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Do you think back on past assessment cases that were particularly puzzling? Are there children who come to mind from the recesses of past years as a school psychologist? Every so often something reminds me of a child I assessed 10 or 15 years ago, and remembering them now I think, “I missed it. In retrospect, that child had an autism spectrum disorder.” There was Juan, the middle school boy who, at the time, I thought had a nonverbal learning disability and an interest in Teenage Mutant Ninja Turtles. Or Jackie, the kindergarten girl who I thought was anxious and aggressive. I recommended that she qualify for special education in the area of emotional disturbance.

As school psychologists, we frequently assess children for autism spectrum disorders (ASD). And while we can easily identify some children with ASD, others have more subtle symptoms that are more challenging to identify. I’m always on a mission to help better identify children with ASD, so that other educators can better understand them, write appropriate goals, and help those students reach their potential. Here are five clues in the data that I’ve learned to look for to more accurately identify ASD.

1. Developmental history: Many clues that may support an autism eligibility can be found in a child’s history. Gathering history may not seem as advanced or glamorous as our standardized assessments; however, some of the most critical information is often present here. Many of us receive parent questionnaires with information that parents have recorded, but I’ve found a few extra minutes talking to parents at an RTI or MTSS meeting can lead to important information in conceptualizing a child’s function. When I am struggling to determine if a child has ASD, my first step is to go back and reread the history. There I often find the data that confirms my suspicions. Here are a few questions that might be helpful and worth more follow-up questions. An answer of yes indicates a symptom that is consistent with ASD:
   1. Is there a family history of developmental disabilities or ASD?
   2. Does the child’s medical history include seizures, prematurity, or complex medical concerns?
   3. Was the child’s language development unusual? Delayed? Sudden? Show a period of regression? Repetitive?
   4. Did the child demonstrate delays in adaptive skills (e.g., toilet training)?
   5. Did the child tend to keep to themselves as a young child (e.g., not engaging with other children at a birthday party, playing alone on the playground)?
   6. Has the child had a series of strong interests?
   7. Has the child ever had any behaviors that seemed unusual?
   8. Has the child had feeding problems and/or sleep problems?
   9. Has the child had a history of sensory seeking or avoiding behaviors?
2. Uneven cognitive patterns: As many of us know, many children with ASD demonstrate significant variations in their verbal and nonverbal cognitive functioning. Look for differences here.
3. Weak adaptive functioning: For a long time, I gathered measures of adaptive functioning because it was necessary data for eligibility decisions, but I did not find much value in the information. Since then, I have learned to see it as a critical clue regarding symptoms consistent with an autism eligibility. Many children with ASD, particularly those with average to above average cognitive abilities, demonstrate significant weaknesses in adaptive skills. Adaptive skills scores also tend to decline over time for children, meaning their deficits become more pronounced as they get older compared to other children their age.
4. Stronger rote than comprehensive academic and language skills: Many children with ASD demonstrate stronger rote academic skills than more advanced academic skills. Think stronger letter naming and basic reading skills than reading comprehension. Skills related to math problem solving and written expression can also be more difficult than math calculation and writing mechanics or spelling. In young children with ASD, you can see hyperlexia or hypercalculia. This can be an exciting strength for caregivers but can also be in stark contrast to children’s functional communication skills. Similarly, we might see strong one-word expressive vocabulary in comparison to more comprehensive expressive language or receptive language.
5. Weak working memory and processing speed: When we are working with children with ASD, we often see weak working memory and processing speed. These can contribute to academic tasks being difficult for them.

Next time you are sitting at your desk, sifting through your assessment data, and scratching your head, try looking for these patterns. My hope is that they help clarify your thinking in determining if you think a child may meet autism eligibility.