Autism Spectrum Disorder (ASD) Assessments:
Our practitioners apply tools like ADOS-2 and ADI-R to provide autism assessments for children.
It is not uncommon for individuals, when they think about autism, to think of the extreme sensory, behavioral, emotional, and communication challenges that are portrayed by the media. Many people don’t understand that autism is on a spectrum from mild to profound. In fact, the term “Asperger’s” has now been reclassified as being part of the ASD spectrum. So, what does that mean?
Neurodivergent individuals, such as those who are autistic, come in many different shapes and sizes. Individuals who display more severe traits of autism have a higher chance of being assessed and provided with appropriate support and interventions to meet the individual’s needs.
Remember, there are many autistic individuals who are very successful, such as Elon Musk. Here is a list of people who are believed to be autistic, retrieved from: https://behavioral-innovations.com/blog/20-famous-people-with-autism-spectrum-disorder-asd/ .
Level Up offers autism assessments from toddlerhood through adulthood.
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.
What Our Process Looks Like:
(1) A family member will connect with our client relations team and identify that they are looking for an autism assessment. At that time, an intake questionnaire is sent out to the family to complete, so our psychologists and other team members trained in autism can review the information.
(2) 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.
a. If you have a psychoeducational assessment that is less than 2 years old, we ask that you send it so we can review the data.
b. We also need to ensure that various assessments were completed to help guide the process.
c. If you do not have a psychoeducational assessment completed, speak to one of the CSR staff and we can complete this for you.
(3) We may send out a pre-screen questionnaire to see if there are symptoms that are associated with autism.
(4) Our CSR team will book you in for an “intake” interview over the phone. This is typically 1 hour in duration and allows us to ask for further information from the intake package. At that time, you may learn more about additional information that the psychologist needs or any recommendations they have.
(5) 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 therapist’s 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***.
Problems 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.
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 identify 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 us 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.