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Assessing Asperger’s and High-Functioning Autism: Tips for Clinicians

Developmentally-based assessments of cognitive, communicative, and other skills provide information important for both diagnosis and program planning for kids with Asperger’s Syndrome (AS) and High-Functioning Autism (HFA). Careful documentation of a youngster’s unique strengths and weaknesses can have a major impact on the design of effective intervention programs and is particularly critical due to the fact that unusual developmental profiles are common.

Given the multiple areas of difficulty, the efforts of experts from various disciplines are often needed (e.g., audiology, neurology, pediatrics, physical and occupational therapy, psychiatry, psychology, speech and language pathology). The level of expertise required for effective diagnosis and assessment may require the services of professionals other than those usually available in a school setting.

In some cases, psychological and communication assessments can be performed by existing school staff, depending on their training and competence in working with kids with AS and HFA. However, other services (e.g., management of seizures, drug therapy, genetic testing, etc.) are managed in the health care sector. Some kids may fall between systems, and therefore not be served well.



Several principles underlie assessment of a youngster with AS or HFA:

1. A developmental perspective is important. Given the strong association of mental retardation with Autism Spectrum Disorders, it is important to view results within the context of overall developmental level.

2. Behavioral difficulties must be considered, since they affect both the youngster’s daily functioning and considerations for intervention.

3. Functional adjustment should be assessed. Results of specific assessments obtained in more highly structured situations must be viewed in the broader context of a youngster’s daily functioning and response to real-life demands. The youngster’s ability to translate skills into real world settings is particularly critical.

4. Multiple areas of functioning should be assessed, including current intellectual and communicative skills, behavioral presentation, and functional adjustment.

5. Social dysfunction is probably the most defining feature of AS and HFA, so it is important that the effect of a youngster’s social challenges on behavior be considered.

6. Variability of behavior across settings is typical. Behavior of a youngster will vary depending on such aspects of the setting as novelty, degree of structure provided, and complexity of the environment. Thus, observation of facilitating and detrimental environments is useful.

7. Variability of skills is typical, thus it is important to identify a youngster’s specific profile of strengths and weaknesses rather than simply present an overall global score. Similarly, it is important not to generalize from an isolated skill to an overall impression of general level of ability, because such skills may grossly misrepresent the youngster’s typical abilities.

Various diagnostic instruments can be used to help structure and quantify clinical observations. Information can be obtained through observation (e.g., Autism Diagnostic Observation Scale) as well as the use of various diagnostic interviews and checklists (e.g., Autism Diagnostic Interview-Revised; Childhood Autism Rating Scale; Autism Behavior Checklist; Aberrant Behavior Checklist). An adequate assessment will involve both direct observation and interviews of mothers, fathers and educators.

The range of symptoms in AS is quite broad and spans the entire range of IQ. A diagnosis can be made in a low-functioning youngster as well as in a youngster who is intellectually gifted. In addition, children with AS vary along a number of other dimensions (e.g., levels of communicative ability, degree of behavioral difficulties, etc.). As a result, in working with the youngster, considerable expertise is required. Clinicians must consider the quality of the information obtained (both in terms of reliability and validity), the involvement of mothers/fathers and educators, the need for interdisciplinary collaboration, and the implications of results for intervention. Coordination of services and facilitating discussion between members of assessment/treatment teams and mothers/fathers is critical.

A range of components must be part of a comprehensive educational evaluation of kids with AS and HFA. These include:
  • communicative assessment
  • consultation regarding aspects of motor, neuropsychological, or other areas of functioning
  • medical evaluation
  • obtaining a thorough developmental and health history
  • psychological assessment

This information is important both to diagnosis and differential diagnosis and to the development of the IEP.

The psychological assessment should establish the overall level of cognitive functioning as well as delineate a youngster’s profiles of strengths and weaknesses. This profile should include consideration of a youngster’s ability to remember, solve problems, and develop concepts. Other areas of focus in the psychological assessment include:
  • social cognition
  • play
  • motor and visual-motor skills
  • adaptive functioning

Kids with AS and HFA will usually need to be observed on several occasions during more and less structured periods.

