1. Autism Spectrum Disorders
Assessment and Diagnosis
David A. Townsend, Ph.D.

2. What is Autism?
• “According to the DSM-IV, autistic disorder is
one of several pervasive developmental
disorders (PDDs) that are caused by a
dysfunction of the central nervous system
leading to disordered development. All children
with PDD are characterized by qualitative
impairments in social interaction, imaginative
activity, and both verbal and nonverbal
communication skills”
(Kabot et. al., 2003, p. 26)
2

3. Pervasive Developmental
Disorders (PDD)
– Most commonly diagnosed
• Autism falls under the PDD
umbrella of PDD – Impairs ability to
communicate, form
• Neurological disorder: relationships, and interact
with others
“severe and pervasive – Results in a range of
impairment in multiple unusual and repetitive
behaviors
areas of development – Typically diagnosed by age
3 or 4 years
– Frequently accompanied by
mental retardation
– Sometimes, uneven levels
of intelligence
(Masland, 2005)

4. Pervasive Developmental Disorders
or ‘Autism Spectrum Disorders’
1997-2004 ASD
Aspergers (reported on IDEA)
increased 471% in
Kansas
Autism RETTS
Retts
PDD
CDD
NOS CDD

5. History of Autism
• Leo Kanner 1943
• Isolated from environment
• Cold, Aloof Parent
• Definitional Parameters have been
consistent:
– Problems in Socialization
– Problems in Language
– Ritualistic Behavior and interests

6. Changes in Conceptualization
• Biological Environmental
• Developmental Psychiatric Disorder
• Spectrum Specific Disorder
• Early Late Detection

7. History of Autism
• Changes in Definition:
• DSM III Formally defined (1980)
• DSM III R “Menu” of characteristics (8)
• DSM IV PDD Spectrum (6 characteristics)

8. Pervasive Developmental
Disorders
• Autism
• Rett’s
• Childhood Disintegration Disorder
• Asperger’s
• Pervasive Developmental Disorder- NOS

9. DSM-IV Criteria for Autistic Disorder
Diagnostic and Statistical Manual of Mental Disorders, 4th edition,
1994, Washington, DC: American Psychiatric Association, pp. 70-
71.
A. A total of at least six items from (1), (2), and (3), with
at least two from (1), and one each from (2) and (3):
(1) Qualitative impairment in social interaction, as
manifested by at least two of the following:
(a) Marked impairment in the use of multiple
nonverbal behaviors such as eye-to-eye gaze,
facial expression, body postures, and gestures to
regulate social interaction;
(b) Failure to develop peer relationships
appropriate to developmental level;
(c) Markedly impaired expression of pleasure in
other people’s happiness;
(d) Lack of social or emotional reciprocity.

10. DSM-IV Criteria for Autistic Disorder
(2) Qualitative impairments in communication as
manifested by at least one of the following:
(a) Delay in, or total lack of, the development of
spoken language (not accompanied by an attempt
to compensate through alternative modes of
communication such as gestures or mime);
(b) In individuals with adequate speech, marked
impairment in the ability to initiate or sustain a
conversation with others;
(c) Stereotyped and repetitive use of language or
idiosyncratic language;
(d) Lack of varied spontaneous make-believe play or
social imitative play appropriate to
developmental level.

11. DSM-IV Criteria for Autistic Disorder
(3) Restricted repetitive and stereotyped patterns of
behavior, interests, and activities, as manifested by at
least one of the following:
(a) Encompassing preoccupation with one or more
stereotyped and restricted patterns of interest that
is abnormal either in intensity or focus;
(b) Apparently compulsive adherence to specific
nonfunctional routines or rituals;
(c) Stereotyped and repetitive motor mannerisms
(e.g. hand or finger flapping or twisting, or
complex whole-body movements);
(d) Persistent preoccupation with parts of objects.

12. DSM-IV Criteria for Autistic Disorder
B. Delays or abnormal functioning in at least one of the
following areas, with onset prior to age 3 years; (1)
social interaction, (2) language as used in social
communication, or (3) symbolic or imaginative play.
C. Not better accounted for by Rett’s Disorder of
Childhood Disintegrative Disorder.

13. Defining Features
• Qualitative Impairment
in Communication
• Qualitative Impairment
in Social Interaction
• Restricted, repetitive,
and stereotyped Neurological disorders
characterized by
patterns of behavior "severe and pervasive
impairment in several
Imitation Deficit (DSM V?) areas of development

14. Rett’s Disorder
• Is a genetic condition affecting only females in
which normal brain development simply stops.
• Its rare-affecting only 1 in every 15,000 children.
• Growth & development appear normal until 5
mos. of age, when the head growth appears to
slow through about 48 mos. of age.
• Overall kids with Rett’s disorder have similar
social & mental impairments of autistic disorder,
but are much worse & more significantly
impaired.

