ASSESSMENT OF AUTISM SPECTRUM DISORDER

(ASDs)

ASD is…

Autism is now thought to be a spectrum of neurodevelopmental conditions, characterized by:

1. Difficulties in the development of social relationships.

2. Communication difficulties.

3. Repetitive behavior or strong narrow interests.

Diagnostic Criteria

DSM-IV (Diagnostic and Statistical Manual-4) Autistic Disorder• Social – qualitative impairment in social interaction (e.g.,

failure to develop peer relationships; impairment in the use of multiple non-verbal behaviours).

• Language and Communication – qualitative impairments in communication (e.g. delay in the development of spoken language; stereotyped and repetitive use of language)

• Thought and Behaviour – restricted repetitive and stereotyped patterns of behaviour, interests and activities (e.g., inflexible adherence to specific, non-functional routines or rituals).

Diagnostic Criteria

• Delays or abnormal functioning in at least one area with onset before 3 yrs; social interaction; language as used in social communication; symbolic or imaginative play.

Asperger’s Disorder

• Must endorse two parts of the autism triad sections 1 and 3. Plus: no clinically significant delay in language or cognitive development.

Diagnostic Criteria

• Diagnostic criteria for ASD continue to develop.

• Popularity of and the wider usage of diagnostic terms in the media and community may be little related to classification systems.

Assessment

Comprehensive Assessment Model

• Assess multiple areas of functioning

• Collect information from a variety of settings

• Provide a single coherent view

• Provide implications for adaptation and learning

• Liaison with schools and other agencies to support implementation of recommendations.

Multidisciplinary Assessment

Diagnostic Assessment• Developmental History

• Cognitive / Behavioral

• Neuropsychological, Academic and Vocational

• Speech, Language and Communication

• Sensory and Motor Skills Assessments

• Specialized Medical Evaluations

Cognitive Assessment

Behaviourally defined disorder, no biological markers.

Screening and diagnosis : behavioural observation within conceptual frameworks.

Cognitive assessments : supplement behavioural scales and developmental

checklists

The Role of Cognitive Assessments

• Individuals with autism demonstrate a typical pattern of performance deficits on intelligence tests.

• Provide standardized information about the overall cognitive functioning of a child.

• Presence of specific deficits, or in rare cases, the presence of superior splinter skills, which may go undetected during behavioral observation.

Selection and interpretation of cognitive measure will depend on a no of factors.

• Common Test Batteries• Non Verbal Test Batteries

Instruments

• Asperger Syndrome Diagnostic interview (ASDI)• Asperger Syndrome Screening Questionnaire (ASSQ)• Australian Scale for Asperger syndrome (ASAS)• Autism Behaviour Checklist (ABC)• Autism Diagnostic Observation Schedule (ADOS) and ADOS-G• Autism Screening Questionnaire (ASQ)• Autism Spectrum Quotient (AQ)• Autistic Diagnostic Interview (ADI, and also ADI-R)• Childhood Asperger Syndrome Test (CAST)• Childhood Autism Rating Scale (CARS)

Munira Haidermota \ Mark Sinclair

Instruments• Child Communication Checklist (CCC)• Diagnostic Interview for Social Communication Disorders (DISCO)• Gilliam Autism Rating Scale (GARS)• Parent Interview for Autism• Pervasive Developmental Disorders – mental retardation (PDD-MR)• Social Response Scale (SRS)• STAT• TEACCH checklist• Wing Autistic Disorder Interview Checklist• Modified - Checklist for Autism in Toddlers (M-CHAT)

Things To Consider

• What population has the tool been validated on?• Is the tool applicable to a New Zealand setting? Can the tool be used

without modification with Māori, Pacific and Asian individuals?• How long does it take to administer the tool?• How many professionals are needed to administer the tool?• What is needed to make the tool available in New Zealand? Training?

Qualifications required? Where can training be accessed? What is the cost of training? Ongoing costs – royalties?

Challenges for Psychologists

• What evidence is there that the tool leads to earlier or more accurate diagnosis?

• What is realistic for Clinical and Educational Psychologists with their service and time constraints?

• When should you refer to a specialist?

• What will a SPECIALIST do?

Modified Checklist for Autism in Toddlers (M-CHAT); Robins, Fein &

Barton 1999)• An appealing 23 item checklist that enjoys

strong content validity. The M-CHAT is a screening test used with toddlers between 16 and 30 month of age to identify children at risk for ASDs.

• M-CHAT should be used only in conjunction with further diagnostic evaluation in the event of a ‘failing” score.

• Item on the checklist resemble the following:i. Does your child play with other children ?ii. Does your child smile when you smile?iii. Does your child engage in pretend play?iv. Does your child enjoy peek-a-boo?v. Does your child respond to his/her name?vi. Does your child sustain eye contact?

• Children who fail three or more items should be referred for further evaluation by specialist.

Baby and Infant Screen for Children with Autism Traits-Part 1 (BISCUIT-Part 1) Matson, Boisjoli & Wilkins,2007)

• The instrument consists of 71 items that assess the core symptoms of autism in toddlers 17-37 months of age.

• The items sre completed by a parent or caretaker on a 3-point scale that includes 0 (not different, no impairment), 1(somewhat different,mild imparment) and 2(very different, severe impairment).

• Item are brief and resemble the following:1. Communicates verbally2. Takes turns3. Sustains eye contact4. Responds to name