How Do They Diagnose the Severity of Autism?

Updated on February 15, 2015
A.E. asks from Springdale, AR
19 answers

I have a sweet little girl who is 22 months old who is in the beginning stages of evaluation. Call me awful but for me it is not a question of if she has autism, but how severe. A lot of people think I am crazy, but I say... they don't know her like I do. It is just so obvious to me. Here is a little bit about my little sweet heart.

She makes eye contact and it is really really good a lot of times, but does have issues with it sometimes where she just doesn't want to look at you, and you have to get down on her level and force her to look at you.
She definitely looks at us to see what our reactions are to things, if she falls she will say Uh OH and look at us to see if we are gonna say something about it lol. She interacts with us... shows us her toys, and wants to know what things are. She was really good with pointing at things that interest her, but she isn't doing that so much here lately... of course she has been sick for a while so she hasn't really been herself lately.
She does use communication words :Bite, Juice, Up when she wants up on the couch, down, done and so on. She can say objects by name such as ball, box, book, baby, blocks, car, olaf (her olaf doll), elmo (her elmo doll), door. There are a lot of things
She says hi and bye bye and waves, she says night night when we put her to bed. If I say Knock Knock she will knock on a window or door with her fist and say "Knock knock".
She can't say yet but she knows the meaning of phrases such as "Its nap time, lets go see nana and papa, do you wanna go outise, are you hungry, bath time (she will run right to the bathroom), do you want to watch tv, go slide down the slide (she has a toy slide that she will go slide down) push the button, bring me your socks". There are more but those are just a few. She responds to those in the appropriate way.
She loves food but is really picky.. doesn't like vegetables, rice, macaroni or anything too sticky. She loves chicken, mashed potatoes, spaghetti (all parts of it the noodles, bread, meat and sauce) yogurt, any kind of chips, quesidilla's, and other stuff.
She can feed herself with a spoon, but not cleanly all the time.
She is very interested in other people, will smile at them, wave and say hi, doesn't have issues with big crowds, does well at restaurants as long as she has colors to play with.
Is stuck on any strict schedule... has no issues with change. Does well at her daycare with eating at the table and staying seated, as well as napping on a cot at nap time.
She loves to be read to. Books are one of her favorite things in the world. She turns the pages for me and will usually put her hand on pictures that she knows what they are and tell me their name. We read at least 30 minutes a night.
She can count to three and can count past 3 to all the way to 6 if I help. She loves do singing games and tries to do the gestures. She is pretty good at that, and knows the words to a lot of songs.
She is a spectacular sleeper. Sleeping from 8:00 to 6:30 am most nights, and taking a 2 to 4 hour nap every day.

The problems we are seeing with her are things you have to be around her a lot to notice for the most part.
First and foremost she does not call me Momma. She knows if someone says "Momma is here" but she will not call me that. As a matter of fact she does not call anyone by their name except "Papa" she will point at him and say "Pa Pa" and then every once in a while she will say "Daddy" to her daddy, she knows who everyone is because the other night she picked her a pair of shoes and said "Shoes" and started to bring them to me so I can put them on and I said "those are daddy's shoes" and she took them to him.
She likes for me and my husband to hold her, she will lay in our arms, give us hugs, likes to be rocked if she can't fall asleep, loves to be thrown in the air, and will sit on us anplay "Horsey", but other than that she doesn't like peole touching her. It makes her angry. She definitely a touch me not. Now it doesn't upset her to the point where she just stays upset, and sometimes she will let her nana and papa kiss and hug on her, and she will definitely let them hold her when I'm not around, but if a kid or adult comes up to her when she isn't in the mood to be touched she will do this little "EH" scream thing and slap at them.
She doesn't throw a lot of tantrums, but when she does get really upset she will hit me a lot. over and over and over again. I will tell her "NO, don't hit" and she knows what I mean, but will forget and do it again 5 seconds later. Just recently she has started slapping herself in the face when she gets mad. She doesn't do it a lot of will during a tantrum.
She doesn't know the name of most of her body parts. She knows "Nose, Mouth, Head, and Hair, teeth and sometimes feet" She will not point at them for the most part if you ask, every once in a while she will do it. She doesn't try to dress or undress herself for the most part. She will put on a hat and say "hat" and she likes to wear bibs.
I wouldn't say she is aloof, she definitely knows what is going on around her at all times, but she doesn't seem like she understands a lot about our world. Like I see these parents who drop their kids off a gym day cares and take them to the daycare center at church and all I can think is dang.... I could never do that. If I dropped Lily off with people she doesn't know she would freak out, she still hates the dreaded drop off at the daycare she has went to since she was 7 weeks old.
I saw one kid at her daycare who is 2 months younger than her go up to the caretake and say "Mama?" he was basically asking if his mama was coming to pick him up.... Lily would never do anything like that....
She hums a lot, arm flaps, hand flaps, and has somewhat repetitive behavior. Likes to tilt her head back, and shift her eyes down and look at things. Seems to have some sensory issues, but they are minor... Like she doesn't have issues with sound, light, touch as far as certain clothes bothering her, or smell.

