Autism can be diagnosed by specialists such as developmental pediatricians, child psychologists, neurologists, psychiatrists, and speech-language pathologists.
Autism spectrum disorder (ASD) is a developmental condition that can impact all aspects of life. Receiving a reliable diagnosis of ASD is life-altering, not only for the person receiving the diagnosis but for those who have relationships with that person, too. Having a diagnosis can help all parties understand and support each other better, as well as grant access to life-changing therapies.
In this article, we will explain the steps to take to obtain a diagnosis, who is qualified to diagnose autism, and what steps to take after the diagnosis to help improve the autism prognosis.
Understanding Autism Spectrum Disorder
ASD is a developmental condition that is characterized by challenges with speech, non-verbal communication, and social interaction, as well as repetitive behavior and obsessive interests. People on the spectrum will require some level of ongoing support throughout their lifetime. Autism covers a wide spectrum of diverse symptoms, and it’s common to find multiple people sharing the diagnosis and presenting completely differently.
For an autism diagnosis, a person needs to reach a certain number of symptoms, which may be a completely different set of symptoms from the next person, varying both in symptom type and severity. For example, one person with ASD may have strong verbal communication skills but struggle with changes, while another may have limited speech but no issues with schedule changes.
Early and accurate diagnosis of autism, followed by early intervention services, is one of the most important predictors of autism prognosis. According to the CDC, autism can be detected at 18 months or younger. Typically, parents are the first to notice autism symptoms, with 80% of the cases of parents noticing signs at the age of 2 years old. The first symptoms of concern were a lack of eye contact, not responding to their name, not following a point, and repetitive behaviors with or without objects.
Studies have shownthat children diagnosed and in early intervention before 24 months of age showed the most reduced ASD symptom severity and were more likely to be integrated into less restrictive environments than those who received no or late therapy, highlighting the importance of acting on an early diagnosis and beginning early intervention. Engagement in therapy has also been shown to improve family dynamics as a whole, with families receiving intervention showing less family dysfunction than those not in therapy.
The Diagnostic Process
Developmental monitoring is the continual process of monitoring your child’s development and comparing it against typical milestones. Areas to look out for include delays in playing, learning, speaking, behaving, and moving.
The CDC has developed a tool called “Learn the signs, act early” to help parents monitor their child’s development and milestones. If you notice your child falling a little behind on some of these milestones, talk with your pediatrician, doctor, or nurse about your concerns. At this point, doctors might begin developmental screening, which is sometimes part of a routine exam. The American Academy of Pediatrics recommends specific ASD screenings to occur at 18 and 24 months of age. The results of the screening may highlight areas of concern that would prompt a developmental evaluation to be conducted.
Several tools and methods are used to assess ASD. One of the most common assessments is the Autism Diagnostic Observation Schedule (ADOS). This is an activity-based assessment tool that can be administered as early as 12 months. During the ADOS, the clinician assesses the child’s communication, social interaction, and imaginative use of materials. The Autism Diagnostic Interview-Revised is another common tool used to diagnose autism. This tool involves a structured parent interview and covers social interaction, communication, and language, as well as restricted and repetitive movements.
It is important to keep in mind that, although both of these tools are considered the “gold standard”, one assessment on its own may not be enough for an autism diagnosis, and a more comprehensive evaluation should take place. For a formal diagnosis, the child’s development, family history, parental and caregiver information, and behavioral observations outside of the formal assessment should all be considered. Moreover, including different professionals in the diagnosis process will help paint a full picture of the extent of the strengths and deficits of the child and will be useful in guiding toward effective interventions.
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Professionals Qualified to Diagnose Autism
Developmental Pediatricians
Often, developmental pediatricians are the clinicians who begin the process of obtaining an autism diagnosis. During routine checkups, pediatricians will monitor the progress the child is making towards their developmental milestones by direct observation and by interviewing the adults in the child’s life. If the child is showing early signs of a developmental delay, the pediatrician may suggest a more formal assessment to begin. They will examine the child’s habits, abilities, how they speak, play, etc. After the assessment, the pediatrician will provide a full report, including any diagnosis they identified. If autism is diagnosed, pediatricians will help to provide and guide caregivers toward a treatment plan.
If the diagnostician suspects there may be another co-morbidity that would require medical tests such as blood tests or brain scans, they will make a referral to other professionals in related fields to ensure all areas of concern are understood and treated.