15. Childhood Disintegrative
Disorder
• A very rare PDD occurring in one in 100,000 children in
which.
• Is striking because it emerges after an extended period
of typical development which often lasts for several
years.
• There is a marked regression in language skills,
communication, social interactions, play, & motor
behaviors.
• Decline may occur over several weeks to several
months.
• In as many as 75% of the reported cases, the
developmental deterioration was dramatic with little
recovery of lost abilities.

16. Asperger’s Disorder
• In 1944, Dr. Hans
• *intense, but very narrow Asperger described a
interests. group of 4 children ages
6-11 with typical
• *speech that was unrelated communication &
to the conversation’s topic cognitive skills, but who
had significant problems
• *interest in letters & number’s with social interactions.
at a very young age.
• Several symptoms were
• *poor empathy. observed from these
• *clumsiness children.
• *difficulty controlling volume
of voice when speaking
• *trouble adjusting to school.

17. How is Asperger’s Disorder different
from Autistic Disorder?
• 1. Children with Asperger’s don’t have the
same level of communication problems that
kids with autistic disorder do. Nearly all kids
with Asperger’s develop speech & language
skills roughly when typical children do.
• 2. Aren’t diagnosed until much later than kids
with autistic disorder, since speech isn’t
usually delayed.

18. How is Asperger’s Disorder different
from Autistic Disorder?
•3. Children with Asperger’s usually don’t score in
range of mental retardation compared with many
autistic kids who do.
• 4. Kids with Asperger’s have verbal abilities
(vocabulary, facts) that are generally better than
their non-verbal abilities. This is the reverse for
kids with Autistic Disorder.
• 5. Socially, kids with Asperger’s have interest in
other people, compared with the solitary
existence of most kids with autistic disorder.

19. Symptoms of Asperger’s Disorder
• *intense, but very narrow interests.
• *speech that was unrelated to the
conversation’s topic
• *interest in letters & number’s at a
very young age.
• *poor empathy.
• *clumsiness
• *difficulty controlling volume of voice
when speaking
• *trouble adjusting to school.

20. PDD-NOS
Pervasive Developmental Disorder –Not Otherwise
Specified
• Prevalence: 1 in 500 children
• Is an autistic spectrum disorder in which some of Known as atypical
the symptoms of autism are present, but not the autism
four traditional required to fit into one of the other
four categories (autistic disorder, Asperger’s Diagnosis given to
disorder, Rett’s Disorder, Childhood children with some
Disintegrative Disorder). symptoms of
autism but who do
• Fits children with a unique mixture of symptoms not meet specific
that fall under the PDD umbrella, but don’t diagnostic criteria
specifically fit into one of the four distinct
diagnoses discussed above. In many cases, these
children are later
confirmed to have
• The heterogeneity of symptoms among children an identifiable
with PDD: NOS & its similarity to other PDD’s has disorder
made it difficult for parents to get clear (Masland, 2005)
information about their child’s condition or a
diagnosis for their child.

21. Onset of disorder
• Autism begins in infancy or early childhood. It
is generally believed to be a lifelong disorder
that a child is born with.
• Although parents may get a firm diagnosis by
36 mos., it is usually common for such a
diagnosis to occur later.

22. Autism Assessment Tools
• Childhood Autism Rating Scale (CARS)
• Autism Diagnostic Interview – Revised
(ADI-R)
• Autism Diagnostic Observation Schedule –
Generic (ADOS-G)
• Checklist for Autism in Toddlers (CHAT)
• Screening Tool for Autism in Two-Year-
Olds (STAT)
• Autism Behavior Checklist (ABC)
• E-1 and E-2 scales by Rimland
• Detection of Autism by Infant Sociability
Interview (DAISI)
• Vineland Adaptive Behavior Scales
(VABS)

23. Autism Behavior Checklist
(ABC)
• The Autism Behavior Checklist (ABC) is a list of questions about a child's
behaviors.
• The ABC was published in 1980 (Krug et al., 1980) and is part of a broader
tool, the Autism Screening Instrument for Educational Planning (ASIEP)
(Krug et al., 1978).
• The ABC is designed to be completed independently by a parent or a
teacher familiar with the child who then returns it to a trained professional
for scoring and interpretation.
• Although it is primarily designed to identify children with autism within a
population of school-age children with severe disabilities, the ABC has
been used with children as young as 3 years of age.

