Preschool Assessment for Autism

7/25/2019 Preschool Assessment for Autism

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Preschool Assessment for Autism

Written by Pam MS, NCSP | Fact checked by Psychology Dictionary staff

rekautismMost children affected by autism sectrum disorder !ASD" are notdiagnosed or treated until reschool or early school age, though the first symtoms

aear in the first or second year of life !Cha#arska, $lin, % &olkmar, '(()"* +his

discreancy bet#een the first signs of symtoms and diagnosis is disiriting for

both ractitioners and arents alike* Fortunately, adances in research on

diagnosis and treatment hae been made oer the ast decade* -t has become

eident that early identification is relatiely stable and that e.edient initiation of

serices and treatment leads to imroed outcomes for these children in terms of

cognition, social skills, language and communication, and adatie functioning*

+his aer attemts to integrate the most current kno#ledge regarding early

manifestation of autism sectrum disorder, #hile highlighting the areas of clinical

ractice and research that remain unclear* -t #ill also discuss some of the current

issues related to classification, diagnosis, assessment and treatment of autism

sectrum disorder young children, as #ell as some interention that hae gained

emirical suort for being effectie*

Preciitated Parental Concern

A ast ma/ority of arents of children #ith ASD first noticed behaioral oddities

during the course of the first t#o years of their child0s life !1aghdadli, Picot, Pascal,

Pry, % Aussillou., '((2", #ith aro.imately 2(3 to 4(3 of arents noticing

issues in the first year or the child0s life and about )(56(3 noticing by the second

year !1aghdadli et al*, '((2"* A arent0s first signs of concern tyically aear

#hen they notice seech and language delays* Atyical social recetiity andgeneral difficulties related to attention, eating, and sleeing are among other most

common first noted concerns !Cha#arska et al*, '((7"* Parental distress may also

surface in resonse to abnormal ariations in deeloment, such as noticeable

slo#ing of deeloment or regression of skills !Sierstein % &olkmar, '((8", either

in seech or in social skills, imitation, or lay skills !Daidoitch et al*, '((("* +he

resence of concurrent cognitie delays, motor delays !De9iacomo %


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Fombonne,:66)", renatal comlications, or sensory deficits !1aghdadli et al*,

'((2" hae also been associated #ith reciitated arental concern* When arents

first aroach the school for adice on ho# to handle their susicions, it is

imortant to inestigate #hat arents hae noticed thus far to get a sense of

symtom seerity and start brainstorming about ho# to best address their

concerns and lan a fitting assessment*

Assessment of ASD in Preschool Children

As is the case #ith all assessments, accurate ealuations include multile sources of

data and informants* When assessing for childhood disorders, it is crucial to hae a

clear understanding of #hat constitutes tyical behaior in a child of the same

deelomental leel* 1eyond those ground rules, assessing reschoolers for ASDlooks much like any other assessment*

;;;;; Deelomental and Medical


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can read basic body language like someone shaking their head, ?no@ !Field %

1ro#n, '((7"* A reschooler has also begun to concetuali>e cause and effect, and

the fact that e.ternal eents can lead to emotions that roduce secific behaiors

!+homson, 9oodin, % Meyer, '(("* 9ross motor skills of a reschooler include,

but are not limited to, the ability to kick a ball, thro# a ball oerhand, /um,

balance on one foot, and ride a tricycle* Fine motor skills include demonstratingsome sort of hand reference #hen #riting and dra#ing eole #ith about three to

si. body arts !Field % 1ro#n, '((7"* For more formal information about a child0s

deeloment, tools like the 1ayley Scale of -nfant and +oddler Deeloment, +hird

Bdition !1ayley5--- 1ayley, '((" and the Mullen Scales of Barly earning !Mullen

Scales Mullen, :664" are #idely used !Cha#arska % 1earss, '(()"* +he 1ayley5---

has been designed for infants bet#een : and 8' months of age, and consists of a

cognitie, language, motor, social5emotional, and adatie behaior scale*

Normatie data from '((8 included about :,7((( children and results indicate

strong alidity and reliability !Cha#arska % 1earss, '(()"* +he Mullen Scales are

discussed in further detail later*

Parent -nterie#s

When looking at a otential case of ASD in a toddler, adult reorts, articularly

from the arent are ery imortant* Parents, or guardians, usually hae the most

information to offer because of the e.tensie amount of time they send #ith their

reschoolers* Semi5structured interie#s are good to use #hen assessing for ASDbecause the more structured format ensures that all of the necessary information is

