Autism Evaluation – Autism Diagnostic Interview – Revised

Takeaway: Parents can spot the signs of autism long before anyone else. You just need an expert to help make sense of what you see. That’s what the Autism Diagnostic Interview-Revised (ADI-R) is all about. It’s a semi-structured interview where a specialist uses your observations to assess whether or not your child is in the autism spectrum disorder (ASD). It provides an opportunity to give your child the kind of care and support she needs.

Autism is a developmental difference that will likely change the way your child lives and experiences her daily life.

As she grows, her brain wires itself uniquely giving her a special set of strengths and weaknesses. A strength, for example, might be the ability to focus intensely on a particular topic or skill and get really good at it. And a weakness might be the need for order and predictability in her routine (causing a mini ‘meltdown’ if she doesn’t get this). The impact of these strengths and weaknesses varies from child to child, so autism is part of a ‘spectrum’ with many ‘subtypes.’ Some autistic children can’t speak, are intellectually challenged, and disconnected from the world around them. And others speak very well, are highly intelligent, and engaged. Either way, if you spot the signs of autism early enough, there’s a lot you can do to limit its negative effects and amplify its positive ones. (Learn more about Autism Spectrum Disorder [ASD].)

The parent is often the first person to spot the signs of autism in their child.

The special connection you have with her means you can pick up on some of the things others won’t. Here are some of the more common signs of autism:

• By 6 months: Not smiling or showing happiness in some way
• By 9 months: Not trying to share sounds with you or using her facial expressions to communicate.
• By 12 months: Not responding to her name, babbling and using ‘baby talk’, or gesturing (pointing, showing, waving, etc.)
• By 1.5 years: Not saying even a few words
• By 2 years: Not using two-word phrases (other than imitating/repeating what you say)

But the thing is, not all of these signs mean your child has autism.

Many children start to speak slightly late, and many get quite obsessed with interesting objects around them (e.g., ceiling fans), or fun activities (e.g., jigsaw puzzles). On paper, this sort of speech delay or obsessive behaviour might signal autism. But they might also just be your child doing her thing, without it meaning anything significant. The signs that matter are part of a pattern of behaviour that children with ASD often show.

That’s why parents need to collaborate with autism practitioners, to make sense of what they’re seeing. The Autism Diagnostic Interview-Revised (ADI-R) is all about.

The ADI- R is a semi-structured interview between the parent and an autism specialist. The parent works as a team to try and piece together their child’s story and sees if it tells anything significant.

The Autism Diagnostic Interview-Revised (ADI-R) helps develop a birds-eye view of the child’s current status.

The parent and the specialist will go over the child’s medical history (and earlier assessments made), how she behaves in general (including any aggressiveness she’s been showing), key developmental milestones she’s passed, and any speech and language issues.

The ADI-R can help the parent figure out the kind of support their child needs. And this will dramatically improve her quality of life.

The questions explore the child’s behaviour patterns in three key areas.

These are the areas most affected by ASD.

1. Social interactions. How does the child engage with the people in her life? For example, does she meet their eyes? Does she smile and use facial expressions to communicate? Does she seem interested in playing with other children? And can she play make-believe with them? Does she enjoy seeing them have fun? Does she try and comfort them when needed?
2. Communication & language. Is the child trying to communicate? Even if she can’t yet speak, is she at least trying to gesture or imitate actions and play? If she can speak, are there noticeable issues? For example, does she randomly echo words you use (if you ask if she wants a cookie, does she repeat ‘cookie’ instead of answering ‘yes’)? Does she refer to herself by her name instead of saying ‘I’ or ‘me’?
3. Repetitive and obsessive behaviours. Does she have quirky rituals? Like, keeping her toys in a specific place and touching them before sleeping? Or asking the same questions and wanting you to repeat a particular answer? Does she need strict routines like putting her clothes on in a particular order? Does she use repetitive movements like rocking, pacing, or flapping her hands?

The great thing about ADI-R is that it draws on caregivers’ observations. But this is also a weakness.

That’s because parents and guardians come in with their own set of biases. And the less objective the answers, the less effective the test. Plus, it’s quite reliable for older children, but much less so for children under the age of two.

ADI-R is often paired up with another test called ADOS (Autism Diagnostic Observation Schedule).

Technically, autism spectrum disorder (ASD) is assessed only against the criteria in the diagnostic manual DSM-5. So, ADI-R is just one of many tools that specialists choose to use. And it’s often paired up with the Autism Diagnostic Observation Schedule (ADOS)  – where the specialist interacts directly with the child, instead of interviewing the parent.

Diagnosing ASD is a complicated process because there are a lot of factors to explore.

For example, if your child is taking longer than usual to speak, it could be a sign of autism. But it could also be a developmental language disorder (DLD), which is different. Or she could just have a hearing problem, which in turn makes it harder for her to mimic speech sounds. These sorts of ‘overlaps’ happen with other challenges, too. For example, hyperactivity could be because of autism, or it could be part of an attention-deficit/hyperactivity disorder (ADHD). Extreme sensitivity to sounds and smells could signify autism, but could also be because of sensory processing issues. And some psychological conditions could cause obsessive behaviours that don’t have anything to do with autism.

That’s why it’s best to use a multidisciplinary team of specialists for these assessments.

The best teams include a paediatrician, a educational psychologist, a speech and language therapist, and an occupational therapist.

Are you concerned that your child is showing signs of autism spectrum disorder (ASD)? Consider contacting a specialist.

The Ed Psych Practice offers consultation, advice, and problem solving for parents, nurseries, schools, and colleges, in London. We have paediatricians and psychologists who can help assess your child and offer guidance and support.

• Phone: +44 (0) 78 3344 7356
• E-mail: Office@TheEdPsych.com

You might also be interested in some of our other posts.

• Questions to Ask Paediatricians About Your Child’s Development
• Auditory Processing Difficulties: When Your Child Listens But Can’t Understand
• Supporting the Emotional Needs of Children with Learning Difficulties
• Developmental Language Disorder (DLD): Why Your Child May Be Struggling to Communicate
• What You Need to Know About Dyspraxia (Or, Developmental Coordination Disorder)
• What is Dyscalculia? And How Can You Learn to Spot It?

How to Unravel Your Child’s Back-to-School Stress and Anxiety

Bharathi: Please link this term to the ADOS post.