Autism Evaluation – What should it look like?

August 6, 2020 The Ed Psych Practice No Comments Referrals ADOS, ASD, Autism Evaluation, Communication Skills, Developmental Disability, Diagnostic Tool, Observational Assessment, Repetitive Behaviour, Social Interaction, Speech and Language

Takeaway: A child’s life can be unnecessarily traumatic if her autism spectrum disorder (ASD) goes unnoticed. Autism Diagnostic Observation Schedule [ADOS] is one of the evaluation tools. It’s a reliable, standardised test trusted by specialists around the world. And it’s used not just to detect ASD, but also to measure the extent of its impact on a child’s abilities.

Autism changes the way your child engages with the world.

As children grow, their brains evolve in a largely predictable way. But an autistic child’s brain develops differently. It ‘wires’ itself uniquely, which can mean wonderful things: Your child might have a great memory, might excel in maths, might become a great artist/musician, or a wizard with computers.

But autism brings its own set of challenges, too.

This alternate set of brain circuits that could help your child excel also come with some drawbacks. For example:

Your child is probably highly sensitive to light and sound — so, many everyday situations (e.g., a classroom filled with boisterous children) could overwhelm her.
She’ll also want a lot of routine and order in her life. So, something as simple as an unusual breakfast or a new route to school might distress her significantly.
And she might have problems communicating. For example, she’ll likely struggle to read facial expressions and body language. So she won’t be able to detect important non-verbal communication like sarcasm, irritation, boredom, etc. And this might mean she can’t really connect with classmates and make friends.

Of course, each child experiences autism differently, which is why these traits lie on an autism ‘spectrum.’

Some children have more challenges to deal with than others (i.e., they’re further along on the autism spectrum). But wherever she is on this spectrum, your child will likely need a fair amount of additional support. Learn more about autism spectrum disorder (ASD).

The earlier you spot and address autism, the better it is for your child. But that’s easier said than done.

For most children, the signs of autism pop up early — usually before the age of 3. And for many, parents will notice the differences within the first few months of life. But it’s not always that simple.

If your child has a ‘milder’ form of autism, she could appear just fine. She might think, learn, and problem-solve as well (or better) than her friends.
She might be able to ‘mask’ her differences. For example, she might be confused by something at school but will mimic her classmates’ behaviour and get by.
Also, teachers might misinterpret her behaviour. If she gets distracted in class, teachers might think it’s because she has attention issues (e.g., attention-deficit/hyperactivity disorder [ADHD])

That’s why having an objective test for autism is so important. The Autism Diagnostic Observation Schedule or the ADOS 2 is one of the more trusted ones around.

It’s a standardised assessment test first developed in 2000 and now used worldwide in 15 languages. You don’t need ADOS to diagnose autism (there are other tests and methods available), but it’s a useful, systematic approach that many schools and practices use.

The purpose of the ADOS is that it can quickly hone in on the kind of support your child will need.

It has four different modules, and the ADOS ‘presenter’ will choose the module that best fits your child’s profile. And since communication is a huge challenge with autism, the test explores your child’s social and communication skills in depth.

If your child can’t yet speak, the ADOS presenter will use Module 1 to assess her needs. She’ll be encouraged to snack, move around the room, play with toys and objects, or imitate specific behaviours.
If your child can speak a little, the presenter will use Module 2. She’ll talk to your child, get her to ‘make-believe’ and play, and give her simple tasks to do.
If your child speaks fluently, the presenter will use Module 3. She’ll use cartoons, social challenges, and conversations to help assess your child. And for older children, she’ll switch to Module 4 — talking to your child about her life, her day-to-day experiences, and her thoughts and feelings about friendships, loneliness, relationships, and the future.

But ADOS isn’t all clinical and objective. It leaves room to explore your child’s unique needs, characteristics, and temperament.

Your child’s behaviours are eventually broken down into a numbered score. But the ADOS presenter is still interacting with her and exploring her reactions to different scenarios. So, the assessment has structure and objectivity but still allows your child to express herself freely. For example, the presenter might give her a rectangular base on which to play with blocks. The base has a picture over which your child can place the blocks, but there aren’t enough blocks to match the elements of the picture. How does she respond? Does she ask for the blocks? Does she scream? Or does she give up? Her reaction has a direct crossover into how she lives her life, and this is what makes ADOS so useful.

ADOS is about more than just detecting autism, though. It helps you process the extent to which autism will affect your child’s life.

Autism is a lifelong developmental disability. It’s affects will stick with your child throughout her life. The ADOS score is one of the ways of understanding how much of an effect autism will have on her day-to-day living: the higher the score, the greater the effect. Once a parent knows exactly where their child stands, they along with their healthcare provider can devise a healthcare programme to help her compensate for her weaknesses and build on her strengths. You’ll, in effect, be able to give her a whole new life!

It’s important to note that an ADOS score is just one step in making an ASD diagnosis.

Paediatricians and psychologists will also be assessing your child needs based on other criteria (e.g., the DSM-5 criteria for ASD) and might want to conduct other assessments, too (like ADI-R: Autism Diagnostic Interview-Revised). ADOS is the gold standard that has earned the respect of specialists the world over. And it’s constantly being refined (it’s currently in its 2nd revision) and updated, which adds to its reliability.

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