What happens during an assessment for autism?

Perhaps you’ve heard the phrase: “If you’ve seen one child with autism, you’ve seen one child with autism.”


Autism spectrum disorder is exactly that – a spectrum. It covers a mind-boggling range of skills and impairments that vary from child to child, adult to adult. What is a symptom for one child may not be for another, and because of this great diversity, it can be difficult to diagnose properly. Some children with autism have been misdiagnosed with another disorder, while others have been told there’s absolutely nothing wrong. On the opposite end, some children have been diagnosed with autism when they may have some other disorder, like ADHD.


It’s imperative, then, that as parent or guardian to a child who may possibly be on the spectrum, that you know exactly what to research and look for. What are the components of an autism diagnosis? What kind of information should you be providing to the professional who’s evaluating your child? What kind of information should they be seeing from you? How can you be sure that your clinician is participating in best practices when it comes to autism assessment?


First things first: why are you considering autism?


Early in a child’s life, parents may notice problems in social interaction and communication. Some parents immediately jump to conclusions – that it may be autism – while others think that it may be something else entirely, like another type of learning disorder.


If, however, your child is exhibiting any of the following and you’re considering the possibility of autism, you may be on the right track.


In babies or toddlers, you may notice that:


  • Your child does not respond to his or her name

  • Your child refuses to make eye contact or smile when being smiled at

  • Your child doesn’t make noise to get your attention

  • Your child does not socialize with others or share interests with others

  • Your child doesn’t seem to notice if you’re experiencing discomfort or pain

  • Your child doesn’t point, wave, or other physical gestures to communicate

  • Your child doesn’t like being cuddled or touched

  • Your child doesn’t mimic or imitate your facial expressions


Your older child may:


  • Seem unaware of other people or situations

  • Not connect with others or make friends

  • Not share interests with others, including toys or games

  • Not appreciate being touched, held or cuddled

  • Not be able to understand other people’s feelings

  • Not like playing ‘pretend’ games or play with toys creatively

Learn more about  social cues .

In terms of language and speech, you child may:


  • Repeat the same words over and over again

  • Responds to questions by repeating the questions instead of answering

  • Not be able to understand simple directions

  • Take things literally or not understand sarcasm or humor

  • Speak in an abnormal tone (i.e. using a sing-song voice or using an odd rhythm)

  • Not speak


Non-verbal communication can be difficult as well. Some things to watch out for include:


  • An unusual reaction to certain sights, sounds, textures or smells

  • Moving unusually, like always walking on tiptoe or being excessively clumsy

  • Seeming robotic (as if without feeling or emotion)

  • Using facial expressions that don’t match their words

  • Following very rigid, structured routines that cannot be bent

  • An attachment to certain toys or objects

  • The repetition of certain actions (like knocking three times, rocking, or flapping of the arms)

  • An inability to adjust to changes in environment or routine


Learn more about  communication in children with autism.

Experts say that if your child is exhibiting any of the above, it’s important to seek a professional who specializes specifically in evaluating autism. This professional should go beyond basic screening and diagnostic tools in an effort to get the broadest and clearest picture of what may be happening with your child instead of jumping to a premature diagnosis.


How does an autism evaluation begin?


Medical practitioners use a variety of screeners as a first step to seeing if a child has autism; they typically use these screeners even before they begin a formal evaluation. The Modified Checklist for Autism in Toddlers, or M-CHAT, for example, is used to identify any kind of red flags, asking questions about behaviors that may indicate autism spectrum disorder. There’s also the Childhood Autism Rating Scale and the Ages and Stages Questionnaire – this is a basic developmental screener. There’s also STAT, or the Screening Tool for Autism in Toddlers and Young Children, which examples symptoms in more detail than the other screeners above.


If those screeners indicate autism spectrum disorder, the clinician then moves on to a more comprehensive evaluation, carried out by someone who is specially trained in autism diagnosis.


Usually, this evaluation begins with a diagnostic instrument, like ADOS-2, also known as the Autism Diagnostic Observation Schedule. This evaluates the child’s social skills and repetitive behaviors – the evaluator could pay attention to things like whether the child asks for help, if he or she mimics behaviors, if they allow other people to speak, and so on. There are no right or wrong answers in this test.


A lesser-used diagnostic instrument is the Communication and Symbolic Behavior Scales (CSBS). It’s play-based and is typically used for toddlers and small children.


Can an autism evaluation be incorrect?


It’s so important to find a professional who is experienced in diagnosing autism spectrum disorder because sometimes, it can be very challenging to distinguish between autism and other disorders, like ADHD. Diagnosing based on a score alone may lead to an incorrect diagnosis, which is why an experienced professional – one who can consider motivations for certain behaviors, for example – is so important for an accurate diagnosis.


A medical professional who is evaluating a child may also conduct interviews with the parents, who’ll be able to share their concerns and advise the clinician of general and daily development. Parent checklists, like the Social Communication Questionnaire, have been found to be exceedingly helpful, especially when led by an autism expert.


In older children, practitioners may even interview the child’s teacher, as it provides even further insight into the child and his or her behaviors in other areas outside of the home.


Is cognitive testing necessary?


A thorough autism assessment should also include cognitive testing, so that the clinician can learn more about how the child organizes, solves problems or plans things out. It allows the expert insight into their strengths and weaknesses, all valuable information for a complete assessment.  


How do we find the right specialist?


If you know of other parents who have had success with a specific clinician, you’re already several steps ahead. But if you’re going into this without having any suggestions or recommendations thrown your way, some of the questions you can ask of a potential evaluator include:


“How much training have you had?”

“How much experience have you had?”

“What is included in your assessment?”

“Will you be in touch with our family doctor or pediatrician?”

“Will you connect with my child’s teacher?”

Remember that it’s important you’re comfortable with your potential provider. If at any point you do not feel supported, if you feel dismissed or if you feel you have many questions left unanswered, by all means, seek other professionals. Learn more about  seeking help.


For more information and support, visit us at  www.allianceabatherapy.com


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