Can a child without a daily routine be diagnosed with Autism Spectrum Disorder (ASD)?

From the Guidelines

A child with no established routine can still be diagnosed with Autism Spectrum Disorder (ASD), as the absence of a routine is not a diagnostic criterion for the condition 1.

Key Diagnostic Criteria

The diagnosis of ASD is based on the presence of persistent deficits in:

• social communication
• social interaction
• restricted, repetitive patterns of behavior, interests, or activities Medications such as risperidone, at a dose of 0.5-1.5 mg/day for 6-12 weeks, may be used to manage associated symptoms of irritability and aggression, but do not address the underlying diagnostic characteristics of ASD 1.

Comprehensive Diagnostic Evaluation

A comprehensive diagnostic evaluation, including:

• behavioral observations
• developmental assessments is necessary to determine the presence of ASD, regardless of the child's routine or lack thereof 1. Some key points to consider in the diagnosis of ASD include:
• age of onset: symptoms must be present in the early developmental period, but may not become fully manifest until social demands exceed limited capacities 1
• differential diagnosis: ASD must be differentiated from other conditions, such as reactive attachment disorder, obsessive-compulsive disorder, intellectual disability, anxiety disorders, and childhood-onset schizophrenia 1
• developmental regression: a loss of skills, which can be observed in some cases of ASD, but is not a diagnostic criterion 1

From the Research

Diagnosis of Autism Spectrum Disorder (ASD)

• A child without a daily routine can exhibit symptoms that may be associated with Autism Spectrum Disorder (ASD), but a daily routine or lack thereof is not a specific diagnostic criterion for ASD 2, 3.
• The diagnosis of ASD is based on a comprehensive evaluation with a multidisciplinary team of clinicians, using standardized measures such as the Autism Diagnostic Observation Schedule-Second Edition and the Autism Diagnostic Interview 2.
• Common early signs and symptoms of ASD in a child's first 2 years of life include no response to name when called, no or limited use of gestures in communication, and lack of imaginative play 2, 4.

Diagnostic Criteria and Tools

• The Diagnostic and Statistical Manual of Mental Disorders, 5th ed., created an umbrella diagnosis that includes several previously separate conditions: autistic disorder, Asperger syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified 3.
• The Autism Diagnostic Observation Schedule – Toddler Module (ADOS-T) is a diagnostic tool that has excellent sensitivity and acceptable specificity for diagnosing ASD in toddlers 5.
• Early warning signs of ASD include the lack of social gestures at 12 months, using no meaningful single words at 18 months, and having no interest in other children or no spontaneous two-word phrases at 24 months 4.

Importance of Early Identification and Intervention

• Early detection and early intervention programs improve functional outcomes for children with ASD 4.
• Family physicians should screen for ASD opportunistically when children attend clinics for acute issues and during scheduled well-child assessments 4.
• Children with suspected ASD should be referred to appropriate specialist centers as early as possible for multidisciplinary assessment and diagnosis 4.