obtained* Since semi5structured interie#s hae a more conersational element to

them, an ealuator can use this tool for the dual uroses of building raort #ith a

client and asking additional =uestions #hen arents offer e.traordinary

information during the =uestioning !1isho % ord, '(("* +he Autism Diagnostic

-nterie#5Eeised !AD-5E e Couteur, ord, % Eutter, '((2" and the Diagnostic

-nterie# for Social and Communication Disorders !D-SC Wing, eekam, ibby,

9ould, % arcombe, '(('" are t#o #idely used and #ell5established semi5

structured interie# tools for assessing toddlers for ASD* +he AD-5E offers scores

on communication, social recirocity, and restrictedGreetitie behaiors, and

contains different calculations for erbal and nonerbal children* A do#nside to

the AD-5E, ho#eer, is it takes about t#o to three hours to administer and tends to

oer5diagnose ASD in children #ith nonerbal mental ages under t#o* +he D-SC

is broader in scoe, as it can be used to diagnose other deelomental disorders

aside from ASD, but it takes about the same amount of time to administer and has

#eaker sychometrics*


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A ne# comuter5based semi5structured tool is the Deeloment, Diagnostic, and

Dimensional -nterie# !2di Skuse et al*, '((8"* +he 2di is intended to assess

autism seerity and syndromes of comorbid conditions, so it is broader in scoe

than the AD-5E* +hough it has high alidity and reliability estimates, the originalsamle used to test the 2di had fe# reschool, nonerbal, and mentally retarded

children* +herefore, 1isho and ord !'((" suggest that the 2di be used in

con/unction #ith a child obserational assessment tool, like the Autism Diagnostic

bseration Schedule !ADS Skuse et al*, '((8"*

bserations

An assessment for susected ASD should not be decided uon before a child

obseration is made #ithin a ariety of social conte.ts !1isho, uyster, Eichler, %

ord, '(()"* Since the resence or absence of certain stimuli may or may not

trigger the behaiors or reactions an assessor is looking for, setting u scenarios to

elicit behaiors associated #ith ASD can roide information not aailable in other

#ays* +he reiously mentioned Autism Diagnostic bseration System !ADS

ord, Eutter, Diaore, % Eisi, :666" is one ractitioner5administered obseration

measure that assesses a number of areas in young children0s behaior !1isho %

ord, '(("* +he actiities are lay5based, so they reeal a lot about behaior

#hen the child is hay and engaged* Aside from lay behaior, the ADS consistsof arious actiities that allo# you to obsere communication behaiors related to

the diagnosis of ASD* +hese actiities can be comleted in as little time as 24 to 8(

minutes, but yield a great deal of information*

Huestionnaires and Checklists

Social and communication imairments are also measureable through=uestionnaires and checklists !1isho % ord, '(("* +hese t#o can be used in

con/unction #ith, or in lace of, interie#s #hen time is limited and access to

interie#ees is difficult* Some e.amles of =uestionnaires are the Childhood

Autism Eating Scale !CAES Scholer, Eeichler, % Eo :6)(", the 9illiam Autism

Eating Scale, Second Bdition !9AES5' 9illiam, '((", the Autism 1ehaior

Checklist in the Autism Screening -nstrument for Bducational Planning I +hird


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Bdition !A1C $rug, Arick, % Almond, '(()", and the Children0s Communication

Checklist, Second Bdition !CCC5' 1isho, '((2"* +he CAES is a diagnostic

measure that #as initially comleted through ractitioner obseration, but is no#

often used as a arent checklist also* 1rief, conenient, and suitable for use #ith

any child oer t#o years of age, the CAES #as deeloed oer a :45year eriod #ith

a normatie samle of about :,4(( eole* +he A1C roides a checklist of 87behaiors tyical of autistic indiiduals for use during the initial screening rocess*