Child Neurologists
A child neurologist is a doctor who treats children who have problems with their nervous system. As part of the assessment process, neurologists may conduct genetic testing, EEGs, and laboratory tests in addition to the screening tools to obtain a more specific and complete diagnosis. There is a strong link between brain neurology and ASD, including neural, structural, and functional differences in the brains of people with ASD.
Involving a child neurologist in the diagnosis of a child with autism can be helpful for several reasons. Medical comorbidities are more common in children with ASD than in the typically developing population. Neurologists can help identify and diagnose any comorbid conditions such as epilepsy, OCD, ADHD, bipolar disorder, etc. These conditions, untreated, can exacerbate the symptoms of autism. Having a dual diagnosis means each condition can be treated individually, by behavior and/or medical therapy, leading to improved outcomes.
Child and Adolescent Psychiatrists
Child and adolescent psychiatrists focus on diagnosing, treating, and preventing mental disorders in children, teenagers, and their families. Psychiatrists can be instrumental in helping to manage some of the more challenging mental health aspects of living with ASD. Autistic individuals exhibit higher than average rates of mental health disorders, which exacerbate the symptoms of autism. Thus, diagnosing and treating these conditions is essential to a better prognosis.
Typically, caregivers may decide to contact a psychiatrist if they feel that their child may be exhibiting more frequent bouts of loss of control, physical rages, including aggression towards themselves or others, screaming episodes, withdrawal, etc. Often, children won’t be able to describe what is happening to them, so it’s important for parents to clearly describe in objective terms what is occurring, starting with the most severe and challenging behaviors to help the psychiatrist with an accurate diagnosis.
After their assessments, psychiatrists can diagnose any co-occurring conditions, such as anxiety and depression, and prescribe appropriate medication and treatment.
Clinical Psychologists
A clinical psychologist is a mental health professional who uses different assessments and tools to help children and adolescents better cope with different life issues. Clinical psychologists are also able to diagnose any comorbid conditions that may be present. For children with ASD, clinical psychologists are useful as they are highly trained in conducting behavior assessments, which examine a child’s behavior and how it correlates to their environment. These assessments help identify the function of certain challenging behaviors, when and why they occur, and what functional replacement could be taught instead.
The clinical psychologist will also identify the child’s learning style, such as visual, verbal, kinesthetic, etc, and create interventions to help teach skills where the child is showing the most deficits. These interventions can be shared with the child’s school team to help support the child across different settings.
Pediatric Neuropsychologists
A pediatric neuropsychologist studies the relationship between brain health and behavior in children. When assessing children with ASD, neuropsychologists carry out detailed analyses of cognitive functioning in people with ASD. These analyses highlight 5 key areas including intelligence, attention, executive function, social cognition, and praxis. Results from these analyses help to highlight the cognitive strengths of each child and underlying cognitive issues that could be worsening symptoms of autism. After their assessments, the neuropsychologist will provide caregivers with a detailed summary of the diagnoses present, strengths, weaknesses, and treatment plans based on these results.
Choosing the Right Professional
When beginning the process of diagnosing ASD, choosing the correct diagnostician for your child is key as they may be part of your treatment team long term. Choosing someone with experience can help for multiple reasons. Firstly and most importantly, they will have assessed many children with ASD and will be able to identify common signs and symptoms. Furthermore, they will be more likely to have useful suggestions and contacts, in terms of parent support groups, social groups as well as other professionals. A more experienced diagnostician may also be more effective in terms of which direction to take the treatment. For example, including early intervention, occupational therapists, child psychologists, etc.
Including a team of various professionals in the diagnosis of your child will be key to accessing the most comprehensive and effective therapy. While there is a level of overlap between professionals, each specialist will be assessing and examining a different part of your child’s development and brain and will be creating targeted intervention plans to help provide the most support to your child.
Finding a diagnostician may feel overwhelming, but certain factors will help narrow down your choices. Firstly, ask your pediatrician for a referral for someone with experience with ASD. Joining parent support groups is also a useful way to connect and discuss with people in similar situations who may be able to provide some guidance in terms of choosing specialists. After you have a few referrals, check whether your insurance will cover the cost and whether the diagnostician is in your network. Once you have reached this stage, assess if there is a long waitlist. With ASD, as with most conditions, time is of the essence. The sooner the doctors can provide a diagnosis, the sooner the child will be able to begin treatment, leading to better outcomes.
After Diagnosis – What Next?
