Autism Diagnosis Instruments And Tests.

Autism is a neurodevelopmental disorder which degrades the child developmental behaviour like social interaction, communication ability, and common behaviour as stated in DSM-5(Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition).

If you need any assistance or have a question about Autism Diagnosis Instruments And Tests, you can consult our HearingSol experts with your problem, feel free to call us on 1800-121-4408. We are always here to help you.

The deficiency gets along in childhood and stays for the lifetime. Some of the simple signs and symptoms of autism are social and emotional reciprocity, repetitive behavior like toe walking, repeating words and inability to communicate. Nowadays you can simply test your child with autism Test or take them to the pediatricians, to know the Autism score of your child by Autism Diagnosis Instruments.

Autism spectrum disorder(ASD) are usually compared with Asperger syndrome and Rett syndrome as they consist of the same definition but different effects. Before searching for the cure of any diseases its first important to diagnose it similarly, in autism we have various instrument to diagnose it. But the best way to diagnose ASD is behavior, not any cause or mechanism.

The number of people diagnosed with Autism has increased dramatically from the 1960s to the present. Sometime an autistic person may have symptoms that are independent of the diagnosis, but that can affect individuals or the family.

How can early autism be diagnosed?

Autism spectrum disorder most of the time appears in early childhood and this cause in many areas of child development like learning to talk, play, and interact with others. From birth to at least 36 months of age, every child should be screened for developmental milestones during routine good visits.

Many parents do not recognize these early sign and symptoms of autism until their children do not start talking at a typical age. Most children with autism are not diagnosed until after age 3, even though health care providers can often see developmental problems before that age 7,8,9.

Developmental Issues in early autism

However, every child facing an autism problem have some degree of development issues in the following three areas:

  • Communicating verbally and non-verbally
  • Relating to others and the world around them
  • Thinking and behaving flexibly
  • Poor skills in pretend play and imitation

Research shows that early detection and early intervention greatly improve outcomes, so it’s important to look for these symptoms when a child is as young as possible.

How parents can find the warning signs

  • Monitor your child’s development. Autism involves many types of developmental delays, such as social, emotional, and cognitive milestones. While developmental delays don’t automatically point to autism, they may indicate a heightened risk.
  • A different child develops at a different pace, so don’t panic if your child starts talking or walking at late. But if your child is not meeting the milestones for their age, then maybe its a problem, concern with your child doctor.
  • Do not tell wait and see approach. You risk losing valuable time at an age where your child has the best chance for improvement.

Diagnosis of early autism

It requires two steps :

Developmental Screening

During the developmental screening, the doctor might ask the parent some questions or talk and play with the child during an exam to see how she learns, speaks, behaves, and moves.

Comprehensive Diagnostic Evaluation

It includes the following activities :

  • Looking at the child’s behavior and development.
  • Interviewing the parents
  • Hearing and vision screening
  • Genetic testing
  • Neurological testing
  • Another medical testing

So the diagnosis of early autism is a complex process. It requires concentration, observation, interview and further follows up. The child can be protected from autism disorder by early diagnosis.

How a typical autism assessment is done?

The diagnostic instrument for Autism research

There are several diagnostic instruments for autism research in which these two are very common and are described below,

Autism Diagnostic Interview-Revised (ADI-R)

It is a structured interview conducted by examiners( Researchers and Clinicians) with the parents of the child who has been referred to have symptoms of Autism or Autism spectrum disorder(ASD). The ADI-R was written by Michael Rutter, MD FRS, Ann LeCouteur, MBBS, and Catherine Lord, Ph.D. and was published by Western Psychological Services(WPS) in 2003.

This interview is conducted for anyone with the mental age of 18 months at least for diagnostic purpose. In this diagnosis, the social development, communicating ability and repetitive behavior of the person referred with ASD is examined by rating them with scores based on a certain interview conducted.

Before conducting this interview, social communication questionnaire (SCQ) the brief 40 true/false questionnaire is completed by the parents or the caregiver about children behavior. It’s like the brief screening session to know the requirement for the full ADI-R session.

ADI-R interview by examiner with the parents of referred child

Structure of Autism Diagnostic Interview

Autism diagnostic interview is for the diagnosis of autism as well as planning for its treatment too. This diagnosis requires the full developmental history of referred child/Adult and takes only 1-2 hours to finish. The parents or the caregiver of the referred child are asked with 93 questions and 3 main behavioral areas of the child either in the current or at a certain point in time.

