Assessment of Autistic Spectrum Disorder The Psychologist’s Place in the Continuum
ASD is…….. <ul><li>Autism is now thought to be a spectrum of neurodevelopmental conditions, characterized by: </li></ul><u...
Diagnostic Criteria <ul><li>DSM-IV . Autistic Disorder </li></ul><ul><li>Social  – qualitative impairment in social intera...
Diagnostic Criteria Cont <ul><li>Delays or abnormal functioning in at least one area with onset before 3 yrs; social inter...
Diagnostic Criteria <ul><li>Diagnostic criteria for ASD continue to develop.  </li></ul><ul><li>Popularity of and the wide...
Additional Diagnostic Schemes <ul><li>Dissatisfaction with DSM-IV has led to the development of other systems.  </li></ul>...
NZ Guidelines <ul><li>ASD in NZ is a disability, not a mental health problem.  CAMHS, CMHCs deal with comorbid disorders. ...
Services <ul><li>Pediatric Services - child development services -most classic autism is identified in child health and be...
Assessment <ul><li>Comprehensive Assessment Model </li></ul><ul><li>Assess multiple areas of functioning </li></ul><ul><li...
Multidisciplinary Assessment <ul><li>Diagnostic Assessment </li></ul><ul><li>Developmental History </li></ul><ul><li>Cogni...
Cognitive Assessment  <ul><li>Behaviourally defined disorder, no biological markers. </li></ul><ul><li>Screening and diagn...
The Role of Cognitive Assessments <ul><li>Individuals with autism demonstrate a typical pattern of performance deficits on...
Instruments   <ul><li>Asperger Syndrome Diagnostic interview (ASDI) </li></ul><ul><li>Asperger Syndrome Screening Question...
Instruments (contd) <ul><li>Child Communication Checklist (CCC) </li></ul><ul><li>Checklist for Autism in Toddlers (CHAT) ...
Things To Consider <ul><li>What population has the tool been validated on? </li></ul><ul><li>Is the tool applicable to a N...
Challenges for Psychologists <ul><li>What evidence is there that the tool leads to earlier or more accurate diagnosis? </l...
Specialist Assessment <ul><li>ASD Specific Diagnostic History </li></ul><ul><li>Autism Diagnostic Interview – revised (ADI...
Challenges <ul><li>Issues confronting Adult Services  </li></ul><ul><li>Differential diagnosis.  </li></ul><ul><li>Formal ...
Presenters <ul><li>Clinical Psychologists: </li></ul><ul><ul><li>Mark Sinclair </li></ul></ul><ul><ul><li>Munira Haidermot...
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Assessment of autistic spectrum disorder, Munira Haidermota and Mark Sinclair

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Assessment of autistic spectrum disorder, Munira Haidermota and Mark Sinclair

  1. 1. Assessment of Autistic Spectrum Disorder The Psychologist’s Place in the Continuum
  2. 2. ASD is…….. <ul><li>Autism is now thought to be a spectrum of neurodevelopmental conditions, characterized by: </li></ul><ul><li>Difficulties in the development of social relationships. </li></ul><ul><li>Communication difficulties. </li></ul><ul><li>Repetitive behavior or strong narrow interests. </li></ul>Munira Haidermota Mark Sinclair
  3. 3. Diagnostic Criteria <ul><li>DSM-IV . Autistic Disorder </li></ul><ul><li>Social – qualitative impairment in social interaction (e.g., failure to develop peer relationships; impairment in the use of multiple non-verbal behaviours). </li></ul><ul><li>Language and Communication – qualitative impairments in communication (e.g. delay in the development of spoken language; stereotyped and repetitive use of language) </li></ul><ul><li>Thought and Behaviour – restricted repetitive and stereotyped patterns of behaviour, interests and activities (e.g., inflexible adherence to specific, non-functional routines or rituals). </li></ul>Munira Haidermota Mark Sinclair
  4. 4. Diagnostic Criteria Cont <ul><li>Delays or abnormal functioning in at least one area with onset before 3 yrs; social interaction; language as used in social communication; symbolic or imaginative play. </li></ul><ul><li>Asperger’s Disorder </li></ul><ul><li>Must endorse two parts of the autism triad sections 1 and 3. Plus: no clinically significant delay in language or cognitive development. </li></ul>Munira Haidermota Mark Sinclair