She is a wonderful little girl and we Iove her to death. And I can handle the fact that she might have autism... I am just wondering how severe it sounds. The EI people are doing a developmemental eval the day after tomorrow at our house, and she is also gonna get an occupational eval. She did not qualify for a speech or physical therapy evaluation, because she is not behind at all physically, and she isn't at least 25% behind speech wise. My question is how do they measure the severity of autism? Does this sound like mild,moderate, severe, asbergers, or Pdd/pdd-nos? I know that no one can officially diagnose her except a professional, but what does this sound like to you in your experience? I am in the process of making notes for the eval... is there anything I should watch other the next 48 hours and jot down to tell them or questions I should ask them? Thank you all so much for any advice you can give me!

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J.T.

answers from Dallas on

My oldest, now 12, was diagnosed at a very young age.... I truly don't see ANYTHING in all that you wrote that even remotely sounds like autism.

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P.K.

answers from New York on

She sounds like a perfectly normal 22 month old. All kids are different and develop differently. My two granddaughters are do so opposite that we laugh. The little one has incredible gross motors skills. Crawled and walked early. Big sister walked at 18 months. Never climbed on anything. Has incredible fine motor skills. Colors and stays in lines. She is 2 1/2. Awesome vocabulary and quite the imagination. Little one just runs and climbs. They are all different. I would not be so quick to want to label her. Just enjoy her for who she is.

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J.C.

answers from Anchorage on

Everything you talk about sounds fairly normal for a toddler so young.

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J.S.

answers from St. Louis on

Just because some kids are ahead of yours doesn't make it autism. I know you have stated no one can diagnose except a professional but you seem to think you can.

The most you have described there are sensory issues and that does not by proxy mean autism. I am ADHD, I have sensory issues. My younger son is autistic, he has sensory issues. My other three have ADHD and no sensory issues. What I mean is one does not lead to another.

Oh thank god, after reading some of the other answers my other observation appears correct. I was thinking this all sounded pretty normal but then I don't have normal kids so my judgment is a bit off. Still everything you listed would not have compelled me to have any of my kids evaluated. Even my son with autism wasn't formally evaluated until he was four and I assure you the issues we quite pervasive. Like he didn't even talk, had no real desire to interact with anyone beyond our family.

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S.S.

answers from Chicago on

I work with autistic children as a special ed assistant. For quite a while actually. Except for the hand flapping, I don't seem to think there is much difference in her behavior from other two year olds. Does she look in the air a lot while you are talking to her? Does her hand flapping accompany frustration? Even the tantrums sound pretty normal. And we all have different personalities as adults, and while she doesn't like being touched that might not be related to autism, I kind of don't like being touched myself. My skin seems to react. And to my knowledge I'm not autistic. So, it might have to do with her senses and who she likes or dislikes. Or her senses. I would be curious to know what the diagnoses is. Like you havenoticed there are various forms and so I'm not going to dispute you if you feel for sure, but she is in touch with the world, isn't rocking or unable to connect so unless she shows some remarkable signs of something else, not to worry, but of course take advantage of any programs there are if she is. Good luck!

5 moms found this helpful

D.B.

answers from Boston on

This doesn't sound like anything other than normal toddler behavior to me. You can't compare kids at this age - some of them talk a lot, some don't, some are social, some aren't.

Your child makes eye contact, waves, talks, eats a variety of things (okay, so she doesn't like sticky foods - a lot of kids have texture issues), she cooperates. She doesn't like to be dropped off someplace - but that's called separation anxiety, not autism. My child was quite late in doing a lot of talking, but he was very early in doing physical things like walking and running. A lot of kids don't transition well from one activity to the next, even at age 5 or 6. So by itself, that doesn't mean anything either. So these are not delays or disabilities, just kids doing things in a different order from the next kid.