The choice of assessment instruments is a complex one and depends on the youngster’s:
  • ability to cope with transitions in test activities
  • ability to respond to complex instructions 
  • ability to respond to social expectations
  • ability to work rapidly
  • level of verbal abilities

Kids with AS and HFA often do best when assessed with tests that require less social engagement and less verbal mediation. In addition to the formal quantitative information provided, a comprehensive psychological assessment will also provide a considerable amount of important qualitative information. It is important that the clinician be aware of the uses and limitations of standardized assessment procedures and the difficulties that these kids often have in complying with verbal instructions and social reinforcement. Operant techniques may be helpful in facilitating assessment.

Difficulties in communication are a central feature of AS and HFA, and they interact in complex ways with social deficits and restricted patterns of behavior and interests in a given child. Accurate assessment and understanding of levels of communicative functioning is important for effective program planning and intervention. Communication skills should be viewed in a broad context of the child’s development. Standardized tests constitute only one part of the assessment of communication abilities in young people with AS and HFA. The selection of appropriate assessment instruments, combined with a general understanding of these disorders, can provide important information for purposes of both diagnostic assessment and intervention.

In addition to assessing expressive language, it is critical to obtain an accurate assessment of language comprehension. The presence of oral-motor speech difficulties should be noted. In kids with AS and HFA, the range of communicative intents may be restricted in multiple respects. Delayed and immediate echolalia are both common and may have important functions. In addition, various studies have documented unusual aspects even of very early communication development in AS and HFA.

In assessing language and communication skills, parent interviews and checklists may be used, and specific assessment instruments for kids with AS and HFA have been developed. For kids under age 3, scores on standardized tests may be particularly affected by difficulties in assessment and by the need to rely on parent reports and checklists. For preverbal kids, the speech-communication assessment should include observation of a youngster’s level of awareness of communication from others, the youngster’s sense of intentionality, the means used for attempting communication, and the quality and function of such means, sociability, and play behaviors. The clinician should be particularly alert to the youngster’s capacity for symbolic behavior since this has important implications for an intervention program.

There are also several standardized instruments that provide useful information on the communication and language development of pre-verbal kids with AS and HFA. These include:
  • Mullen Scales of Early Learning
  • MacArthur Communicative Development Inventor
  • Communication and Symbolic Behavior Scales

For kids with some verbal ability, social and play behaviors are still important in terms of clinical observation but various standardized instruments are available as well, particularly when the youngster exhibits multi-word utterances. Areas to be assessed include:
  • articulation
  • expressive language and comprehension
  • morphology
  • pragmatics
  • prosody
  • receptive and expressive vocabulary
  • semantic relations
  • syntax

The choice of specific instruments for language-communication assessment will depend on the developmental levels and chronological age of the youngster. Additional observations may address aspects of topic management and conversational ability, ability to deal with non-literal language, and language flexibility. The clinician must be flexible and knowledgeable about the particular concerns related to assessment of kids with AS and HFA.

Motor abilities may represent an area of relative strength for a youngster, but as time goes on, the development of motor skills in both the gross and fine motor areas may be compromised, and motor problems are frequently seen in young kids with AS and HFA. Evaluations by occupational and physical therapists are often needed to document areas of need and in the development of an intervention program. Standardized tests of fine and gross motor development and a qualitative assessment of other aspects of sensory and motor development, performed by an expert in motor development, may be helpful in educational planning.


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

The Mark Hutten Show

If you missed this week's show, you can listen to a recording of it here: All About Autism Spectrum Disorders - Radio Show Archive

How to Have a Meltdown-Free Thanksgiving: Tips for Parents of Kids on the Spectrum

"My son with HFA does not do well with guests (and rarely seen family members) showing up at our house on Thanksgiving. Any helpful suggestions regarding how to make things run more smoothly this year?"

I'm glad you're thinking ahead. Prevention, prevention, prevention is key. If you have to intervene, it's often too late to circumvent behavioral issues.

Many parents of children with Aspergers and High-Functioning Autism (HFA) experience difficulties, both with handling the sensory overload that comes with Thanksgiving events, and with understanding the deeper meanings of this special day.

The challenges of kids with an autism spectrum disorder - and the behaviors that result - can be mysterious for those who have had little experience with them (e.g., other family members). Most of these behaviors arise from differences in the ways that these kids experience, understand and interact with the world.

