Assessment ASD Flashcards
Who diagnoses?
Interdisciplinary collaboration
SLP plays a key role on an interdisciplinary team, whose members possess expertise in diagnosing ASD.
If no appropriate team is available, an SLP who has been trained in the clinical criteria for ASD and who is experienced in the diagnosis of developmental disorders, may be qualified to diagnose these disorders as an independent professional.
For more information check out ASHA’s newPractice Portaland/orposition statementon autism.
Diagnosing ASD
In most cases, a stable diagnosis of ASD is possible before or around a child’s second birthday (Chawarska, Klin, Paul, Macari, & Volkmar, 2009).
Early, accurate diagnosis can help families access appropriate services, provide a common language across interdisciplinary teams, and understand the child’s difficulties.
Diagnosis periodically reviewed, as diagnostic categories and conclusions may change as the child develops.
Signs and symptoms common to ASD
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Social Communication
Language and Related Cognitive Skills
Behavior and Emotional Regulation
Sensory and Feeding
Special Considerations: Adolescents and Adults With ASD
Deficits in joint attention
difficulty orienting to people in a social environment,
limited frequency of shared attention,
impaired monitoring of emotional states,
restricted range of communicative functions to seek engagement and comfort from others,
limitations in considering another’s intention and perspective.
Deficits in social reciprocity
difficulty initiating and responding to bids for interaction,
limitations with maintaining turn-taking in interactions,
problems with providing contingent responses to bids for interaction initiated by others.
Use and understanding of nonverbal and verbal communication
facial expressions, body language, and gestures as forms of communication are delayed in early development and remain unconventional as the child grows up
unconventional gestures (e.g., pulling a caregiver’s hand toward an item) emerge prior to more conventional gestures (e.g., giving, pointing, and head nods/headshakes)
understanding of gaze shifting, distal gestures, facial expressions, and rules of proximity and body language is limited
receptive language appears more delayed than expressive
use of immediate echolalia and/or delayed echolalia (scripted language)
Deficits in social cognition
Mental processes involved in perceiving, attending to, remembering, thinking about, and making sense of the people in our social world (Moskowitz, 2005)
Deficits in social and emotional learning including difficulty
managing emotions
appreciating the perspectives of others
developing prosocial goals
using interpersonal skills to handle developmentally appropriate tasks(Payton et al., 2000)
differentiating one’s own feelings from the feelings of others (i.e., Theory of Mind)
integrating diverse information to construct meaning in context (i.e., central coherence) (Frith & HappÈ, 1994)
Impaired acquisition of words, word combinations, and syntax
initial words are often nouns and attributes
words representing social stimuli, such as people’s names (i.e., subjects) and actions (i.e., verbs), are delayed
child loses words previously acquired
Vocal development deficits
atypical response to caregiver’s vocalizations
atypical vocal productions beyond the first year of life
abnormal prosody once speech emerges (speech may sound robotic)
Conversation deficits
limitations in understanding and applying social norms of conversation (e.g., balancing turns, vocal volume, proximity, and conversational timing)
provision of inappropriate and unnecessary information in conversational contexts
problems taking turns during conversation
difficulty initiating topics of shared interest
preference for topics of special interest
difficulties in recognizing the need for clarification
challenges adequately repairing miscommunications
problems understanding figurative language, including idioms, multiple meanings, and sarcasm
Symbolic play deficits
delayed acquisition of functional and conventional use of objects
repetitive, inflexible play
limited cooperative play in interactive situations
Literacy deficits
Difficulty
reading for meaning
understanding narratives and expository text genres that require multiple perspectives
getting the main idea and summarizing
providing sufficient information for the reader when writing
Executive functioning deficits
lacking/limited flexibility
poor problem solving
poor planning and organization
lack of inhibition
Behavior and Emotional Regulation
Difficulty
dealing with changes in routine and/or changing from one activity to the next
generalizing learned skills
sleeping
crying, becoming angry, or laughing for no known reason or at inappropriate times
anxiety and/or social withdrawal
