ASD screening and diagnostic tools and techniques

Tool name ADOS Autism Diagnostic Observation Schedule Lord et al 1989 Brief description ADOS is an observation based tool which can be used from the age 18 months upwards. It is well received by parents who report their children perceiving it as a play session. There are 4 modules which allow for observations to be made of individuals at various levels of verbal communication ranging from non-verbal to verbally fluent. ADOS looks at 3 areas of assessment: social, communication and restricted repetitive behaviours. It needs to administered by a trained specialist and takes around 30-45 minutes ADOS has a good validity rating. Parents reported the play based approach reduced stress for both child and adult. This tool involves observations of the childs behaviour. The child is rated from 1-4 on fifteen items. It can be used from age 2 years with no upper age limit being specified. The procedure can be administered by specialists but no training is required The process takes about 10-15 minutes CARS has a good validity rating. Purpose Aids diagnosis in combination with other tools ADOS is designed to look at and quantify the characteristics seen in autism spectrum disorder What do the results tell the family This identifies their childs specific deficits in social skills, communication, emotional literacy, language and play activities. Re-assessment informs parents of progress. How can the results be used for educational planning and how? Owing to the very specific identification of deficits appropriate interventions can be planned and put into place earlier. Specific areas of concern can be included in the IEP. The classroom teacher and teacher aide can build on the childs strengths.

CARS Childhood Autism Rating Scale Eric Schopler 1993

ADI-R Autism Diagnostic InterviewRevised

This is an interview based assessment with parents or care-givers that have a good knowledge of the child. ADI-R can be used for individuals from 18 months upwards and takes around 2-3 hours to administer. It looks primarily at the triad of impairments and uses 93 items arranged in 5

Screening and diagnosis in combination with other tools CARS was designed to help differentiate children with autism from those with other developmental delays. Diagnosis of ASD and differentiating ASD from other developmental disorders

The childs behaviours are rated for age and situation appropriateness. The results provide information around relating to people, agility and coordination, sensory responses, adaptation to change, verbal and non-verbal communication, fear and nervousness, activity level and intellectual responses.

Areas of concern can be included in the IEP. The classroom teacher can build on the childs strengths and plan to work on the weaker areas. Sensory information could lead to adaptation of the environment at school and activity level information may inform the frequency of breaks required by a child. The information and rating can be used to inform educational planning in the areas of language development, social skills, interests and other general behaviours.

Identifies if the child has ASD and can be used for planning treatment interventions. A diagnosis aids parents in securing support from other agencies, including funding.

Designed by Lord, Rutter & LeCouteur 2004.

(GARS-2) Gilliam Autism Rating ScaleSecond Edition James E. Gilliam 1995

groups: opening questions, communication, social development, interests and general development. Items are rated on a -0-9 scale. The questions are open ended and reports suggest this is well received as the interviewees feel they are being listened to and valued. ADI-R needs to be administered by trained professionals with clinical experience. Parents reported the open ended questions facilitated feelings of being listened to and valued. GARS-2 is a screening and diagnostic checklist based on criteria from DSM-IV and the Autism Society of America. The assessment can be used with 3 to 22 year olds and takes 10-15 minutes to administer. It uses 3 subscales: stereotyped behaviours, communication and social interaction. Evidence is gathered from a parent interview, observations and the administrators responses to key questions and their interpretations. Administrators need to be graduates in this area and have some experience in administering and interpreting test. Non-graduates are able to administer the test with training and appropriate experience.

3di Developmental, Dimensional and Diagnostic Interview Skuse et al 2004

3di is a computerised diagnostic tool comprising of an interview with parents, with an option to include information from teachers. It may also include direct observation of the child. If the pre-interview package for parents is completed on the computer beforehand then the interview with the child will be around 45 minutes. This option was seen as a strength by parents. This tool can be used for individuals from 4-25 years of age if a parent or care-giver is available to provide information. It consists of 183 items covering demographics, family, developmental history and motor skills. 266 questions are related to ASD and 291 are related to

To provide assistance to psychologists, teachers, parents or clinicians. Screening and diagnosis of Autism. Provides a global rating of autism behaviours. Data gathered from GARS-2 may also be used in research. Diagnosis of autism and information on the severity of autism impairments.

Identifies if the child has ASD and the severity of deficit within each area of the triad of impairments. Data supports parents in making adaptations in the home. It provides information on the individuals present level of functioning and through reuse can track progress.

GARS-2 is designed to provide information for teachers to make adaptations in the classroom. Information gathered can be used to inform and assist with planning of educational intervention in the areas of behaviour, language skills and social skills. Information can be used for goal setting in IEPs.

3di generates reports that are accessible to parents and it is reported to be well liked by parents. It identifies if the child has ASD and the severity of deficit within each area of the triad of impairments.

Information generated by the report can be used to inform planning and intervention around the target areas identified. Appropriate agencies or professionals can be approached to provide specific interventions such as speech language therapy.

