Autism Screening Tools
Healthcare professionals use a variety of tools to screen for and test autism spectrum disorder (ASD). While certain questionnaires are more commonly used than others, there are a variety of testing tools that healthcare professionals may draw from. They may use different tools in different situations depending on the child’s age, ability level, and/or context (screening done at a doctor’s office vs testing done by someone who specializes in children’s behavior). Below, we present a quick summary of the most commonly used testing tools as well as more in-depth descriptions.
Quick Summary of Tools
Ages and Stages Questionnaires (ASQ): used to screen infants and young children for developmental delays during the first five years of life (a very important time period for children’s brain development).
Communication and Symbolic Behavior Scales (CSBS): an in-depth tool, that uses parent interviews and direct observations of natural play to collect information on communication development in young children.
Parent’s Evaluation of Development Status (PEDS): a simple, 10-item questionnaire that is completed by parents at the pediatrician clinic.
Modified Checklist for Autism in Toddlers (M-CHAT): a 23-item questionnaire in a yes/no format given to parents to complete in pediatrician clinics at the 18- and 24-month well-child exam.
Screening Tool for Autism in Toddlers and Young Children (STAT): an interactive screening tool used by pediatricians/clinicians to assess social and communicative behaviors (imitation, play, requesting, and directing attention) in children between 24 to 36 months of age.
Autism Diagnostic Observation Schedule (ADOS-G): a standardized observational assessment instrument that includes various play-based activities that are designed to observe social interaction, communication skills, and restricted and repetitive behaviors associated with an ASD diagnosis.
The Childhood Autism Rating Scale (CARS): identifies children (2 years and older) with ASD and helps distinguish them from developmentally handicapped children who are not autistic.
The Autism Diagnostic Interview-Revised (ADI-R): an experienced clinician interviews parents or caregivers about the child’s (2 years or older) developmental history and current behavior.
Screening Tools
Ages and Stages Questionnaires (ASQ-3)
Age range: 1 month to 5 ½ years
Administration time: 12-18 minutes to complete and score
Purpose: ASQ is a development screening tool that is used by early educators and health care professionals to assess a child’s strength and developmental concerns.
Assessment: Parents and caregivers are given a questionnaire to complete at home, in the office’s waiting room, or as part of in person or over the phone interview. The questionnaire screens for communication, gross motor, fine motor, problem solving, and personal-social skills.
For more information, click here: https://agesandstages.com/products-pricing/asq3/
Communication and Symbolic Behavior Scales (CSBS)
Age range: 6-24 month-old functional communication age; up to 6 years old if atypical development
Administration time: 50-75 minutes for child assessment; 60-75 minutes for in-depth scoring
Purpose: Health professionals will interview parents and use direct observations of natural play to collect information on communication development. CSBS surveys both communication skills and indicators of symbolic development, such as gestures, facial expressions, and play behaviors.
Assessment: A videotaped Behavior Sample is assessed during a caregiver-child naturalistic play interaction. Twenty-two scales are organized into seven clusters: Communicative Function, Communicative Means- Gestural, Communicative Means- Vocal, Communicative Means- Verbal, Reciprocity, Social-Affective Signaling, and Symbolic Behavior. An overall composite score is calculated which can indicate “concern” or “no concern.”
To see how CSBS is administered, click here: Communication and Symbolic Behavior Scales Administration – YouTube
For more information, click here: https://www.txautism.net/evaluations/communication-and-symbolic-behavior-scales#:~:text=The%20Communication%20and%20Symbolic%20Behavior%20Scales%20%28CSBS%3B%20Wetherby,up%20to%2072%20months%20who%20exhibit%20atypical%20development.
Parents’ Evaluation of Developmental Status (PEDS)
Age range: birth to 8 years old
Administration time: 10 minutes
Purpose: Detects and addresses developmental and behavioral problems in children from birth to 8 years of age.
Assessment: PEDS is a 10-item questionnaire that is completed by parents and scored by a practitioner.
For more information, click here: https://www.rch.org.au/ccch/peds/Parents__Evaluation_of_Developmental_Status_(PEDS)/
Modified Checklist for Autism in Toddlers (M-CHAT)
Age range: 16-30 months
Administration time: 10 minutes
Purpose: This 23-item questionnaire has been found to accurately identify toddlers on the autism spectrum. However, the test can yield false positive result, so a phone follow-up interview is recommended. Many pediatric clinics have incorporated the M-CHAT questionnaire into the well-child exams.
Assessment: Parents answer a 23-item questionnaire in a yes/no format. A positive test will result in a phone interview, and if both the questionnaire and phone follow-up are positive, then a referral for an diagnostic evaluation is recommended.
For more information, click here: https://research.chop.edu/car-autism-roadmap/modified-checklist-for-autism-in-toddlers-m-chat#:~:text=Modified%20Checklist%20for%20Autism%20in%20Toddlers%20%28M-CHAT%29%20,a%20yes%2F%20…%20%207%20more%20rows%20
Screening Tool for Autism in Toddlers and Young Children (STAT)
Age reference: 24-36 months of age
Administration time: 20 minutes
Purpose: The STAT is an interactive tool used by providers to screen toddlers for autism spectrum disorder.