If you really want an evaluation, by all means get one. But please be open to whatever they say. And you sound like you have an active and interested little girl who communicates, understands, and engages in a variety of activities. If she has anything at all, it really doesn't sound severe or even moderate. Unless you've left out some key indicators, I'm not seeing anything that would cause someone to worry.

Updated

This doesn't sound like anything other than normal toddler behavior to me. You can't compare kids at this age - some of them talk a lot, some don't, some are social, some aren't.

Your child makes eye contact, waves, talks, eats a variety of things (okay, so she doesn't like sticky foods - a lot of kids have texture issues), she cooperates. She doesn't like to be dropped off someplace - but that's called separation anxiety, not autism. My child was quite late in doing a lot of talking, but he was very early in doing physical things like walking and running. A lot of kids don't transition well from one activity to the next, even at age 5 or 6. So by itself, that doesn't mean anything either. So these are not delays or disabilities, just kids doing things in a different order from the next kid.

If you really want an evaluation, by all means get one. But please be open to whatever they say. And you sound like you have an active and interested little girl who communicates, understands, and engages in a variety of activities. If she has anything at all, it really doesn't sound severe or even moderate. Unless you've left out some key indicators, I'm not seeing anything that would cause someone to worry.

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M.S.

answers from Portland on

I am guessing that your daughter might have Sensory Processing Issues and might need to see an Occupational Therapist who specializes in this, but I doubt she is autistic. I work as a SPED teacher and have 2 kids with SPD (sensory processing disorder) and one of them is also autistic. I think your little one sounds pretty normal, but would benefit from some OT. The amount that you are going to get from EI is not enough to hardly count, and she will probably need to be seen in private practice. We did the EI route, and it helped us get a lot of eye contact and engagement, but you don't seem to have those problems. I think she just needs to learn to regulate her senses.

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J.C.

answers from Philadelphia on

I am not an expert but I have been around autistic kids. You did not write anything in your post that leads me to believe she even autistic. Did you leave certain behaviors out of your post?

The fact that she is verbal, can follow commands and can point is huge. I would say there is no was she is severely or even moderately autistic. She is not even 2 and already has some great skills. What does her pediatrician say?

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R.B.

answers from Dallas on

You are getting an OT (occupational therapy evaluation) who are you having evaluate for Autism Spectrum disorder and why? Is EI (early childhood intervention) they are not qualified to make an ASD diagnosis.

I really didn't see many red flags here. Question: does your spouse refer to you as "mama" and do you refer to yourself as mama?

From what you describe I don't see:
1. A social impairment
2. Repetitive restrictive behaviors
3. A cognitive delay

Sounds like speech delay and maybe some sensory issues although from what you describe they sound very limited in scope and mild - this feels like a stretch even but maybe you are leaving out some things. Some typical developing kids are only affectionate on occasion.

Toe walking is a hallmark autistic trait yet some do some don't and I've seen NT kids do this all this to say flapping hands at times doesn't mean someone has autism.
I'm DSM 4 days these where basically the different categories :

Autistic disorder: mild to moderate or severe

PDD-NOS

ASPERGERS

Your post was so long it's hard to get to what is a concern - they eye thing your talking about might be a vision or eye teaming issue. OT can work on eye teaming. At her age vision is not fully developed.

I hope this is helpful and I hope your daughter is not on the spectrum. My son brings so much joy to our life but I'd never wish autism on anyone.

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P.G.

answers from Dallas on

ADD: Most of what you write doesn't really shout autism. In our case, there was a family history, and his daycare noticed a "difference" in how he related to the other kids - he's very social, but he was "out of sync" if that makes any sense. My son was also speaking before he was 1 year old - his communication challenges were in social language.

I would say trust your gut, but don't panic.

ORIGINAL: My son is 8, was diagnosed mild-moderate PDD-NOS at 4. It's a wide range of behaviors. I don't really remember, because like you, the symptoms weren't "stereotypical" of the TV version. Please feel free to PM me if you want to chat. :)

I also started a website - links to autistic bloggers and tons of resources - it's called autistikids.com. You can email me through there as well (____@____.com).

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D.K.

answers from Pittsburgh on

She actually sounds rather normal for her age. Is the flapping constant or just occasional? Was the evaluation triggered by you or by a teacher/physician/etc?

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J.G.

answers from Chicago on

I'm sorry to say that everything you list sounds normal to me.

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T.S.

answers from San Francisco on

Why do you think she's autistic at all, she sounds very...normal....???