+his reised edition coers normed data for indiiduals bet#een the ages of t#o

through :2 years and :: months* +he 9AES5' assists ractitioners in identifying

autistic5like behaiors in indiiduals reschoolers through young adults* -t also

hels estimate the seerity of the childJs disorder* -tems on the 9AES5' are based

on the definitions of autism adoted by the Autism Society of America and the

Diagnostic and Statistical Manual of Mental DisordersK Fourth Bdition5+e.t

Eeision !DSM5-&5+E"* 9AES5' #as normed on a reresentatie samle of oer

one thousand eole #ith autism from 8) states #ithin the Lnited States, and has

strong sychometric characteristics that #ere confirmed through studies of the

testJs reliability and alidity* +he CCC5' allo#s one to screen for language

imairments and erbal ragmatic imairments in children* +he 7(5item

=uestionnaire screens for communication roblems in children ages four to si.teen*

+he one ma/or disclaimer about this measure is that it #as normed in the Lnited

$ingdom*

anguage +esting

9athering data about a child0s language leel is critical to assessing for ASD*

anguage ability can hae imortant imlications for both interention and

outcome in children #ith ASD* anguage measures like the Eeynell Deelomental

anguage Scales !Eeynell %


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+he Mullen Scales of Barly earning !Mullen, :664" or the Differential Ability

Scales !DAS, Blliott, :66(" are t#o assessment tools that yield nonerbal -H scores

that are not oerly influenced by a child0s erbal abilities and are more aroriate

for measuring intelligence in children #ith otentially seere language delays!1isho % ord, '(("* Lsing more traditional measures like the Wechsler

Preschool and Primary Scales of -ntelligence, +hird Bdition !WPPS-5--- Wechsler,

'(('" is less aroriate because it does not take into account otential slinter

skills in e.ressie and recetie language abilities* -f the WPPS-5--- is

administered, additional language measurements may be need to be gien as #ell

to construct an accurate rofile of erbal intelligence !1isho % ord, '(("*

-ssues to Consider for Standardi>ed Measures

Assessment tools resuose a reertoire of abilities in their test taking

oulations, including comrehension of simle soken language, #hich is not

al#ays characteristic of children #ith ASD* Moreoer, some of the skills necessary

for successful test taking are skills that many reschoolers #ith ASD hae not yet

deeloed* For e.amle, een tests designed for ery young children re=uire the

child to oint to an ob/ect or icture to indicate a resonse choice, but many

reschooler #ith ASD do not understand ointing or use it as a mode of

communication* Another challenge of testing reschoolers #ith susected ASD isthat they are often =uite difficult to engage, thus it is not al#ays easy to distinguish

the child0s lack of ability from the ractitioner0s inability to engage the child in an

actiity !1isho % ord, '(("*

+o increase the chance of a alid assessment, ractitioners should create a testing

enironment in #hich the child is most likely to erform best* +his can be

accomlished by allo#ing sufficient time for the assessment, haing a arent

aailable for the child if needed, and not introducing too many ne# adults during

the assessment* -t is also useful to organi>e an assessment such that #ork is

intersersed #ith lay !1isho % ord, '(("*

Play Assessment


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Play assessment has been secifically mentioned as an aroriate #ay to ealuate

the needs of young children by the National Association of School Psychologists* -t

has become increasingly oular because of the aradigm shift to#ard ecologically

alid assessment, conte.t based interentions, and rogress monitoring !$elly5

&ance % Eyalls, '(()"* Further, it is seen as a culturally sensitie ractice* +hough

there are three tyes of lay assessments mentioned by NASP, only one aroachhas been emirically tested to an accetable degree* +he Play in Barly Childhood

Baluation System !P-BCBS Fiscus, '(("* +here are many consideration to

account for before holding a lay session* Settings like the child0s classroom or

daycare are referred, and the toys selected must match the gender, e.ected

deelomental leel, and age of the child !$elly5&ance % Eyalls, '(()"* +oys

should be isible and groued together to encourage thematic lay !$elly5&ance %

Eyalls, '(()"* NASP endorses non5facilitated lay, or free lay #ith minimal

direction because research sho#s that facilitated lay sessions imacts

standardi>ation and often has no effect or a negatie effect on the child0s lay*

+hus, child5centered lay and erbal raise is referred* -n the P-BCBS

assessment, children engage in free lay for about 2(584 minutes #hile being

ideotaed, if ossible* -t yields a core subdomain, B.loratoryGPretend lay, as

#ell as many sulemental domains like roblem5soling skills and lanning,

categori>ation, and =uantitatie skills* +he information obtained from a coding

rocedure is then comared to norms of tyically deeloing children, #hereafter

cognitie functioning estimates are roduced and discreancies are noted !$elly5

&ance % Eyalls, '(()"*

Bidence 1ased -nterentions

After a child has been diagnosed #ith ASD and data about his or her intelligence,

