Toddlers. The M-CHAT is validated for screening toddlers between 16 and 30 months of age, to assess risk for autism spectrum disorders (ASD). This screening tool contains an autism symptoms checklist of twenty-three questions to be answered by the parent. The questions are all yes or no and the complete list follows here:
1. Does your child enjoy being swung, bounced on your knee, etc.?
2. Does your child take an interest in other children?
3. Does your child like climbing on things, such as up stairs?
4. Does your child enjoy playing peek-a-boo/hide-and-seek?
5. Does your child ever pretend, for example, to talk on the phone or take care of a doll or pretend other things?
6. Does your child ever use his/her index finger to point, to ask for something?
7. Does your child ever use his/her index finger to point, to indicate interest in something?
8. Can your child play properly with small toys (e.g. cars or blocks) without just
mouthing, fiddling, or dropping them?
9. Does your child ever bring objects over to you (parent) to show you something?
10. Does your child look you in the eye for more than a second or two?
11. Does your child ever seem oversensitive to noise? (e.g., plugging ears)
12. Does your child smile in response to your face or your smile?
13. Does your child imitate you? (e.g., you make a face-will your child imitate it?)
14. Does your child respond to his/her name when you call?
15. If you point at a toy across the room, does your child look at it?
16. Does your child walk?
17. Does your child look at things you are looking at?
18. Does your child make unusual finger movements near his/her face?
19. Does your child try to attract your attention to his/her own activity?
20. Have you ever wondered if your child is deaf?
21. Does your child understand what people say?
22. Does your child sometimes stare at nothing or wander with no purpose?
23. Does your child look at your face to check your reaction when faced with something unfamiliar?
As far as scoring the M-CHAT, the instructions for this list state that children who fail more than 3 items total or 2 critical items (particularly if these scores remain elevated after the follow-up interview) should be referred for diagnostic evaluation by a specialist trained to evaluate Autism Spectrum Disorder (ASD) in very young children.
Again, there is a huge disclaimer here—do not self-diagnose and do not get alarmed or panicked. If your child is not meeting milestones, print out this post and score it on a separate piece of paper. Then ask another adult close to your child (the other parent, grandparent, or care giver) to go through these questions and score separately. If, after going through these with adults that know the child best and there appears to be some warning signs or some symptoms that aren’t typical, make an appointment with your child’s pediatrician.
When you take your child to see the doctor, bring both lists and the scores that were completed by you and the other parent/caregiver. This will provide the basis for an initial discussion with your doctor regarding your child’s ultimate diagnosis, whatever that may be. I have helpful information for finding a good pediatrician on my son’s website and have linked to it here.
All the best to you and your family and if you have any questions at all—or comments—please email me or leave your comments here!
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