Screening and Diagnosis of ASD

ASD is an abbreviation for autism spectrum disorder. Since May 2013, the DSM-5 (Diagnostic and Statistical Manual) uses the term ASD which was previously part of the family of Pervasive Developmental Disorders (PDD) – Asperger Syndrome, autism and Pervasive Development Disorder Not Otherwise Specified. However, children now are on a continuum of ASD, instead of subcategories of PDD.

How do you know if a child has ASD?
Every child is different and signs observed will vary from one child to another.
However, there are some common aspects such as:
o Language and communication difficulties
o Impaired social interactions
o Repetitive behaviors and restricted interests
o Sensory issues

In some children, signs emerge at a very young age. Smiling in infancy may not happen. Eye contact isn’t regulated during social interactions, or decreased in terms of quality. Often, the child doesn’t turn when his name is called, or doesn’t follow conversations that are started with him. He has little interest in sharing what he sees; his wants and interests aren’t mutually shared with others. He may continue to use his name first rather than the pronoun “I” or repeat phrases heard (echolalia).

The child has difficulty understanding emotions (will laugh when someone is angry). Also, the child may have little variation in facial expression. Children may not point. In addition, the child may not use various gestures when speaking (e.g. yes and no, greeting with the hand, shrugging etc.).

Children with ASD may be interested in taking, placing, rotating and aligning objects. They may prefer to engage in repetitive play instead of interacting with others. Some accumulate knowledge on specific subjects (i.e. dinosaurs).

Particular physical movements can be observed: hand flapping, shaking an object in front of their eyes, jumping on the spot, turning around in circles, going in and out of a room etc.

At the sensory level, children may tolerate white noise (food processor, vacuum) and plug their ears. Other can’t tolerate some textures of foods, or the feel of
certain clothing.

Anxiety is often present in children with ASD. It often occurs when there is a change, unforeseen or new. These children tend to want control, isolate, or engage in rituals or repetitive movements that help them reduce this anxiety.

What are the steps to get an assessment for a child with a suspected ASD?
The way to start an evaluation, available to the public, is through the CLSC. The child is then directed to an assessment clinic (hospital), where a multidisciplinary team performs an evaluation. The team consists of a physician, occupational therapist, a psychologist, a speech therapist etc. However, for the past few years, psychologists are the only professionals who can give an ASD diagnosis in Quebec.

It is preferable that this diagnosis is given through collaboration with other professionals, but the current College of Physicians guidelines don’t require it at the moment. What is important is to turn to a qualified and experienced professional for children with ASD who will be able to differentiate diagnoses (e.g. an anxious child with a language disorder might look like a child with ASD). To assess ASD, the appropriate psychometric tools are the ADI-R (Autism Diagnostic Interview-Revised) and ADOS (Autism Diagnostic Observation Schedule). The ADI-R is a structured interview with the parents, completed over a period of about 3 hours while the ADOS is a test done with the child often in the presence of the parent. During the ADOS assessment, the examiner assesses the child’s ability to respond to his name or smile socially, make eye contact, understanding emotions, engage in symbolic play, converse, use gestures to communicate etc. In addition, it’s equally important to consider observations made in the child’s environment (e.g. school, daycare) as well as reports previously written by other professionals (e.g. occupational therapist, speech therapist etc.).