24. ABC
• The ABC has 57 questions divided into
five categories: (1) sensory, (2) relating,
(3) body and object use, (4) language, and
(5) social and self-help
• The ABC appears to have limited usefulness in identifying children
with autism who are under the age of 3. [A]
• When used in conjunction with other diagnostic instruments and
methods, the ABC may have some usefulness as a symptom
inventory to be completed by parents or teachers. Clinicians could
utilize this inventory in structuring their evaluation

25. ABC (Krug et al.,
1978)

26. Checklist for Autism in
Toddlers (CHAT)
• The Checklist for Autism in Toddlers (CHAT) is a brief screening instrument
that is intended to detect possible autism in toddlers. Since it is a screening
test, the CHAT provides a first level of evaluation leading to a yes/no
decision that, at the current time, autism is either unlikely or is possible (and
requires further evaluation). The CHAT was published in 1992 (Baron-
Cohen, et. al., 1992).
• The CHAT takes only about five to ten minutes to administer and score.
• Specific training is not required, and it can be administered by a variety of
individuals. The CHAT is designed to be used with toddlers as young as 18
months of age.
• The CHAT consists of nine yes/no questions to be answered by the child's
parent.
• These questions ask if the child exhibits specific behaviors, including: social
play, social interest in other children, pretend play, joint attention, pointing to
ask for something, pointing to indicate interest in something, rough and
tumble play, motor development, and functional play. The CHAT also
includes observations of five brief interactions between the child and the
examiner, which enable the clinician to compare the child's actual behavior
with the parental reports.

27. CHAT
• Checklist for Autism in Toddlers
• “most well known screening test for identifying
ASD in young children” (Kabot et. al., 2003, p. 28)
• If CHAT suggests autism, an in-depth
assessment is recommended; if it does not,
further evaluations are recommended. (Kabot et. al.,
2003)
• “used to help identify the early signs of autism at
18 months by assessing the child’s attainment of
developmental milestones” (Robins et. al., 2001, p. 133)
27

29. CHAT
Checklist for Autism in Toddlers
18-month visit
9 Parent Questions/5 physician Observations
5 Key Items
1. Parent: “Enjoy playing peek-a-boo?” - joint attention
2. Parent: “Use his/her index finger to point, to ASK for
something?) protoimperative pointing
3. Physician : “Oh look (point), there’s a (toy).” - following
a point
4. Physician: “Can you pour a glass of water?”–
pretending
5. Physician: “Where’s the light?” - producing a point

30. M-CHAT
• Modified Checklist for Autism in Toddlers
• “a 23-item parent-report checklist, examining
children’s developmental milestones” (Robins et. al.,
2001, p. 140)
• “a simple screen that can be given to all children
during pediatric visits” (p.133)
• “does not rely on the physician’s observation of
the child, but on parents’ report of current skills
and behaviors” (p. 133)
• “solely for the purpose of initial screening” (p. 141)
30

32. STAT
• Screening Tool for Autism in Two-Year-Olds
• “designed for use by professionals involved in
early identification and intervention”
• “relatively brief interactive measure that can be
used to identify children in need of more
extensive follow-up” (p. 29)
• “differs from the CHAT in that it was developed
as a second-stage screening instrument to
differentiate children with autism from children
with other developmental disorders”
32

33. Diagnosing Autism
• several tests have been developed that
are now used in diagnosing autism
– CARS rating system (Childhood Autism
Rating Scale)
– The Checklist for Autism in Toddlers (CHAT)
– The Autism Screening Questionnaire
– The Screening Test for Autism in Two-Year
Olds
33

34. Diagnosis
Diagnosis :
• Out of 1,300 families surveyed:
– The average age of diagnosis of autism was 6 years of age,
despite the fact that most parents felt something was wrong
by 18 months of age
– Less than 10% of children were diagnosed at initial
presentation
– 10% were either told to return if their worries persisted, or
that their child "would grow out of it"
– The rest were referred to another professional (at a mean
age of 40 months); of which:
• 40% were given a formal diagnosis
• 25% were told "not to worry"
• 25% were referred to a third or fourth professional

35. Autism Diagnostic Observation Schedule
(ADOS; ) Lord et al., 1989
• The Autism Diagnostic Observation Schedule (ADOS;
Lord et al., 1989)
• consists of eight tasks, four focusing on social behaviors
and four on communicative behaviors.
• The test was intended primarily for older, higher-
functioning, verbal autistic children.

