Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition that affects social interaction, communication, interests, and behavior. It’s termed a “spectrum” because of the wide variation in the type and severity of symptoms individuals experience.
1. Key Characteristics:
2. Causes and Risk Factors:
3. Diagnosis:
4. Associated Conditions:
5. Treatment and Intervention:
6. Living with ASD:
Occupational therapists (OTs) play a vital role in the assessment and intervention process for individuals with Autism Spectrum Disorder (ASD). Their holistic approach ensures that both the individual and their environment are taken into account. Among their many responsibilities, OTs often assess sensory processing and interoceptive awareness in individuals with ASD.
Collaborative Role:
Occupational therapists offer valuable insights and strategies for individuals with ASD, especially in the realms of sensory and interoceptive assessments. By understanding and addressing these areas, OTs contribute significantly to enhancing the quality of life and functional performance of those with ASD in various environments.
Some of our providers are trained in completing autism assessments and identifying autism from other struggles, such as ADHD. Unique personalities can be a challenge. This is why a robust assessment is completed. Our providers can begin to identify autism around 18 months of age.
Every piece of information that we collect from parents, teachers, the child, and our clinical observations allow us to start the process of understanding the individual. An autism assessment uses a host of diagnostic tools to help guide the clinician to understand the whole child.
Our team members strive hard to ensure that each individual feels supported and comfortable when they arrive at Level Up. We will ask about any sensitivities that may be present and we will try our best to remove any triggers. While we cannot guarantee a complete removal, we will minimize sensory struggles as best we can.
1. The psychologist will use a diagnostic instrument such as the Autism Diagnostic Observation Schedule, or the ADOS-2. The ADOS is a test with different modules to accommodate a range of children. There is a version for toddlers that is play-based. For kids older than thirty months, there are modules that include more conversation, according to the child’s language level. This is not the kind of test where there are correct answers. The purpose of the ADOS-2 is to evaluate the social skills and repetitive behaviors displayed by the child during the test. This means the evaluator is paying attention to certain things, such as if the child asks for help when they need it, giving others a chance to speak and following along with changes of subject. During the interactions at the office, the psychologist will be gathering further information.
2. There are often instances where it may be difficult to identify from the information collected if autism is present. Many individuals who are gifted have learned a series of behaviors and adaptive skills to “appear normal”. We often refer to this as “neurotypical behaviors”- or behaviors that society deems to be appropriate. In these instances, we need to complete the Autism Diagnostic Interview (ADI). This is a comprehensive interview, typically completed with the parents to understand the history of the child. Due to the time that is required to complete this assessment, it can be costly, taking anywhere between 4-6 hours of clinical interview time.
3. People who are neurodivergent also experience difficulties with sensory processing. We often ask our occupational therapists to complete sensory assessments, motor assessments, and other diagnostic testing and interviewing to identify other environmental situations that may help us to understand the whole person. *Occupational therapists who are involved bill out for a separate assessment with associated fees*.
4. Some individuals may benefit from a language assessment to understand if there are language and communication challenges. *Speech and language pathologists involved bill out a separate assessment with associated fees*.
Level Up practitioners use a combination of diagnostic assessment, clinical interviews, and research to determine if the individual has a diagnosis. This is because diagnostic tools do not diagnose, clinicians do.
Here are some problems with over-relying on diagnostic tools alone:
Dr. Epstein notes that, even with these tools, it is important to be working with a mental health professional who has experience diagnosing people on the autism spectrum. “You want to be working with someone who understands the subtleties,” she says. “For example, a person who has real expertise will be able to distinguish if a child has poor eye contact because the child is shy, versus if there is poor eye contact in the way we expect to see it in autism spectrum disorder.”
A recent study underscores the difficulty in distinguishing between autism and other disorders, like ADHD, using even gold-standard tools like ADOS. Looking at school-age kids with high verbal functioning, the study found that 21% of children with ADHD—but not autism—met diagnostic criteria for autism when given the ADOS.
“The minute that we diagnose blindly based on score, we’re going to misplace a lot of kids into categories,” lead researcher Somer Bishop, assistant professor of psychiatry at the University of California, San Francisco, tells Spectrum, an online journal on autism research. “These instruments were designed to assist in clinical decision-making, but they are not a replacement for a clinical brain.”
Catherine Lord, director of the Center for Autism and the Developing Brain at New York-Presbyterian Hospital, who developed the ADOS, adds that it’s important to consider the motivation for the behavior. A child with ADHD might avoid an adult’s gaze because he thinks he has done something wrong, she tells Spectrum, rather than because of a social deficit. Or, a child’s face might be unexpressive because she is bored or distracted, not because she is less expressive in general.
Screeners and diagnostic tools are ways of gathering information, but they have to be considered in the context of other information from a range of adults who know the child. A full evaluation should also include a thorough interview with the child’s parents, covering general development and current concerns. The interview should also closely investigate ASD-related symptoms. To gather more information, parents might be asked to fill out special questionnaires as well.
When you embark on a journey to determine if your loved one has autism, the services that you will receive at Level Up are similar to the experience you would have at an assessment centre in a hospital. Our psychologists work with our multi-disciplinary assessment team to ensure no stone is left unturned. If the psychologist has identified that motor skills, sensory struggles, or language and communication issues exists, we discuss our findings and concerns with our team. We then relay this information back to you, so you can decide if you would like other providers to complete their assessments. This approach is used to understand the whole-person. This is important because it allows for tailored interventions to support the individual’s needs.
We understand that this can be an overwhelming process, so please speak to our team and feel free to ask any questions that you may have. We strive to ensure the best support to meet your family’s needs.
If you have questions Autism Spectrum Disorder (ASD) Assessments services, please contact our client relations team.
