Screening and Diagnosis of Autism Spectrum Disorder for Healthcare Providers

Developmental screening can be done by a number of professionals in health care, community, and school settings. However, primary health care providers are in a unique position to promote children’s developmental health.

Primary care providers have regular contact with children before they reach school age and are able to provide family-centered, comprehensive, coordinated care, including a more complete medical assessment when a screening indicates a child is at risk for a developmental problem.

Screening Recommendations

Research has found that ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable.[1] However, many children do not receive a final diagnosis until they are much older. This delay means that children with an ASD might not get the help they need. The earlier an ASD is diagnosed, the sooner treatment services can begin.

The American Academy of Pediatrics (AAP) recommends that all children be screened for developmental delays and disabilities during regular well-child doctor visits at:

  • 9 months
  • 18 months
  • 30 months

Additional screening might be needed if a child is at high risk for developmental problems because of preterm birth or low birth weight.

In addition, all children should be screened specifically for ASD during regular well-child doctor visits at:

  • 18 months
  • 24 months

Additional screening might be needed if a child is at high risk for ASD (e.g., having a sibling with an ASD) or if symptoms are present.

It is important for doctors to screen all children for developmental delays, but especially to monitor those who are at a higher risk for developmental problems due to preterm birth, low birth weight, or having a sibling or parent with an ASD.

Read more about the recommendations for screening »

In February 2016, the United States Preventive Services Task Force released a recommendation regarding universal screening for ASD among young children. This final recommendation statement applies to children ages 3 and younger who have no obvious signs or symptoms of ASD or developmental delay and whose parents, caregivers, or doctors have no concerns about the child’s development. The Task Force reviewed research studies on the potential benefits and harms of ASD screening in young children who do not have obvious signs or symptoms of ASD. They looked at whether screening all children for ASD helps with their development or quality of life. The final recommendation statement summarizes what the Task Force learned: There is not enough evidence available on the potential benefits and harms of ASD screening in all young children to recommend for or against this screening. This recommendation statement is not a recommendation against screening; it is a call for more research. For more information, please visit

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Developmental Screening in Pediatric and Primary Care Practice

Integrating routine developmental screening into the practice setting can seem daunting. Following are suggestions for integrating screening services into primary care efficiently and at low cost, while ensuring thorough coordination of care.

An example of how developmental screening activities might flow in your clinic:


Screening flow chart


For information on reimbursement for developmental screening:

Involving Families in Screening

Research indicates that parents are reliable sources of information about their children’s development. Evidence-based screening tools that incorporate parent reports (e.g., Ages and Stages Questionnaire, the Parents’ Evaluation of Developmental Status, and Child Development Inventories) can facilitate structured communication between parents and providers to discover parent concerns, increase parent and provider observations of the child’s development, and increase parent awareness. Such tools can also be time- and cost-efficient in clinical practice settings.2,3,4 A 1998 analysis found that, depending on the instrument, the time for administering a screening tool ranged from about 2 to 15 minutes, and the cost of materials and administration (using an average salary of $50/hour) ranged from $1.19 to $4.60 per visit.5

Screening children and providing parents with anticipatory guidance―that is, educating families about what to expect in their child’s development, how they can promote development, and the benefits of monitoring development―can also improve the relationship between the provider and parent.6 By establishing relationship-based practices, providers promote positive parent-child relationships, while building the strongest possible relationship between the parent and provider. Such practices are fundamental to quality services.

Developmental Screening Tools

Photo: Physician holding child

Screening tools are designed to help identify children who might have developmental delays. Screening tools can be specific to a disorder (for example, autism) or an area (for example, cognitive development, language, or gross motor skills), or they may be general, encompassing multiple areas of concern. Some screening tools are used primarily in pediatric practices, while others are used by school systems or in other community settings.

Screening tools do not provide conclusive evidence of developmental delays and do not result in diagnoses. A positive screening result should be followed by a thorough assessment. Screening tools do not provide in-depth information about an area of development.

Selecting a Screening Tool

When selecting a developmental screening tool, take the following into consideration:

  • Domain(s) the Screening Tool Covers
    What are the questions that need to be answered?
    What types of delays or conditions do you want to detect?
  • Psychometric Properties
    These affect the overall ability of the test to do what it is meant to do.
  • The sensitivity of a screening tool is the probability that it will correctly identify children who exhibit developmental delays or disorders.
  • The specificity of a screening tool is the probability that it will correctly identify children who are developing normally.
  • Characteristics of the Child
    For example, age and presence of risk factors.
  • Setting in which the Screening Tool will be Administered
    Will the tool be used in a physician’s office, daycare setting, or community setting? Screening can be performed by professionals, such as nurses or teachers, or by trained paraprofessionals.