language leel, social skills, and associated sychological and medical conditions

hae been gathered, recommendations should be made to the child0s family about

aroriate serices, useful strategies, and releant goals* Since symtoms are so

ariable, there is no single interention or combination of interentions that #ill be

best for eery child #ith ASD* +hus the child0s indiidual rofile, rather than the

diagnosis of ASD itself, should be the basis for design and imlementation of

interention*

Desite limited research comaring the effectieness of different interentions for

children #ith ASD, there is no shortage of treatments claiming to be effectie*


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Whereas some of these interentions are based on #idely acceted theories about

the core deficits of ASD, others hae little or no scientific basis and are ie#ed as

generally ineffectie !Da#son % Watling, '((("* +he most consistent findings in

the treatment literature suggest alied behaioral analysis is the most deendable

aroach !Fa/a % Da#son, '(("* Naturalistic A1A aroaches hae been gaining

oularity, esecially since the infamous Discrete +rial +raining !D++" aroachhas been critici>ed as not being generali>able* -ncidental teaching has emerged

from this criticism* -ncidental teaching tries to create controlled, yet comfortable

and natural enironments for the child in #hich learning can occur by e.anding

the child0s sontaneous behaiors #ithin more deelomentally aroriate

behaiors !Fa/a % Da#son, '(("* Practitioners try to romt an elaboration of the

initial behaior done by the child, for #hich the child gains contingent access to a

desired item or actiity and receies raise* +he Walden model incororates these

ractices in the classroom and home enironments* +he Walden +oddler Model at

Bmory Lniersity !Mc9ee et al*, :666" is designed for ery young children #ith

autism, and research is indicating this interention model is effectie in increasing

langue and social functioning !Fa/a % Da#son, '((", esecially #hen used #ith

other A1A techni=ues like D++*

Bmirical suort has also been deried for the +reatment and Bducation of

Autistic and Eelated Communication5


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child and targets them in treatment through the use of ideo feedback* Eecordings

of arent5child interactions are reie#ed and scanned for secific dyadic atterns*

+hese atterns are then e.amined, and strategies are deeloed to imroe secific

asects of the arent5child communication system that seem faulty* +his method

not only inests more in the arents, #hich increases the likelihood the child

receies consistent theray, but it informs the arents on ho# to ad/ust theircommunication and interaction atterns as their child deelos and matures*

Shared attention, modeling, adated communication, and arental sensitiity and

resonsieness are emhasi>ed* +reatment starts #ith sychoeducation for the

child0s arents, follo#ed by regular consultation* Child0s +alk may be used to

comlement other treatments, but research sho#s it is resonsible for significant

imroements in symtom seerity, e.ressie language, oening circles of

communication, and arent5child interaction !Fa/a % Da#son, '(("*

ther interention ractices #hich hae had some ositie effect on children #ith

ASD include seech theray, occuational theray, music theray, social skills

training, and Floor +ime* Current research suggests that children #ith ASD should

be aggressiely enrolled in secial theray for at least '(5'4 hours a #eek !National

Eesearch Council, '((:"* Eather than selecting a single tye of theray, many

e.erts suggest finding a good combination of ractices to tailor an interention to

fit the indiidual needs of the reschooler* +aking that multidiscilinary and

multi5method aroach, arents of children #ith ASD should enroll their children

in a number of different treatments or educational rogram, in addition to regular

reschool !1isho % ord, '(("*

As eident by the myriad of assessment rocedures and interention ractices that

hae sychometric suort and emirical research backing their alue, the autism

sectrum disorder has been a ma/or focus of the sychoeducational rofession for

=uite some time* +he good ne#s is that children are receiing early interention at

a younger age than eer before, and ositie outcomes are increasing*


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Eeferences

1aghdadli, A*, Picot, M*, Pascal, C*, Pry, E*, % Aussillou., C* !'((2, Setember"*