The interview is divided into 5 sections which are,

  • Opening questions
  • Communication questions
  • Social development and play questions
  • Repetitive and restricted behavior questions and
  • Questions about general behavior problems
Opening questions

It is the first question section of the ADI-R diagnosis interview and the related question signifies the quality of social interaction a child poses. In this section, the question is asked which is related to emotional sharing, offering and seeking comfort, social smiling and responding to other children.

Communication questions

In this section, the child gets a score for his/her language and communicating behavior. The investigator asks the question regarding stereotyped utterances i.e the sound or words that the child uses and repeat most often. The parents or caregivers are also asked about pronoun reversal and social use of language by the child.

Social development and play questions

In this section, the parents or caregivers are asked about the child social behavior in public. Like do they respond to the social discussion or are they able to express their emotions or desires?. Do they imitate the facial expression of the new people or are selective about their food, clothes or something else. This question represents the social development of the child and maintaining friendships represents their play behavior.

Repetitive and restricted behavior questions

likewise, the other sections, the repetitive and restricted behavior involves the questions regarding child unusual preoccupation, hand and finger mannerisms, and unusual sensory interests. Unusual preoccupation like staring at moving objects for hours and sensory interests like placing their toys in some specific manner always which is very unusual for normal children.

Questions about general behavior problems

This sections notice the response of a referred children regarding self-injury, aggression, and overactivity. Sometimes they can be very quiet for big incidence and very vulnerable to the small loss.

The response to these question by the parents or caregivers helps in developing the treatment for the referred child in accord with their behavior. The questions asked in these interviews are very open-ended. And the parents and the caregiver could easily answer all the questions. ADI-R interviews provide the investigator with all the required information to determine a valid rating for each behavior. In this diagnosis, the parents or the caregivers are provided with an opportunity to speak for there child and it is valued by the interviewer. Taking part in this interview gives a better understanding to the parents about Autism spectrum disorder(ASD) and its treatment.

Autism Score rating scale

After the interview, the interviewer evaluates the obtained responses and rate score for each question based on their standards known as the Childhood Autism Rating Scale (CARS).

  • 0 – No frequent sign or symptoms for the specified type.
  • 1 – Behavior is mild in the specified type, but not sufficiently severe to meet the criteria for 2 ratings.
  • 2 – Definite abnormal behavior
  • 3 – Extreme severe condition for the specified behavior
  • 7 – Abnormal in the general area of the coding, rather than the specified area
  • 8 – Not applicable
  • 9 – For the answer not given to the asked question.

Algorithm and cutoff score for Autism

After scoring for all the specified types now it’s time for the total marks obtained after applying the algorithm. The algorithm is applied by dropping the score from 3 to 2 and the score 7,8, and 9 are termed as 0. It is done because the score 3,7,8,9 do not show the autistic behavior and should not be added to the totals.

So, the score 0,1,2 are closely related to the criteria for the diagnosis of ASD according to DSM-IV and the ICD-10. If the grand total of all these specific areas exceeds the cutoff then the referred child results as an Autistic child. These cutoff score resulting in autism diagnosis were determined using the results of many years of extensively reviewed research. The cut-off score for the 3 specific behaviors in ASD is,

  • Social interaction: 10
  • Communication and language: 8 (if verbal) or 7 (if non-verbal)
  • Restricted and repetitive behaviors: 3

Training for the Invigilator

The invigilator should possess extensive knowledge and training for Autism Spectrum Disorder(ASD) to conduct and score in an interview. The training takes either 2 months or more than that to be able to conduct the interview through an examiner. There are two types of training provided, one for the invigilator and another one for the research purpose. This training and workshops are conducted by WPS and the required Information regarding ADI-R research and training, workshops, including current dates and locations, can be found at CADB (the Center for Autism and the Developing Brain).

Autism Diagnostic Observation Schedule (ADOS)

After ADI-R(Autism Diagnostic Interview-Revised), we have ADOS(Autism Diagnosis Observation Schedule) which is an instrument for diagnosing Autism. It was first introduced by Catherine Lord, Ph.D., Michael Rutter, M.D., FRS, Pamela C. DiLavore, Ph.D., and Susan Risi, Ph.D. in 1989 and was commercially available in 2001 by Western Psychological Services(WPS). Likewise ADI-R (The Autism Diagnostic Interview-Revised), ADOS is also a structured and semi-structured protocol which consist of the interaction between the examiner and the person with an assessment.

