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
What is ADOS-2?
It includes an additional module - ‘toddler’, which is designed to assess communication, social interaction, play, and restricted and repetitive behaviours in children from 12 months of age
Which ‘gold-standard’ method should be used?
Ideally, both together (results in higher validity of diagnosis)
What interview schedules have a broader focus (beyond detecting autism)
The diagnostic interview for social communication disorders (DISCO) & the developmental, dimensional and diagnostic interview (3Di). They help build up an individual’s profile of abilities and disabilities
What is DISCO?
The DISCO was developed in accordance with the concept of autism as a spectrum of related conditions, and it has proved an accurate tool for diagnosing autism spectrum disorder as defined in DSM-5
What topics does DISCO cover?
Infancy history, age of any setback in development, gross motor skills, self-care, communication, social interaction with adults and peers (social play), imitation, imagination, skills, motor and vocal stereotypes, responses to sensory stimuli, repetitive routines and resistance to change, emotions, activity pattern, maladaptive behaviour, sleep pattern, catatonic features, quality of social interaction, history of psychiatric conditions or sexual problems
What is 3Di?
The 3Di (Skuse, Warrington et al., 2004) is an interview schedule predicated on the concept of ASD as a dimensional condition in the sense that very many distinct dimensions of behaviour may (or may not) be affected to a greater or lesser extent. The major innovation associated with this procedure is that the trained interviewer enters responses onto a computer which analyses the data and produces an immediate report
What are the methods for screening ASD in toddlers and young children?
Checklist for Autism in Toddlers (CHAT) (good specificity but weak sensitivity), Modified CHAT
What is CHAT?
A checklist with 9 yes/no questions. For example, “Does your child ever PRETEND?” or “does your child ever use their index finger to point, to indicate INTEREST in something?”. The updated M-CHAT consists of 23 questions
What are the methods for screening ASD in adults?
Autism-Spectrum Quotient (ASQ/ AQ) - a self-report questionnaire assessing social skills, attention switching, attention to detail, communication, imagination
What methods are used for screening across all ages?
The social communication questionnaire (SCQ), the DISCO signposting set, 3Di-sv (short version), the social responsiveness scale (SRS). All questionnaires
What is CARS/CARS-2?
The Childhood Autism Rating Scale. CARS-2 has three forms - the standard version rating booklet, the high-functioning version rating booklet, the questionnaire for parents or caregivers
What areas do CARS assess?
Relating to people, imitation, social-emotional understanding, emotional response, emotional expression and regulation of emotions, body use, object use, object use in play, adaptation to change, restricted interests, visual response, listening response, taste/ smell/ touch response and use, fear or nervousness, fear or anxiety, verbal communication, nonverbal communication, activity level, thinking/ cognitive integration skills, level and consistency of intellectual response, general impressions
What is RBQ/ RBQ-2?
The RBQ (Repetitive Behavior Questionnaire) is a screening method and assessment tool that is used to assess repetitive behaviours associated with autism spectrum disorder (ASD)
What is MIGDAS/ MIGDAS-2?
Monteiro Interview Guidelines for Diagnosing the Autism Spectrum. Provides evaluators with an efficient method of systematically gathering and organizing the info needed to diagnose ASD in children to adults. Includes a checklist/ questionnaire for patterns of observations. Follows the agenda of the child to explore that child’s sensory-driven worldview as the child plays with toys and discusses preferred topics with a group of adults (dynamic)
What is the descriptive triangle in MIGDAS?
Differences in brain-style related to language and communication, sensory use and interests, and social relationships and emotional responses
What are the different levels in MIGDAS?
Level 1 (requiring support - mild but significant), level 2 (requiring substantial support - moderate), level 3 (requiring very substantial support - significant)
