Signs of Autism-Assessment

The important goals of assessment include a categorical diagnosis of autism that looks at differential diagnosis, a refined precise documentation of the child’s functioning in various developmental domains and ascertaining presence of co-morbid conditions.

A categorical diagnosis of autism and placement in its subtypes has important implications for intervention, prognosis and legal rights (Cohen & Volkmar 1997). However, a rigorous assessment of its core symptoms – psychological assessment, communication and behaviour are critical to treatment.

There is a need to evaluate functioning in intellectual abilities both verbal and performance, social competence receptive and expressive language skills and social use of language and self care and other abilities of daily living to place an individual in a broader developmental framework (Cohen & Volkmar 1997).

There is a higher risk of certain co-morbid conditions that occur with autism. These require to be identified and need clinical attention. Co-morbidity includes medical disorders like PKU, Fragile X, Tuberosclerosis, Rett’s Disorder and Down’s syndrome. Epilepsy is seen to occur in 25% of individuals with autism and needs to be ruled out. Psychiatric and behavioural difficulties like hyperactivity, obsessive-compulsive phenomena, self-injury, stereotypy, tics and affective symptoms may need pharmacological intervention (Brasic et al 1994, McDougle et al 195, Ghaziuddin Tsai & Ghaziuddin 1992).

The evaluation should include a careful development and health history especially of the first 3 years of life. Real examples of behaviour like eye contact, response to name, finger points to share attention etc often provide better descriptions (Schopler & Reichler, 1972). A diagnostic examination should include observation of the child during structured and unstructured periods. Social deficits are more obvious during unstructured times and in school recess. Areas of observation and inquiry should include (a) social development (b) Communication (c) response to environment (d) play skills (e) self -awareness (f) motor behaviours like hand flapping (g) behaviour problems. Some of the diagnostic instruments that are available are, Childhood Autism Rating Scales (CARS) The Autism Diagnostic Interview (ADI-R) (Lord et al 1994), Autistic Continuum (), The Autism Diagnostic Observation Schedule (ADOS Lord et al 1989).  Of these the most comprehensive available are ADOS and ADI, which together provide a structured detailed interview and an observation method to assess objectively an individual’s social ability, communication skills and behaviour.

Psychological assessment should be done using standardised procedures. Nonetheless, minor clinical modifications may be necessary as the usual verbal instructions and social reinforcements may not be enough in children with autism (Klin et al., 1997). The results obtained must be viewed with caution and made explicit in the report. Some of the tests that are used are Wechsler’s Preschool and Primary Scale of Intelligence (WPPSI-R 1989), Wechsler’s Intelligence Scale for Children (WISC-III, 1991), Kaufman-Assessment Battery for Children (K-ABC Kaufman & Kaufman 1983) and Leiter International Performance Scale (Leiter 1980).   Such tests provide acceptable measures of current developmental level but have poor predictive value and stability over time (Klin et al., 1997). Children with autism have strengths in visual perceptual tasks like puzzles and weakness in conceptual and reasoning tasks. This observation highlights the importance of emphasizing the latter in management programmes.

Similarly play, communication and social Emotional Functioning should be assessed using standardised batteries.

A total of six or more manifestation from 1,2 and 3 below:

• Qualitative impairment of social interaction (at least two manifestations)

1. Marked impairment in the use of multiple types of nonverbal behavior such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interactions:
2. Failure to develop peer relationships appropriate to developmental level:
3. Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by lack of showing, bringing, or pointing out objects of interests): and
4. Lack of social or emotional reciprocity.

• Qualitative impairment of communication (at least one manifestation):

1. Delay in, or lack of, development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gestures or mime):
2. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others:
3. Stereotyped and repetitive use of language or idiosyncratic language: and
4. Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.

• Restrictive and stereotyped patterns of behavior, interests, and activities (at least one behavioural manifestations)

1. Encompassing preoccupation with one or more restricted, repetitive, and stereotyped patterns of interest that is abnormal either in intensity or focus.
2. Apparently inflexible adherence to specific, non-functional routines or rituals:
3. Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements): and
4. Persistent preoccupation with parts of objects.

• Delays or abnormal functioning, with onset before the age of 3 years, in at least one of the following areas:

1.  Social interaction
2. Language as used in social communication
3. Symbolic or imaginative play

A determination that Rett’s disorder or childhood disintegrative disorder does not account better for the observed symptoms.

For more information on the assessments we do please call +971 4 4298 498, or visit the Contact Us page and send us an email.

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