Most Aspergers and HFA children find it hard to understand the social and emotional meanings of language and nonverbal behavior (e.g., words about emotions or facial expressions, tones of voice that convey emotions, etc.). They also have a harder time understanding their own feelings, and those of others.



Many kids on the autism spcctrum are easily overwhelmed by sights, sounds and touch – and even by smells and tastes. As a method of protection, these kids may shut-out sensory information by withdrawing or absorbing themselves in repetitive behaviors or idiosyncratic interests, which can interfere with learning about their surroundings and connecting with the family members who care most about them. It can be painful for parents when their special needs child “disconnects,” which motivates many of them to move mountains to help their child learn to engage in relationships with them and others.

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

Adjusting to changes in routine or to new events and experiences is often a much bigger challenge for kids on the spectrum. Lights and music and special decorations that may be magical for other kids may lead these young people to panic, scream and run out of the room, or fall on the floor and thrash about. As with other transitions, limiting changes in routine and new sensations, and introducing them very gradually whenever possible, can help these kids begin to open up to them.

The youngster's behavior is “predictably unpredictable” during transitions. Over time, moms and dads learn what to expect. They learn how to prevent or shorten the frequency of meltdowns by preparing their youngster in advance, even rehearsing small bits of the new activities. Providing protection against too much stimulation and being sure that their son or daughter has access to favored toys and activities can also often help them to relax.

Still, moms and dads are bound to be on guard at times of heightened excitement. They know they may need to drop everything to try to help their youngster pull himself together again. Brothers and sisters of the child are often on guard, too – and may even be frightened. Often, siblings feel responsible and wish that they could make everything all better. Or they may feel guilty about their desire to have a “normal” family.

Moms and dads may feel all alone and without support as they raise a youngster with Aspergers or HFA. These feelings are bound to be intensified during Thanksgiving, when the challenges are often even greater and their youngster’s differences seem to stand out more. Having relatives and friends who don’t judge – and who really care and are eager to help – can make a big difference. Yet, it may be hard for those who have not had direct contact with the youngster to imagine what it’s like for parents and siblings when communication, social interaction and sensory processing are disrupted.

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

So how can families affected by an autism spectrum disorder get together for family functions in a way that is pleasing for everyone? Here are some tips:

1. As much as possible, attempt to stick to your youngster’s normal home routine on Thanksgiving Day (even though you may be entertaining guests later that day). As you get closer to the hour when guests will be arriving, make sure to prepare your youngster in advance for what is to come.

2. These kids need structure and routine. When Thanksgiving disrupts the usual schedule, the youngster can become anxious, depressed, and agitated. Minor incidents can turn into violent and explosive displays of anger. Visiting family members can make Thanksgiving easier by understanding the youngster's disorder and by doing whatever is necessary to support the mother and father.

3. Be sure to allow your child to have access to his special interests throughout the day (e.g., favorite toy, personal DVD player, iPod, etc.) to make him more comfortable. Also, if he displays “stimming” behaviors (i.e., repetitive behaviors like opening and closing a door, snapping his fingers, rocking back and forth, etc.), explain to your guests why it’s important to allow the youngster to continue the activity. These activities may bring comfort to kids on the spectrum, and help them cope with the changes around them. If others are uncomfortable with your child’s behavior, they can excuse themselves discreetly from the room if necessary, but don’t try to force the child to stop the behavior (unless it is overly-disruptive or rude).

4. Be sure to watch your child’s intake of sweets, sugar and caffeine during Thanksgiving Day, which can trigger anxious feelings and resultant meltdowns.

5. Changes to a daily routine, good or bad, can trigger a meltdown that is way out of proportion to the cause. Even a small and seemingly insignificant incident can result in a meltdown. The youngster may not respond well to decorating the home and having extended family over for Thanksgiving dinner. Thus, moms and dads should consider keeping Thanksgiving celebrations as low-key as possible.

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


6. Focus on a few things that you know are important to make sure you have prepared around this time. Of course, some things may need modification so that it is possible to enjoy them with your youngster (e.g., if there is a danger of him hurting himself on fragile decorations, put them higher up and out of reach; some special foods may not be served; the child may need frequent time-outs from visiting family in order to de-stress).

