Autism is a “spectrum disorder”, meaning that there is a wide range of symptoms, skills, and levels of impairments or disability that children with ASD can have. Some children are mildly impaired by their symptoms, while others are severely affected. Autism often goes undiagnosed until the child is way past the formative years of his/her life. It can be partly blamed on the lack of awareness about the condition and also, negligence or denial on the part of parents to recognize apparent differences in the child.
Diagnosis of Autism
Parents are the first source to identify or notice different or unusual behaviors in a child that can range from inadequate social communication, not responding to name, inconsistent eye contact or absence of social smile.
- The first signs of autism include poor response to name or sounds and an age-inappropriate non-verbal communication in addition to other signs.
- The reason may initially seem to be deafness but that can be ruled out with the help of a simple test like Brain stem evoked response audiometry (BERA).
- MRI or CT scan of the brain may also be prescribed by a doctor in order to observe the brain structure.
- The child may also be evaluated for Fragile X Syndrome that can be detected with the help of some simple blood and urine tests.
According to the Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR) there were five disorders classified under the umbrella term officially known as Pervasive Developmental Disorder (PDD) which are Autistic disorder, Asperger's Syndrome, Pervasive Developmental Disorder- Not Otherwise Specified (PDD-NOS), Rett's Syndrome and Childhood Disintegrative Disorder. However, according to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM - V) a diagnosis of ASD now includes several conditions that used to be once diagnosed separately: autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger's syndrome. These conditions are now all called autism spectrum disorder.
The diagnostic criteria for ASD according to DSM V:
A. Persistent deficits in social communication and social interaction across multiple contexts, as indicated by the following, currently or by history:
- Reduced sharing of interests, emotions, and failure to respond to social conversation.
- Poorly combined verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures.
- Difficulty in adjusting to behaviors to suit various social contexts; sharing imaginative play.
B. Restricted, repetitive patterns of behavior, interests, or activities, as disclosed by at least two of the following, currently or by history:
- Lining up toys or repetition of simple motor behavior (echolalia).
- Extreme distress at small changes, rigid thinking patterns, and actions conducted routinely in the same manners.
- Strong attachment or engrossed with unusual objects.
- Apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects.
C. Symptoms must be present in the early developmental period (However, the symptoms may not fully manifest until social demands exceed limited capacities, or may be covered by learned strategies in later life).
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual disability or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur. To make combined diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
Note- This list is not intended for self-assessment. Diagnosis should be done by the specialist.
Psychological assessment entails a wide array of scientific methods employed to collect information about the client which is then integrated to reach an impression of the problem that further helps in devising the future course of the treatment. These methods include interviews, observations and psychometric tests among other things.
The assessment of children with autism requires multiple evaluators, using multiple methods of gathering information. A formal diagnosis is best done by a team of professionals comprising of developmental pediatrician, a child psychiatrist, a psychologist, an occupational therapist, a speech and language pathologist, and a few others. So this team of professionals carries out several assessments and tests, which pinpoints the exact areas in which the child has problem.
Working with appropriate assessment methodology and criteria for success. The method of assessment should be consistent. Once the assessment is done, the information needs to be gathered, summarized and interpreted. Some of the assessment methods that is used are Behavior observation, clinical interview, case studies, and multiple choice questions etc.
Role of Clinical Psychologist:
A Psychologist would first take a detailed history of the child i.e. his/her cognitive development, behavior, social functioning and family history. After the detailed history is taken, various psychological tests specifically designed for autistic children would be conducted to evaluate their problems and to confirm the diagnosis. Then, together with the family member and the client, they formulate a program of treatment according to the client’s needs and then, the client’s progress on a regular basis is ensured so that their needs are met by the course of action, and adjustment is done if necessary.
Tools that are used:
- Childhood Autism Rating Scale: The Childhood Autism Rating Scale is a diagnostic assessment method that rates children on a scale from one to four for various criteria, ranging from normal to severe, and yields a composite score ranging from non-autistic to mildly autistic, moderately autistic, or severely autistic. The scale is used to observe and subjectively rate fifteen items.
- Social Communication (SCQ): The Social Communication Questionnaire (SCQ) (formerly called the Autism Screening Questionnaire) is a screening tool designed to identify children who may be on the autism spectrum. The SCQ is designed to be used by parents or primary caregiver and is intended for use with children aged 4 years and over as long as his or her mental age exceeds 2 years. The score identifies individuals who may be on the autism spectrum and who should be referred for a more complete evaluation.
- Malin's Intelligence Scale for Children (MISIC): It measure intelligent quotient, to identify learning disability and to identify cognitive problems (e.g. memory, attention, concentration, perception etc.) The test is administered for use with children from the age group 5 to 15years.
- Autism Diagnostic Observation Social (ADOS): The Autism Diagnostic Observation Schedule (ADOS) is a semi-structured tool of assessment used with children diagnosed with Autism to evaluate the problem areas in various domains like communication, social interaction and play including imaginative play. It consists of 4 modules ranging from nonverbal to verbally-fluent appropriate for individuals with differing levels of development and language.