Josie Barbaro (psychologist): There isn’t necessarily a standardised way to assess a child for autism but typically what parents might expect is that they will go and see a paediatrician, a psychologist or a speech pathologist and their child will be directly observed by one of these healthcare professionals and the parents themselves will also be asked various questions.
Katherine Pye (speech pathologist): Often parents have observed a whole lot of things that the paediatrician might not be able to see in the clinic so it always involves a long conversation with parents about what they have observed. Ideally the paediatrician would also spend some time at least playing with the child and getting a sense for themselves about what the child’s interaction skills and interests are like. Some assessments also include seeing the child in different environments. So they might usually have the child come in to a clinic or do a home visit to do some assessment there but they might also go, say if the child is in childcare, they might go in and watch what the child is doing in their natural environment but outside of a clinic kind of setting.
Josie Barbaro: There are goal standard diagnostic instruments that people can use to diagnose autism. One of them, a very known instrument, is called the ‘Autism Diagnostic Observation Schedule’ or the ADOS, and this is a semi-structured play-based assessment. So, the clinician is engaging with the child with toys and is prompting the child for various behaviours, so looking at how the child communicates with the clinician. Is the child approaching the clinician to try and communicate with them? Is the child interested in what’s going on? How does the child play? All of those types of behaviours.
Katherine Pye: The clinician will be interested in the earlier stages of development as well.
Onscreen text: There is no single test for autism spectrum disorder (ASD). Diagnosis involves a range of tests. Read more in our article on autism diagnosis for children.
Katherine Pye: So we’d be asking parents to think back to when the child was first learning to talk, even younger when they were looking and smiling as a baby, so trying to get an idea of that the child was like as a baby or a younger child as well as looking very much at what the child is like now.
Josie Barbaro: We use lots of different toys and activities. The one that children love is using the bubbles for example. So, we will use a little blower and do some bubble type games and looking at the child, and what we’re looking for is we’re looking for the child’s eye contact. Is the child flicking his or her attention between the bubbles and the clinician, and we call this ‘joint attention’ when you are sharing your attention between what is going on in the environment and another person, and we do that very often. If a child is not doing that then that is one of the behaviours that we notice in autism. They may also engage in other games like pretend play, so a pretend birthday party or a pretend bath to see is the child pretending to engage in actions like feeding a baby? Is the child trying to draw the clinician’s attention to his or her behaviours as well because we know that typically developing children will draw other people into their world and if they are not doing that then they are at high risk of receiving a diagnosis of autism.
Katherine Pye: Some of the other assessments that would be carried out by speech therapists might involve formal language assessment, and there are also actually a whole range of other assessments that look at what’s called ‘pragmatics’ or sort of social skills. So it’s not only about how much language a child has but it’s how they are using it.
Josie Barbaro: We look at why a child communicates and how. So, a child with autism can and does communicate to ask for things, to request things but may not communicate to share their interest in what they find interesting, so we do differentiate between how a child communicates to ask for something and if a child communicates to share their interest with you. We look at skills like fine motor skills, which means how children are manipulating objects with their hands. We look at whether or not children can complete puzzles or match pictures for example, and we look at their understanding of language and also their use of language. And so when we do this we see whether or not a child has a delay in their language or speech development or a delay in their overall development.
Katherine Pye: If a child has some difficulties with their social skills that could be because they have an overall developmental delay and their social skills could actually be in line with their other learning, which would suggest that autism isn’t the reason for their difficulties but what we want to know is if they have some difficulties with their social skills is that more impaired than their other skills, and so we need to really compare overall learning and the social side of skills which is why we need to assess both of those things during an autism assessment. We are always very conscious that in any assessment of a child all we’re getting is a snapshot of what that child is doing on that particular day in that particular setting so it’s very important to really talk to parents about what else happens outside of the sessions.
Josie Barbaro: I think it’s important that parents feel as if they are being heard because parents know their child better than anyone else and so we may see a child only for a few hours but a parent obviously deals with their child, or interacts with their child, every day so it’s really important that we hear about what they have to say and what their concerns are and how they perceive their child’s behaviour as well as combining our professional observations of the child so we can try and merge those two pieces of information together to make a correct diagnosis for that child.