Any discussion of the long or short versions of the autism screening test is bound to have proponents on one side or the other.

In my opinion, the 97-question autism screening test is far better suited as a test for ADHD; if you get through it without going nuts, you don’t have ADHD.

So, let’s make a distinction, right now, between screening for autism, and diagnosing autism. My job is to identify children who would benefit from early intervention to improve their function in the future.

The “short-list” autism screening test questions that I ask, usually at 18 months of age, are:

“Yes” is good:

Does the child point or look where you point?
Does the child watch your face and react to your expressions?
Does the child pretend-help around the house?
Does the child play with toys “appropriately” (“drive” cars, “talk to” dolls?)
Does the child play interactively with other children?”Yes” is bad:

Stereotype behavior?
Preoccupation with something that isn’t interactive with a person?
Fear of noise?

And here is the short list of important diagnostic factors from Dr Wall’s autism screening test (in Nature):

A2^*	Frequency of vocalization directed to others	Communication
B1^*	Unusual eye contact	Social interaction
B2	Responsive social smile	Social interaction
B5^*	Shared enjoyment in interaction	Social interaction
B9^*	Showing	Social interaction
B10^*	Spontaneous initiation of joint attention	Social interaction
C1	Functional play with objects	Play
C2	Imagination/creativity	Play

The first thing we need to do is step away for a moment from autism as a diagnosis, and start thinking of it as having failed a class in the school of hard knocks. Of course, ability has a lot to do with it, but to equate ability and performance is ridiculous.

Clinical autism is lack of elementary competence in interpersonal tasks: figuring out what someone feels or thinks, and trying to influence what they feel or think.

Paying attention to other people is the first step; imitating their interpersonal strategies is another; and “rehearsing” these strategies with pretend play is another.

Two possible factors that could decrease learning of interpersonal skills are:

lack of motivation (“the irrelevant parent”)
strong competing motivations (mainly to techno-toys and games)

In order for skills to be learned, the parent must become the most important object in the child’s world: one whose wrath is to be avoided, one from which all beneficence flows; one who matters, who inspires respect and therefore interest. In short, a leader.

And if the parent’s buttons are harder to find and push than those of a gaming handset, and if the effects of pushing those buttons will be more dramatic than anything on screen, that will be the parent worthy of attention.

Dr. Anatoly Belilovsky

A recognized expert in pediatric asthma and an advocate for immediate, comprehensive illness diagnosis, Anatoly Belilovsky, M.D., has gained acclaim and a large patient following for his fresh approach to general pediatrics and urgent treatment.

Board-certified in pediatric medicine, the Princeton graduate is listed as one of America’s Top Pediatricians and is a recipient of the Americhoice Quality of Care Award for his groundbreaking work with pediatric asthma patients.

Dr. Belilovsky is a dedicated physician whose mission is to provide quality urgent care 365 days a year and comprehensive early detection of illness through cutting-edge diagnostic methods and state-of-the-art non-radiological equipment. www.BabyDr.us.