36. ADOS
• Purpose: Allows you to • Format: Standardized
accurately assess and behavioral observation and
diagnose autism and coding
pervasive developmental • Score: Cutoff scores for
disorder across ages, both a narrow diagnosis of
developmental levels, and autism and a broader
language skills diagnosis of pervasive
• Ages / Grade: Toddlers to developmental disorder
adults
• Administration Time: 35
to 40 minutes

37. ADOS-G
• Autism Diagnostic Observation Schedule-
Generic
• “semistructured assessment of play, interaction,
and social communication” (Kabot et. al., 2003)
• requires “extensive training of clinicians before it
can be administered”
• “four modules that match age and
communication levels of individuals from
childhood to adulthood”
37

38. The Pre-Lingusistic Autism
Diagnostic Obesvation Schedule
(PL-ADOS)
• Semistructered assessment of:
– Play
– Interaction
– Social Communication
• Behaviors observed in a limited time
period in a clinical setting
• Less inclusive than CARS, ADI-R (Lord 95)

39. PL-ADOS
• The Pre-Linguistic Autism The PL-ADOS may be useful
Diagnostic Observation as part of a multidisciplinary
Schedule (ADOS; Lord et al., intake assessment in
1989) is a semistructured diagnosing young children
observation scale modified to with possible autism. [C]
diagnose young children Since extensive training is
(under the age of 6 years) who needed to learn how to
are not yet using phrase administer the PL-ADOS, it
speech and are suspected of may not be a practical
having autism. The PL-ADOS assessment method in
consists of eight tasks, four certain clinical situations.
focusing on social behaviors
and four on communicative
behaviors. It takes
approximately 30 minutes to
administer and it is a semi-
structured assessment of play,
interaction, and social
communication.

40. Childhood Autism Rating
Scale (CARS)
• The Childhood Autism Rating Scale
(CARS) is the most widely used
standardized instrument specifically
designed to aid in the diagnosis of autism
for use with children as young as 2 years
of age.
• Published in 1980 (Schopler et al., 1980),
the CARS was originally correlated to the
DSM-III and then to the DSM-III-R.
• The CARS is intended to be a direct
observational tool used by a trained
clinician. It takes about 20-30 minutes to
administer.

41. CARS
• The CARS may be useful as part of the assessment
• The 15 items of the CARS of children with possible autism in a variety of
include: settings: early intervention programs, preschool
developmental programs, and developmental
• Relationships with People, Imitation, diagnostic centers.
• Among the autism assessment instruments
• Affect, Use of Body, reviewed, the CARS appears to possess an
• Relation to Non-human Objects, acceptable combination of practicality and research
support, despite the limited research on its use in
• Adaptation to Environmental Change, children under 3 years of age.
• Visual Responsiveness, •
• It is very important that professionals using the
• Auditory Responsiveness, CARS have experience in assessing children with
• Near Receptor Responsiveness, autism and have adequate training in administering
and interpreting the CARS. [D1]
• Anxiety Reaction,
• Verbal Communication, • An autism assessment instrument that is practical,
is supported by research, and includes a severity
• Nonverbal Communication, rating (such as the CARS) may be useful for
collecting consistent information to assist with
• Activity Level, Intellectual estimating the prevalence of autism and assess
• Functioning, and the clinician's general functional outcomes (especially if tied to other
information about interventions and service delivery)
impression.

42. Autism Diagnostic Interview -
Revised (ADI-R)
• The Autism Diagnostic Interview-Revised
(ADI-R) is a semi-structured interview for a
clinician to use with the child's parent or
principal caregiver.
• The original version of this test, the Autism
Diagnostic Interview (ADI) was published in
1989 (LeCouteur et al., 1989) and was
correlated to the ICD-10 definition of autism.
• The original ADI was intended primarily for
research purposes, providing behavioral
assessment for subjects with a chronological
age of at least five years and a mental age of
at least two years

43. ADI-R
• The ADI-R may be useful as part
• the ADI-R takes from 11/2 to 2 of a multidisciplinary intake
hours to administer and can be assessment in diagnosing young
used with children as young as children with possible autism.
two years of age (with a mental • Because of the time needed to
age greater than 18 months). administer the ADI-R, and the
extensive training needed, this
test may not be a practical
• The ADI and the ADI-R focus assessment method in all clinical
on getting maximal information situations.
from the parent about the three • A structured parent interview,
key areas defining autism: such as the ADI-R, is a method
(1) reciprocal social interaction; that can help maximize parental
– (2) communication and recall but is not a substitute for
language; and direct observation of the child by a
– (3) repetitive, stereotyped professional assessing the child.
behaviors. Therefore, it is important to
supplement structured parent
interviews with direct observation
of the child.

