Introduction
Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition that affects social interaction, communication, interests, and behavior. It’s termed a “spectrum” because of the wide variation in the type and severity of symptoms individuals experience.
1. Key Characteristics:
- Social Interaction and Communication Challenges:
- Difficulties in understanding and interpreting other people’s feelings and emotions.
- Challenges in expressing one’s own emotions.
- Struggling with verbal and non-verbal communication, including body language, facial expressions, and tone of voice.
- Restricted and Repetitive Behaviors:
- Repeating specific behaviors or rituals.
- Intense focus on a single interest or hobby.
- Sensitivity or under-reactivity to sensory stimuli like sounds, lights, or textures.
2. Causes and Risk Factors:
- Genetics: Several genes have been identified that make a person more susceptible to ASD.
- Environmental Factors: Certain prenatal and perinatal complications might increase the risk.
- Brain Irregularities: Early brain development differences in children with ASD.
- No Link to Vaccines: Extensive research has shown that there is no connection between vaccines and ASD.
3. Diagnosis:
- Developmental Monitoring: Observing and tracking a child’s growth and development over time.
- Developmental Screening: A short test to determine if a child is learning basic skills when they should or if there are delays.
- Comprehensive Evaluation: Involves vision and hearing screening, genetic testing, neurological testing, and other medical testing.
4. Associated Conditions:
- Intellectual Disability: Some individuals with ASD may also have challenges with intellectual skills.
- Sleep Disturbances: Difficulties with sleep initiation and maintenance.
- Gastrointestinal Disorders: Such as constipation, stomach pain, or other GI symptoms.
- Epilepsy: Higher prevalence in those with ASD.
- Anxiety and Depression: Often accompany ASD, especially in older children and adolescents.
5. Treatment and Intervention:
- Behavioral and Educational Therapy: Helps with communication, social skills, and repetitive behaviors.
- Medication: Can be used to treat symptoms associated with ASD like anxiety, depression, or obsessive-compulsive disorder.
- Family Therapies: Educate families and provide strategies to handle challenging behaviors.
6. Living with ASD:
- Strengths: Many individuals with ASD excel in visual skills, music, art, or academic skills.
- Challenges: Social situations, unfamiliar settings, or changes in routine can be difficult.
- Support: Early intervention, therapies, support from loved ones, and understanding from the community are crucial.
Role of Occupational Therapists in Assessing ASD
Occupational therapists (OTs) play a vital role in the assessment and intervention process for individuals with Autism Spectrum Disorder (ASD). Their holistic approach ensures that both the individual and their environment are taken into account. Among their many responsibilities, OTs often assess sensory processing and interoceptive awareness in individuals with ASD.
- Occupational Therapy and ASD:
- Holistic Approach: OTs assess and address physical, psychological, and social needs.
- Functional Performance: They evaluate how ASD impacts daily activities and independence.
- Environmental Considerations: OTs might suggest modifications in home, school, or community settings to support individuals with ASD.
- Sensory Assessments:
- Sensory Profiles: Determine how individuals with ASD respond to sensory stimuli. This can identify hypersensitivities (over-responsiveness) or hyposensitivities (under-responsiveness) to sensory inputs.
- Functional Implications: OTs evaluate how sensory processing challenges affect daily routines, behaviors, and participation in activities.
- Recommendations: After assessment, OTs might suggest sensory-based interventions or environmental modifications to support sensory needs.
- Interoceptive Assessments:
- Understanding Interoception: Interoception is the ability to recognize and understand internal bodily sensations, like hunger, fullness, and emotional states.
- Interoceptive Profile: OTs assess an individual’s ability to recognize and respond to internal cues. For instance, some individuals with ASD may struggle to recognize when they’re thirsty, hungry, or need to use the restroom.
- Interventions: Based on assessments, OTs might introduce strategies to enhance interoceptive awareness or provide alternative methods for understanding and acting on internal cues.
Collaborative Role:
- Interdisciplinary Collaboration: OTs often work alongside speech therapists, physical therapists, psychologists, and educators to provide comprehensive care.
- Family Involvement: OTs collaborate with families to ensure strategies are consistently implemented across environments. They might also provide education and resources to families to better support their loved ones.
Occupational therapists offer valuable insights and strategies for individuals with ASD, especially in the realms of sensory and interoceptive assessments. By understanding and addressing these areas, OTs contribute significantly to enhancing the quality of life and functional performance of those with ASD in various environments.
Understanding The Autism Spectrum Disorder (ASD) Assessment Process At Level-Up
Some of our providers are trained in completing autism assessments and identifying autism from other struggles, such as ADHD. Unique personalities can be a challenge. This is why a robust assessment is completed. Our providers can begin to identify autism around 18 months of age.
Every piece of information that we collect from parents, teachers, the child, and our clinical observations allow us to start the process of understanding the individual. An autism assessment uses a host of diagnostic tools to help guide the clinician to understand the whole child.
The Steps to Our Process
When you connect with our client relations team for an autism assessment, an intake questionnaire is sent out to the family to complete. Our psychologists and other team members will review the information.
