What Should I Expect in a Good Evaluation for Autism Spectrum Disorder?
What Should I Expect In A Good Evaluation for Autism Spectrum Disorder?
Autism spectrum disorder (ASD) is a behavioral disorder. There is NO brain scan, blood test, or genetic test that will indicate whether or not your child meets criteria for diagnosis. While the research is growing every day and we may someday have a more definitive medical procedure for diagnosing, we’re not there yet.
Who can diagnose autism?
Of course, there are many people who offer autism evaluations based only on parent information. Insist on being an informed consumer when it comes to your child. Psychologists (PhDs) are typically the ones doing thorough developmental evaluations for ASD. Some of the other professions that may diagnose autism include pediatricians, neurologists, psychiatrists, or other physicians (MDs). Here in Texas, school-based professionals (school psychologists) can also evaluate and find a child eligible for services as a student with autism.
What questions should I ask?
Before committing to an ASD evaluation, it’s important to find out what assessment instruments the clinician uses, whether they are the ones most widely accepted in the field, and if they are using the most up-to-date versions. Test publishers update our instruments every few years, so using an outdated version of a test may compromise the validity of your results.
What’s involved in a formal evaluation?
The most thorough evaluation for ASD will incorporate information from a variety of sources, both formal and informal. The parent interview should include a very detailed review of the child’s prenatal and birth history, health history, family history, and progression of developmental milestones. Depending on the nature of your child’s red flags for ASD, you’ll want to make sure that there are no medical explanations for your child’s difficulties, such as genetic or metabolic disorders or traumatic brain injury, for example. Regardless of the child’s age at the time of the evaluation, it is very important to review his/her early play skills and interests during early childhood, as patterns in the child’s behavior at this age often give us hints at what to expect in the future. The child should be observed in a naturalistic setting, which may be home, school, or even a playroom in a clinical setting. When possible, it’s also nice to get information from others who have worked with or observed the child, including school teachers, day care, mothers’ day out, or pre-k instructors. These adults tend to have a great perspective on typical development of your child’s age-group and may have additional insight or concerns to share. As you know, kids often behave differently across settings, so having others’ perspectives is helpful.
When it comes to the formal assessment, there are many rating scales specific to ASD for parents and teachers to complete. On many of them, the child’s functioning is compared to same-age peers and results can give an idea of just how problematic the skills are. Direct assessment with the child should always include what has been designated as the “gold standard” instrument in ASD evaluation: the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). The ADOS-2 is the most highly researched and accepted instrument in assessment for ASD and can be used at virtually any age (12 months and up). Social skills should be assessed either formally with a rating scale, or informally by collecting information from other sources. For school-age children and adolescents, perspective-taking and theory of mind can be directly assessed as well. Optimally, the evaluation also would include formal assessment of the child’s cognitive functioning (intelligence/IQ) and adaptive functioning (self-care skills) to rule out an intellectual disability.
What about involving other professionals?
A multidisciplinary or team approach is very helpful for this process, given the unique needs of children with ASD. If a speech/language pathologist (SLP) and an occupational therapist (OT) are not involved in the initial evaluation, they should be consulted shortly after the ASD diagnosis is made. The SLP will assess speech/language use more thoroughly and devise an individualized plan for services. The OT can assist with gross and fine motor skills development in addition to sensory needs for those children with significant sensory-related preferences and aversions.
How often should we reevaluate?
Reevaluation should occur periodically, no less than once every three years, particularly when a child is young at initial diagnosis. Once the ASD diagnosis has been reconfirmed, the periodic assessment can update skills progress and indicate areas in need of additional or continued support.
How do we get started?
If you have concerns that your child may have autism spectrum disorder or would like more information about the screening or evaluation process, contact us today!