  5. 5. Diagnostic Criteria <ul><li>Diagnostic criteria for ASD continue to develop. </li></ul><ul><li>Popularity of and the wider usage of diagnostic terms in the media and community may be little related to classification systems. </li></ul>Munira Haidermota Mark Sinclair
  6. 6. Additional Diagnostic Schemes <ul><li>Dissatisfaction with DSM-IV has led to the development of other systems. </li></ul><ul><li>Gilbergs criteria for Aspergers; 9 key points. </li></ul><ul><li>Baron-Cohen; reworked DSM IV criteria to adapt to higher functioning adult presentations (AAA). E.g., sections on qual impairments verbal/non-verbal communication and in imagination. </li></ul><ul><li>DSM-V. Aspergers will be gone; both conditions to be subsumed under ASD, and individuals differentiated on the basis of severity. </li></ul>Munira Haidermota Mark Sinclair
  7. 7. NZ Guidelines <ul><li>ASD in NZ is a disability, not a mental health problem. CAMHS, CMHCs deal with comorbid disorders. </li></ul><ul><li>Emphasis on MDT (suggestion of specialist teams within adult mental health services). </li></ul><ul><li>And on the use of “valid” instruments (? “Gold standard” issue). </li></ul><ul><li>Development of formal pathways for diagnosis (developmental services coordinators in place). </li></ul><ul><li>Assessment of cognitive and adaptive skills should be considered and formally assessed if appropriate. </li></ul>Munira Haidermota Mark Sinclair
  8. 8. Services <ul><li>Pediatric Services - child development services -most classic autism is identified in child health and before school age. </li></ul><ul><li>CAMHs frequently do ASD diagnoses, sometimes as a formal process. </li></ul><ul><li>Adult Mental Health Services may be required to make formal diagnoses. </li></ul>Munira Haidermota Mark Sinclair
  9. 9. Assessment <ul><li>Comprehensive Assessment Model </li></ul><ul><li>Assess multiple areas of functioning </li></ul><ul><li>Collect information from a variety of settings </li></ul><ul><li>Provide a single coherent view </li></ul><ul><li>Provide implications for adaptation and learning </li></ul><ul><li>Liaison with schools and other agencies to support implementation of recommendations. </li></ul>Munira Haidermota Mark Sinclair
  10. 10. Multidisciplinary Assessment <ul><li>Diagnostic Assessment </li></ul><ul><li>Developmental History </li></ul><ul><li>Cognitive / Behavioral </li></ul><ul><li>Neuropsychological, Academic and Vocational </li></ul><ul><li>Speech, Language and Communication </li></ul><ul><li>Sensory and Motor Skills Assessments </li></ul><ul><li>Specialized Medical Evaluations </li></ul>Munira Haidermota Mark Sinclair
  11. 11. Cognitive Assessment <ul><li>Behaviourally defined disorder, no biological markers. </li></ul><ul><li>Screening and diagnosis : behavioural observation within conceptual frameworks. </li></ul><ul><li>Cognitive assessments : supplement behavioural scales and developmental checklists </li></ul>
  12. 12. The Role of Cognitive Assessments <ul><li>Individuals with autism demonstrate a typical pattern of performance deficits on intelligence tests. </li></ul><ul><li>Provide standardized information about the overall cognitive functioning of a child. </li></ul><ul><li>Presence of specific deficits, or in rare cases, the presence of superior splinter skills, which may go undetected during behavioral observation. </li></ul><ul><li>Selection and interpretation of cognitive measure will depend on a no of factors. </li></ul><ul><li>Common Test Batteries </li></ul><ul><li>Non Verbal Test Batteries </li></ul>Munira Haidermota Mark Sinclair
