Who Is Qualified to Diagnose Autism in Children?

Autism Spectrum Disorder (ASD) is a very common neurological and developmental condition. According to the Centers for Disease Control (CDC), ASD is estimated to affect about 1 in 36 kids as of 2020. Despite the prevalence of ASD and increasing awareness, many people still have misconceptions about what ASD is. Misconceptions and stereotypes can prevent children from getting diagnosed. Early diagnosis can be life-changing because it means that autistic people can understand themselves better as they grow up and get access to treatment, school accommodations, and other critical forms of support. For example, some families may qualify for financial assistance if a child has an ASD diagnosis.

ASD is marked by differences in social interaction and communication, repetitive behaviors, restricted interests, and other symptoms. What these symptoms look like can vary dramatically. In many cases, kids and their parents see and work with multiple providers before getting an official ASD diagnosis. So, who is qualified to diagnose autism in children?

Let's discuss the role different healthcare providers can play in helping your child get an official ASD diagnosis, starting with their primary care physician. We will outline the specific professionals qualified to provide a diagnosis directly and how other professionals might play a role in the evaluation process. 

Primary Healthcare Providers

Often, a child's primary care physician or pediatrician is the first person you'll see during their journey toward a possible ASD diagnosis. The American Academy of Pediatrics (AAP) recommends that all kids are screened for ASD in early childhood at 18 and 24 months old. Most kids aren't diagnosed at this age. Screening tools used in a pediatrician's office are not the same as an autism evaluation and do not have 100% accuracy in detecting ASD. That said, since evaluations are often expensive and time-consuming, these tools can detect possible ASD symptoms and identify the need for an evaluation.

Multiple screening tools can be used to detect possible ASD symptoms. The screening tools applicable to your child will depend on their age. These may include:

• The Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R). The M-CHAT-R is a 23-point questionnaire. This is one of the most common pre-diagnostic screening tools for ASD in young children. 
• Ages and Stages Questionnaire (ASQ). The ASQ is a general developmental screening tool meant to detect developmental delays, which some, but not all, autistic people experience.
• The Screening Tool for Autism in Toddlers and Young Children (STAT). The STAT is an interactive tool designed to aid early diagnosis and detection of ASD in children aged 24-36 months.
• The Social Communication Questionnaire (SCQ). The SCQ, designed for those aged 4+, is a brief questionnaire for parents consisting of yes-or-no questions related to a child's behavior in social situations.
• The Autism Spectrum Ratings Scales (ASRS). The ASRS assesses for possible ASD symptoms in those aged 2-18 years old.

If you suspect that your child has ASD, you may complete these screening tools as recommended by a medical doctor or fill them out at home and bring the results to a child's pediatrician. Reviewing the diagnostic criteria for ASD and writing down the symptoms your child experiences in each category is another way to raise the possibility that your child has ASD to a healthcare provider.

Although your child's primary care provider can't provide an official diagnostic evaluation, they can refer your child to a specialist for an official autism assessment. This could be a developmental pediatrician, a clinical psychologist, a child and adolescent psychiatrist, or a pediatric neurologist.

Developmental Pediatricians

In many cases, a developmental pediatrician will be the one to provide a child with an official autism diagnosis. The difference between a developmental pediatrician and the medical doctor your child sees for regular well-child visits is that a developmental pediatrician will have specialized training in developmental disorders like ASD. Here's what seeing a developmental pediatrician for your child's ASD diagnosis might look like. 

Comprehensive evaluation process

ASD is a complex neurodevelopmental disorder requiring a comprehensive evaluation. Since all autistic people show symptoms differently, and since ASD symptoms can often overlap with other disorders (e.g., anxiety, obsessive-compulsive disorder, or ADHD), it's integral that other symptom causes are ruled out. While a PCP can provide an initial, informal screening to determine whether a formal diagnostic assessment is appropriate, developmental pediatricians can administer a child's formal diagnostic assessment.

The two primary diagnostic tools used to assess for ASD include:

• The Autism Diagnostic Interview-Revised (ADI-R). The ADI-R is a standardized interview used to diagnose ASD and distinguish it from other developmental disorders. During the ADI-R, providers talk with the parent or caregiver and ask about a child's developmental history.
• The Autism Diagnostic Observational Schedule (ADOS). The ADOS test differs from the ADI-R, partially in that it involves an interview or play session with the child. During this interview or session, the developmental pediatrician will observe a child's behavior and look for ASD symptoms.

ASD is diagnosed based on criteria in the most recent updated version of the American Psychiatric Association (APA)'s Diagnostic and Statistical Manual of Mental Disorders (DSM) at any given time. As of 2024, that is the DSM-5 criteria. Learn more about recognizing the signs of ASD here. 

Collaborating with other healthcare professionals

Even if a developmental pediatrician administers an autism assessment and provides an official diagnosis, they may collaborate with other healthcare providers as needed. As part of the evaluation process, some kids see other medical professionals for assessment or support purposes. For example, a speech-language pathologist who can assess for and help kids improve social interaction skills.

