Developmental Monitoring
Developmental monitoring is an active, ongoing process of
watching a child grow and encouraging conversations between parents and
providers about a child's skills and abilities. Developmental monitoring
involves observing how your child grows and whether your child meets the
typical developmental milestones, or skills that most children reach by a
certain age, in playing, learning, speaking, behaving, and moving.
When you take your child to a well visit, your child's
doctor or nurse will also do developmental monitoring. The doctor or nurse
might ask questions about your child's development or will talk and play with
your child to see if they are developing and meeting milestones. (CDC, 2025).
Developmental Screening
Developmental screening takes a closer look at how your
child is developing and is more formal than developmental monitoring. It is a
regular part of some well-child visits even if there is not a known concern.
The American Academy of Pediatrics (AAP) recommends
developmental and behavioral screening for all children during regular
well-child visits starting at the age of 9 months.
In addition, AAP recommends that all children be screened
specifically for autism during regular well-child visits at 18 months and again
at 24 months.
Developmental screening can be done by a doctor or nurse, or
other professionals in healthcare, community, or school settings. Your doctor
may ask you to complete a questionnaire as part of the screening process.
Additional screening should also be done if a child is at high risk due to a
family history of autism, or if behaviors associated with autism are present.
If your child’s healthcare provider does not periodically
check your child with a developmental screening tool, you can ask that it be
done.
The Modified Checklist of Autism in Toddlers (M-CHAT-R) is
one of the AAP’s recommended tools. The M-CHAT-R™ is a scientifically validated
checklist of questions used for screening children between 16 and 30 months of
age to assess their risk for autism spectrum disorder (ASD). The MCHAT-R
screener should be completed by the family and a professional to screen for red
flags associated with autism. The MCHAT screener does not diagnose, it is only
used to identify children who may need to be referred for a full evaluation.
There is a possibility that your child may fail the M-CHAT-R but may not meet
criteria for a diagnosis of autism. Therefore, it is important to follow up
with your health care provider (Hyman, 2020).
Other Recommended Evaluations
A screening tool does not provide a diagnosis, but it
indicates if a child is on the right development track or if a specialist
should take a closer look. Your health care provider may provide referrals for
additional testing or refer your child for Early
Intervention services prior to an autism evaluation.
- An audiological assessment (hearing test) referral should
be made for all concerns regarding speech, language or hearing difficulties.
This is usually done by an audiologist.
- A cognitive evaluation (or developmental assessment) using
standardized tests that measure both verbal and nonverbal abilities should be
performed by a professional experienced in testing children.
- A medical and neurological evaluation may need to be
conducted to assess such issues as acquired brain injury, seizure disorder,
self-injury and sleep or eating disturbances.
- A speech-language-communication evaluation should be
performed on all children who have communication difficulties. This is typically
done by a speech-language pathologist (SLP).
- A physical or occupational therapist should assess a
child's sensorimotor skills if they exhibit difficulties with movement or
sensory responses.
Comprehensive Evaluation of Autism Spectrum Disorder
If the screening tool identifies an area of concern, a
formal evaluation may be needed. This formal evaluation is an in-depth look at
a child’s behavioral development. These assessments are usually conducted by a
team of specialists, including neurodevelopmental pediatrician, psychologist,
or psychiatrist. General pediatricians and child psychologists comfortable with
application of the Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition (DSM-5) criteria can also make an initial clinical diagnosis. The
specialist may observe the child, give the child structured tasks, ask the
parents or caregivers questions, or ask them to fill out questionnaires. The
results of these formal evaluations highlight your child's strengths and
challenges and can inform whether they meet criteria for a developmental
diagnosis of autism. Having a clinical diagnosis facilitates initiation of
behavioral and/or adaptive services. Currently, there are no medical tests
(blood tests, scans, or X-rays) to diagnose autism. It is based on behavioral
testing; therefore, careful review of the child’s behavioral history and direct
observation of symptoms are necessary.
Comprehensive Documentation
Upon a clinical diagnosis of autism, the diagnosing
specialist should provide a comprehensive written report of the results of your
child’s evaluation. This should also include information on your child’s present
developmental levels of functioning. For Nevada Medicaid purposes, the
diagnostic comprehensive report should also be accompanied by a form called Autism
Spectrum Disorder (ASD) Diagnosis Certification for Requesting Initial Applied
Behavior Analysis (ABA) Services (also known as the FA-11F
form). This form is needed for prior authorization of intervention and
treatment of autism.
Document
Resources:
Centers
for Disease Control. (2025, April 15). Screening for Autism Spectrum Disorder. Centers
for Disease Control and Prevention. https://www.cdc.gov/autism/diagnosis/index.html.
Hyman,
S. L., Levy, S. E., Myers, S. M., & Council On Children With Disabilities,
S. O. D. A. B. P. (2020, January 1). Identification, evaluation, and management
of children with autism spectrum disorder. American Academy of Pediatrics. https://publications.aap.org/pediatrics/article/145/1/e20193447/36917/Identification-Evaluation-and-Management-of?autologincheck=redirected.