In order to rule out other potential issues, a psychoeducational assessment (cognitive, academic, social and emotional, and possible personality traits)) must be completed, so we can identify any intellectual deficits, as well as the strengths of the individuals. We require a full psychoeducational assessment that has been completed within the last two years. Identifying autism is a rigorous process.
We may send out a pre-screen questionnaire to see if there are symptoms that are associated with autism.
You may receive additional assessment tools that help us to understand the individual’s social communication and day-to-day functioning.
Coming to Level-Up
Our team members strive hard to ensure that each individual feels supported and comfortable when they arrive at Level Up. We will ask about any sensitivities that may be present and we will try our best to remove any triggers. While we cannot guarantee a complete removal, we will minimize sensory struggles as best we can.
1. The psychologist will use a diagnostic instrument such as the Autism Diagnostic Observation Schedule, or the ADOS-2. The ADOS is a test with different modules to accommodate a range of children. There is a version for toddlers that is play-based. For kids older than thirty months, there are modules that include more conversation, according to the child’s language level. This is not the kind of test where there are correct answers. The purpose of the ADOS-2 is to evaluate the social skills and repetitive behaviors displayed by the child during the test. This means the evaluator is paying attention to certain things, such as if the child asks for help when they need it, giving others a chance to speak and following along with changes of subject. During the interactions at the office, the psychologist will be gathering further information.
2. There are often instances where it may be difficult to identify from the information collected if autism is present. Many individuals who are gifted have learned a series of behaviors and adaptive skills to “appear normal”. We often refer to this as “neurotypical behaviors”- or behaviors that society deems to be appropriate. In these instances, we need to complete the Autism Diagnostic Interview (ADI). This is a comprehensive interview, typically completed with the parents to understand the history of the child. Due to the time that is required to complete this assessment, it can be costly, taking anywhere between 4-6 hours of clinical interview time.
3. People who are neurodivergent also experience difficulties with sensory processing. We often ask our occupational therapists to complete sensory assessments, motor assessments, and other diagnostic testing and interviewing to identify other environmental situations that may help us to understand the whole person. *Occupational therapists who are involved bill out for a separate assessment with associated fees*.
4. Some individuals may benefit from a language assessment to understand if there are language and communication challenges. *Speech and language pathologists involved bill out a separate assessment with associated fees*.
Challenges With Interpretation
Level Up practitioners use a combination of diagnostic assessment, clinical interviews, and research to determine if the individual has a diagnosis. This is because diagnostic tools do not diagnose, clinicians do.
Here are some problems with over-relying on diagnostic tools alone:
Dr. Epstein notes that, even with these tools, it is important to be working with a mental health professional who has experience diagnosing people on the autism spectrum. “You want to be working with someone who understands the subtleties,” she says. “For example, a person who has real expertise will be able to distinguish if a child has poor eye contact because the child is shy, versus if there is poor eye contact in the way we expect to see it in autism spectrum disorder.”
A recent study underscores the difficulty in distinguishing between autism and other disorders, like ADHD, using even gold-standard tools like ADOS. Looking at school-age kids with high verbal functioning, the study found that 21% of children with ADHD—but not autism—met diagnostic criteria for autism when given the ADOS.
“The minute that we diagnose blindly based on score, we’re going to misplace a lot of kids into categories,” lead researcher Somer Bishop, assistant professor of psychiatry at the University of California, San Francisco, tells Spectrum, an online journal on autism research. “These instruments were designed to assist in clinical decision-making, but they are not a replacement for a clinical brain.”
Catherine Lord, director of the Center for Autism and the Developing Brain at New York-Presbyterian Hospital, who developed the ADOS, adds that it’s important to consider the motivation for the behavior. A child with ADHD might avoid an adult’s gaze because he thinks he has done something wrong, she tells Spectrum, rather than because of a social deficit. Or, a child’s face might be unexpressive because she is bored or distracted, not because she is less expressive in general.
Clinical Interviews
Screeners and diagnostic tools are ways of gathering information, but they have to be considered in the context of other information from a range of adults who know the child. A full evaluation should also include a thorough interview with the child’s parents, covering general development and current concerns. The interview should also closely investigate ASD-related symptoms. To gather more information, parents might be asked to fill out special questionnaires as well.
When you embark on a journey to determine if your loved one has autism, the services that you will receive at Level Up are similar to the experience you would have at an assessment centre in a hospital. Our psychologists work with our multi-disciplinary assessment team to ensure no stone is left unturned. If the psychologist has identified that motor skills, sensory struggles, or language and communication issues exists, we discuss our findings and concerns with our team. We then relay this information back to you, so you can decide if you would like other providers to complete their assessments. This approach is used to understand the whole-person. This is important because it allows for tailored interventions to support the individual’s needs.
We understand that this can be an overwhelming process, so please speak to our team and feel free to ask any questions that you may have. We strive to ensure the best support to meet your family’s needs.
Have More Questions?
If you have questions Autism Spectrum Disorder (ASD) Assessments services, please contact our client relations team.