  13. 13. Instruments <ul><li>Asperger Syndrome Diagnostic interview (ASDI) </li></ul><ul><li>Asperger Syndrome Screening Questionnaire (ASSQ) </li></ul><ul><li>Australian Scale for Asperger syndrome (ASAS) </li></ul><ul><li>Autism Behaviour Checklist (ABC) </li></ul><ul><li>Autism Diagnostic Observation Schedule (ADOS) and ADOS-G </li></ul><ul><li>Autism Screening Questionnaire (ASQ) </li></ul><ul><li>Autism Spectrum Quotient (AQ) </li></ul><ul><li>Autistic Diagnostic Interview (ADI, and also ADI-R) </li></ul><ul><li>Childhood Asperger Syndrome Test (CAST) </li></ul><ul><li>Childhood Autism Rating Scale (CARS) </li></ul>Munira Haidermota Mark Sinclair
  14. 14. Instruments (contd) <ul><li>Child Communication Checklist (CCC) </li></ul><ul><li>Checklist for Autism in Toddlers (CHAT) </li></ul><ul><li>Diagnostic Interview for Social Communication Disorders (DISCO) </li></ul><ul><li>Gilliam Autism Rating Scale (GARS) </li></ul><ul><li>Parent Interview for Autism </li></ul><ul><li>Pervasive Developmental Disorders – mental retardation (PDD-MR) </li></ul><ul><li>Social Response Scale (SRS) </li></ul><ul><li>STAT </li></ul><ul><li>TEACCH checklist </li></ul><ul><li>Wing Autistic Disorder Interview Checklist </li></ul>Munira Haidermota Mark Sinclair
  15. 15. Things To Consider <ul><li>What population has the tool been validated on? </li></ul><ul><li>Is the tool applicable to a New Zealand setting? Can the tool be used without modification with Māori, Pacific and Asian individuals? </li></ul><ul><li>How long does it take to administer the tool? </li></ul><ul><li>How many professionals are needed to administer the tool? </li></ul><ul><li>What is needed to make the tool available in New Zealand? Training? Qualifications required? Where can training be accessed? What is the cost of training? Ongoing costs – royalties? </li></ul>Munira Haidermota Mark Sinclair
  16. 16. Challenges for Psychologists <ul><li>What evidence is there that the tool leads to earlier or more accurate diagnosis? </li></ul><ul><li>What is realistic for Clinical and Educational Psychologists with their service and time constraints? </li></ul><ul><li>When should you refer to a specialist? </li></ul><ul><li>What will a SPECIALIST do? </li></ul>Munira Haidermota Mark Sinclair
  17. 17. Specialist Assessment <ul><li>ASD Specific Diagnostic History </li></ul><ul><li>Autism Diagnostic Interview – revised (ADI-R). </li></ul><ul><li>Diagnostic Interview for Social and Communication Disorders (DISCO) </li></ul><ul><li>Developmental, Dimensional and Diagnostic Interview (3di) </li></ul><ul><li>ASD Specific Clinical Observations and Assessment </li></ul><ul><li>Childhood Autism Rating Scale (CARS) </li></ul><ul><li>Autism Diagnostic Observation Schedule–Generic (ADOS-G) </li></ul><ul><li>Individual Profiling </li></ul><ul><li>Neuropsychological, adaptive, cognitive functioning </li></ul><ul><li>Biomedical Investigations </li></ul><ul><li>Comorbid Conditions </li></ul>Munira Haidermota Mark Sinclair
  18. 18. Challenges <ul><li>Issues confronting Adult Services </li></ul><ul><li>Differential diagnosis. </li></ul><ul><li>Formal diagnoses. </li></ul><ul><li>Emphasis on developmental history in the diagnoses and absence of good information about early development </li></ul><ul><li>Veneer of social competence in some individuals. </li></ul><ul><li>Where does management fall under </li></ul><ul><li>Getting a referral accepted by NASC services. </li></ul><ul><li>Child Services </li></ul><ul><li>Early Age </li></ul><ul><li>Complex Presentations </li></ul><ul><li>(attentional difficulties, behavioral rigidities and emotional dysregulation). </li></ul><ul><li>Common use of diagnostic labels complicates assessment process. </li></ul><ul><li>Comorbid Mental Disorder </li></ul><ul><li>Anxiety </li></ul>Munira Haidermota Mark Sinclair
  19. 19. Presenters <ul><li>Clinical Psychologists: </li></ul><ul><ul><li>Mark Sinclair </li></ul></ul><ul><ul><li>Munira Haidermota </li></ul></ul><ul><ul><li>WHIRINAKI </li></ul></ul><ul><ul><li>Child and Adolescent Mental Health Service </li></ul></ul><ul><ul><li>Counties Manukau District Health Board </li></ul></ul>

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