Types of Screening Tools

There are many different developmental screening tools. CDC does not approve or endorse any specific tools for screening purposes. This list is not exhaustive, and other tests may be available.

Selected examples of screening tools for general development and ASD:

A more comprehensive list of developmental screening tools is available from the American Academy of Pediatrics (AAP), including descriptions of the tools, sensitivity and specificity. The list includes general screening tools, as well as those for ASD.

Diagnostic Tools

Photo: Adult screening a child

There are many tools to assess ASD in young children, but no single tool should be used as the basis for diagnosis. Diagnostic tools usually rely on two main sources of information—parents’ or caregivers’ descriptions of their child’s development and a professional’s observation of the child’s behavior.

In some cases, the primary care provider might choose to refer the child and family to a specialist for further assessment and diagnosis. Such specialists include neurodevelopmental pediatricians, developmental-behavioral pediatricians, child neurologists, geneticists, and early intervention programs that provide assessment services.

For more information on screening, diagnosis, prevalence and more, please visit:

In addition to the resources linked above, the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5) provides standardized criteria to help diagnose ASD

See DSM-5 diagnostic criteria »  Top of Page

Myths About Developmental Screening

Myths About Developmental Screening
Myth #1 There are no adequate screening tools for preschoolers.
Fact Although this may have been true decades ago, today sound screening measures exist. Many screening measures have sensitivities and specificities greater than 70%. [5], [11]
Myth #2 A great deal of training is needed to administer screening correctly.
Fact Training requirements are not extensive for most screening tools. Many can be administered by paraprofessionals.
Myth #3 Screening takes a lot of time.
Fact Many screening instruments take less than 15 minutes to administer, and some require only about 2 minutes of professional time.[5], [12]
Myth #4 Tools that incorporate information from the parents are not valid.
Fact Parents’ concerns are generally valid and are predictive of developmental delays. Research has shown that parental concerns detect 70% to 80% of children with disabilities.[13],[14]


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  2. Regalado M, Halfon N. Primary care services promoting optimal child development from birth to age 3 years. Archives of Pediatrics & Adolescent Medicine 2001;155:1311-1322.
  3. Skellern C, Rogers Y, O’Calaghan M. A parent-completed developmental questionnaire: follow up of ex-premature infants. Journal of Paediatrics and Child Health 2001;37(2):125-129.
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  5. Glascoe FP. Collaborating with Parents. Nashville, TN: Ellsworth & Vandermeer Press, Ltd.; 1998.
  6. Nelson CS, Wissow LS, Cheng TL. Effectiveness of anticipatory guidance: recent developments. Current Opinions in Pediatrics 2003;15:630-635.
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  8. Lord C, Risi S, Lambrecht L, Cook EH, Leventhal BL, DiLavore PC, et al. The Autism Diagnostic Observation Schedule–Generic: a standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders 2000;30(3):205-230.
  9. Van Bourgondien ME, Marcus LM, Schopler E. Comparison of DSM-III-R and Childhood Autism Rating Scale diagnoses of autism. Journal of Autism and Developmental Disorders 1992;22(4):493-506.
  10. Gilliam JE. Gilliam Autism Rating Scale – Second Edition (GARS-2). Austin, TX: Pro-Ed; 1995.
  11. Committee on Children and Disabilities, American Academy of Pediatrics. Developmental surveillance and screening for infants and young children. Pediatrics 2001;108(1):192-195.
  12. Dobrez D, Sasso A, Holl J, Shalowitz M, Leon S, Budetti P. Estimating the cost of developmental and behavioral screening of preschool children in general pediatric practice. Pediatrics 2001;108:913-922.
  13. Glascoe FP. Evidence-based approach to developmental and behavioral surveillance using parents’ concerns. Child: Care, Health, and Development 2000;26:137-149.
  14. Squires J, Nickel RE, Eisert D. Early detection of developmental problems: strategies for monitoring young children in the practice setting. Journal of Developmental and Behavioral Pediatrics 1996;17:420-427.
2023 Community Report on Autism. The latest ADDM Network Data