What happens during an assessment for ASD?

[Peppermint Poppies]

My DS, who is turning 4 in April, is having an assessment for ASD this coming Friday. The people doing the assessment are the Australian Autism Spectrum Association (also known as Aspect). They sent us a confirmation letter which said they would use the Autism Diagnostic Interview and Autism Diagnostic Observation Schedule during the assessment.

I'm wondering what happens during this assessment. Will they be observing DH and I playing with DS, or will DS be alone with the assessor without us present? What sorts of tasks do they ask him to do? And what sorts of questions will they ask us? We filled out a lengthy questionnaire, and I'm wondering what's left to say that we haven't said already.

Some background on DS:

13mo - never ending crankiness

20m old - obsessed with keys

23m - doesn't know how to play with toys

27mo - me struggling with parenting DS

32mo - when does high needs become special needs?

[kme]

I am not familiar with the Autism Diagnostic Interview but the ADOS is usually between the child and the interviewer.  They will do structured activities with him, communcate with him,etc and evaulate his ability to maintain a conversation, play skills, etc.  It is supposed to be the gold standard in diagnosing ASD.  Yes, you have filled out a lot of questionaires, probably given them lists of concerns, etc but now it is time for them to observe your child and see where the deficits are and what may be causing them (ie, the Diagnosis).

Good luck!

[BookGoddess]

When we did the ADOS in the past, the evaluator spent some time playing with DD.  They did a variety of age appropriate play activities.  The second part involved me answering all sorts of questions about DD's skills, habits, behaviors, etc.  The entire process took a few hours.  

[Momsteader]

Agree with PP'ers. Not sure how it works in other countries, but this is how ours went!

Ds was evaluated at 5. For us, the interviewer and neuropsych chatted with ds and I together and built some comfort and rapport with him, and then interviewer asked if he'd like to go and play some games with her and see the toys she had while mommy kept talking. (A lot of the assessments look like games/toys to a kiddo!) And ds went with her willingly. I chatted with the neuropsych for a while and she had some more specific questions. (Yours may not include this part but my ds had already been having ST/PT/OT/Play therapy/Dev Ped appts and she was combing all that into her official report. After that, I waited in the waiting room and it took at least an hour. I had previously filled out some questionaires that were then combined w/ the in person assessment.

The neuropsych then chatted with us for a few moments at the end with some final questions, assured me that she thought my son was far too social to be on the spectrum, and sent us on our way. I was feeling wonderful about that.  Then a week later, she called me really upset, because she said she shouldn't have said what she did...as he she was placing him on the spectrum, and dx him Asperger's and felt we needed further evaluation by a neurologist for his tics. My son WAS very social with ADULTS only, so that had intially skewed her view of him, but when she viewed the other information which included some group play therapy and group OT sessions, she could see that peer interactions were severely affected. I got a really thorough 15 page report that I have still referred to as he's gone through stages and she was so 'on' about I am amazed at times!

Anyway, to your ds, it will look like playtime and he'll probably have fun with the one on one playtime, and the interviewers are really good at getting the kids to do the things they need with them.

[Emmeline II]

My ds is nearly 7years old so his evaluation was more "academic" and less "play." At the results appointment I asked if they had considered that he would be 7 next month and the Dr. said that their evaluations are down to the month--so he was evaluated at 6y 7m.

Ds' appointment was from 9-1.

1.       I did an intake summary for 10-15min. with Dr. in “playroom” for 10-15min. (room with table, bed sized bench, toys and a one-way mirror)

2.       Filled in more surveys (filled out a couple extensive surveys pre-appt) while the Dr. did some sort of table flip chart with ds; then followed the speech evaluator, testing ds in the playroom.

3.       Did history of ds with Dr., from pregnancy to present, in exam room.

4.       Dr. did physical with ds, then health and family history with me in exam room.

5.       Ds went to do psychological and IQ testing in playroom while…

6.       I filled in more surveys with social worker in exam room.

The official schedule was:

09:00-11:00      MD                            Medical/physical

                         MA CCC-SLP            Speech/Language

11:00-1:00       PhD                            Cognitive/achievement

                         LMSW                       Psychosocial/adaptive

The doctor said that she could see why I was concerned about Asperger's (ds currently has an ADHD/w disturbance of emotion and conduct diagnosis from his psych) but also said that ds was on the borderline (regarding age) for diagnosis. I was so tired after that appointment; Ds' therapy appointments tend to wipe me out too, though I usually only talk briefly with the therapist then sit in the waiting room with dd.

The results (as transcribed from the Dr.’s teeny tiny handwriting)

1.      Average to high average ability (performance IQ – TONI 3 =117 > verbal SIT-R 94).

2.      Achievement commiserate with ability (WIAT II – word reading =140, reading comprehension =121, spelling =130, numerical operations =102).

One score somewhere was abnormally low; I think it was part of the verbal SIT-R, a section with “strange stories” where you identify what someone is feeling knowing that the feeling is not what they said (like a person who hates apple pies saying “thank you, it’s just what I wanted” when given an apple pie—why would they say that? because they didn’t want to hurt the giver’s feelings).

3.      Mild to moderate pragmatic language disorder.

4.      Social developmental delay; in part due to ADHD.

5.      ADHD combined.

6.      Disruptive behavior.

7.      Anxiety (performance and social anxiety)

8.      Chronic motor/vocal tics

9.      Possible CAPD.

10.  Hyperacusis/sensory concerns.

Therapy Referrals

1.      Speech therapy with attention to pragmatics.

2.      Continue CBT to address anxiety and behavior.

3.      CAPD evaluation.

4.      OT to address sensory concerns.

Regarding Asperger’s, the Dr. said that he appears to meet the criteria but that he was a little young for diagnosis and that the ADHD complicates the picture (she went into a lot more detail than that; apparently the diagnostic team spent a lot of time debating this point). We will reevaluate in a year – added maturity and addressing some of his other issues may give us a clearer picture. The appointment took about 2 hrs.

[Peppermint Poppies]

Thanks everyone. It's pretty much  what I was expecting so I'm glad there won't be any huge surprises.

The play thing will be interesting though - DS pretty much doesn't play. He talks to me, talks about toys, throws toys, chews on toys, rages at toys, talks to me about what's wrong with the toys, but doesn't actually play with them. He does get extremely anxious around strangers and consequently becomes amazingly compliant, so he might do better than I am expecting him to do. Mostly he's not keen to talk to other adults at all, but very occasionally he'll feel instantly comfortable with someone. I'm kind of hoping he doesn't do that, since it's not typical for him, and I don't want it to skew his results too much. God, I feel awful for writing that :(

[Emmeline II]

Originally Posted by Peppermint Poppies 

Thanks everyone. It's pretty much  what I was expecting so I'm glad there won't be any huge surprises.

The play thing will be interesting though - DS pretty much doesn't play. He talks to me, talks about toys, throws toys, chews on toys, rages at toys, talks to me about what's wrong with the toys, but doesn't actually play with them. He does get extremely anxious around strangers and consequently becomes amazingly compliant, so he might do better than I am expecting him to do. Mostly he's not keen to talk to other adults at all, but very occasionally he'll feel instantly comfortable with someone. I'm kind of hoping he doesn't do that, since it's not typical for him, and I don't want it to skew his results too much. God, I feel awful for writing that :(

You could let them know this ahead of time and they could allow some time for observation with you and him alone in the room.