Child Psychologists and Psychiatrists

"Psychologist" and "Psychiatrist" are not synonymous terms. However, like a developmental pediatrician, both child psychiatrists and psychologists can provide an official ASD diagnosis if they have specialized training. If the psychiatrist or psychologist your child sees is the one to administer an official autism evaluation, they'll use the same diagnostic tools as a developmental pediatrician.

Child psychiatrists and psychologists can also aid the diagnostic process by assessing a child's social and behavioral symptoms, even if another professional provides the official diagnosis.

Providing therapy and support services

First, let's break down the differences between a psychologist and a psychiatrist:

• A child psychologist is a mental health professional who can provide therapy services, assess for conditions, or refer to other providers. Despite having doctorate-level education, child psychologists aren't medical doctors like psychiatrists are.
• A child psychiatrist is a medical doctor who specializes in youth mental health. Child psychiatrists may administer medications, assess for conditions, and provide referrals to other healthcare professionals.

Child psychologists, therapists, social workers, and counselors are also not the same. Therapists, social workers, and counselors can all provide therapy or counseling services but don't have the same education level as psychologists and cannot diagnose ASD. 

Working with families to develop treatment plans

Common treatment options for ASD symptoms include ABA therapy, speech therapy, occupational therapy, and sensory integration therapy. Whether for ASD or another concern, a child and adolescent psychiatrist or psychologist may recommend treatment options based on your child's specific symptoms or needs. 

Speech and Language Therapists

Children may see a speech-language pathologist (SLP) for various reasons. If participating in the diagnostic process for ASD, an SLP's main role will be to evaluate a child's communication skills.

Assessing communication skills

Speech-language pathologists will consider both a child's verbal and non-verbal communication skills. These include social communication skills like:

• Joint attention
• Interactive play and taking turns
• Verbal speech in the context of the child's developmental level and age

If an SLP participates in your child's evaluation process, they will ask you (the parent or primary caregiver) questions about the child's social interactions at home and in other environments to ensure that they and other providers can see the full picture.

Providing interventions to improve language development

Following a child's evaluation, a speech-language pathologist will provide recommendations for treating any concerns they may notice. For example, SLPs might recommend ongoing treatment to help a child understand and use body language or speak clearly, among other social communication skills. Many autistic people work with health professionals like SLPs for these treatments. SLPs can also help non-verbal or minimally verbal children and their families learn about and use augmentative and alternative communication devices (AAC devices).

Collaborating with other professionals to address communication challenges

Although SLPs can play a vital role in helping kids with ASD navigate social situations, there are times when they may recommend that a child see another qualified professional to work on specific skills. Similarly, they can collaborate with other providers a child sees to ensure that their treatment plan is comprehensive and complementary. 

Occupational Therapists

Occupational therapists can help children with sensory issues, motor skills, and various daily living skills, like personal hygiene tasks or getting dressed. They can also play a critical role in the diagnostic process for some autistic children. Here are three ways an occupational therapist (OT) might help your family during and after the diagnostic process.

Evaluating sensory and motor skills

While an SLP might look at a child’s speech and language abilities, an occupational therapist can evaluate your child for sensory processing differences, motor skills, and other possible concerns as part of the diagnostic process. They will then share the results of any evaluations with the provider (e.g., a developmental pediatrician) who administers an official autism assessment. 

Developing strategies to improve daily functioning

In addition to aiding the diagnostic process, an occupational therapist can develop strategies to improve a child's daily functioning, whether as part of an early intervention model or post-diagnosis. Children do not need a formal diagnosis of ASD to see an occupational therapist. 

Working with families and educators to create supportive environments

Occupational therapists can provide families and educators with individualized guidance. Guidance from an occupational therapist (OT) can help parents and educators create the most supportive environment possible at home and school. For example, an OT may:

• Offer parents strategies for navigating specific challenges (e.g., sensory issues) at home.
• Give educators advice for helping a child learn and feel more comfortable in classroom environments. 
• Help with developing an individualized education plan (IEP).

Occupational therapists and other providers your child sees before, during, or after the diagnostic process can be great advocates for kids who need school accommodations and other services. Sometimes, a child will continue seeing members of their assessment team, like an OT, following their diagnosis as part of their treatment plan.

Conclusion

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder. Due to the complexity of ASD, autistic people often see multiple medical and mental health professionals during the evaluation process to ensure accurate diagnosis. Professionals qualified to provide an official autism diagnosis include developmental pediatricians, neurologists, psychologists, or psychiatrists with specialized training. 

Other providers, like occupational therapists and speech-language pathologists, can also be a part of a child's assessment team. These providers all have unique areas of specialty and often work together to help autistic children get a formal diagnosis.

Early intervention for ASD is associated with benefits like better daily living skills and can be very important for autistic children. If you suspect that your child could have ASD, seeing multiple providers who are well-versed in ASD can be essential.