44. ADR-I
• Purpose: Useful for • Administration Time: 1
diagnosing autism, 1/2 to 2 1/2 hours,
planning treatment, and including scoring
distinguishing autism from • Format: Standardized
other developmental interview and response
disorders coding
• Ages / Grade: Children
and adults with a mental
age above 2.0 years

45. ADI-R
• Autism Diagnostic Interview – Revised
• “has demonstrated good sensitivity and
specificity in validity testing” (Kabot et. al., 2003)
• “require[s] extensive time and training to
administer”
• “may be most useful as part of a more in-depth
assessment in children for whom screening tests
suggest a fairly high level of concern for autism”
45

46. Social Communication Questionnaire
(SCQ)
• Purpose: Offers a quick, • Format: Parent
easy, and inexpensive way questionnaire with 40 yes
-
to routinely screen for or n items. Current and
- o
autism spectrum disorders Lifetime Forms
• Ages / Grade: Over 4.0 • Scores: Total score with
years, with a mental age cutoff points
over 2.0 years
• Administration Time:
Less than 10 minutes

47. Retrospective Video Analysis
• “families in increasing numbers have home
videos which inadvertently provide
documentation of their children’s development”
(Baranek)
• “an excellent option for accessing very early
periods in development – months or years
before a child with autism is diagnosed” (
• “methodological problems…(e.g. difficulty
controlling variables such as the age of subjects
and length, content, or structure of the video
segments)” can be controlled
47

48. Features Distinguishing Autism Based
on Home Videotapes at 12 months
• Pointing
• Showing
• Looking at Others
• Orienting to Name
Only the latter two distinguished children with
autism from children with developmental delays.
(Osterling & Dawson, 1994; 1999)

49. Who should diagnose autism?
• Although educators, parents, and other health care professionals
identify signs and symptoms characteristic of autism, a clinician
experienced in the diagnosis and treatment of autism is usually
necessary for accurate and appropriate diagnosis.
• Clinicians must rely on their clinical judgment, aided by guides to
diagnosis, such as DSM-IV and the Tenth Edition of the International
Classification of Diseases (ICD-10), as well as by the results of
various assessment instruments, rating scales, and checklists.
• These instruments and criteria should be used by practitioners not
as experienced in the diagnosis of autism.

50. PDD Behavior Inventory™ (PDDBI™)
Ira L. Cohen, PhD, Vicki Sudhalter, PhD
• Purpose: Assess responsiveness to intervention
in children with a pervasive developmental
disorder in ages 1.6-12.5 years
• Age Range: Preschool
Child
Admin: Rating Forms completed by informant
(e.g., parent, teacher, caregiver); Individual or
groupTime:30-45 minutes for Extended Forms;
20-30 minutes for Standard Forms

51. 51

52. 52

53. Early Indicators: 0-6 mos.
Typically Developing Child Autistic Child
• Head turns when name • Does not respond to
is called social cues without
• Matches the direction of repeated prompting
a mom’s head turn to • Displays minimal
the visible target affective responses
• Starts to develop joint • More passive, quieter
attention • May lag behind in
• Attends to affective motor skills
displays of others (Zwaigenbaum, 2005; Dawson
et. al., 2004; Werner et. al.,
• Responds to emotions 2000)
53

54. Conjunctive Reinforcement
(Dunst et al. 06)

55. Early Indicators: 7-12 mos.
Typically Developing Child Autistic Child
• Succeeds at joint • Greater incidence of
attention unusual posturing
• Seeks emotional • Needs more prompts
to respond to name
information from adult
faces when presented • Mouthing of objects
with uncertainty (social • Social touch aversion
referencing) (Zwaigenbaum et. al., 2005;
Dawson et. al., 2004; Werner et.
al., 2000; Baranek, 1999)
55

56. Early Indicators: 7-12 mos.
Typically Developing Autistic Child
Child • Pays little attention to
• Elementary vocal distress of others
communication • Lacks of social smiling
and appropriate facial
• Early social imitation
expressions
skills
• Unstable attention
(Zwaigenbaum et. al., 2005;
Dawson et. al., 2004; Werner et.
al., 2000; Baranek, 1999) 56

57. The Transitivity of Preconditioned Infantile Memories During Deferred Imitation
Deferred Imitation:
Demonstration:
• model a sequence of
three target actions
• 24-h imitation test:
1) remove the mitten
2) shake the mitten
3) attempt to replace
the mitten

