Comprehensive Assessment for Asperger’s and High-Functioning Autism

"How does one go about getting their child assessed for an autism spectrum disorder, and what is involved in the assessment? We have our suspicions and are thinking we should have our son tested."

A diagnosis of an autism spectrum disorder can be given by a psychologist, a child psychiatrist, a developmental pediatrician, or a child neurologist. Asperger’s and High Functioning Autism (HFA) involve delays and deviant patterns of behavior in multiple areas of functioning that often require the input of specialists with different areas of expertise, particularly overall developmental functioning, neuropsychological features, and behavioral status. Thus, the clinical assessment of children with Asperger’s and HFA is most effectively conducted by an experienced interdisciplinary team.

Let’s look at a few important points that should be made clear before we discuss the various areas of assessment…

First, most children with Asperger’s and HFA have average- to above average- levels of Full Scale IQ. As a result, they are often not thought of as in need for special programming. All too often, people view the “special needs” child as a person who is simply experiencing difficulties in behavior, social interaction, or in peer relationships. This is a true down-play of what is really going on. Asperger’s and HFA is a serious and debilitating developmental disorder impairing the child's capacity for socialization. It is NOT a transient or mild condition. Moms and dads need to be aware of the current lack of knowledge about Asperger’s and HFA, and the common confusions of use and abuse of the disorder currently prevailing in today's society.

Second, given the complexity of the disorder, the importance of developmental history, and the common difficulties in securing adequate services for kids on the autism spectrum, it is very important that moms and dads observe and participate in the assessment.

Third, assessment findings should be translated into a single, coherent view of the child (i.e., easily understood, detailed and concrete – with realistic recommendations). When writing their reports, specialists should strive to express the implications of their findings to the child's day-to-day adaptation, learning, and vocational training.

In the majority of cases, a comprehensive assessment will involve the following components: psychological assessment, neuropsychological assessment, psychiatric examination, history, and communication assessment.

Psychological Assessment—

This component attempts to establish the overall level of intellectual functioning, profiles of strengths and weaknesses, and style of learning. The specific areas to be examined and measured include:

• academic achievement
• adaptive functioning (e.g., degree of self-sufficiency in real-life situations)
• neuropsychological functioning (e.g., problem-solving, concept formation, visual-perceptual skills, motor and psychomotor skills, memory, executive functions)
• personality assessment (e.g., mood presentation, common preoccupations, compensatory strategies of adaptation)

Neuropsychological Assessment—

The neuropsychological assessment of children with Asperger’s and HFA involves certain procedures of specific interest. Whether or not a Verbal-Performance IQ discrepancy is obtained in intelligence testing, it is advisable to conduct a fairly comprehensive neuropsychological assessment including:

• concept formation (both verbal and nonverbal)
• executive functions 
• facial recognition
• gestalt perception
• measures of motor skills (e.g., coordination of the large muscles, manipulative skills, visual-motor coordination, visual-perceptual skills)
• parts-whole relationships
• spatial orientation
• visual memory

A recommended protocol would include the measures used in the assessment of children with Nonverbal Learning Disabilities. Particular attention should be given to demonstrated or potential compensatory strategies (e.g., children with significant visual-spatial deficits may translate the task or mediate their responses by means of verbal strategies or verbal guidance, which may be important for educational programming).

Psychiatric Examination—

The psychiatric examination should include observations of the child during more and less structured periods (e.g., while interacting with the mother or father, while engaged in assessment by other members of the evaluation team). Specific areas for observation and inquiry include:

• ability to intuit other's feelings
• ability to infer other's intentions and beliefs
• capacities for self-awareness
• development of peer relationships and friendships
• level of insight into social and behavioral problems
• patterns of special interest and leisure time
• perspective-taking
• quality of attachment to family members
• social and affective presentation
• typical reactions in novel situations

Problem behaviors that are likely to interfere with remedial programming should be noted (e.g., marked aggression). The child's ability to understand ambiguous nonliteral communications (e.g., teasing and sarcasm) should be examined, because misunderstandings of such communications may elicit aggressive behaviors. Other areas of observation involve:

• anxiety
• coherence of thought
• depression
• panic attacks
• presence of obsessions or compulsions

History—

A careful history should be obtained (e.g., information related to pregnancy and neonatal period, early development and characteristics of development, medical and family history). A review of previous records including previous evaluations should be performed. Also, several other specific areas should be directly examined because of their importance in the diagnosis of Asperger’s and HFA, including:

• areas of special interest (e.g., favorite occupations, unusual skills, collections)
• development of friendships
• development of motor skills
• emotional development
• history of onset/recognition of the problems
• language patterns
• mood presentation
• past and present problems in social interaction
• patterns of attachment of family members
• self-concept
• social development

Communication Assessment—

The communication assessment attempts to obtain both quantitative and qualitative information regarding the various aspects of the child's communication skills. It should go beyond the testing of speech and formal language (e.g., vocabulary, articulation, sentence construction, comprehension), which are often areas of strength. The assessment should examine:

• content, coherence, and contingency of conversation
• nonliteral language (e.g., humor, metaphor, irony, absurdities)
• nonverbal forms of communication (e.g., gestures, gaze)
• pragmatics (e.g., adherence to typical rules of conversation, turn-taking, sensitivity to cues provided by the speaker)
• prosody of speech (e.g., pitch, melody, volume, stress)

Asperger’s can be diagnosed through several different assessment tools, most of which are targeted toward kids and young adults (e.g., Australian Scale for Asperger's Syndrome, Asperger's Syndrome Diagnostic Scale, Childhood Autism Spectrum Test, Adult Asperger Assessment). Asperger's assessment tests are performed in conjunction with behavioral evaluations and analysis of intake information provided by moms and dads, educators, and the child himself or herself. These assessments help to ensure accuracy in diagnosing Asperger's so that future treatments and accommodations can be implemented.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book


==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism
  

COMMENTS:

•    Anonymous said... Getting through a school day without upset at kids teasing......Good day today.

•    Anonymous said... I am new to this site and grateful for it

•    Anonymous said... I ended up going to our Minister of Education to get help for my son as he is well above average in schooling, but because of his behaviour he was close to being suspended and the RBLT said she could not put anything in place as he didn't need it. The Minister got something's put in place, but we ended up changing schools and the RBLT at that school put in a socializing programme for him to teach him how to play with kids, and this was everyday during class time. What a difference it made, he was actually able to be in the playground at breaks.

•    Anonymous said... Just having this epiphany myself this week. I've felt inappropriate thinking of my asperger son as special needs as his physical and intellectual abilities are fine. But when I found myself celebrating with his teacher that my 11 year old was sitting in a chair and doing his schoolwork... I was like yeah, duh, that's kinda special needs.

•    Anonymous said... my 18 year old who has been attending a wonderful exclusionary school for his needs that are increasingly aspergers believes he needs to curse to get past his anger. I don't allow cursing. he wont consider other options also he persevered when he's agitated and that's when I tend to lose my cool. I practice disengagement but fear he feels abandoned and since he's adopted I might be inadvertently hurting him. any thoughts? thank you hope im not out of order here

•    Anonymous said... My son is 3 with aspergers. And too is swearing, we have got most of the bad words out of his temper swearing. Now he only goes too bullshit+t. He says this when angry happy, even today he changed his name to Gordon bullshit+t. For a couple of hours and when I wouldn't say it. He got angry at me for not saying his new name. Its just a dealing mechanism. I also have asperges, and when I am really anxious, or very angry and defensive, I have a truckers mouth as well. Its just all about love and acceptence. He may acknowledge that you don't like it, but it also could be a eternal comfort for his brain too.

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