Best Practice Guidelines for the Assessment and
Diagnosis of Autistic Spectrum Disorders for Children
and Adolescents
Autism Spectrum Disorders Special Interest Group
Psychological Society of Ireland
NUI Galway, 13th January 2012
Overview
• Development and purpose of the guidelines
• Introduction to the guidelines
 Components of the assessment
 Diagnostic process:
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Psychological evaluation
Differential diagnosis
Feedback to parents
Development of the Guidelines
 In reply to the stated needs of our special interest group
members, and in response to inquiries and questions from other
interested professionals
 Discussions at ASDSIG meetings throughout 2005-2009
 It is intended to use these guidelines in conjunction with the
International Test Commission Guidelines on the use of
Psychometric Tests and the PSI proposed Policy on the use of
Psychometric Tests in Ireland
Purpose of the Guidelines
 Intended as a tool to help psychologists make informed
decisions regarding their role in identification, diagnosis
and assessment
 Provides recommendations, guidance, and information
 Based on current international best practice
International Literature
 Assessment, Diagnosis and Clinical Interventions for Children and Young People with Autism
Spectrum Disorders, A National Clinical Guideline (Scottish Intercollegiate Guidelines Network,
2007)
 National Autism Plan for Children (National Autistic Society, 2003)
 Standards & Guidelines for the Assessment & Diagnosis of Young Children with ASD in British
Columbia (British Columbia Ministry of Health Planning, 2003)
 Children’s Mental Health Ontario (2003)
 Autistic Spectrum Disorders: Best Practice Guidelines for Screening, Diagnosis and Assessment
(California Dept. of Developmental Services, 2002)
 The Report of the Task Force on Autism
(Department of Education and Science, 2001)
Introduction to the Guidelines 1
 Multi-disciplinary approach is optimum to provide a
comprehensive assessment and diagnosis
 Primary goal is to characterise difficulties that can lead to the
most appropriate intervention service for the child and family
 Difficulties must be interpreted relative to the child’s
developmental level
 Accurate assessment of cognitive functioning is essential for
prognosis and intervention planning
Introduction to the Guidelines 2
 A best estimate of cognitive functioning is fundamental to
the diagnostic assessment process and can be reasonably
obtained by appropriate test selection and adaptation of
procedures
 Differential diagnosis allows for the identification of clinical
features consistent with an ASD, as well as other disorders
of childhood
 Literature suggests that there may be an under-diagnosis of
girls
Introduction to the Guidelines 3
 Early Childhood
 Primary School
 Secondary School
 Guidelines addresses this in highlighting differences in
approaches in the age groups
0 – 6 years
6 – 18 years
Diagnostic Process
Suspicion
Screening
Referral to local Child and Family Centre or ASD
Team
- Multidisciplinary Assessment where
parents are involved as active participants in the
diagnostic process
Feedback to parents
Treatment and intervention
Components of the Assessment & Diagnostic
Process
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Review of records/history
Medical/physical evaluation
Developmental interview with Parent/Guardian
Direct child evaluation
 Direct observation
 Interview
Psychological evaluation
 Cognitive assessment
 Adaptive functioning assessment
 Mental health assessment
Communication assessment
Evaluation of social competence & functioning
Restrictive behaviours, interests and activities
Family functioning
 Secondary Components
 Differential Diagnosis
 Feedback to parents/clients
Parent/Guardian Interview
 Detailed developmental history
 Description of specific impairments or differences
 Developmental timing/pattern in triad of impairments
 Autism Diagnostic Interview – Revised (ADI-R)
 The Diagnostic Interview for Social and
Communication Disorders (DISCO)
Direct Child Evaluation
 Observation of the child
 home
 preschool
 school
 with peers
 Identify behaviours and symptoms relating to DSM/ICD
criteria
 Autism Diagnostic Observation Schedule – Generic (ADOS-G)
Child Interview
 Manage conversation, reciprocity, initiation, shifting,
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maintenance
Recognise & respond to clarification or requests
Interpret non-literal language i.e. humour, sarcasm, irony
Recognise indirect and polite forms
Awareness of the need to shift in register
Flexibility in dealing with situations & ability to modulate
response
Nonverbal communication, such as gaze, body positioning,
mirroring etc.
Psychological Assessment
 Every effort should be made to get a ‘best estimate’ of
child’s cognitive functioning. Why is this important?