58. Deferred Imitation:
100
*
80
Latency (s)
60
40
20
0
C/A D/A A/C
Demo/Test Group

59. Early Indicators: 13-24 mos.
Typically Developing Autistic Child
Child • Minimal responses to
• Exhibits joint attention others (lack of
empathy)
• Engages in social
• Does not exhibit
relations
pretend play
(Dawson et. al., 2004; Kabot et.
al., 2003; Robins et. al., 2001;
Charman et. al., 1997)
59

60. Early Indicators: 13-24 mos.
Typically Developing Autistic Child
Child • Impaired joint
• Communicates, both attention
receptively and • Less gazing at people
expressively • Absence of pre-
• Shows greater linguistic functions
(i.e. declarative
incidences of pretend pointing, showing
play objects)
(Dawson et. al., 2004; Kabot et.
60
al., 2003; Robins et. al., 2001;
Charman et. al., 1997)

61. Early Indicators: 13-24 mos.
Red Flags: Significant differences between the
ASD and Delayed Development (DD) groups
and the ASD and Typical Development (TD)
groups
• Lack of showing
• Unusual prosody
• Repetitive movements or posturing of body,
arms, hands, or fingers
• Repetitive movements with objects
(Wetherby et. al., 2004)
61

62. Early Indicators: 13-24 mos.
Red Flags: Significant differences between the
ASD and TD groups, not the ASD and DD
groups
• Lack of response to contextual cues
• Lack of pointing
• Lack of vocalizations with consonants
• Lack of playing with a variety of toys
conventionally
(Wetherby et. al., 2004)
62

63. Early Indicators: 2-4 yrs.
Typically Developing Autistic Child
Child • EEG does not
• Pro-social behaviors differentiate between
are very developed mother’s and stranger’s
• Face recognition face
registers on EEG • Social orientation, joint
• Socially appropriate attention, attention to
contingent or others’ distress still
synchronized gazing lacking
(Dawson et. al., 2004; Kabot et.
• Plays with a variety of al., 2003; Dawson et. al., 2002) 63
toys conventionally

64. Considerations for Assessing
Autistic Children
• Gross and fine motor impairments are common among
children with autism (Blackwell, 2001).
– Motor stereotypes are also common, such as hand
flapping, finger mannerisms, body rocking, or unusual
posturing.
– The severity of motor deficits is inversely related to IQ.
• Sensory impairments include preoccupation with the
sensory features of an object, over or underresponsiveness
to particular stimuli, or inconsistent responses to sensory
stimuli overall.
• Attention disorders are present in nearly all autistic
children to some degree (Rapin, 2002).
– The manifestations are variable, though. Some are highly
distractible and hyperactive, while others can
demonstrate long attention spans but only for a select
few activities which they find highly interesting.

65. Social Joint Attention
Initiate Joint Attention – IJA Responds to Joint Attention (RJA)
(emerges 6-9 months) (emerges 3-6 months)

66. General Indicators of Autism:
Sensory Processing
• Sensitive startle response
• Avoidance of eye gaze
• Under responsiveness to startle stimuli
• Unusual sleep patterns
• Unusual or exaggerated fears
• Dropping oneself on the floor
• Excessive seeking of movement
(Audet, 2004)
66

67. Abnormal Responses to Sensory
Stimulation
• Unlike normal individuals, autistic children have difficulty
filtering out extraneous stimuli from their environment (sounds,
lights, and skin sensations may be overwhelming for them).
• --kids may throw tantrums to sounds, or try to repeat sounds
as if enthralled with them.
• --certain tactile sensations may be perceived as painful or
itchy to the skin (tactile aversions).
• Young autistic children appear to use senses of smell & taste,
more than auditory or visual modalities to explore their world.
• --Pain thresholds will vary, being very insensitive one minute
to vary sensitive the next.

68. General Indicators of Autism:
Motor Skills
• Low muscle tone
• Limited oral exploration or play
• Excessive drooling
• Prone to choke or gag
• Limited food tolerance
• Delayed development in gross and fine motor
skills
(Audet, 2004)
68

69. Making an Autistic Disorder Diagnosis
• Frequently used criteria to make a diagnosis are:
• Absence or impairment of imaginative and social play
• Impaired ability to make friends with peers
• Impaired ability to initiate or sustain a conversation
with others
• Stereotyped, repetitive, or unusual use of language
• Restricted patterns of interests that are abnormal in
intensity or focus
• Apparently inflexible adherence to specific routines or
rituals
• Preoccupation with parts of objects

