Our service’s main role is to identify autism.
Autism is a neurotype (a style of brain functioning) which influences how someone interacts with and experiences the world. There are lots of autistic people in the world with different strengths, challenges and support needs.
Often, autism assessments focus on areas related to the diagnostic criteria, which often means a focus on areas of difficulty. This should not detract from the multitude of strengths that autistic people have, and the impact of the environment on autistic people’s lives.
We use the use the autism diagnostic observation schedule, 2nd edition, (ADOS-2) as part of our assessment. The ADOS-2 is a standardised assessment which contributes towards identifying a young person as autistic. Standardised assessments are formal assessments that have been designed to measure a person’s abilities compared to other people of their age. The average level of ability for a person at each age has been determined by using these assessments on hundreds of people of varying abilities.
The ADOS-2 uses play based activities and social conversation to look at the following areas of development:
- Communication: use of words and sentences (verbal communication), body language and intonation (nonverbal communication) to talk about their experiences and ask someone about their experiences.
- Social interaction: use of verbal and nonverbal communication to share interest in their own and others’ thoughts and feelings.
- Play: use of imagination, playing together with another person, sharing and turn taking.
- Interests and behaviours associated with the Autistic experience: particular/repeated motor movements or behaviours, preferences for sameness, routine or particular patterns of behaviour, need to complete a series of actions or spoken routines, sensory interests, talking about specific areas of interest, particular passions or areas of expertise.
Autistic people usually have differences in these areas which can be observed during the ADOS -2. By using the scoring system in the assessment, the assessor gets information that helps decide if someone might be autistic. A speech and language therapist, occupational therapist or clinical psychologist will carry out the assessment, and the observations are discussed in a multi-disciplinary discussion with a paediatrician.
Differential assessments
If further information about a child’s understanding and use of language is needed as part of the autism assessment process the Speech and Language Therapists can carry out some standardised and informal assessments. Informal assessments are non-standardised and are used to explore the child’s pattern of strengths and needs.
They might use one or more of the following formal assessments:
- BPVS3 – British Picture Vocabulary Scales 3rd Edition (ages 3-16)
Checks understanding of nouns (e.g., globe) concepts (e.g. fluffy) and verbs (e.g. snarling) by listening to a spoken word and then pointing to the correct picture from a choice of four.
- CELF 5 – Clinical evaluation of language fundamentals (ages 5-21)
Checks understanding of: sentences; how words go together; remembering a story. Checks ability to use words in a sentence.
- TROG-2 – Test for reception of grammar (ages 4-18 )
Checks understanding of sentences by listening to a sentence and then pointing to the correct picture from a choice of four.
RAPT– Renfrew Action Picture Test (ages 3-8.5)
Learning disability
If there is a question about a young person’s level of learning (cognitive abilities) they might see the psychology team for a Cognitive Assessment. This assessment helps to answer the questions: does this young person have autism, a learning disability, or both? This assessment can therefore support differential diagnosis and provide further understanding of a young person’s neurodevelopmental profile.
Learning disabilities exist as part of natural human variation. To identify a learning disability, a person’s cognitive (thinking and learning skills) and adaptive functioning (independence skills) must fall in the bottom 1-2% of the population. This means that learning new information and skills is difficult, and requires more time and support. This is different to specific learning difficulties (e.g. dyslexia), or having cognitive abilities that fall in the below average to average ranges.
Identifying learning disability is important because if expectations are too high, or learning is not pitched at the right level, those with a learning disability can miss opportunities to learn and their self-esteem can be impacted.
Having a learning disability does not equate to a lack of potential- all people can learn if learning is pitched at the right level, and support is well matched to a person’s cognitive abilities and strengths. It is important to acknowledge that current educational and societal structures favour specific cognitive abilities, this does not mean that having a learning disability is inherently negative – all people can make a valid contribution to society and live successful lives as part of their communities.
To assess a young person’s cognitive ability we might use:
- WISC-V – Wechsler Intelligence Scale for Children 5th
This is a standardised assessment which uses several subtests to measure five areas of general cognitive ability: verbal comprehension, visual spatial processing, fluid reasoning, working memory and processing speed. This is for children aged 6 to 16 years.
- WPPSI-IV – Wechsler Pre-school and Primary Scales of Intelligence 4th
This is similar to the WISC but for children aged 2 to 7 years.
- ABAS or Vineland- Adaptive Behaviour Assessment System or Vineland Adaptive Behaviour Scales
Both these tools gather information about abilities in day to day living skills needed to function independently at home, school and in the community.