using idiosyncratic strategies for self-regulation (e.g., chewing on clothing, rocking, hand flapping, vocal play)
using unconventional behavioral strategies and emotional expressions (e.g., aggression, tantrums …)
Sensory and Feeding Challenges
over-responsiveness, under-responsiveness, or mixed responsiveness patterns to environmental sounds, light, visual clutter, and social stimuli (e.g., social touch, proximity of others, voices)
preference for nonsocial stimuli leading to intense interests with sensory aspects of objects and events
patterns of food acceptance or rejection
Research on Early Indicators
Evidence to suggest that diagnostic features of ASD are evident in very young children. Most families/caregivers report observing symptoms within the first 2 years of life and typically express concern by 18 months of age. Studies of children with ASD have found
parental reports of abnormalities in their children’s language development and social relatedness were first noticed at about 14 months of age (Chawarska et al., 2007)
displays of significantly fewer joint attention and communication behaviors at 1 year of age than shown by their typically developing same-age peers (Osterling & Dawson, 1994; Werner & Dawson, 2005)
demonstrated atypical eye contact, passivity, decreased activity level, and delayed language by 12 months of age (Zwaigenbaum et al., 2005)
subtle differences in sensory-motor and social behavior (Baranek, 1999) as well as differences in the use of communicative gestures (Watson et al., 2013) by 9 to 12 months of age
a decline (from normative levels) in eye fixation from 2 to 6 months of age not observed in infants who did not develop autism (Jones & Klin, 2013)
Screening
Screening procedures evaluate the main characteristics that differentiate ASD from other developmental disorders:
eye gaze, joint attention
orienting to one’s name
pointing to or showing objects of interest
pretend play
Imitation
nonverbal communication
language development
Comprehensive Assessment
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1 Relevant case history, including information related to the child’s health, developmental and behavioral history, and current medical status
2 Medical evaluation, including general physical and neurodevelopmental examination, hearing and vision testing, possible genetic and metabolic testing
3 Medical and mental health history of the family
4 Comprehensive speech and language assessment
5 May include evaluation of the potential benefit of using augmentative andalternative communication (AAC)
6 Standardized Assessment
7 Parent/Teacher/Self-Report Measures—rating scales, checklists, and/or inventories completed by the family member(s)/caregiver, teacher, and/or individual.
8 Interviewing to understand of the person’s and the family’s perceptions, views, desires, and expectations
9 Naturalistic observation, in everyday social settings with others
10 Play observation
11 Dynamic assessment
Dynamic assessment
Language assessment
Identify strengths, weaknesses and learning potential.
Emphasizes learning process and accounts for amount and nature of examiner investment.
Highly interactive and process-oriented.
Speech and Language Assessment
receptive language
expressive language
speech
literacy skills
social communication (See Social Communication Benchmarks ASHA – pdf
conversational skills
speech prosody
Instruments
Parent Report screening
Modified Checklist for Autism in Toddlers (M-CHAT R/F);
Social Communication Questionnaire (SCQ) 2003
Social Responsiveness Scale 2nd ed. (SRS-2) 2012
Teacher Report
Autism Behavior Checklist (ABC) 2008
Social Responsiveness Scale 2nd ed. (SRS-2)
Parent Interview
Child Observation and Rating
Gilliam Autism Rating Scale (GARS-3)
Autism Diagnostic Observation Schedule (ADOS-2)
ADOS-2
The Process of Diagnosing an Autism Spectrum Disorder Part 2: The Autism Diagnostic Observation Schedule (ADOS) Video Summary In Part 2, Latha Soorya, Chief Psychologist
What is the ADOS-2?
Semi-structured, standardized measure of behaviour consistent with the autism spectrum
Social Affect
Restricted and Repetitive Behaviour
Imagination/Creativity
Allows for reliable diagnostic classification in children 12 months of age through adulthood
Importance of clinical skills of the practitioner
Addresses deviance versus delay in development
Consists of 5 modules, each designed for use with specific client types
One source only
Not diagnostically sufficient alone
Symptoms can be either current OR BASED ON HISTORY
Play
Children need to become “play partners” and “turn-taking partners”.
Play assessment helps us determine if the child can do the above.
Childs play activities reflect what the child understands about objects, events, and actions in the world.
Symbolic play and pretend play are important because it tells us the child has the ability to deal with underlying symbols or mental representations.