70. Early Indicators: 0-6 mos.
Typically Developing Child Autistic Child
• Head turns when name • Does not respond to
is called social cues without
• Matches the direction of repeated prompting
a mom’s head turn to • Displays minimal
the visible target affective responses
• Starts to develop joint • More passive, quieter
attention • May lag behind in
• Attends to affective motor skills
displays of others (Zwaigenbaum, 2005; Dawson
et. al., 2004; Werner et. al.,
2000)
• Responds to emotions 70

71. Early Indicators: 7-12 mos.
Typically Developing Child Autistic Child
• Succeeds at joint • Greater incidence of
attention unusual posturing
• Seeks emotional • Needs more prompts
to respond to name
information from adult
faces when presented • Mouthing of objects
with uncertainty (social • Social touch aversion
referencing) (Zwaigenbaum et. al., 2005;
Dawson et. al., 2004; Werner et.
al., 2000; Baranek, 1999)
71

72. Early Indicators: 7-12 mos.
Typically Developing Autistic Child
Child • Pays little attention to
• Elementary vocal distress of others
communication • Lacks of social smiling
and appropriate facial
• Early social imitation
expressions
skills
• Unstable attention
(Zwaigenbaum et. al., 2005;
Dawson et. al., 2004; Werner et.
al., 2000; Baranek, 1999)
72

73. Early Indicators: 13-24 mos.
Typically Developing Autistic Child
Child • Minimal responses to
• Exhibits joint attention others (lack of
empathy)
• Engages in social
• Does not exhibit
relations
pretend play
(Dawson et. al., 2004; Kabot et.
al., 2003; Robins et. al., 2001;
Charman et. al., 1997)
73

74. Early Indicators: 13-24 mos.
Typically Developing Autistic Child
Child • Impaired joint
• Communicates, both attention
receptively and • Less gazing at people
expressively • Absence of pre-
• Shows greater linguistic functions
(i.e. declarative
incidences of pretend pointing, showing
play objects)
(Dawson et. al., 2004; Kabot et. 74
al., 2003; Robins et. al., 2001;
Charman et. al., 1997)

75. Early Indicators: 2-4 yrs.
Typically Developing Autistic Child
Child • EEG does not
• Pro-social behaviors differentiate between
are very developed mother’s and stranger’s
• Face recognition face
registers on EEG • Social orientation, joint
• Socially appropriate attention, attention to
contingent or others’ distress still
synchronized gazing lacking
(Dawson et. al., 2004; Kabot et.
• Plays with a variety of al., 2003; Dawson et. al., 2002) 75
toys conventionally

76. Considerations for Assessing
Autistic Children
• Language is delayed, distorted, or absent altogether in
children with autism (Kanner, 1997).
– This makes it likely that IQ scores will be misleading, as
many subtests of cognitive assessments are verbal, or
require a solution that would be enhanced by a verbal
strategy
– Some preschool dysphasic autistic students who turn out
to possess normal intelligence once they learn to speak,
are mislabeled as mentally deficient when initially
assessed with language-loaded tests.
– Nonverbal assessments, such as the Universal Nonverbal
Intelligence Test (UNIT) can be effective in measuring
cognitive functioning in autistic children without the
danger of misdiagnosis based on speech-language
impairments.

77. Autism as a developmental disorder:
What is manifested as autism changes with development
Development is affected by having autism
It is important that the developmental Considering the cultural and family
context
assessment: A child's life is embedded within a cultural
and family context. When assessing
children with possible develop-mental
be individualized for each child disorders, including autism, it is essential to
utilize procedures that are reproducible by consider:
the family's culture
other professionals parent priorities
parenting styles
family support systems
focus on the child's presenting problems In evaluating a child with possible autism, it
(such as suspected delays or deviations in is important to recognize that there may be
cultural and familial differences in
development or behavioral problems) expectations about such things as eye
contact, play and social interaction, and
pragmatic use of language.
define the child's strengths and/or If English is not the primary language of the
compensatory abilities family, it is important for professionals to
look for ways to communicate effectively
with the family and the child, including
make use of parents' observations of their finding professionals and/or translators who
speak the child's family's language(s)
child's skills and behaviors

78. • Both positive (abnormal) behaviors, and
negative (the absence of normal) behaviors
are required to make a diagnosis of ASD.
• This means that developmental level and
contextual effects (in what kind of
circumstances does the child or adult
function?) can both have significant effects on
diagnostic judgments.