Eelationshi

bet#een age of recognition of first disturbances and seerity in young children #ith

autism*

Buroean Child % Adolescent Psychiatry, :'!2", :''5:'7*

1aranek, 9* +* !:666"* Autism during infancyK A retrosectie ideo analysis of

sensory5motor and

social behaiors at 65:' months of age* Oournal of Autism and Deelomental

Disorders, '6, ':25

''8*

1isho, D* &* M* !'((2"* Deeloment of the Children0s Communication Checklist,

Second Bdition*

ondon, BnglandK Pearson*

1isho, S* % ord, C* !'(("* Autism Sectrum Disorders* -n O* * uby !Bds*",


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Cha#arska, $*, $lin, A*, Paul, E*, % &olkmar, F* !'((7, February"* Autism sectrum

disorder in the

second yearK Stability and change in syndrome e.ression* Oournal of Child

Psychology and

Psychiatry, 8)!'", :')5:2)* Eetrieed February :2, '((6, doiK:(*::::G/*:865

7:(*'((*(:)4*.

Cha#arska, $*, $lin, A*, Paul, E*, % &olkmar, F* !'(()"* Autism Sectrum

Disorders in -nfants and

+oddlersK Diagnosis, Assessment, and +reatment* Ne# orkK +he 9uilford Press

Daidoitch, M*, 9lick, *, man, 9*, +irosh, B*, % Safir, M* !'(((, Aril"*

Deelomental

regression in autismK Maternal ercetion* Oournal of Autism and Deelomental

Disorders, 2(!'",

::25::6*

Da#son, 9*, % Watling, E* !'(((, ctober"* -nterentions to facilitate auditory,

isual, and motor

integration in autismK A reie# of the eidence* Oournal of Autism and

Deelomental Disorders,

2(!4", 8:458':*

De 9iacomo, A*, % Fombonne, B* !:66), Setember"* Parental recognition of

deelomental

abnormalities in autism* Buroean Child % Adolescent Psychiatry, 7!2", :2:5:2*

Blliot, C* D* !:66("* Differential Abilities Scale !DAS"* San Antonio, +QK

Psychological Cororation*

Fa/a, S*, % Da#son, 9* !'((" Barly interention for autism* -n O* * uby !Bd*"*


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session resented at the annual meeting of the National Association of School

sychologists,

Anaheim, CA*

9illiam, O* B* !'(("* 9illiam Autism Eating Scale, Second Bdition* Austin, +QK

PE5BD*

$elly5&ance, * % Eyalls, 1* * !'(()" 1est ractices in lay assessment and

interention* -n A*

+homas and O* 9rimes !Bds*" 1est Practices in School Psychology !4thed*"*

1ethesda, MDK National

Association of School Psychologists*

$rug, D* A*, Arick, O* E*, % Almond, P* O* !'(()"* Autism Screening -nstrument for

Bducational

Planning* Portland, EK AS-BP Bducational Comany*

eCouteur, A*, ord, C*, % Eutter, M* !'((2"* +he Autism Diagnostic -nterie#

Eeised !AD-5E"* os

AngelesK Western Psychological Serices*

Mars, A* B*, Mauk, O* B*, % Do#rick, P* !:66)"* Symtoms of erasie

deelomental disorders as

obsered in rediagnostic home ideos of infants and toddlers* Oournal of

Pediatrics, :2', 4((54(8*

Mullen, B* !:664"* Mullen Scales of Barly earning* Circle Pines, MNK American

9uidance Serice*

National Eesearch Council* !'((:"* Bducating children #ith autism* Committee on

Bducational

-nterentions for Children #ith Autism* Washington DCK National Academy Press*

sterling, O*, % Da#son, 9* !:668"* Barly recognition of children #ith autismK A

study of first birthday

home ideotaes* Oournal of Autism and Deelomental Disorders, '8, '875'47*

>onoff, S* % Cathcart, $* !:66)"* Bffectieness of a home rogram interention for

young children


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#ith autism* Oournal of Autism and Deelomental Disorders, '), '452'*

Scholer, B*, Eeichler, E* O*, Eo, 1* !:6)("* Childhood Autism Eating Scale*

Minneaolis, MNK

Pearson*

Seere, S* !'(('"*


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Wiig, B*

Documents

Preschool Assessment for Autism