7. Food can cause upsets and meltdowns from some HFA youngsters. If there is nothing served that your child enjoys, it can be upsetting and frustrating. Make sure to consider his diet and appetite during Thanksgiving, and don’t force him to indulge in typical Thanksgiving menus when he may not want to try new foods. This is not the time to force the youngster to eat new foods.

8. If you are stressed, your child will sense it. So stay calm and relax as much as possible so that you can enjoy yourself – and decrease your youngster’s anxiety.

9. In the days leading up to Thanksgiving, use role-play and rehearsal to let your youngster practice and learn how to deal with the upcoming social situations.

10. Lower your expectations of what you can really do. In this way, what you do will be less stressful and make Thanksgiving special.




11. Make the demands on yourself realistic, and don't try to do so much that you feel only frustration. Make realistic lists and work on things one at a time. Looking at Thanksgiving Day is less overwhelming if you take it in small pieces.

12. Many kids on the spectrum are sensitive to certain smells. If this is the case with your child, and you are visiting in another family member’s home, let them know ahead of time. Unscented products are usually preferable. These children may react negatively to candles and other smells. Be aware of what triggers problems for your youngster, and try to avoid them rather than handle them after an incident occurs.

13. Noise is a major problem for some of these kids. Minimize noise and allow your child to wear earplugs or use his iPod during large family gatherings if necessary. Keep music low, and avoid over-crowded rooms of people talking. Find a peaceful place for your child to go when the crowd grows and noise is high (e.g., a quiet bedroom, sunroom, dad’s office, etc.). A short rest with a snuggly blanket and quiet time can work wonders.

14. Take pictures of the family gathering and work with your youngster to make a book of pictures that can help him remember the things that you did. This can be used to prepare him for next year’s Thanksgiving celebration.

15. Watch for signs of over-stimulation before they escalate.


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

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

==> 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



Best Comment:
 
Really spot on advice. Holidays, large groups & any new stress is really tough for my son (& then for his sister who gets upset when he has a meltdown). Easy enough for us to understand the suggestions but how do you help extended family to understand that you're only trying to do the best you can for your child & not trying to make dinners & get togethers difficult. I've tried in the past to bring it up but it hasn't gone over well & has caused more of an issue. It can feel so isolating at those times. Lack of understanding makes an already tough time of year for him into a really hard time.

My child has been rejected by his peers, ridiculed and bullied !!!

Social rejection has devastating effects in many areas of functioning. Because the ASD child tends to internalize how others treat him, rejection damages self-esteem and often causes anxiety and depression. As the child feels worse about himself and becomes more anxious and depressed – he performs worse, socially and intellectually.

Click here to read the full article…

How to Prevent Meltdowns in Children on the Spectrum

Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it starts, the Asperger's or HFA child is totally out-of-control. When it ends, both you and your child are totally exhausted. But... don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day -- and sometimes into the next - the meltdown can return in full force.

Click here for the full article...

Parenting Defiant Teens on the Spectrum

Although Aspergers [high-functioning autism] is at the milder end of the autism spectrum, the challenges parents face when disciplining a teenager on the spectrum are more difficult than they would be with an average teen. Complicated by defiant behavior, the teen is at risk for even greater difficulties on multiple levels – unless the parents’ disciplinary techniques are tailored to their child's special needs.

Click here to read the full article…

Older Teens and Young Adult Children with ASD Still Living At Home

Your older teenager or young “adult child” isn’t sure what to do, and he is asking you for money every few days. How do you cut the purse strings and teach him to be independent? Parents of teens with ASD face many problems that other parents do not. Time is running out for teaching their adolescent how to become an independent adult. As one mother put it, "There's so little time, yet so much left to do."

Click here to read the full article…

Parenting Children and Teens with High-Functioning Autism

Two traits often found in kids with High-Functioning Autism are “mind-blindness” (i.e., the inability to predict the beliefs and intentions of others) and “alexithymia” (i.e., the inability to identify and interpret emotional signals in others). These two traits reduce the youngster’s ability to empathize with peers. As a result, he or she may be perceived by adults and other children as selfish, insensitive and uncaring.

Click here
to read the full article...

Highly Effective Research-Based Parenting Strategies for Children with Asperger's and HFA

Become an expert in helping your child cope with his or her “out-of-control” emotions, inability to make and keep friends, stress, anger, thinking errors, and resistance to change.

Click here for the full article...

My Aspergers Child - Syndicated Content