Autism Spectrum Evaluations
What is Autism Spectrum Disorder? You may have already noticed that the term Autism Spectrum Disorder is different from diagnostic labels that have historically been used such as Autism and Asperger’s Disorder. In 2013 the American Psychiatric Associated released the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). This version of the DSM introduced the diagnosis of Autism Spectrum Disorder in place of what was formerly diagnosed as Autism or Asperger’s Disorder. Symptoms characteristic of autism are now conceptualized according to a spectrum of severity; with severity levels being categorized according to the level of support the individual requires. For example, the three levels of severity are: Level 1 (Requiring support), Level 2 (Requiring Substantial Support), and Level 3 (Requiring Very Substantial Support). Each level is then defined to describe the level of deficits that must be present to warrant each level of support.
Autism Spectrum Disorder is characterized by two features: a) persistent deficits in social communication across multiple contexts, and b) restricted, repetitive patterns of behaviors, interests, or activities. Let’s start by breaking down the feature of deficits in social communication.
Previous conceptualizations of autism separated deficits in social interaction and communication into separate categories. In contrast, the most current edition of the DSM has focused on the concept of deficits in social communication. Aka, the manner in which an individual uses communication for social purposes. Neurotypical children and adults use a variety of verbal and non-verbal means of communicating to convey social intent. Individuals with autism spectrum disorder often lack the “nuts and bolts” of social communication that present without conscious thought in typically developing children and adults.
Social communication deficits often manifest as deficits in social-emotional reciprocity; deficits in non-verbal communicative behaviors used for social interactions; and deficits in developing, maintaining, and understanding relationships. Problems with social-emotional reciprocity can be observed via an abnormal social approach; difficulty with normal back-and-forth conversation; reduced sharing of interests, emotions, or affect; and failure to initiate or respond to social interactions. Examples of deficits in nonverbal communication used for social interaction include poorly integrated verbal and nonverbal communication, abnormalities in eye contact and body language-or deficits in understanding and use of gestures, and a lack of facial expressions and nonverbal communication. Deficits in developing, maintaining, and understanding relationships, range from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to the absence of interest in peers. These deficits in social communication are a primary focus of our autism spectrum evaluations, which will be discussed later on this page.
Problems with restricted, repetitive patterns of behaviors, interests, or activities can manifest as stereotyped (meaning the behavior lacks function or purpose-aside from self-stimulation) or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, or idiosyncratic phrases). Children or adults may also demonstrate an insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat the same food every day). They may show highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest). And they may demonstrate hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
Recent prevalence rates (as of 2018) have shown that Autism Spectrum Disorder affects 1 in 59 children. With such a high prevalence rate, early screening and intervention is paramount to achieving improved communication and social abilities. An autism spectrum evaluation will test your child to determine the presence of social communication deficits and restricted, repetitive patterns of interests, behaviors, or activities. Observational testing is used to observe your child while he or she is engaged in play or other structured activities. Various games, activities, and interactions occur that are designed to elicit typical or atypical social communication behavior and restricted, repetitive patterns of behaviors, interests, or activities. We also administer comprehensive questionnaires to parents/caregivers regarding symptoms related to autism spectrum disorder and other neurodevelopmental disorders. In addition, our team will also assess cognitive functioning via an intelligence test (to rule out the potential of an intellectual disability as the cause for the child/adult’s symptom presentation), and we assess for other factors such as adaptive functioning, communication ability, and behavioral symptoms.
An autism spectrum evaluation can last up to four hours, but it is sometimes shorter given the age and/or participation level of the individual. We can test toddlers as young as 18 months old, and adults throughout the lifespan. The assessment is then tailored to be appropriate to the individual’s developmental level (aka, it would be strange to ask an adult to engage in pop-up toy play, while this game would be enjoyable for an 18-month-old toddler) and level of speech development. Parent and caregivers should bring snacks, drinks, and encouragement for your child. Also be prepared to answer very specific questions about your child’s behavior and questions about your child’s early developmental history. In addition, other children are not allowed to be present during the evaluation. This allows the individual to focus specifically on the examiner or parent without being distracted by the presence of other children. Thus, if you have other children at home, make sure you have a caregiver that is willing to watch your children while your child participates in the evaluation.
Book an appointment at Colorado’s favorite autism spectrum evaluation center to get those answers you’ve been searching for. Call us today!