Autism Assessment: Clinical Considerations across Development

1
Autism Assessment Clinical Considerations across
Development

• Rachel J. Hundley, Ph.D.
• Clinical Psychologist
• Childrens Hospital Boston
• Harvard Medical School

2
Parents Concerns

• Should I be concerned about my childs excessive
  moodiness?
• Will Dylan be ok when his brain matures?
• Patrick shows little respect for authority. What
  can we do?
• What would be the best school or therapeutic
  programs for my child?

3
Parents Concerns

• Should I be concerned about my childs excessive
  moodiness?
• Will Dylan be ok when his brain matures?
• Patrick shows little respect for authority. What
  can we do?
• What would be the best school or therapeutic
  programs for my child?

4

• Igor is very aggressive with parents and peers.
  His behavior is especially concerning now that he
  is getting bigger and more destructive.
• What will Katherine be like as an adult?
• What caused my child to have these problems?
• Someone suggested that Shondra might have autism.
  I want a second opinion.

5
Teachers Concerns

• Jack tries to boss all of the other children and
  is very focused on the rules.
• Esther has a hard time approaching peers.
• I am worried about D.J.s difficulty with reading
  comprehension.
• Playground time, lunch, and the bus are
  especially hard times for Michael.

6
Diagnostic Possibilities . . .

• Cognitive Impairment
• Language Disorder
• Autism Spectrum Disorder
• Anxiety or Mood Problems
• Behavior Disorder
• Sensory Integration Disorder
• Thought Disorder
• Developmental Coordination Disorder

7
Clinical Assessment Process by which clinicians
gain understanding of individuals (families)
necessary for making informed decisions.

8
Purposes of Clinical Assessment

• Screening
• Brief
• Demonstrate Effectiveness
• Allow for Standardization
• Show Strengths

9
Purposes cont.

• Show Obstacles to Treatment
• Rule things out
• Second Opinions
• Structures Feedback
• Leads to Recommendations

10
Components of Psychological Assessment

• Current Issues
• Developmental History
• Cognitive Functioning
• Academic Achievement
• Adaptive Behavior
• Social/Play Skills
• Emotional Adjustment
• Specific Diagnostic Tests

11
Behavior Observations

• Language
• Expressive Skills
• Receptive Skills
• Social
• Eye contact
• Facial Expressions
• Joint Attention
• Appropriateness

12

• Emotional
• Mood
• Regulation
• Self-Report
• Behavior
• Attention, Activity Level,
• Distractibility
• Limit Testing
• Self Injury, Aggression

13

• Motor
• Sensory
• Sensory Seeking
• Sensory Aversions
• Atypical
• Complex mannerisms
• Repetitive Behaviors
• Perseveration

14
Assessment Tools/Testing

• Determining appropriate diagnosis
• Assess frequency and intensity of transitory
  states
• Assess traits to predict behaviors or symptoms

15
What does a test do?

• Measures a variety of dimensions
• Assess problem severity
• Potential to help with diagnostic clarification
  and treatment decisions
• References norm groups

16
Properties of useful tests

• Reliability
• Sensitivity
• Specificity
• Validity

17
What does a test not do?

• Provide answers outside of its domain
• Define an individuals ultimate potential

18
No single measure captures the complexity of an
individual or family.
19
Completing the Assessment

• Formulation
• Diagnosis
• Recommendations
• Constructive Feedback
• Implementation and Follow-up Care
• Collateral Contacts
• Research

20
Autism Spectrum Disorders
21
What is Autism?

• Developmental Disorder
• Affects communication, reciprocal social
  interactions and play, interests, and behavior
• Symptoms are present prior to 3 years of age
• Lifelong
• Changes with Age and Development
• One in a spectrum of Pervasive Developmental
  Disorders

22
Defining Features

• Qualitative Impairment in Communication
• Qualitative Impairment in Social Interaction
• Restricted, repetitive, and stereotyped patterns
  of behavior

23
Autism Spectrum Diagnoses

• Autistic Disorder
• Aspergers Syndrome
• Pervasive Developmental Disorder, NOS
• Retts Syndrome
• Child Disintegrative Disorder

24
Autism Spectrum Disorders

• Present before the age of 3
• Found in all cultures and economic groups
• Four times more common in boys
• Many children test as also having cognitive
  impairment (up to 75)
• Clues to etiology

25
How does one assess for autism?

• No medical test
• Behavioral diagnosis
• General Impressions
• Questionnaires
• Gold-Standard
• measures

26
Thinking About Assessment

• Consider referral questions
• History hopefully multiple sources
• Direct observation
• Testing a variety of domains

27
Specific Diagnostic Instruments

• Autism Diagnostic Interview (ADI-R)
• Structured interview with parents
• Algorithm
• Autism Diagnostic Observation Schedule (ADOS)
• Play and Interview based assessment
• Behavioral Ratings

28
Things to Do Before an Assessment

• Think carefully about your questions
• Provide the clinicians with your childs previous
  reports and IEPs
• Prepare your child. If you dont know what to
  expect, call and find out.

29
Day of the Assessment

• Be on time
• Bring your child a snack
• Try to have at least two adults present
• Try to leave siblings with another caregiver
• Take notes
• Ask questions
• Bring your childs communication system