79. Surveillance and screening
• In the United States, states must follow federal Public Law 105-17:
the Individuals with Disabilities Education Act Amendments of 1997–
IDEA’97, which mandates immediate referral for a free appropriate
public education for eligible children with disabilities from the age of
36 months, and early intervention services for infants and toddlers
with disabilities from birth through 35 months of age.

80. For all Autistic Infants and Children:
Diagnoisis of autism
• Requires a comprehensive multidisciplinary approach, and can
include one or more of the following professionals:
psychologists, neurologists, speech–language pathologists
and audiologists, pediatricians, child psychiatrists,
occupational therapists, and physical therapists, as well as
educators and special educators.
• Reevaluation within 1 year of initial diagnosis and continued
monitoring is an expected aspect of clinical practice because
relatively small changes in the developmental level affect the
impact of autism in the preschool years.

81. For all Autistic Infants and Children:
Speech, language,and communication
evaluation
• A comprehensive speech–language–
communication evaluation should be Recommendations:
performed on all children who fail language
developmental screening procedures by a
speech–language pathologist with training and Receptive 1
expertise in evaluating children with
(ROWPVT-r; Gardner 1990)
developmental disabilities.
• Comprehensive assessments of both
preverbal and verbal individuals should REEL-R (Receptive,
account for age, cognitive level, and expressive, emergent, lanquage
socioemotional abilities, and should include scale; Bzoch 91)
assessment of receptive language and
communication, expressive language and
communication, voice and speech production,
Language
and in verbal individuals, a collection and Pathologist
analysis of spontaneous language samples to
supplement scores on formal language tests.

82. For all Autistic Infants and Children:
Cognitive and adaptive behavior
evaluations
• Cognitive evaluations should be
Recommendation:
performed in all children with autism by a
Raven’s Progressive
psychologist or other trained professional.
Matrices (Motiron 2007)
• Cognitive instruments should be
appropriate for the mental and chronologic Vineland Adaptive
age, provide a full range (in the lower Behavior Scales
direction) of standard scores and current (Sparrow, et. Al; 85)
norms independent of social ability,
include independent measures of verbal Differential Ability
and nonverbal abilities, and provide an Scales (Elliott, 1990)
overall index of ability.

83. For all Autistic Infants and Children:
Sensorimotor and occupational therapy
evaluations
• Evaluation of sensorimotor skills by a Recommendations:
qualified experienced professional Analysis of Sensory
(occupational therapist or physical therapist) Behavior Inventory
should be considered, including assessment ( Morton and Wolford, 94)
of gross and fine motor skills, praxis, sensory
processing abilities, unusual or stereotyped Audiometric
mannerisms, and the impact of these
components on the autistic person’s life. assessment
• An occupational therapy evaluation is
indicated when deficits exist in functional
skills or occupational performance in the Complete
areas of play or leisure, self-maintenance Medical
through activities of daily living, or productive
school and work tasks.
Examination

84. For all Autistic Infants and Children:
Neuropsychological, behavioral, and
academic assessments
• These assessments should be performed Recomendations:
as needed, to include social skills and
relationships, educational functioning, Bayley Scales of
problematic behaviors, learning style, Infant Development II
motivation and reinforcement, sensory
functioning, and self-regulation.
• Assessment of family resources should
be performed by appropriate
psychologists or other qualified health
care professionals and should include
assessment of parents’ level of
understanding of their child’s condition,
family (parent and sibling) strengths,
talents, stressors and adaptation,
resources and supports, as well as offer
appropriate counseling and education.

85. Bayley Scales of Infant Development II
(BSID-II)
• Type of Test A standardized assessment of infant development. Purpose The test is
intended to measure a child's level of development in three domains, cognitive, motor
and behavioral. Age Range One month to 42 months old
• Test Components The BSID-II consists of three scales: mental, motor and behavior
rating scales. The test contains items designed to identify young children at risk for
developmental delay.
• Testing and Scoring Procedures The examiner presents test materials to the child
and observes the child's responses and behaviors. Performance results can be
expressed as a developmental age or developmental quotient.
• Time for Administering Test The administration time ranges from 30 minutes to 60
minutes.
• Standardization/Norms BSID normative data reflects the U.S. population in terms of
race/ethnicity, infant gender, education level of parents and demographic location of
the infant. The Bayley was standardized on 1,700 infants, toddlers, and preschoolers
between 1 and 42 months of age. Norms were established using samples that did not
include disabled, premature, and other at-risk children. Corrected scores may be
used for these higher risk groups, but their use is controversial

86. For all Autistic Infants and Children:
• Autism Society of America (ASA)
7910 Woodmont Avenue
Bethesda, MD 20814 Web Site:
http://www.autism-society.org/