Chapter 11 - Assessment, Diagnosis, and Screening Flashcards
What is the purpose of assessments?
Diagnostic assessments are designed to determine whether or not an individual belongs to a particular diagnostic group (i.e. ASD). Screening assessments are designed to identify those who may be at risk for a particular disorder. Info is gathered that is relevant to generalized descriptions of autistic behaviour
What are the uses of diagnosis?
To help people with ASD themselves and their families, to facilitate communication between practitioners, to provide information needed for the provision and financing of services, to ensure comparability between participants assessed in different research studies
How can a diagnosis help families?
Gives parents a lever with which to obtain appropriate education or other interventions for their child, helps parents to make sense of their child’s problems/ differences, guides parents and others to share their problems and learn from others (ex: attending workshops), protects parents from negative reactions from others
What are some arguments against diagnosis?
Adverse effects for individuals and families (stigmatization, labelling) & overuse or misuse of diagnosis
What are the stages of the diagnostic pathway?
Identify children at risk of ASD, stage 1: initial developmental assessment, stage 2: diagnostic assessment, confirmation of ASD diagnosis
What is involved in identifying children at risk?
Take into account the concerns of parents/ care providers, risk factors (family history), red flags noticed by anyone. Red flags that are identified lead to a referral to early intervention services or speech-language pathologist
What is involved in stage 1: initial developmental assessment?
A physician or other community-based care provider is consulted. Review of health records, observe child in community setting, perform developmental or ASD screening questionnaires. If the child’s analysis is not consistent with ASD then they will likely have focused early intervention or educational services as needed. If it is consistent with ASD then a geneticist will be consulted for possible familial or syndromic basis.
What is involved in stage 2: diagnostic assessment?
Involves an experienced pediatrician, developmental pediatrician, child psychologist. Integration of all prior information. Detailed diagnostic history and assessment based on DSM criteria. Evaluation of medical and mental health comorbidities. Genetic investigations. Referral as needed to evaluate language, cognitive and adaptive development at various times in child’s life. If the diagnosis is confirmed then they are referred for specialized interventions, family support, and counselling. If the diagnosis is uncertain then support and treatment is provided for other diagnoses identified and there is likely a reassessment in 1-2 years
When should a diagnosis be made?
As soon as possible is not always better, the ideal age is around 3-4. A diagnosis should be done as early as it can be done with reasonable certainty or when a diagnosis will help an individual understand themselves/ get the support they need
Who should make the diagnosis?
A family doctor should be initially consulted. Later on a pediatrician/pediatric neurologist, clinical/ educational psychologist, speech and language therapist, and a preschool education or family liaison specialist. Diagnoses are a collaborative effort
What are the NICE guidelines for diagnosing older children and adults?
Be undertaken by professionals who are trained and competent, be team-based and draw on a range of professionals and skills, where possible involved a family member/ partner/ carer/ other informant or use documentary evidence of current and past behaviour and early development
What are the ‘gold-standard’ procedures for diagnosing ASD?
Autism Diagnostic Interview-Revised (ADI-R) & Autism Diagnostic Observation Schedule (ADOS)
What is ADI-R?
The ADI-R consists of a lengthy semi-structured interview in which a parent or primary caregiver is questioned by a trained clinician using a set of questions designed to elicit information on certain topics. The interviewer records and codes responses. The ADI-R is not designed to differentiate between putative subtypes of ASD
What topics does the ADI-R cover?
Family background, education, previous diagnoses, medications, their behaviour in general terms, early development and developmental milestones, language acquisition, current functioning with regard to language and communication, social development and play, interests and behaviours, other clinically relevant behaviours (ex: hearing impairment, epilepsy)
What is ADOS?
The original ADOS consisted of four sets of specified activities, to be carried out using a kit of materials supplied with the test. Sets of activities are referred to as ‘modules’, each module being designed for use with individuals within a particular age or ability range, from preschoolers with little or no language to adults with fluent language. During the assessment and observer takes notes and codes the individual’s behaviour
