Physician Specialist Glossary

The American Academy of Pediatrics (AAP) recommends screening children for autism during regularly scheduled well-child visits. This policy helps doctors identify signs of autism early in its course. Early diagnosis and treatment can help the child reach his or her full potential.

When a developmental delay is recognized in a child, further testing can help a doctor find out whether the problem is related to autism, another pervasive developmental disorder (PDD), or a condition with similar symptoms, such as language delays or avoidant personality disorder. If your primary care provider does not have specific training or experience in developmental problems, he or she may refer your child to a specialist-usually a developmental pediatrician, psychiatrist, speech therapist, or child psychiatrist-for the additional testing.

• Behavioral assessments. Various guidelines and questionnaires are used to help a doctor determine the specific type of developmental delay a child has. These include:²
  • Medical history. During the medical history interview, a doctor asks general questions about a child's development, such as whether a child shows parents things by pointing to objects. Young children with autism often point to items they want, but do not point to show parents an item and then check to see if parents are looking at the item being pointed out.
  • Diagnostic guidelines for autism. The American Association of Childhood and Adolescent Psychiatry (AACAP) has established guidelines for diagnosing autism.² The criteria are designed so a doctor can assess a child's behavior relating to core symptoms of autism.
  • Other behavioral questionnaires. Additional diagnostic tests focus on children younger than age 3.
  • Clinical observations. A doctor may want to observe the developmentally delayed child in different situations. The parents may be asked to interpret whether certain behaviors are usual for the child in those circumstances.
  • Developmental and intelligence tests. The AACAP also recommends that tests be given to evaluate whether a child's developmental delays affect his or her ability to think and make decisions.

• Physical assessments and laboratory tests. Other tests may be used to determine whether a physical problem may be causing symptoms. These tests include:
  • Physical exam, including head circumference, weight, and height measurements, to determine whether the child has a normal growth pattern.
  • Hearing tests, to determine whether hearing problems may be causing developmental delays, especially those related to social skills and language use.
  • Testing for lead poisoning, especially if a condition called pica (in which a person craves substances that are not food, such as dirt or flecks of old paint) is present. Children with developmental delays usually continue putting items in their mouth after this stage has passed in normally developing children. This practice can result in lead poisoning, which should be identified and treated as soon as possible.

Other lab tests may be done under specific circumstances. These tests include:

• Chromosomal analysis, which may be done if intellectual disability is present or there is a family history of intellectual disability. For example, fragile X syndrome, which causes a range of below-normal intelligence problems as well as autistic-like behaviors, can be identified with a chromosomal analysis.
• An electroencephalograph (EEG), which is done if there are symptoms of seizures, such as a history of staring spells or if a person reverts to less mature behavior (developmental regression).
• A magnetic resonance image (MRI), which may be done if there are signs of differences in the structure of the brain.

Early detection

All doctors who see infants and children for well-child visits should watch for early signs of developmental disorders. Developmental screening tools, such as the Ages and Stages Questionnaire or the Modified Checklist for Autism in Toddlers (M-CHAT), can help assess behavior.

If a doctor discovers the following obvious signs of developmental delays, the child should immediately be evaluated:⁴

• No babbling, pointing, or other gestures by 12 months
• No single words by 16 months
• No 2-word spontaneous phrases by 24 months, with the exception of repeated phrases (echolalia)
• Any loss of any language or social skills at any age

If there are no obvious signs of developmental delays or any unusual indications from the screening tests, most infants and children do not need further evaluation until the next well-child visit.

But children who have a sibling with autism should continue to be closely monitored, because they are at increased risk for autism and other developmental problems.

When socialization, learning, or behavior problems develop in a person at any time or at any age, he or she should also be evaluated.

What is dyslexia?

Dyslexia is a learning problem that makes it hard to read, write, and spell. It occurs because the brain jumbles or mixes up letters and words. Children with dyslexia often have a poor memory of spoken and written words.

Having dyslexia does not mean that your or your child’s ability to learn is below average. In fact, many people with dyslexia are very bright. But not being able to read well can make many areas of learning difficult.

Dyslexia is also called specific reading disability, reading disorder, and reading disability.

What causes dyslexia?

Experts don't know for sure what causes dyslexia. But it often runs in families. So it may be passed from parents to children (genetic disorder). Also, some studies have found problems with how the brain links letters and words with the sounds they make.

Dyslexia is not caused by poor vision, and people with dyslexia do not see letters and words backward.

What are the symptoms?

Signs of dyslexia in children who are too young for school include:

• Talking later than expected.
• Being slow to learn new words.
• Problems rhyming.
• Problems following directions that have many steps.

After a child begins school, the signs of dyslexia include:

• Problems reading single words, such as a word on a flash card.
• Problems linking letters with sounds.
• Confusing small words, such as "at" and "to."
• Reversing the shapes of written letters such as "d" for "b." For example, the child may write "dat" instead of "bat."
• Writing words backward, such as "tip" for "pit."

If your child has one of these signs, it does not mean that he or she has dyslexia. Many children reverse letters before age 7. But if your child has several signs and reading problems, or if you have a family history of dyslexia, you may want to have your child checked for the problem.

How is dyslexia diagnosed?

A doctor or a school professional (such as a reading specialist) will ask you what signs of dyslexia you and your child’s teachers have seen. He or she will ask your child questions too. Your child may be offered to take reading and skill tests. Tests may include those that look at your child's personality and how he or she learns, solves problems, and uses words. Your child may also have an IQ test.

These tests can help find out if your child has dyslexia or another learning problem.

How is it treated?

Treatment uses a number of teaching methods to help your child read better. These methods include:

• Teaching how letters are linked to sounds to make words.
• Having the child read aloud with a teacher’s help.
• Teaching the child to listen to and repeat instructions.

United States law requires schools to set up a learning plan to meet the needs of a child with dyslexia. This plan is called an Individualized Education Program (IEP). You, your child's teachers, and other school personnel will have a say in designing the plan. The plan is updated each year based on how well your child is doing and what your child's needs are.

Medicines and counseling usually are not a part of treatment for dyslexia.

Dyslexia is a lifelong problem, but early treatment during childhood can help. Support from family, teachers, and friends is also important.

Frequently Asked Questions