ADOS session between the examiner and the childThe examiner notes the behavior of the subject and assigns them to the predetermined observational categories. The results from these observational categories are combined to produce an analyzing score for further diagnosis. After conducting the interactive section with the person with assessment, the scores obtained are compared with the research-determined cut-offs to diagnose the potential symptoms of either classic autistic disorder(Autism) or autism spectrum disorders(ASD).

Method to conduct ADOS

It’s an interactive section between the examiner and the child/adult with an assessment which hardly takes 30-60 minutes to administer. ADOS consists of structured and semi-structured tasks which provide the subject with a series of opportunities to express their social and communication behavior. This helps to diagnose Autism symptoms.

It’s revised edition was introduced on 2012 by WPS with shorts of changes like updated norms, improved algorithms for Modules 1 to 3 and a new Toddler Module that facilitates assessment in children ages 12 to 30 months. ADOS is not used for the individuals coming under the following criteria,

  • It could not serve to the Adults who are nonverbal.
  • ADOS should not be used for the diagnosis of the people who are blind, deaf, and have sensory or motor disorder.
  • The minimum developmental requirement for the subjects to use the ADOS instrument is to walk.

Modules of ADOS

Autism Diagnosis Observation Schedule(ADOS) consists of 4 modules within them which are based on the developmental and language level of the subjected individual. Each and every referred individual are categorized according to their ability in these modules and are treated likewise. The criteria to be under the following given module are as follow,

Module 1: Module one is for the children who use either very little or no phrase speech. Example response to their names, bubble play, and social smile.

Module 2: The person who uses phrase speech to communicate but does not speak fluently are under this module. In these both modules the subjects are required to move around the room so, the ability to walk is generally taken as a minimum developmental requirement to use the ADOS instrument as a whole.

Module 3: Module 3 is for the younger subjects who are fluent in phrase speech. Like, Goodbye, Thank You and more.

Module 4: Whereas, Module 4 is for adolescents and adults who are verbally fluent. Like, reciprocal play, responding to others emotion and comments (exhibition of empathy).

Training and workshops for ADOS-2

There are several organizations which provide training on ADOS as no examiner could conduct the interaction protocol without proper training and knowledge. WPS the producer of ADI-2 and ADOS offers several clinical workshops for professionals who are unfamiliar with the revised version of ADOS i.e ADOS-2. The workshops of ADOS by WPS includes,

  • Observation classes for attendees, in which the instructor interact with the child having ASD.
  • The attendees learn and practice scoring.
  • The attendees are provided to focus on Module 1 and then later up to Module 4.
  • They are provided with study materials for toddler module in order to complete the workshop.

The research training is offered by the authors and the colleagues of ADOS-2. It includes public research on item coding accuracy to the specific criteria along with designed to help with high cross-site interrater reliability. The trained researchers and clinicians of ADOS and ADOS-2 are provided with one-day workshops. This focuses on the learning of the toddler module offered by CADB(Center for Autism and the Developing Brain).

Some of the Disadvantages with over popularity of Autism.

Some other disorder like hearing loss, speech disorder, and intellectual disability(general learning disability) show some of the differential diagnosis like ASD which can result in your child with Autistic symptoms. So, it’s important for parents to choose a trained and renowned center to diagnose their child.

Some of the disadvantages of overdiagnosis of Autism are as follows,

  • Presence of Autism can hide the symptoms of other coexisting disorder like Depression and its linked deficiency.
  • With the popularity of Autism, the problem of underdiagnosis and overdiagnosis is taking place.
  • Due to the change in diagnostic practice, the number of ASD reported are increasing.
  • Since the drug treatment options are available, the providers of these medicines are promoting the overdiagnosis of the children with Autism with uncertain symptoms.
  • Due to the overdiagnosis cases, the price of this test is increasing rapidly causing in delay diagnosis for the required cases.

Parents are diagnosing their child with Autism at the age of 14 months which is unstable to show any symptoms of ASD as the diagnosis become stable over after 3 years of life.

So, you can say that the child diagnosed with ASD at the age of 3 is more likely to meet Autistic symptoms criteria rather than the child of 14 months with ASD. Although the early signs and symptoms of Autism are missed sometimes in child and are diagnosed after years later in adulthood. People can claim disability living allowance or other benefits for autism in some locations.

If you need any assistance or have a question about Autism Diagnosis Instruments And Tests, you can consult our HearingSol experts with your problem, feel free to call us on 1800-121-4408. We are always here to help you.

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