 Provides a framework for the interpretation of all of the
other qualitative and quantitative observations (made as part
of the observation)
 Provides a framework for decisions on intervention and
teaching strategies
 Identification of strengths
 Entitlement to services
Formal Testing
Individuals with an ASD cover the entire spectrum of intellectual
functioning and formal language capacities
However
A large number present with significant
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Language delay
Social interaction
Poor imitation skills
High distractibility
Low tolerance
Issues in Psychometric Testing
 Correlations between different batteries reported in test manuals
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may not be directly applicable to this population
Drops in standard scores over time
Drops in standard scores at around school entry
Be cognisant of ‘floor effects’
Be aware of complexity of diagnoses at extreme ends of
cognitive ranges
Challenge of defining what is the ‘average’ in autism
Challenge of assessing nonverbal, uncooperative children
Formal Testing: Tests of
General Ability
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Bayley Scales of Infant Development III
Griffiths Mental Development Scales
Stanford – Binet Intelligence Scale: 5th Edition
Wechsler Pre-school and Primary Scale of Intelligence: 3rd UK
Edition (WPPSI-III UK)
Wechsler Intelligence Scale for Children: 4th UK Edition (WISCIV UK)
Kaufman Assessment Battery for Children, 2nd Edition
British Ability Scales II
Woodcock-Johnson III NU Test of Cognitive Abilities (WJ-III)
Non Verbal Measures
 Leiter International Performance Scale Battery: Revised
 Wechsler Nonverbal Scale of Ability
 Test of Nonverbal Intelligence 3rd Edition (TONI III)
 Raven’s Progressive Matrices
Adaptive Functioning
 The capacity for personal and social self sufficiency in real life
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situations.
Information about child’s typical functioning
Key consideration in determing supports for independent living
Adaptive behaviour deficits not in keeping with overall cognitive
level (Klin et. al., 2007)
In ASD populations, inconsistent correlations between adaptive
functioning and ASD symtomatology, depending on age and
cognitive functioning (Perry, Flanagan, Geiier & Freeman, 2009)
Adaptive Functioning
 Vineland Adaptive Behaviour Scales 2nd Edition Interview
Edition (2006)
 Adaptive Behaviour Assessment System 2nd Edition
(ABAS II)
 AAMD Adaptive Behaviour Scales
 Adaptive Behaviour Scale: Second Edition
Mental Health Assessment
Inform differential diagnosis & determine the presence of
co-existing conditions
Self report measures for children & adolescents:
 Piers Harris Self-Esteem Scale
 Becks Youth Inventories
 Achenbach Child Behaviour Checklist – Youth Self Report
 Behaviour Assessment System for Children – Self Report of
Personality Protocol
Communication Assessment
Analysis of socio-communicative & socio-affective behaviours:
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Eye contact & use of gaze to communicate intent and share attention
Gestures such as pointing & coordination of gesture and eye gaze
Body language – recognition of personal space
Turn-taking skills
Use of facial expression to communicate
Assess across settings & under differing degrees of structure and
interactive partners.
Measures including nonverbal/preverbal communicative components:
 Communication and Symbolic Behaviour Scales
 Autism Diagnostic Observation Schedule-Generic
Assessment of Social Competence
Data collection from multiple sources:
 Observation during the evaluative assessment
 Teachers & other care providers
 Parent interview
 Naturalistic setting
Measures include:
 Vineland Adaptive Behaviour Scales (teacher & parent edition)
 Adaptive Behaviour Assessment System
 Child Behaviour Checklist
Restricted and Repetitive
Behaviours
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Stereotyped behaviours
Repetitive use of objects
Self-injury
Object attachment
Repetitive use of language
Narrow and circumscribed interests
Is there a clear function?
Is this developmentally appropriate?
Could the same RRB be better described by another condition?
Family Functioning
 Important element of diagnostic evaluation and
intervention
 Family needs for support, respite, and management of
challenges within the home
 Diagnostic process is often highly stressful for the family,
particularly if the dx is unclear
Secondary Components
 Academic assessment in the school age child or adolescent
 Assessment of basic concepts in younger children
 Learning styles and thinking differences
Comorbidities
 Intellectual disability – 55% (Charman, Pickles,
Simonoff, Chandler, Loucas & Baird, 2011)
 ADHD
 Anxiety Disorders
 Epilepsy
 Genetic disorders: Down Syndrome, Fragile X, Tuberous
Sclerosis
 Depression
 GI difficulties
Differential Diagnosis
 Important to differentiate ASDs from conditions that lead to
abnormalities in language, play and social development
 Over 60 different metabolic disorders & genetic syndromes
associated with ASDs
 Need for caution superficial similarities between ASD and the
behavioural phenotypes of certain genetic syndromes (Moss &
Howlin, 2010)
Differential Diagnosis
 Asperger Syndrome
 ADHD
 Developmental delay/Intellectual disability
 Developmental Language Disorders
 Visual and hearing impairments
 Neurological dysfunction
 Genetic syndromes
Differential Diagnosis
 ODD/Conduct Disorder
 Selective mutism
 Schizophrenia
 Depression
 Anxiety Disorders
 Psychological deprivation
 Coexisting conditions
Feedback to Parents/Client
 Clearly and accurately explain the nature of the ASD, and if relevant,
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intellectual disability
Be wary of making long term predictions; be sensitive
Clearly state if you don’t know something and allow parents to hold
onto hope
Offer guidance and support, e.g., parent support groups
Initiate ‘treatment’ immediately
Give information to take home
Provide a follow-up appointment and provide the name of a contact
person
Access the document..
PSI members: free to download from
www.psychologicalsociety.ie
Non PSI-members contact
The Psychological Society of Ireland,
Floor 2, Grantham House,
Grantham Street, Dublin 2
Tel : 01- 472 0105 or info@psihq.ie
Thanks for listening!
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Any questions?