When conducting an ASD specific case history, what would you need to find out?
- Family history of SLC or social communication difficulties
- Pregnancy and birth
- Medical history
- Milestones
- Notable behaviours: obsessions, preoccupation’s, routines, self stimulating behaviours, ability to cope with change and transitions
- Development of joint attention, prelinguistic development (meaningful sounds, babbling, gestures)
What needs to be assessed in an OT’s Motor and sensory development assesment?
- Gross and Fine motor movement
- Observation of gait and posture
- Eating and drinking (oral motor skill, unusual responses or preferences)
- Sensory: Hypo- or hyper- sensitivity to pain, temperature, taste, texture, smell, light, noise, touch
What elements of a child’s play need to be observed?
- Quality and stage: Symbolic Play Test
- Joint attention play, imitation play, imaginative play
- specific toy/game preferences
- Observe peer interaction in play/nursery
What elements of a child’s attention, listening and cognition need to be observed?
- Stage of attention in play/interaction in relation to age, joint attention with parents, others…
- Hearing assessment, parental concerns about hearing
- Activity levels and fluctuation
- Cognitive development / symbolic understanding (Educational or Clinical Psychologist assessment?)
- Intentionality, contingency awareness, object permanence stages
What elements of a child’s RECEPTIVE language need to be observed and how can it be tested?
- Vocabulary understanding
- Situational understanding
- Assess on Reynell Developmental Language Scales, or Preschool Language Scales or REEL, information carrying word level via Derbyshire Language Scheme assessments or informal testing
- Parent questionnaires e.g. MacArthur- Bates-
Communicative Development Inventories
What elements of a child’s EXPRESSIVE language need to be observed?
- How do they communicate non-verbally? Symbolic noises, canonical babbling, gestures etc.
- Pointing to get, and pointing to show/share?
- Interaction with parent / SLT – how parent thinks child communicates
- Communication functions used; how do they request, comment, wave bye bye, gain attention, etc. Do they show or point to things?
- Pragmatics – eye contact, social initiations, responses etc.
What are the core impairments of autism?
- Social communication/interaction impairments
2. Restrictive or repetitive behaviours, interests and activities
What are the two diagnostic systems and what are their core principles?
ICD-10 (WHO) UK
- Triad of impairments: 1. Social interaction deficits,
2. Social communication deficits
3. RRBIs
- Diagnosis in separate categories (e.g. Aspbergers,
Classic Autism….)
DCM-5 (USA)
- Dyad of impairments: 1. Social interaction/communication
deficits
2. RRBIs
- All diagnosis are ASD, but on different dimensions
What variation can there be from one child to another, both with a diagnosis of autism?
- Varying severity of ASD symptoms
- Varying levels of intellectual functioning (at least 50%
have a co-existing intellectual disability) - Varying levels of Language functioning (10% remain non
verbal)
Associated conditions for ASD?
- Mental Health disorders (e.g. anxiety, depression, OCD)
- Emotion regulation and neuro-cognitive issues
- Sensory processing disorder and developmental motor
disorder closely associated
What are examples of alerting signals for ASD?
- Loss of language skills (regression) may affect around a third of children with ASD
- Reduced social interaction and responsiveness (e.g. responding to name, imitation, social smiling, eye gaze)
- Atypical or repetitive interests in objects, insistence on sameness
Examples of screening tools for autism include?
- Checklist for Autism in Toddlers (CHAT)
- Social Communication Questionnaire (For older children)
What are some purposes of diagnosis?
- Help parents (and other family members) understand their child and adapt to their situation
- Ensure the child is supported and nurtured accordingly (as early as possible)
- Ensure services are alerted to the child’s needs and can make plans and provisions accordingly.
What are the three principles of assessment in ASD?
Must be:
- Multidisciplinary
- Multi setting
- Multi method
What three stages will diagnostic assessment include?
- Initial general developmental/ medical assessment
- Multi-agency ASD specific assessment
- Possible referral to tertiary services
What three parts with the ASD specific assessment involve?
- Observations of child within contexts
-Range of relevent contexts and partners
-e.g. Home/ day care/ Educational settings
-Focus on reciprocal social interaction &
communication, and RRBIs - ASD specific case history
-Developmental: widely probe about past and current
behaviours in relevant areas
-Family history: Careful exploration - Individual assessment
-ASD specific (ADOS)
-Broader functioning (physical/medical, cognitive,
sensory, communicative)
What are the 5 modules of ADOS?
- Toddler Module: 12-30 months yr old
- Module 1: Pre-verbal/ single words (31m+)
- Module 2: phrase speech
- Module 3: Fluent speech (child/adolescent)
- Module 4: Fluent speech (adolescent/ adult)
What are the key things observed in the toddler module? What might the adult assessing the child do?
Observe:
- Free play
- Response to name, social smile, joint attention
- Routines (symbolic and social)
Adult will:
- playfully (but intentionally) prevent access to child’s
chosen toy
- appear unable to complete a play activity
- briefly ignore the child
What are the key things observed in module 3? What might the adult assessing the child do?
Observe:
- child’s play: construction, make believe, interact with
others, can child demonstrate a daily task
- child’s conversation and reporting: can they describe a
picture, tell a story from a book
- Can they request more pieces, cope with a break
Adult will:
- Interview child about emotions, relationships, loneliness,
social difficulties and annoyance.
What early SLT assessment might be preformed?
- Parent Report (e.g. McArthur-Bates-Communicative-
Development-Inventories) - Informal Communication observation
- Observation tools and scales (e.g. Communication
Symbolic Behaviour Scales- Developmental Profile) - Standardised assessment (e.g. Preschool language scale)
What might later SLT assessment be testing?
Through various sources (observations, standardised assessments, reports and samples)
- Standardised Language Assessment (Is expressive
stronger than receptive?) - Stereotyped behaviours: Echolalia, neologisms
- Pronoun reversal
- Prosody: rate, volume, rhythm, fluency, intonation
- Pragmatic Functioning
According to DSM5, what differential diagnosis could be given? How do these two diagnosis differ?
- Autism Spectrum Disorder
- Social Communication Disorder
- ASD includes the presence of RRBIs, SCD doesn’t.
According to Wetherby et al (2004), What differentiates children with ASD to TYPICALLY DEVELOPING children under 2?
- Lack of response to contextual cues
- Lack of pointing
- Lack of vocalisations with consonants
- Lack of varied conventional play with toys
According to Wetherby et al (2004), What differentiates children with ASD to DEVELOPMENTALLY DELAYED CHILDREN and typically developing children under 2?
- Lack of appropriate gaze
- Lack of warm, joyful expressions with gaze
- Lack of sharing enjoyment and interest
- Lack of response to name
- Lack of showing
- Unusual prosody
- Repetitive movements or posturing of body, arms,
hands and fingers - Repetitive movements with objects
