What does an autism assessment involve?
Autism is a condition where children have difficulties with their social interactions as well as having restricted or repetitive interests. The incidence of autism has slowly increased which may be related to better identification and awareness in the community, but may also be due to a general increase in the condition. Currently approximately one in 88 children will be diagnosed with autism and it is more common in boys at a ratio of approximately 3:1.
We get quite a few referrals asking for an autism assessment, but what does this actually entail?
The first step is taking a good history from the child and parents. Your paediatrician will mainly be interested in your child’s ability to play with other children and how they form friendships. They will be interested in your child’s social communication skills ie eye contact, pointing, gesturing, reading facial expressions etc. as well as their understanding of social relationships and situations.
Like any developmental condition, the paediatrician will ask for information from the school and other care providers. This can be in the form of letters or questionnaires.
There are gold standard assessments available for autism, but these can be quite time-consuming and sometimes expensive. The Autism Diagnostic Observation Schedule (ADOS) it’s probably the most widely used. This is a play based assessment used to assess your child’s social communication skills and to look for signs of restricted or repetitive play.
The Autism Diagnostic Interview (ADI-R) is a set of 93 questions that helps determine whether the longitudinal history is suggestive of autism. Together both these assessments provide the best correlation with the DSM-5 and is considered as the best tests currently available.
Other assessments can help provide more information, such as school observations and reports from speech/occupational therapists and psychologists. Often a hearing test will be requested to ensure there are no hearing problems. Unfortunately there are no blood or radiology tests available that help in making a diagnosis of autism.
After putting all this information together your paediatrician will need to determine whether your child’s presentation meets the diagnostic criteria according to the DSM-5 (see below).
Should you have any questions please talk to your health care professional.
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history
- Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
- Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
- Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
- Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
- Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
- Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked 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 (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.