Assessment: The STAT consists of 12-items that assess/observe key social and communicative behaviors including imitation, play, requesting, and directing attention.
For more information, click here: https://vkc.vumc.org/vkc/triad/stat/
Childhood Autism Rating Scale, Second Edition (CARS2™)
Age range: 2 years or older
Administration time: 5-10 minutes
Purpose: Health professionals directly observe individuals to help distinguish autistic children from developmentally handicapped children who do not have autism. CARS2 expands upon the original CARS test’s clinical value, and has modules especially for testing autistic people who have fewer or less extreme autistic behaviors (those with high or average IQ scores, better verbal skills, and subtle behavioral and social deficits).
Assessment: 15-items asked to be observed during the assessment, using a 4-point response scale. Ratings are not only based on frequency of the behavior, but also on duration, intensity, and peculiarity.
The 15 items address the following functional areas:
- Relating to People
- Imitation (Standard-ST form); Social-Emotional Understanding (High Functioning-HF form)
- Emotional Response (ST); Emotional Expression and Regulation of Emotions (HF)
- Body Use
- Object Use (ST); Object Use in Play (HF)
- Adaptation to Change (ST); Adaptation to Change/Restricted Interests (HF)
- Visual Response
- Listening Response
- Taste, Smell, and Touch Response and Use
- Fear or Nervousness (ST); Fear or Anxiety (HF)
- Verbal Communication
- Nonverbal Communication
- Activity Level (ST); Thinking/Cognitive Integration Skills (HF)
- Level and Consistency of Intellectual Response
- General Impressions
For more information, click here: https://www.cognitivecentre.com/assessment/childhood-autism-rating-scale-second-edition-cars2/#:~:text=Childhood%20Autism%20Rating%20Scale%2C%20Second%20Edition%20%28CARS2%E2%84%A2%29%201,and%20Touch%20Response%20and%20Use%20More%20items…%20
Diagnosis Tools
Autism Diagnostic Observation Schedule, Second Edition (ADOS®-2)
Age range: 12 months through adulthood
Administration time: 40-60 minutes
Purpose: Trained specialists make direct observation under controlled situations to provide an autism diagnosis (or not).
Assessment: ADOS-2 is a standardized instrument tool that includes various play-based activities in a controlled setting. The assessment obtains information on restricted and repetitive behaviors, communication skills, and reciprocal interactions associated with an autism diagnosis. Different ADOS modules may be used depending on the age of the patient.
Video: What is the ADOS Test? | Autism Diagnosis and Testing – YouTube
Example: Someone trained to administer the ADOS may set up a scenario where a child is at a birthday party. They might show the child a series of objects, like a baby doll, Play-Doh, a plate, a candle, then see how the child uses those objects in the context of a birthday party. A child without autism might play with the objects by turning the Play-Doh into a cake, putting the candle on the cake, placing the cake on the plate, and singing to the baby doll. If the child displays unusual behaviors for age, such as chewing on the candle or licking the plate, then the tester would give a negative score (a score leaning towards autism). During the controlled scenario, the practitioner will also examine verbal skills, response to name, and pointing. If you are worried about your child showing signs for autism, ask your pediatrician for a referral for an ADOS-2 test.
Autism Diagnostic Interview, Revised (ADI®-R)
Age range: Children and adults with a mental age greater than 2 years
Administration time: 90-150 minutes (including scoring)
Purpose: ADI-R is used to diagnose autism, plan appropriate treatment, and distinguish between other developmental disorders.
Assessment: An experienced clinician will interview parents/guardians about the developmental history of the individual being evaluated. ADI-R focuses on three functional domains, which are reciprocal social interaction, communication and language, and restricted, repetitive, and stereotypical behaviors.
For more information, click here: https://www.appliedbehavioranalysisedu.org/what-is-adi-r-and-how-does-it-work/
Article by: The Autism ToolKit
References:
- Ages and Stages Questionnaire (ASQ) | Continuing and Professional Education | Human Services (ucdavis.edu)
- ASQ-3 – Ages and Stages
- CSBS™ – Brookes Publishing Co.
- Parents’ Evaluation of Developmental Status (PEDS) : About PEDS (rch.org.au)
- Modified Checklist for Autism in Toddlers (M-CHAT) | CHOP Research Institute
- Vanderbilt TRIAD – Screening Tool for Autism in Toddlers and Young Children (STAT) (vumc.org)
- (ADOS®-2) Autism Diagnostic Observation Schedule, Second Edition (wpspublish.com)
- Childhood Autism Rating Scale, Second Edition (CARS2™) – The Cognitive Centre
- (ADI®-R) Autism Diagnostic Interview, Revised (wpspublish.com)
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