Identifying autism as early in life as possible increases the chances of being treated sooner, which improves a child’s subsequent learning and development. A new checklist that only takes five minutes for parents to complete at doctor’s waiting rooms might well help do this, researchers from the University of California, San Diego, reported in the Journal of Pediatrics.

Unfortunately, too many children are being diagnosed with an Autism Spectrum Disorder a very long time after their parents first notice and report concerns about their child. In many cases the child is not diagnosed until well after he/she starts school.

Thomas R. Insel, M.D., director of the National Institute of Mental Health, said:

“Beyond this exciting proof of concept, such a screening program would answer parents’ concerns about their child’s possible ASD symptoms earlier and with more confidence than has ever been done before.”

Karen Pierce, Ph.D. and team set up a network of 137 pediatricians in San Diego County. The pediatricians attended a one-hour seminar, after which all 1-year-old babies were screened using the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist. This is a short questionnaire in which parents and caregivers fill in data regarding the baby’s gestures, gaze, words, sounds, and other communication signals appropriate for a 1-year-old.

The authors say the checklist can help spot language delay, developmental delay, and also ASD (autism spectrum disorder).

Children who failed the screen were referred for further testing and reassessed twice yearly until they were three years old.

32 out of 10,479 screened children were found to have ASD. After taking into account regression and late onset cases, the numbers correlated with what one would expect from 12-month-old babies, the authors added. The screening process appeared to provide a 75% accuracy diagnosis, when those identified as having developmental and language delay, or some other form of delay were included.

Those found to have developmental delay, 89% of those with language delay and the children diagnosed with ASD went on to have behavioral therapy. Treatment started when the children were approximately 17 months old – this compares to a national average of 5.7 years of age for diagnoses and treatment coming later, according to the CDC (Centers for Disease Control and Prevention).

Very few of the participating pediatricians had been screening babies for ASD systematically before the study began. 96% of the pediatricians thought the program was good. 100% of them continued it.

Dr. Pierce said:

“In the context of a virtual lack of universal screening at 12 months, this program is one that could be adopted by any pediatric office, at virtually no cost, and can aid in the identification of children with true developmental delays.”

The authors say more studies are required to redefine the screening tool, monitor kids for longer, and to determine what barriers there are in treatment follow-up.

Below are the questions asked in the checklist for the parent or caregiver to complete. It is called the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist.”

Emotion and Eye Gaze

  • Do you know when your child is happy and when your child is upset?
  • When your child plays with toys, does he/she look at you to see if you are watching?
  • Does your child smile or laugh while looking at you?
  • When you look at and point to a toy across the room, does your child look at it?


  • Does your child let you know that he/she needs help or wants an object out of reach?
  • When you are not paying attention to your child, does he/she try to get your attention?
  • Does your child do things just to get you to laugh?
  • Does your child try to get you to notice interesting objects – just to get you to look at the objects, not to get you to do anything with them?


  • Does your child pick up objects and give them to you?
  • Does your child show objects to you without giving you the object?
  • Does your child wave to greet people?
  • Does your child point to objects?
  • Does your child nod his/her head to indicate yes?


  • Does your child use sounds or words to get attention or help?
  • Does your child string sounds together, such as uh, oh, mama, gaga, bye bye, bada?
  • About how many of the following consonant sounds does your child use: ma, na, ba, da, ga, wa, la, ya, sa, sha?


  • When you call your child’s name, does he/she respond by looking or turning toward you?
  • About how many different words or phrases does your child understand without gestures? E.g., if you say “where’s your tummy,” “where’s Daddy”, “give me the ball,” or “come here” without showing or pointing, your child will respond appropriately.

Object use

  • Does your child show interest in playing with a variety of objects?
  • About how many of the following objects does your child use appropriately: cup, bottle, bowl, spoon, comb or brush, toothbrush, washcloth, ball, toy vehicle, toy telephone?
  • About how many blocks or rings does your child stack?
  • Does your child pretend to play with toys (e.g. feed a stuffed animal, put a doll to sleep, put an animal figure in a vehicle)?

Do you have any concerns about your child’s development (If “yes”, describe on back).

“Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist” (The Checklist – PDF)
By Amy M. Wetherby, Ph.D., CCC-SLP, & Barry M. Prizant, Ph.D., CCC-SLP

“Catching, Studying, and Treating Autism Early: The 1-Yr Well-Baby Check-Up Approach”
Pierce K, Carter C, Weinfeld M, Desmond J, Hazin R, Bjork R, Gallagher N.
Journal of Pediatrics. 2011 Apr.

Written by Christian Nordqvist