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Autism Spectrum Disorder (ASD) Assessment

Autism Spectrum Disorder (ASD) Assessment

Autism Spectrum Disorder – Diagnostic Assessment Package

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterised by deficits in social communication and interaction, as well as restricted or repetitive patterns of behaviour, interests and activities. There is often also significant sensory processing difficulties present. The behaviours and difficulties associated with ASD are often quite evident very early on in an individual’s development, with parents identifying things being “not quite right, or different”. All children with ASD vary, and are unique in their attributes and symptomatology. The behaviours associated with ASD can vary within individuals as they grow and develop, and many with milder forms of severity can respond quite favourably to intervention if identified early enough.  This can greatly improve the quality of life for the child as they grow into an adult. 

The aim of conducting an ASD Assessment

The aim of an ASD assessment with a psychologist is to explore a child’s developmental profile and determine whether or not they meet diagnostic criteria for Autism Spectrum Disorder as defined within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association, 2013).

Will the Assessment provide Diagnostic Clarity?

In South Australia, to obtain a formal diagnosis of ASD there are currently to accepted methods.

  1. A single assessment from an AHPRA accredited Clinical Psychologist.
  2. A dual assessment from two accredited AHPRA clinicians from differing disciplines (e.g., a registered psychologist, speech pathologist, psychiatrist or a paediatrician) who must both provide an assessment and comprehensive report. 

 

Dr Alissa Knight is a Clinical Psychologist. As such, she is able to provide a comprehensive psychological assessment for parents and guardians that will fulfill SA diagnostic requirements, and the requirements of funding agencies such as NDIS.  This may reduce the costs for families who may struggle to financially afford an assessment with two clinicians (e.g., a psychologist and speech pathologist). However, if parents/guardians are wanting a dual diagnosis, Dr Alissa Knight is very happy to collaborate with other healthcare professionals. 

Looking at The Difference Between Girls and Boys with Autism Spectrum Disorder in Assessment

What Does ASD Look Like in Girls?

WHAT DOES AUTISM LOOK LIKE IN GIRLS?

Although every girl with ASD is different, here are some common characteristics in girls with ASD to look out for:

  • A special interest in animals, music, art, and literature
  • A strong imagination (might escape into their own world)
  • A strong almost obsessive desire to arrange and organise objects, toys, and other thing in a specific way. Can become very emotionally upset if their arrangements are moved, shifted or out of place.
  • Not wanting to play cooperatively with female peers (for example, they can appear to be playing with other children, but likes to dictate the rules of play or preferring to play alone to maintain control)
  • A tendency to ‘mimic’ others in social situations in order to blend in
  • An ability to hold their emotions in check at school, but be prone to extreme emotional meltdowns or explosive behaviour at home (can be seen as very aggressive or out of control)
  • Strong sensory sensitivities, especially to sounds, smells and touch (for example; clothing tags, socks or even deodorant, or can smell certain things for example with much more intensity than the average person).
  • Lack of awareness of the need for social interaction. Appears unbothered if they are or are not participating in group activities with other children.
  • A lack of desire to initiate interaction with others.
  • Being perceived as a loner, shy or withdrawn. They can often come across as though they are intensely ‘analysing’ others and the situation before they are willing to speak or join in.
  • A tendency to imitate others (copy, mimic or mask) in social interactions,
  • A tendency to ‘camouflage’ difficulties by masking or developing compensatory strategies.
  • Having just one, or a few, close friendships.
  • Behaving in an intense or possessive way within friendships.
  • Advanced language skills for their age.
  • A good range and frequency of non-verbal communication.

Girls with ASD – How is it so Regularly Missed or Misdiagnosed?

From a clinical standpoint,  possibly one of the most consequential shortcomings of ASD research and practice in history is the inaccurate representation and lack of awareness of females with ASD.

In the past, there has indeed been a stereotypical assumption that ASD is inherently a male dominated developmental disorder. In fact, looking at documented reports of prevalence rates of ASD among children, it has historically been reported in females at a substantially lower rate, with most studies indicating a 4:1 male to female ratio.

However, more recent meta-analysis report that the true ratio is more likely to be around 3:1, with evidence to suggest the current gold-standard diagnostic procedures used to identify ASD in children has led to a population of ‘camouflaged’, undiagnosed ASD girls (Loomes et al., 2017).

When girls are referred to professionals, their behaviours and characteristics are often compared to those which typically represent most boys with ASD, and often get misinterpreted and misdiagnosed as merely anxiety, avoidant personality disorder and eating disorders. The vast majority of diagnostic assessment and intervention services for ASD and/or ADHD are targeted towards boys, leaving many girls and families without the type of support they need. This is concerning given there is recent evidence to suggest that girls with ASD have lower daily living skills than boys with ASD, suggesting that girls who ultimately meet criteria on gold-standard diagnostic measures are more severely affected in real-world settings than their male counterparts (Van Wijngaarden-Cremers et al., 2014).

There is no question, that historically as an Australian community, we are failing girls with ASD. The detrimental consequences of this are multifactorial, affecting girls with ASD and their families directly in physical, mental, social, emotional, and learning attributes, are the wider community economically. In light of this knowledge, my hopes for young girls are they do not become victims to a failing system, and they are able to seek appropriate intervention from experienced healthcare professionals who have worked with girls with ASD and can truly improve the quality of their life.

 

What Does ASD Look Like in Boys?

WHAT DOES AUTISM LOOK LIKE IN BOYS?

