Autism Diagnosis | Diagnosing ASD | Developmental Monitoring & Autism Screening | FAQ on ASD Assessment

Diagnosing ASD

Getting an autism diagnosis:

What autism screening tools are there?

Getting an autism diagnosis:

What autism screening tools are there?

There are several autism screening tools that can be used, including the Autism Diagnostic Observation Schedule (ADOS) performed by a child psychologist, and parent interview scales such as the Child Autism Rating Scale (CARS), Autism Diagnostic Interview-Revised (ADI-R), and Developmental, Dimensional and Diagnostic Interview (3DI). Measures of a child’s speech and language skills and intellectual ability also help professionals plan interventions.

Monitoring, screening, evaluating, and diagnosing children with ASD as early as possible is important to make sure children receive the services and support they need to reach their full potential. There are several steps in this process. 


Autism Screening

Autism Diagnostic Observation Schedule

The Autism Diagnostic Observation Schedule (ADOS) is the current gold standard for a behavioural observational assessment of individuals suspected of having ASD.
During the ADOS, the psychologist will use a standard set of activities to assess your child’s social communication and interaction behaviours, play and use of materials. The set of activities used will depend on your child’s language and developmental age.

Child Autism Rating Scale

CARS was developed by Eric Schopler, Robert Reichier and Barbara Rochen Renner. Just like any other autism assessment tool, it was made to help in the diagnosis of autism in children.

 The difference CARS has from other behavior rating tools is that it actually can tell the difference if your child has autism or other developmental delay disorders like mental retardation. It makes it easier for healthcare providers, educators, and parents to identify and classify children with autism.

Autism Diagnostic

The Autism Diagnostic Interview-Revised (ADI-R) is a structured interview conducted with the parents of individuals who have been referred for the evaluation of possible autism or autism spectrum disorders. 

The interview, used by researchers and clinicians for decades, can be used for diagnostic purposes for anyone with a mental age of at least 24 months and measures behavior in the areas of reciprocal social interaction, communication and language, and patterns of behavior.

Developmental, Dimensional and Diagnostic Interview (3DI)

The Developmental, Dimensional and Diagnostic Interview is a standardized, computer-based diagnostic interview in which individual scores of children from the age of 3 years old and upward in both clinical and normal populations with suspected autism spectrum disorder (ASD) can be scored in terms of their severity, frequency, and comorbidity.

It was specifically designed to be easy and practical in its use, requiring minimal training and automation of reporting. The interview offers a dimensional assessment across the full range of autism spectrum characteristics.

Where can I get a diagnosis in Singapore?

If you suspect that your child to have ASD, we recommend consulting your family doctor as soon as possible to get a referral to get it assessed. 

If not, we recommend consulting a Developmental and Behaviour Paediatrician to assess your child. You are able to find them at:

  1. KK Women’s and Children’s Hospital – Department of Child Development
  2. National University of Singapore – Child Development Unit
  3. Singapore Baby and Child Clinic (SBCC)
  4. Quek and Marcou Developmental and Behavioural Paediatrics Clinic
  5. International Baby Child and Adolescent (IBCA) Clinic

Who are Development and Behavioral Paediatricians?
Developmental and Behavioral Paediatrician offers multidisciplinary service committed to providing holistic care for children with developmental, learning and behavioural difficulties. Developmental and Behavioral Paediatrician assess and manage children from birth to 7 years old with a range of learning, behavioural and developmental needs. 

These include: Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder – ADHD (Children), Speech and Language Disorders, children with Hearing Impairments, Developmental Delays, Specific Learning Disabilities (i.e. Dyslexia, Developmental Coordination Disorder, Specific Language Impairment), behavioral difficulties, and children with chronic illnesses at risk of developmental delays. 

Step 1: Developmental Monitoring

DSM-5 – Autism Spectrum Disorder

Developmental monitoring observes how your child grows and changes over time and whether your child meets the typical developmental milestones in playing, learning, speaking, behaving, and moving. Parents, grandparents, early childhood providers, and other caregivers can participate in developmental monitoring. You can use a brief checklist of milestones to see how your child is developing. If you notice that your child is not meeting milestones, talk with your doctor or nurse about your concerns.