CHAT Checklist for Autism in Toddlers Baron-Cohen et al 1992

ASQ Autism Screening Questionnaire Lord, Rutter et al 1998

PIA Parent Interview for Autism Stone & Hogan 1993

mental sates seen in other disorders. Administrators need to be trained. CHAT is a screening tool designed to be used at 18months of age. It consists of a short questionnaire that can be completed by parents and health care professionals. The parent section has 9 questions and the health care professional section has 5 items base on observation: pretend play, protodeclaractive pointing, following a point, pretending, producing a point. The focus of this tool is to look for key communication behaviours that are absent including joint attention and pretend play. If a child fails the assessment they will be re tested in 1 month to allow for slight delays in development. If the assessment is failed a second time a referral for diagnosis will be made. CHAT is an inexpensive, quick, easy to administer, online option for screening. The ASQ (now known as the Social Communication Questionnaire SCQ) is a screening questionnaire that can be used with individuals from 4 years upwards provided they have a mental age of 2 years or more. It consists of a parent questionnaire of 40 yes/no items. There are 2 forms: the Lifetime form looks at the childs entire development, the Current form looks at recent behaviours over the 3 month period prior to the assessment. It provides a quick, easy to administer and affordable method of screening. If a child is identified as possibly having ASD a referral for diagnosis is made. The PIA is a structured interview for use with children of pre-school age and below. It consists of 118 items on 11 scales: social relating, affective responses, motor imitation, peer interactions, object play, imaginative play, language understanding, non-verbal communication, motoric behaviour, sensory responses and need for sameness. The ratings go from 1= almost never to

Identification of infants at risk of social communication disorders.

Alerts parents to social communication deficits allowing them to seek a diagnosis and implement early intervention strategies. Staring intervention early can help to reduce the stress a family is currently experiencing or could potentially experience in the future.

If the child is attending an Early Childhood Centre, staff will be able to implement strategies identified for early intervention of key deficits in behaviours.

Looks at communication and social skills in children with possible ASD concerns. Comparison of symptom levels across different developmental disorders To screen for ASD symptoms and track changes in the frequency of symptoms over time.

Informs parents if a diagnosis should be sought. Provides information on the severity of deficit behaviours allowing parents to implement early intervention rather than having to wait for a diagnosis. With reuse progress over time can be tracked.

Early Childhood Centre and school staff can focus interventions on identified areas of concern. The data collected will provide teachers with an increased awareness of the childs needs and understanding of their behaviour.

Informs parents if a diagnosis should be sought. Allows for early intervention strategies to be implemented prior to diagnosis. Provides information on the childs progress over time.

Early Childhood Centre staff can focus interventions on identified areas of concern. Staffs are afforded an increased awareness of the childs needs and understanding of their behaviour.

5= almost always. It takes around 45 minutes to administer. ASAS ASAS is a rating scale for high functioning children Australian Scale at primary school level. There are rating scales for for Aspergers both parents and teachers. It looks at 6 different Syndrome areas: social and emotional ability, communication Garnett and skills, cognitive skills, specific interests, movement Attwood 1998 skills and other characteristics including sensory responses. It does not require training to be delivered and does not need to be done face to face.

Screens for possibility of ASD and need for diagnostic referral in children of primary school age

Informs parents of high functioning children if a diagnosis of ASD should be sought. Information from the 6 different symptom areas can aid identification and implementation of appropriate intervention strategies.

Teachers gain an awareness and understanding of the childs behaviour and can use information from the data to develop intervention programs bases on the childs needs and building on the childs strengths.

References
Childhood autism rating scale. (2013). Retrieved from Wikipedia: http://en.wikipedia.org/wiki/Childhood_Autism_Rating_Scale 3di autism diagnostic interview. (n.d.). Retrieved from 3di griff-it: http://www.ixdx.org/3di-index.html Assessment and diganosis. (n.d.). Retrieved from ASSET specialists in autism: http://www.autismtraining.co.uk/asd-assessment-and-diagnosis.html Autism centre: Diagnostic Tools. (n.d.). Retrieved from Patient-Centered Guides: http://oreilly.com/medical/autism/news/diag_tools.html#CARS Brassard, M. R., & Boehm, A. E. (2008). Preschool assessment: Prinicples and practice. Guildford Press. Retrieved from http://books.google.co.nz/books/about/Preschool_Assessment.html?id=FjWwR26uE6AC&redir_esc=y Checklist for autism in toddlers ( CHAT). (n.d.). Retrieved from The National Autism Society: http://www.autism.org.uk/chat Education, M. o. (2008). New Zealand Autism Spectrum Disorder Guideline. Wellington: Ministry of Health. Filipek, P. A. (1999). The screening and diagnosis of autism spectrum disorders. Journal of Autism and developmental Disorders, 2(17). McClintock, J. M., & Fraser, J. (2011). Diagnostic instruments for autism spectrum disorder: A brief review. New Zealand Guidelines Group. The Australian scale for Asperger's syndrome. (n.d.). Retrieved from Oasis@Maap: http://www.aspergersyndrome.org/Articles/The-Australian-Scale-for-Asperger-sSyndrome.aspx