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 is one of those common conditions which remain unidentified or undiagnosed until very late into the developmental or formative years of a child. The reasons behind this are limited awareness of parents as well as denial or hesitancy in accepting their child's problems.
Diagnosis of Autism
As parents, you would probably be the first one to notice your child displaying some delay in development or unusual behaviors like failing to make eye contact, absence of a social smile or lack of response to his or her name. Those with the experience of parenting, may very well be able to identify the latter's developmental delays or socio-behavioral problems.
- The very first sign is that the baby does not respond to any signals or gestures made by the parents thereby giving an impression that he/she might have a hearing problem. Brain stem evoked response audiometry (BERA) is one of the first tests recommended by the family doctors or pediatricians to rule out hearing problems.
- Doctors may also prescribe an MRI or CT scan of the brain to examine the brain structure.
- Your family doctor or pediatrician may also request for few blood and urine tests to analyze the child's DNA for the presence of a fragile X syndrome. Fragile X syndrome is a genetic condition involving changes/defects in the coding on a part of the 'X' chromosome.
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, Asperge'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 imaginativeplay.
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 a trained professional.
Psychological assessment refers to scientific methods psychologists often use to understand the human personality. When combined with information from interviews, observations, and other sources, assessments can help clients explore new and more effective ways of resolving human problems.
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 children with Autism would be conducted to evaluate their problems and to confirm the diagnosis. Then, together with the family member and the child, they formulate a program of treatment according to the child’s needs and then, the child’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 caregivers and is intended for use with children aged 4 years and above 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 measures 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 assessment of communication, social interaction, and play (or imaginative use of materials) for individuals suspected of having autism. The ADOS consists of four modules, each of which is appropriate for children and adults of differing developmental and language levels, ranging from nonverbal to verbally-fluent.