Autism Screening - Developmental Monitoring

Step 2: Autism Screening - Developmental Screening

Developmental Screening takes a closer look at how your child is developing. Your child will get a brief test, or you will complete a questionnaire about your child. The tools used for developmental and behavioral screening are formal questionnaires or checklists based on research that ask questions about a child’s development, including language, movement, thinking, behavior, and emotions. Developmental screening can be done by a doctor or nurse, but also by other professionals in healthcare, community, or school settings. Developmental screening is more formal than developmental monitoring and normally done less often than developmental monitoring. Your child should be screened if you or your doctor have a concern. However, developmental screening is a regular part of some of the well-child visits for all children even if there is not a known concern.


Autism Screening - Developmental Screening

FAQ on Autism Assessment

1. At What Age can Autism be Diagnosed?

Although some children show autistic features in early infancy, it can be difficult to give a definitive diagnosis of autism before 2 to 2.5 years old. In addition, some behaviours associated with autism are also frequently found in children who have developmental delay. This may make it difficult to distinguish between the two conditions in very young children. However, many children with autism can be screened for the disorder from as young as 18 months. Your doctor will determine the most suitable age for diagnosis based on the developmental status of the child.

2. How is the diagnosis of autism made? Are there any special tests the doctor can do to determine whether my child is autistic?

At present, there are no diagnostic tests for ASD, unlike certain medical conditions where a blood test or X-ray may provide exact results. Instead, the diagnosis is based on a detailed developmental history and observation of the child’s behaviors.

However, autism can co-exist with certain medical conditions and your doctor may recommend blood tests, genetic tests or brain scans to rule out the presence of these other conditions.

3. What are the tests that the pediatricians and specialists will use in the
diagnosis of ASD?

A detailed medical and developmental history from the parents is obtained by the pediatrician. Behavioral observations and developmental screens are also performed in the clinic. The doctor may also give out questionnaires to parents and teachers to ascertain if the child has difficulties at home or in school that may be related to autism. A physical examination will also be performed to exclude other co-existing medical conditions.

Next, psychological testing will involve tools developed specifically for diagnosing ASD. These include the Autism Diagnosis Interview-Revised (ADI-R), the Autism Diagnostic Observation Schedule (ADOS), the Child Autism Rating Scale (CARS), and Developmental, Dimensional, and Diagnostic Interviews (3DI).

The ADI-R is a standardized, semi-structured clinical interview for caregivers. The interview can take up to 3 hours and it focuses on behaviors in three areas: quality of social interaction, communication, and language, and repetitive, restricted, and stereotyped interests and behavior.

 The ADOS is a semi-structured assessment of communication, social interaction and play or imaginative use of materials for children suspected of having ASD. The ADOS requires a 30 to 45 minutes observation period of the child’s behaviour and interaction.
CARS aids in evaluating the child’s body movements, adaptation to change, listening response, verbal communication and relationship to people. It is suitable for use with children over 2 years of age. The examiner observes the child and also obtains relevant information from the parents.
3DI is a semi-structured parent interview designed to facilitate the evaluation of suspected ASD.
In addition, testing of the child’s cognitive skills may be necessary and can be assessed with the Vineland Adaptive Behaviour Scales 2nd Edition (VABS-II) for younger children and standardised IQ testing for older children.

4. How is a typical autism assessment like?

A typical autism assessment will take at least 2 hours. These assessments will include a combination of detailed parental interviews and child observations using the tools mentioned above. These are usually scheduled to be completed within a day. However, depending on the child’s cooperation, interviews and observations may be scheduled on different visits. Generally, for children less than 5 years old, two assessment sessions will be booked. For children more than 5 years old, three assessment sessions will be booked.

5. What can I do to prepare for the autism assessment session?

  • Try to schedule the autism assessment to take place when your child is at his best. If your child needs to take an afternoon nap, then don’t schedule the session in the afternoon.
  • Allow the child to have plenty of rest the night before as well as a good breakfast on the day of the test.
  • Note your child’s developmental milestones (e.g. age of walking, first single words, etc.) and any unusual behaviours (e.g. spinning body, lining up objects, etc.) and how long these behaviours have lasted. All these information will be useful during the parental interview.

6. Why is it important to make the diagnosis? Can I wait till my child is much older?

It is important to identify children with possible ASD early so that they can receive appropriate intervention and support services. Research indicates that early intervention can improve children’s developmental outcomes, including improved language, cognitive, social and motor skills

The earlier a diagnosis is made, the sooner the child can participate in early intervention programmes that are specifically designed for ASD.

There are situations where a diagnosis may also be helpful for schoolgoing children. For example, a diagnosis allows support of the Special Needs Officer (SNO) in mainstream schools or when seeking examination accommodation.