Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Early indicators of developmental delay or autism spectrum disorder (ASD) that should prompt further investigation primarily involve regressions in developmental milestones, significant concerns from family, and the presence of specific risk factors NICE CKS,NICE CG128.
- Regression of Developmental Milestones:
- A child under 3 years of age who experiences regression of language or social developmental milestones should be referred for further investigation NICE CKS,NICE CG128.
- For children or young people over 3 years of age, regression in language developmental milestones warrants referral NICE CKS,NICE CG128.
- Regression in motor developmental milestones at any age is also an indicator for referral NICE CKS,NICE CG128.
- Limitations in Activities of Daily Living:
- Persistent and significant limitations or impairments to activities of daily living caused by clinical features suggestive of autism, at any age, should prompt referral NICE CKS.
- Moderate limitations or impairments to activities of daily living caused by clinical features suggestive of autism, especially when accompanied by significant family and/or carer concerns about the child's development or functioning, warrant consideration for referral NICE CKS,NICE CG128.
- Family and Carer Concerns:
- Significant family and/or carer concerns about a child's level of development or functioning are important indicators NICE CKS,NICE CG128.
- Risk Factors for Autism:
- Factors associated with an increased prevalence of autism should also prompt consideration for investigation NICE CKS,NICE CG128. These include, but are not limited to, having a sibling with autism, birth defects affecting the central nervous system, gestational age less than 35 weeks, parental schizophrenia-like psychosis or affective disorder, maternal use of sodium valproate in pregnancy, a learning (intellectual) disability, Attention Deficit Hyperactivity Disorder (ADHD), neonatal or epileptic encephalopathy, and certain chromosomal or genetic disorders such as Down's syndrome, fragile X, muscular dystrophy, neurofibromatosis, or tuberous sclerosis NICE CG128.
- Other Considerations:
- New clinical features suggestive of autism developing, or ongoing concerns about a possible diagnosis of autism after a period of 'watchful waiting', should lead to referral NICE CKS.
- It is important not to rule out autism based on good eye contact, smiling, showing affection to family members, reported pretend play, or normal language milestones NICE CG128. Similarly, difficulties appearing to resolve after a needs-based intervention or a previous assessment that concluded no autism should not preclude further investigation if new information becomes available NICE CG128.