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Diagnosis of Autism and Asperger
Diagnosis of Autism, Asperger's and PDD requires a determination as to whether
the child has Autism or whether the
observed behaviours are the result of a medical or other condition. In the clinic,
we
use a structured procedure as described below. Often families are
referred to us after a diagnosis has been made by other health professionals. In
which case we will use the information already gathered by these professionals.
Autism Spectrum Disorder is not diagnosed using empirical biological tests, such
as a blood test or brain scans. A diagnosis of autism is made by a Psychologist
after gathering and considering the following information:
- A developmental and clinical history.
- Testing of cognitive functioning .
- Receptive and expressive language assessment.
- Observations of behaviours.
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 Developmental and clinical History
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This is done over a few sessions. In the clinic, this
part of the assessment is made by a Senior Psychologist and a Medical
Practitioner. The assessment is made using a structured interview
Questionnaire and consultations.
- Cognitive testing
- Our ability to learn depends on our cognitive skills. A psychologist
at the clinic will assess your child's cognitive abilities. It is
essential that the psychologist be experienced with Autism Spectrum
Disorders, so he/she can make appropriate interpretations of your child's
behaviours. The psychological assessment will
provide valuable information for the formulation of your child's
treatment program and management strategies.
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- Receptive and expressive language
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A number of tests are
used to form a picture of your child's expressive
and receptive communication skills. Both, verbal (spoken) and non-verbal
communication (use of gesture and reading of body language) skills will
be tested. Many children will also have their pragmatic language skills
assessed. Pragmatic language skills refer to how effectively children
use words and gesture to communicate with others. Evaluation of the
child's communication skills should include a comprehensive assessment
of the oral motor and speech motor systems. This may include:
- Non-speech motor functions:
posture and gait, gross and fine movement coordination; oral
movement coordination, mouth posture, drooling, swallowing, chewing,
oral structures, symmetry, volitional vs. spontaneous movement.
- Speech motor functions:
struggle and strain during speech attempts, visible groping of
mouth, deviations in prosody (rate, volume, intonation, etc.),
fluency of speech, hyper/hyponasality, speech diodochokinesis
involving alternative and sequential speed on consecutive repetitive
attempts at utterance, volitional vs. spontaneous attempts.
- Articulation and phonological
performance: amount of verbal output, sound repertoire,
reluctance to speak, interactive ability, intelligibility and type
of errors, effects of performance load and increasing complexity;
connected speech sampling.
- Language performance:
comprehension and expression, type of utterances, semantic and
syntactic ability, effect of increased length of input,
conversational abilities.
- Others: ability to sustain
and shift attention, reaction to speech, distractibility.
- Observation of Behaviours
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 Information is obtained about the child's behaviour using
standardised rating scales such as the Childhood Autism Rating Scale
(CARS). Behavioural observations may be done, in part, by observing the
child's behaviours as recorded on a home video. The CARS is a15-item
behavior rating scale which helps to identify children with autism and
to distinguish them from developmentally handicapped children who do not
have autism. In addition, it distinguishes mild or moderate from severe
autism.
Developed over a 15-year period and with more than 1,500 cases, the
CARS includes items drawn from five prominent systems for diagnosing
autism. Each item covers a particular characteristic, ability, or
behavior. After observing the child and examining relevant information
from parent reports and other records, A senior Psychologist at the
Clinic rates the child on each item. Using a 7-point scale, he or
she indicates the degree to which the childıs behaviors deviate from
those of a normal child of the same age.
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- Exclusion Criteria
- Exclusion criteria
- Medical and psychiatric conditions that may result in Autistic-like
behaviours need to be excluded. For example
PANDAS,
Rett's Disorder or Childhood Disintegrative Disorder to name a
few. The following is a brief description of the other four pervasive
developmental disorders.
Pervasive Developmental Disorder, Not
Otherwise Specified (PDD,NOS) is diagnosed when autistic
symptoms are present but the full criteria for autistic disorder are
not met. Therefore, persons diagnosed with PDD-NOS present with
autistic symptoms, but typically are not as involved with the social
and communication deficits as persons who meet the full criteria for
autism. Generally, they are higher functioning and more responsive
to treatment.
Asperger's Disorder was first
described by a German doctor, Hans Asperger, in 1944 (one year after
Leo Kanner's first paper on autism). In his paper, Dr. Asperger
discussed individuals who exhibited many idiosyncratic, odd
behaviors. Unlike children with autism, children diagnosed with Asperger's disorder develop lucid speech before age four years and
their grammar and vocabularies are usually adequate for normal
conversation. Their speech is sometimes stilted and their repetitive
voice tends to be flat and emotionless; their conversations focus on
self-centered interests. Asperger's disorder is characterized by
concrete and literal thinking. Persons with Asperger's disorder are
usually obsessed with complex topics, weather, music, science,
astronomy, history, etc. Intellectual ability for most is in the
normal to above normal range in verbal ability and in the below
average range on tasks of visual-perceptual organization. Sometimes
it is assumed that the individual who has autism and average mental
ability has Asperger's disorder. However, it's more likely that there may
be several forms of high-functioning autism, of which Asperger's
syndrome is only one form.
Rett's Disorder is a
degenerative disorder which affects only girls and usually develops
between the ages of six months to 18 months. Some of the
characteristic behaviors may include the following: loss of speech,
repetitive hand-wringing, body rocking, head banging and social
withdrawal. Individuals suffering from this disorder may be severely
to profoundly mentally retarded. This disorder, along with childhood
disintegrative disorder, is extremely rare.
Childhood Disintegrative Disorder
(CDD) is included among the PDDs because these children apparently
develop normally for two or more years before suffering a distinct
regression in their abilities. Affected children lose previously
acquired functional skills in expressive or receptive language,
social skills or adaptive behavior including bowel or bladder
control, play, or motor skills. CDD occurs much less
frequently than autism or one of the other PDDs. Children with CDD
exhibit the social, communicative and behavioral deficits observed
in autism, including the loss of desire for social contact,
diminished eye contact, and loss of non-verbal communication.
- Genetic Anomalies
- Information is gathered with regards to whether there are any
genetic anomalies that may account for some of the observed behaviours.
This is done through a paediatrician, either the child's own or a
specialist on our recommendation.
- Hearing Tests
- It is important to ensure that the child is able to hear normally.
One of the behaviours noticed by many parents is their child's unusual
auditory response of "acting as though deaf". An auditory assessment
will exclude the possibility of a hearing impairment. If necessary a hearing test may be arranged
by the clinic.
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