Wednesday, September 16, 2015

Getting an Evaluation for Autism Spectrum Disorder

Deciding that your child might need an evaluation for Autism Spectrum Disorder (ASD) is usually the culmination of a 3 step process.

STEP 1: THERE IS A CONCERN. A parent, family member, caregiver, teacher, speech-language pathologist, therapist, or pediatrician may be concerned that a child shows signs of developmental difference or delay. Sometimes parents have filled out a screening questionnaire that indicates a concern. Maybe a therapist, teacher, or doctor talks to a parent, or a parent expresses a concern to a healthcare professional or directly to an education agency.  If an individual expresses a concern to you, it is a good idea to contact your child’s pediatrician. The pediatrician may want you to complete a screening questionnaire or may want to observe your child. If a screening questionnaire and/or brief observation indicates there might be risk of delay or developmental differences, a referral for an in-depth evaluation is made. Even if screening questionnaires are not used, referrals might be made if a concern is expressed.

Screening Tools:
  • M-CHAT – Modified Checklist for Autism in Toddlers
  • Infant Toddler Checklist
  • SRS-2 – Social Responsiveness Scale
  • SCQ – Social Communication Questionnaire
  • ASRS – Autism Spectrum Rating Scale
  • Ages and Stages (of Child Development)
  • Denver (Developmental Screening Test)
  • SORF – Systematic Observation of Red Flags
STEP 2: REFERRAL. Parents, healthcare professionals, or therapists contact someone who is qualified to do an evaluation of development to make an appointment for an evaluation. The referral might be made to an early intervention agency or school district, a developmental pediatrician, a psychologist, a psychiatrist, or possibly a pediatric neurologist. Additional referrals may also be made to other professionals, such as audiologists, speech-language pathologists, physical therapists, and/or occupational therapists to evaluate other areas of development. Evaluations through early intervention and school districts happen relatively quickly. Sometimes the wait for a developmental pediatrician can be much longer. Parents should pursue both kinds of evaluations – educational and medical – at the same time. This is because children must be evaluated through the education system in order to receive educational services, and educational services can begin without a medical diagnosis.

STEP 3: THE EVALUATION AND RECOMMENDATIONS. There are two core elements that are necessary: (1) parent interview to gather information about the child’s birth, medical, and developmental history; and (2) clinical observation of the child’s behavior – preferably using standardized measures. Based on the information provided by a parent, the observations of the child, and the examiner’s clinical judgment, a diagnosis, if any, will be provided, along with recommendations for intervention.

Parent interviews might be done on paper, in person, or over the phone. An evaluation might take place in a home, a healthcare clinic, a medical office, a school, an early intervention center, or in a psychologist’s office. There may be more than one evaluator, who will usually meet as a team to make a diagnosis and/or recommendations for services, if needed. In-person observations are primarily play-based and are made up of various activities geared toward a child’s developmental level. Evaluators play and talk with the child and ask him or her to do simple tasks as part of the evaluation. For very young children, parents typically stay with their child throughout the evaluation.

Many of the developmental tests follow a progression of skills and include some items that the child will not be able to do. It is important to remember that this is the way development levels are determined, and all children eventually encounter activities that they do not know how to do as they go through an evaluation. At the end of the evaluation, or perhaps a week or so later, the clinician or the team will meet with the parents to discuss diagnostic impressions and recommendations for interventions and services to help the child make developmental progress. A report will be given or mailed to the parents with the full results of the evaluation and written recommendations.

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