After the autism diagnosis is confirmed, treatment options should be explored without too much delay. The reason for this is early diagnosis and intervention are associated with more positive long-term effects on symptoms and skill acquisition. Applied Behavior Analysis (ABA) therapy is a commonly recommended treatment approach due to its strong evidence base for teaching functional and adaptive skills while reducing challenging behaviors associated with ASD. ABA is also helpful as there is a heavy focus on parent training and education which can help when first receiving an autism diagnosis. At the same time, your diagnostician may recommend speech and occupational therapy. Speech therapists will help to work on all areas of communication while occupational therapists will work on fine and gross motor skills as well as self-regulation strategies.
Receiving a diagnosis can take a mental and emotional toll. Knowing where to begin and who to turn to for support can be overwhelming, so it’s important to remember you are not alone. There are in-person or online support groups that can help with the practical and emotional sides of receiving an autism diagnosis.
Frequently Asked Questions
Here are a handful of questions we’ve received about autism diagnosis from different professionals, along with our clearest answers.
Can a Therapist Diagnose Autism?
It depends on what kind of therapist you’re talking about. Many therapists, like licensed mental health counselors or marriage and family therapists, can recognize the signs of autism and may even do screenings. But when it comes to making an official diagnosis, especially one required for school services or insurance coverage, most therapists aren’t qualified unless they have specific credentials, such as being a licensed clinical psychologist. So, they’re a great starting point, but usually not the final stop.
Can a Psychiatrist Diagnose Autism?
Yes, absolutely. Psychiatrists are medical doctors trained to diagnose a wide range of mental health and developmental conditions, including autism. They can also prescribe medication if your child needs help managing things like anxiety or sleep, which sometimes come along with autism. That said, some psychiatrists focus more on medication than on in-depth developmental evaluations, so you’ll want to find one with experience diagnosing autism in kids.
Can an LCSW Diagnose Autism?
Licensed Clinical Social Workers (LCSWs) play a huge role in supporting families, but they typically can’t make a formal autism diagnosis unless they have additional training and credentials. Many LCSWs are great at spotting early signs and guiding families through the diagnostic process, but they usually refer to a psychologist, developmental pediatrician, or specialist for the actual diagnosis.
Can a Neurologist Diagnose Autism?
Yes, pediatric neurologists can diagnose autism, and they often do, especially when there are concerns about seizures, motor delays, or other neurological issues that might overlap with autism symptoms. They may use developmental screening tools or refer families to other specialists for a more comprehensive evaluation. If your child already sees a neurologist, it’s worth asking if they handle autism assessments or if they can coordinate that part of care.
Can a BCBA Diagnose Autism?
No, Board Certified Behavior Analysts (BCBAs) are not licensed to diagnose autism. Their role usually begins after a diagnosis, when they work with families to create and implement behavior support plans, such as through ABA therapy. While BCBAs are not diagnosticians, they are often familiar with autism and may notice signs early on. If they see something concerning, they can guide families toward the right professionals for an evaluation.
Can a Psychiatric Nurse Practitioner Diagnose Autism?
Sometimes, yes. Psychiatric Nurse Practitioners (PMHNPs) can be licensed to diagnose mental health conditions, and in some states, they are allowed to diagnose autism as well, especially if they have training in child development. As with psychiatrists, it’s important to make sure the provider has specific experience evaluating children for autism before moving forward with a diagnosis through them.
Can a Speech Therapist Diagnose Autism?
No, speech-language pathologists (SLPs) cannot officially diagnose autism. However, they can assess speech, language, and social communication skills, which are often affected in children with autism. Many families first start exploring a diagnosis after concerns are raised by a speech therapist. While they can’t provide the diagnosis themselves, SLPs are often an important part of the team that helps gather information during the process.
Can a Speech Pathologist Diagnose Autism?
This is the same as asking about a speech therapist, since “speech-language pathologist” is the formal title. And the answer is no — they cannot diagnose autism. However, they often play a key role in the early stages of identifying concerns. Their evaluations are valuable, and their input is often included when a team of professionals works together to assess a child for autism.
Conclusion
Obtaining a diagnosis from the right professional is instrumental in helping to guide your child’s autism treatment. If you do not feel comfortable or supported, seek a second opinion until you find a doctor that you trust. This person should be a resource of information, so make sure you educate yourself and ask as many questions as possible to ensure your child is receiving the most effective intervention.
It takes a village to raise a child, and this may be even more true for a child with autism. Gather a strong team of professionals who can lend their expertise and support to help your child maximize their potential. If you have any concerns about your child’s development and milestones, do not hesitate to seek a diagnosis. As previously mentioned, your child’s best chances come from early intervention services, and any delays in treatment may negatively impact their future chances at a more independent life.
LCSWs can administer tools like Sensory Screening, ADOS etc and do have scope to diagnose .