To meet diagnostic criteria for Autism Spectrum Disorder (ASD) according to the DSM-5 criteria, a child must have ongoing difficulties in the home and community in the following areas: social communication and interaction plus at least two types of restricted, repetitive behaviours.

Speech pathologists look at the social communication aspect to help inform a paediatrician’s diagnosis.  An occupational therapist (OT) assesses restricted repetitive behaviours, motor skills, executive functioning, sensory differences through play and every day activities. Below are a list of the communication behaviours and signs of Autism that speech language pathologists (SLP) look for in order to inform paediatricians who make a diagnosis. Just because a child has some of the below signs it doesn’t mean they are autistic but it indicates further assessment is recommended.

Examples of differences in social communication and interaction that are common in Autism:

• difficulty initiating greetings others with gesture, verbal language or eye contact
• difficulty in responding to greeting with gesture, verbal language or eye contact
• difficulty taking multiple turns in a game e.g. rolling a ball back and forth
• difficulty maintaining a conversation for multiple turns
• difficulty approaching others to play and knowing how to join in play
• not knowing how to respond when others initiate a social interaction
• not sharing in others interests
• speaking only about their own special interests
• differences in how expressive language has developed- may be non-speaking, advanced in language or learn language in scripts or chunks
• differences in eye contact and facial expressions
•  differences in body language: can be closed off or overly touchy and friendly.
• difficulty understanding others use of gesture- e.g. following eye gaze when pointing.
• difficulty showing emotions through language and facial expressions
• difficulty understanding others emotions and reacting appropriately
• difficulty adjusting behaviour to suit various social contexts (inside/ outside/ home/public)
• difficulties in sharing in imaginative play with peers
• may not be interested in peers and prefer to play alone
• may try to make friends and play with peers but needs to control the play and has difficulty following others ideas

A child does not need to demonstrate all of the above differences in social communication and interaction be autistic. Autism is a spectrum of behaviours and not all children present in the same way. But if your child has difficulty in a number of the areas above further assessment is recommended.

So what can you do next?
Get on a waitlist for a paediatrician assessment. Your GP can refer you to a private paediatrician or to the Child Development Service in your local area. This can take many months in both private and public settings.
While you are waiting for this appointment you can:

• Talk to a speech pathologist about a social communication assessment
• Get an assessment from an OT in terms of restricted and repetitive behaviours
• Consider an ADOS assessment. ADOS stands for Autism Diagnostic Observation Schedule. ADOS is a standardised diagnostic test for Autism. The ADOS-2 provides a highly accurate picture of current symptoms, unaffected by language. It is a standardised assessment of communication, social interaction, play, and restricted and repetitive behaviours in children and adult. It can be used to evaluate almost anyone suspected of having ASD—from 1-year-olds with no speech to adults who are verbally fluent and is considered a gold-standard diagnostic tool. The ADOS-2 is not required to make a diagnosis of autism but it can be very informative. Only a psychologist, OT or SLP who has had specific training in the ADOS may administer this assessment. A paediatrician can use their own assessments and observations to make a diagnosis based on the DSM 5 criteria.
• Call the NDIS– If your child is under 6 years with developmental concerns in at least 2 areas you can apply for ECEI funding through the NDIS. This federal funding is to support capacity building therapies such as occupational therapy and speech pathology for children with a developmental delay or disability. You do not need to have a diagnosis to access this funding if your child is under 6. Children over 6 years do need to have a diagnosed disability to access funding. It can take many months to go through the NDIS application process so if you have concerns call now.

As always talk to your friendly speech pathologist for recommendations and ideas of what to do while you are going through a diagnostic process. We work with lots of autistic children at Rainbow Speech Pathology and have a range of neurodiversity affirming therapies we can offer to work on social communication.

Written by Calla Dolton – Speech Pathologist