Essentials of Autism Spectrum Disorders Evaluation and Assessment
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Essentials of Autism Spectrum Disorders Evaluation and Assessment

Celine A. Saulnier, Pamela E. Ventola

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eBook - ePub

Essentials of Autism Spectrum Disorders Evaluation and Assessment

Celine A. Saulnier, Pamela E. Ventola

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About This Book

Quickly acquire the knowledge and skills you need to utilize the varied assessments frequently used in evaluating autism spectrum disorders

With both the detection and awareness of autism spectrum disorders (ASD) on the rise, there is an urgent need for an increasing number of professionals to not only learn about the nature and course of the various autism spectrum disorders, but also to know how to identify, assess, and diagnose the presence of these disorders. Essentials of Autism Spectrum Disorders Evaluation and Assessment addresses the main domains of assessment, defines the purpose of the assessment, suggests test instruments, and discusses the unique clinical applications of each instrument to the diagnosis of ASD.

Like all the volumes in the Essentials of Psychological Assessment series, each concise chapter features numerous callout boxes highlighting key concepts, bulleted points, and extensive illustrative material, as well as test questions that help you gauge and reinforce your grasp of the information covered.

Providing an in-depth look at ASD evaluation and assessment, this straightforward book includes samples of integrated reports from comprehensive model diagnostic evaluations and prepares clinical and school psychologists, as well as speech and language pathologists, to effectively evaluate and assess ASD.

  • Complete coverage of the identification andassessment of autism spectrum disorders

  • Expert advice on avoiding common pitfalls

  • Conveniently formatted for rapid reference

Other titles in the Essentials of Psychological Assessment series:

  • Essentials of Dyslexia Assessment and Intervention

  • Essentials of Assessment Report Writing

  • Essentials of School Neuropsychological Assessment

  • Essentials of Evidence-Based Academic Interventions

  • Essentials of Specific Learning Disability Identification

  • Essentials of Processing Assessment

  • Essentials of Executive Function Assessment

  • Essentials of Cross-Battery Assessment, Second Edition

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Chapter 1
Autism spectrum disorders (ASD) are among the most common childhood disorders, with prevalence rates reaching near 1% of the population (CDC, 2007a, 2007b). Defined as a lifelong neurodevelopmental disorder with a complex genetic etiology, ASD's symptoms tend to unfold over the course of early development. Research indicates that 80% to 90% of parents report their first concerns about their child's development by the second birthday and often earlier. However, the mean age of diagnosis continues to be well over the age of three despite these concerns (Chawarska et al., 2007). Moreover, when experienced clinicians make a diagnosis of ASD at 18 to 24 months, the stability of diagnosis is quite strong, also around 80% to 90% (Chawarska et al., 2009). This highlights an extremely concerning gap between when first concerns are raised and when something is actually done to help the child; often because of a limited awareness of the early markers of ASD by professionals on the front line. These facts underscore the necessity for clinicians of all disciplines to learn about and be vigilant for the early signs of ASD, so that children can be effectively evaluated and efficiently diagnosed. Only then can these children subsequently receive the critical early and intensive intervention that is associated with optimal outcome (National Research Council, 2001).
Most parents of children who develop ASD express concerns regarding their child's development prior to the second birthday, well over a year before diagnostic evaluations take place, on average. Professionals need to be extra vigilant in not only validating concerns, but also in taking immediate action to assess and identify potential risk for ASD.
Diagnostic Criteria
Although the causes of ASD are likely neurobiological in nature, the spectrum of disorders still requires diagnosis based on behavioral symptomatology. The current diagnostic criteria put forth in the Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR; APA, 2000) fall under the category of Pervasive Developmental Disorders (PDD), which includes Autistic Disorder, or autism; Asperger's Disorder, or Asperger syndrome, Rett's Disorder, Childhood Disintegrative Disorder (CDD), and Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS). The behavioral features of all five PDDs fall within the following subcategories: (1) impairments in social interaction; (2) impairments in communication; and (3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities. A diagnosis of Autistic Disorder, the most prototypical of the PDDs, requires onset of delays or deviance in development prior to the age of three and a total of at least six impairments in all subcategories, with at least two falling within the area of social interaction.
Rapid Reference 1.1
Pervasive Developmental Disorders in the DSM-IV-TR
Autistic Disorder
Asperger's Disorder
Rett's Disorder
Childhood Disintegrative Disorder
Pervasive Developmental Disorder, Not Otherwise Specified
Asperger Syndrome
The description of Asperger syndrome is more complicated. The DSM-IV-TR defines the disorder as having impairment in at least two areas of social interaction and one restricted, repetitive, and stereotyped pattern of behavior, but not meeting full criteria for Autistic Disorder. The criteria further stipulate that there can be no clinically significant delays in the development of language, cognition, and self-help adaptive skills during the first three years of life (APA, 2000). However, many clinicians overlook the text of the DSM-IV-TR and resort only to the charts. In this case, the text signifying “during the first three years of life” would be missed, resulting in misdiagnoses of older individuals with Asperger syndrome who most certainly do present with areas of deficit in cognitive, adaptive, and language abilities (e.g., Klin et al., 2007; Saulnier & Klin, 2007).
Furthermore, if one refers only to the charts and not the text, the description of circumscribed interests—the all-encompassing preoccupations with topics of interest that tend to be more specific to Asperger syndrome than the other PDDs—would be similarly overlooked. These criteria have generated a great deal of controversy, resulting in tremendous variation in the diagnosis of Asperger syndrome, both clinically and in research. This variability and lack of consistency in defining the disorder has ultimately resulted in removal of the subtype from the forthcoming DSM-5 (APA, 2010), which is not without controversy (e.g., Wing, Gould, & Gillberg, 2011).
Clinicians are cautioned against merely relying on the DSM-IV-TR charts for determining diagnostic criteria for the PDDs, as the descriptions of the most differentiating features of Asperger syndrome are included within the text of the DSM-IV-TR but not within the charts.
Clinicians and researchers who have closely studied and worked with individuals with Asperger syndrome invariably view this subtype as qualitatively distinct from the other PDDs, given the verbosity, social motivation, and fixation on topics of interest in these individuals. Ironically, these same symptoms can cause the most confusion in differential diagnosis. Common misconceptions propose those with Asperger's to be individuals without cognitive impairment; individuals with higher verbal than nonverbal IQ scores; individuals who have social intent; individuals who have mild or subtle social impairments; or individuals with perseverative interests, such as Thomas the Tank Engine—confusing getting “stuck” on a character or video rather than wanting to obsessively collect details about the topic of, for instance, trains. These misconceptions can have negative implications on outcome for individuals with Asperger syndrome because they are assumed to be less impaired and more able to navigate the world without supports—which is certainly not the case for many individuals.
Common misconceptions of Asperger Syndrome include the following characteristics interpreted in isolation:
  • Individuals with ASD without cognitive impairment
  • Individuals with ASD who have higher verbal than nonverbal IQ scores
  • Individuals with ASD who have social intent and motivation to interact with others
  • Asperger Syndrome is “mild autism”
It is not one of these behaviors, in isolation, that defines Asperger syndrome, but the overall profile of behavior, including developmental history. In early childhood, the social vulnerabilities of toddlers with Asperger syndrome are often masked by their relative strengths in other areas—such as their often precocious language; fixation on numbers and letters to the point of self-reading; and bourgeoning circumscribed interests. It is typically not until these children are immersed in social settings, where the social demands far outweigh their capacity to engage, that red flags are raised.
During the school-age years, individuals with Asperger syndrome tend to have more social motivation to interact with their peers, often inserting themselves into interactions inappropriately and/or lacking the appropriate social awareness to effectively navigate an interaction. Yet, they can have just enough awareness to understand the failed nature of their attempts, placing them at great risk for anxiety, depression, and isolation. In autism, individuals tend to be more socially passive; they certainly may respond to direct interaction, often even appropriately, but they are less likely to initiate interactions with their peers. Furthermore, self-awareness in autism can be more impaired, acting as a buffer in that individuals might not be as cognizant of their failed social experiences. Nevertheless, as stressed previously, social motivation should not be interpreted in isolation when distinguishing Asperger syndrome from other PDDs.
Unlike autism, Asperger syndrome is often not detected in the first few years of life because in early childhood, the social vulnerabilities of toddlers with Asperger syndrome are often masked by their precocious language, affinity for numbers and letters, and regurgitation of facts on topics of interest. It is not until these children are immersed in social settings, such as preschool, that their true social impairments are recognized. For this reason, clinicians need to be extra vigilant in screening for social impairments in young children who have strong language and cognitive skills.
Don't Forget
Individuals with ASD, particularly those with Asperger Syndrome who tend to have a modicum of social awareness, are at great risk for mood disorders such as anxiety and depression. The...

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