Although every boy with ASD is different, here are some common characteristics in boys with ASD to look out for:

  • Showing a tendency to have trouble taking turns in conversations, or trying to dominate when talking or playing with others.
  • An intense conversational focus on topics that are of interest to them, but a reluctance to talk about subjects in which they’re not interested.
  • Using a monotone or unusual rhythms when speaking, or very formal or informal language.
  • Some boys with ASD may develop only limited speech, and be quite delayed in general.
  • Difficulty in picking up on the tone of voice used by others, or their use of non-literal language (e.g., sarcasm, common figures of speech, etc.), and so not understanding a speaker’s intention or mood.
  • Making or maintaining eye contact can be difficult.
  • Difficulties in responding to others’ non-verbal cues, such as body language and facial expressions. A boy with ASD may also make facial expressions that are unexpected to some.
  • Difficulty in following instructions that contain more than one or two steps.
  • Inflexibility when it comes to setting and following rules, at school, at home or when playing.
  • Difficulties in answering questions or talking about themselves, or responding consistently to their name (having to call their name over and over again before they respond).
  • Some boys with ASD may refer to themselves as ‘you’ rather than ‘I’
  • Initiating conversations with other children can be difficult, as can developing or maintaining friendships.
  • Difficulty in expressing their wants or needs with detail.
  • A preference for spending time with adults or younger children, rather than others of the same age.
  • A preference for playing alone rather than with others, or avoiding group activities.
  • Difficulties in recognising and respecting others’ personal space, emotions, thoughts and boundaries (i.e., Theory of Mind).
  • An intense Interest in unusual hobbies, some of which may not be viewed as age appropriate.
  • An intense interest in particular toys or objects, sometimes at the exclusion of all others.
  • Repetitive behaviours, such as always arranging objects in a particular and precise way, closing all the doors in the house, etc.
  • Constant repetition of words or phrases.
  • Making unusual noises, likes squeals and grunts, or constant throat clearing.
  • Strong or extreme reactions to some sensory experiences, like sound, taste and smell, or no reaction to other inputs like pain, heat or cold (can have a very high pain tolerance).
  • Only wanting to eat certain foods based on their texture, or refusing to eat particular foods.
  • Adhering to routines closely and becoming upset when they aren’t followed or get altered.
  • Walking on their tippy toes.
  • Difficulty in adapting to new or unfamiliar social settings and situations.
  • Difficulty in transferring learned skills from one context or scenario to another.
  • Regularly refusing to go to child care or school, or becoming very distressed when made to go.
  • Unusual or repetitive body movements, such as clapping, flapping hands, rocking, spinning in a circle, biting or finger flicking, etc.
  • Constant fidgeting and difficulties in sitting or standing still (taking into account developmental age).
  • Irregular sleeping patterns, such as staying awake late into the night, or frequent waking during the night, often at the same time.

Assessments used in the Autism Spectrum Disorder Diagnostic Package

The tests used in the Autism Spectrum Disorder Assessment Package  includes:

A comprehensive parent interview using the Autism Diagnostic Interview – Revised (ADI-R)

The Autism Diagnostic Interview-Revised (ADI-R) is a comprehensive, standardised and structured interview used for assessing children and adolescents suspected of having an Autism Spectrum Disorder (ASD). The Autism Diagnostic Interview-Revised (ADI-R) is a comprehensive, standardised and structured interview used for assessing children and adolescents suspected of having an Autism Spectrum Disorder (ASD). The ADI-R (along with the ADOS-2) is considered the gold standard in the assessment and diagnosis of children with ASD. The instruments appear to have a complementary effect in aiding diagnosis and confirm the importance of a multidisciplinary assessment process with access to information from different sources and settings.

Childhood Autism Rating Scale, 2nd Edition (CARS-2)  

The Childhood Autism Rating Scale, 2nd Edition (CARS-2) is designed as a clinical rating scale for the trained psychologist to rate items indicative of Autism Spectrum Disorder (ASD) after direct observation of the child. Covering the entire Autism Spectrum, the (CARS-2) helps to identify children with ASD and determine symptom severity through quantifiable ratings based on direct observation. Widely used and empirically validated, the CARS-2 has proven to be especially effective in: Discriminating between children with autism and those with severe cognitive deficits and distinguishing mild-to-moderate from severe ASD.

The Social Responsiveness, 2nd Edition (SRS-2)

The SRS-2 identifies the presence and severity of social impairment associated with ASD. Specifically, a total score on the SRS-2 indicates the level of severity in social deficits that represent clinical chart eristics typically observed in ASD individuals. Five treatment subscale scores are evaluated: Social Awareness, Social Cognition, Social Communication, Social Motivation, and Restricted Interests and Repetitive Behaviour. Two additional subscales in line with DSM-5™ are also evaluated: Scores on these subscales allow the scorer to compare the clients behaviours and symptoms to DSM-5 diagnostic criteria for ASD.

For children aged 4* – 7 years old;

The Stanford Binet Early – Fifth Edition (SB-5)

*Please find description above for the SB-5 under Psycho-Educational package

For children aged 6 – 16 years old;

Wechsler Intelligence Scale for Children – Fifth Edition (WISC-V). 

*Please find description above for the WISC-V under Psycho-Educational package

For children aged 4* – 16 years old;

Wechsler Individual Achievement Test – Third Edition (WIAT-III) 

*Please find description above for the WIAT-III under Psycho-Educational package

The Adaptive Behaviour Assessment System–Third Edition (ABAS–3) (Parent and Teacher version)

The ABAS-3 is a rating scale useful for assessing skills of daily living in individuals with developmental delays, autism spectrum disorder, intellectual disability, learning disabilities, neuropsychological disorders, and sensory or physical impairments. Rating forms are filled out by the parent and a teacher. The ABAS-3 covers three broad domains: conceptual, social, and practical, using 11 skill areas within these domains. Tasks focus on everyday activities required to function, meet environmental demands, care for oneself, and interact with others effectively and independently. On a 4-point response scale, raters indicate whether, and how frequently, the individual performs each activity.

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