Autism Consultation Explained: What You Need To Learn About Screening and More!

The prevalence of Autism Spectrum Disorder (ASD) in children has been steadily increasing. In Singapore, 1 in 150 children is currently being diagnosed, which is higher than WHO’s global figure of 1 in 160. The importance of an early diagnosis is paramount as it allows the skills needed to enhance the child’s quality of life to be imparted at a younger age. Younger children have higher brain plasticity, which means that their brains have a greater ability to change and adapt as a result of experience. Consequently, the impact of any intervention will be more pronounced and effective.

Psychological assessments are carried out using standardised testing protocol in order to uncover potential ASD in children. They are valuable as it allows for an accurate diagnosis, for the appropriate interventions to be carried out. However, these assessments may be demanding on the child as it takes them away from their comfort zone. A successful assessment requires the assessor to possess the ability to understand and manage the challenging behaviours that the child may exhibit during the session.

This blog describes the different testing tools which are employed to help diagnose children with ASD, when you need to make that call, and what your role is as a parent through this process.

The benefit of family involvement in autism screening

Research indicates that obtaining the parents’ cooperation is essential to the screening process. This is because they are reliable sources of information about the child’s daily life and development and can provide the assessor vital information about their behaviours at home, which might not be immediately visible. Hence, parents may be considered as co-therapists.

Evidence-based screening tools that incorporate the parents’ account of happenings in the home setting help to foster structured communication between parents and providers. Examples of collaborative screening tools include the Ages and Stages Questionnaire, the Parent’s Evaluation of Developmental Status, and Child Development Inventories.

A parent’s involvement also sheds light on the main areas of concern for the child. This collaborative dynamic between you and the provider reveals the collective observations about your child’s development. This is particularly helpful especially in home-based therapies where most of the behaviours of concern are being exhibited in the home setting.

We aim to constantly keep you in the loop, ensuring that you are in a better position to enhance your child’s learning progress and improve their behaviour.

What is a psychological evaluation?

When parents, teachers, or any individuals who are working closely with a child detect possible developmental, learning, or behavioural delays, they may be referred for a psychological assessment.

An evaluation provides information that will determine if the child meets the criteria for any possible diagnoses. This is important as the appropriate plan for intervention, in order to best help the child, can then be developed. It also enables parents, teachers, and other providers to better understand the child’s strengths and weaknesses. Obtaining this knowledge is crucial for you, as it then becomes easier to map out goals and determine how best to monitor progress.

When should you decide to let your child undergo psychological evaluation? 

Anytime you notice any significant delays in your child (this can take the form of social interactions, learning, speech etc), you can have them undergo a psychological evaluation to determine if they meet the criteria for Autism Spectrum Disorder (ASD).

You are the primary source of information about their intellectual or academic strengths and weaknesses, these include language skills, speech, and/or difficulties with behaviour and executive functioning (e.g. display self-control, sustained attention, problem solving). Make sure that you provide a detailed and accurate account as this will be essential in creating an accurate diagnosis.

These evaluations consist of several components so that we are able to synthesise the information about the child from multiple perspectives. This allows providers to create a stronger diagnosis rather than relying solely on the results of a standardised test.

What are Standardised Tests?

Standardised tests are assessments that are administered, scored, and whose results are interpreted in a consistent and uniform manner. They provide normalised scores that can be used to compare your child’s performance to a baseline. It is usually administered in a one-to-one setting, and it’s conducted either by a psychologist or any qualified professional.  

In education settings, standardised tests are administered by a school psychologist to determine if a student is eligible for special education services.  They may also be administered in a medical or clinical setting to determine if a child meets criteria for a diagnosis such as an intellectual or learning disability. There are several traits, characteristics, or abilities of the child that may be examined using individually administered standardised tests.

Professionals may first employ screening tools to decide whether your child displays sufficient signs of autism to be recommended to undergo a full assessment. Some professionals also use these screening tools in conjunction with their own professional judgment to make a diagnosis.

The different types of screening tools available today include:

Autism Behaviour Checklist (ABC) – This is a clinical tool that is used to screen for autism in individuals 3–35 years of age. This was designed to objectively identify autism in children. The scale utilizes an observer’s rating of the child’s behaviour to quantify behaviours typically associated with Autism.

Childhood Autism Rating Scale – Second Edition (CARS2) – This is a 15-item rating scale used to identify children with autism and distinguish them from those with developmental disabilities. It is empirically validated and provides concise, objective, and quantifiable ratings based on direct behavioural observation.

Social Communication Questionnaire – Previously known as the Autism Screening Questionnaire (ASQ), the SCQ is a brief instrument that helps to evaluate the communication skills and social functioning of a child who may have autism or other disorders in the spectrum.

Social Responsiveness Scale – Second Edition (SRS-2) – This is a 65-item rating scale measuring deficits in your child’s social behaviour associated with Autism Spectrum Disorder (ASD), as outlined by the Diagnostic and Statistical Manual of Mental Disorders.

What are the barriers to success in individualized standardised testing for children with ASD?

There are certain characteristics of autism spectrum disorder which may impact performance during standardised testing.

• Language Deficits. Some children on the autism spectrum may display delayed speech and language skills. That is why professionals take into consideration verbal language proficiency as this may have an impact on how they process directions as well as their ability to explain what they know.
• Behavioural Difficulties. Children on the autism spectrum are likely to engage in disruptive behaviours.  For example, this type of behaviour can be displayed if a child finds a task too difficult and causes them stress or anxiety. A child may also have a hard time participating in standardised testing if he/she struggles with following verbal instructions or engages in stereotyped or repetitive behaviours. In these circumstances, the child will be more likely to engage in off-task behaviours that impair their ability to complete activities to the best of their ability.
• Joint Attention Deficits. Joint attention is the child’s ability to share interest in an object or event with someone else. During standardised testing, the child is made to look at pictures, or other activities when asked to do so. Otherwise, they may not understand the task. It’s typical for children with ASD to have delayed joint attention and this may impact their performance.
• Sustained Attention. It’s typical for children in the autism spectrum to struggle with maintaining their attention, especially during activities that they’re not interested in. This can affect performance during tests that have a time limit.  

What modifications can psychologists make to accommodate children with ASD?

In consideration of these barriers, behavioural therapists who use standardised testing will make the appropriate adjustments to support improved outcomes. Whilst the process often requires certain structured procedures, therapists who work with children on the spectrum may need to employ certain adaptations to better accommodate the specific needs of each child.

If you’re still unsure of your child’s situation, we would be happy to conduct an assessment. Book an autism consultation with us today and we would be happy to answer all your questions and discuss the necessary screening your child needs.