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M.S.

answers from Kansas City on

You might check with your State program for "Parents as Teachers", which was initiated in Missouri in 1981 and now in 50 states. They come to your home quarterly and evaluate growth and development of your child from infancy to age 3 or 4.
My grandchildren were seen in their home from the time they were a few months old until age 3 or 4. My grandson is 5 and in Kindergarten, so has "graduated" from the program, but granddaughter is just past 2 1/2 and she is seen every 3 months for evaluation. The teacher plays with her and evaluates interaction, eye contact, coordination, mobility, dexterity, language skills, all things developmental for age appropriate behavior.
They will tell you how your child ranks with others, where they excel or might be behind.

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A.J.

answers from Williamsport on

You know your daughter best.

All I'll say is that your daughter is doing just as much or more than my kids did at 22 months as far as talking and understanding and stuff.

ALL KIDS will throw tantrums without discipline. All kids. Or at least 99% of kids. Often much more severely than what you describe. Often inclusive of hitting themselves, banging their heads, puking, etc. Saying "no we don't hit" is not discipline. It is not a consequence. You may not agree with consequences and discipline at this age, which is the parenting norm now and that's fine, but just understand: tantrums without discipline are normal and have nothing to do with autism.

Take away the tantrums and I see nothing else here that seems autistic at her age. Both my second and third children were way behind her at 22 months and my third was prone to much more severe tantrums. Hated being dropped off places with strangers etc. Didn't like to be touched by people often..My second barely spoke 'til age 3. All my kids are extremely picky eaters. Hand flapping is a kid thing unless it's extreme. And the repetition at that age can be downright bizarre and comical. Dressing and undressing themselves? None of my kids did that with any regularity until around three.

I come from a huge family and had my kids later in life. I saw how extremely different kids are in their development and how WAY OFF BASE the milestones spelled out in lots of mainstream materials are. So it would have take some really "out there" behavior for me to suspect Autism to begin with. 2 years old is way too early to test for this imo unless your gut says something is seriously developmentally delayed with her comprehension of things. I had FOUR FRIENDS get their kids early intervention and Autism screening at age two for not talking yet as per "guidelines" only to find out they were completely normal.

All my kids are completely normal and Autism free. Get all the tests you need to reassure yourself, but I see nothing alarming in your post.

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A.B.

answers from Louisville on

I realize that it may simply be difficult to adequately describe things that are worrisome and that as her mom, there are probably things that stand out to you from interacting with your daughter that others may not notice, but you seem to be stretching for her to be diagnosed with something. Everything in your post sounds to me, as the mom of five children, like a totally normal almost two year old. None of the early indications of any form of autism seem to be present.

The link here shows by age a lot of the common, early symptoms that your child MIGHT have some form of autism. But they will even tell you, these are not guarantees that your child has it. Incidentally, by this checklist, there is nothing in your written description of your daughter that is a reason for concern:

http://www.autismsciencefoundation.org/autism-early-signs

I don't think you're crazy, by the way, but I do think you are stressing yourself out unnecessarily. Hopefully the evaluation can give you the reassurance you need so you can enjoy your daughter without worrying that there's something wrong with her.

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E.S.

answers from Jacksonville on

My oldest was evaluated at 18 months by CARD (Center for Autism and Related Diseases) a few years ago. We were told that he wouldn't be given a diagnosis at that young of an age unless it was needed in order for insurance to cover any therapies. At this age, they usually will tell you that she has red flags and will start for therapy for any behaviors. They won't usually diagnose until around 4 or 5 years old.

We did therapy for a few years and were eventually told that he is not autistic but has some quirks.

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G.B.

answers from Oklahoma City on

The evaluation team will give questionnaires to all those who interact with your child on a daily or even semi daily way. When we had my grandson evaluated for SPD they sent the questionnaires to Mother's Day Out teachers, Sunday School teachers, babysitters, and both my hubby and I filled one out too.

The evaluation has many parts and is over an extended period of time so they get a good look at all the areas. It's a process where they see how far into certain areas she is and when she's not in some areas at all.

It will get done and they'll help you understand it along the way. Talk to them or google methods for evaluation of autism.

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B.B.

answers from New York on

So, early intervention does not diagnose anything. They are not allowed to, actually. They do tests and then if there are delays, they will reccomend therapy and then might suggest follow up with a neurodevelopemental pediatrician. Honestly, I don't really see red flags so moderate or severe autism is really not on the table here. It can take up to 6 months to get an appt with a ND pediatrician at a local hospital so if you are concerned, make the call now because it is much easier to diagnose autism past the age of 2, especially if it is milder.

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