Screening tools

Screening tools are assessments that identify at risk children. Children who are found to be at risk with the screening tool, should go for further assessments. Screening tool commonly used by clinical/ developmental psychologists and psychiatrists in India is

M-CHAT-R/F (Modified Checklist for Autism in Toddlers, Revised with Follow-Up)

The Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F; Robins, Fein, & Barton, 2009) is a two-stage parent-report screening tool designed to assess the risk of Autism Spectrum Disorder (ASD). The M-CHAT-R/F is freely available for download for clinical, research, and educational purposes. Here are the usage instructions:

• The M-CHAT-R can be utilized and scored during routine well-child care visits, and it is also suitable for specialists and other professionals to evaluate the risk of ASD.
• The primary objective of the M-CHAT-R is to maximize sensitivity, meaning it aims to identify as many cases of ASD as possible. Consequently, there is a relatively high rate of false positives, indicating that not all children who score as at risk will be diagnosed with ASD.
• To address this, the Follow-Up questions (M-CHAT-R/F) have been developed. Users should be aware that even with the Follow-Up questions, a significant number of children who screen positive on the M-CHAT-R will not receive an ASD diagnosis. However, it's important to recognize that these children are at a heightened risk for other developmental disorders or delays, making it crucial to consider further evaluation for any child who screens positive.

Occupational Therapy Evaluation

As an occupational therapist (OT), the evaluation of a child with autism involves a comprehensive assessment of various domains, including social, communication, cognitive, sensory, and motor skills. It is valuable to incorporate a sensory profile of the child and consider the results of assessments conducted by other professionals. The Autism Spectrum Disorder (ASD) assessment conducted by an occupational therapist can take place in diverse settings, such as at home, in school, or at one of our clinics.

During the ASD assessment, the occupational therapist, using their clinical expertise and specialized training, employs a combination of a sensory profile, autism checklist and clinical observation. The checklist and sensory profile is designed to gather information on how the child perceives and interacts with the world. For example, it includes questions related to the child's comfort level in social situations, their preference for solitary play versus engaging with others, and other factors that provide insights into their sensory experiences and responses. This multidimensional assessment approach helps tailor intervention strategies to meet the child's specific needs and challenges.

Speech and Language Evaluation

As a Speech Language pathologist (SLP), one can conduct initial screenings to identify any communication and language delays or atypical behaviors that may be indicative of autism. SLPs can conduct comprehensive assessments to evaluate a child's communication and language skills. This assessment may involve evaluating speech and language development, as well as social communication abilities.

Diagnostic tools

It's important to emphasize that while SLPs and OTs are experts in the area of communication and functional skills respectively, they do not have the authority to diagnose autism. The formal diagnosis of autism is typically made by a medical professional, clinical psychologist, or developmental pediatrician based on a comprehensive evaluation that considers various factors, including communication and language development, social interactions, and repetitive behaviors.

CARS - Childhood Rating Scale

The Childhood Autism Rating Scale (CARS) has been updated as the CARS-2. The original CARS was a widely-used rating scale for autism, primarily designed for individuals with co-occurring intellectual functioning. However, it faced criticism for not accurately identifying higher-functioning individuals on the autism spectrum. The CARS-2 preserves the original CARS format for use with younger or lower-functioning individuals (now known as the CARS2-ST or "Standard Form"). Simultaneously, it introduces a distinct rating scale designed for higher-functioning individuals (referred to as the CARS2-HF or "High Functioning").

Clinically, the original CARS was sometimes misused as a parent questionnaire, but it was originally intended as a clinician rating scale to be completed following direct observation of the child by a professional knowledgeable about autism, who had also received some brief training on how to assess the CARS items. The CARS-2 maintains this format. Parent input can be gathered using the CARS2-QPC (Questionnaire of Parent Concerns), a form that parents use to document their observations (although it is not scored).

Specific guidelines for usage include: + CARS2-ST can be employed with children under the age of 6, or over the age of 6 but with an estimated IQ of 79 or lower, or if there is a significant communication impairment. + CARS-HF is administered to children aged 6 or older, with an estimated IQ of 80 or higher, and who possess fluent communication skills.

Autism Diagnostic Observation Schedule (ADOS) - (ADOS; Lord, Rutter, DiLavore, Risi, 1999)

The Autism Diagnostic Observation Schedule (ADOS) is considered the 'gold standard' for assessing and diagnosing autism and pervasive developmental disorder (PDD) in individuals of all ages, developmental stages, and language abilities. This semi-structured assessment is versatile and can be applied to evaluate individuals suspected of having autism, ranging from toddlers to adults, and encompassing those with a wide spectrum of language skills.

The ADOS comprises four distinct modules, each of which can be administered in a relatively short timeframe of 35 to 40 minutes. The module selected for assessment depends on the individual's expressive language level and chronological age. Guided by the instructions in the manual, the appropriate module is chosen for each person. Module 1 is designed for children who do not consistently use phrase speech, Module 2 for those using phrase speech but not verbally fluent Module 3 for fluent children, and Module 4 for fluent adolescents and adults. It's worth noting that the ADOS does not specifically address nonverbal adolescents and adults within the autism spectrum. During the ADOS assessment, there's a 30- to 45-minute observation period that offers ample opportunities for a trained administrator to observe social and communication behaviors relevant to the diagnosis of pervasive developmental disorders. As the ADOS is conducted, observations are recorded and later coded to formulate a diagnosis. Cut-off scores are provided for both the broader diagnosis of PDD/atypical autism/autism spectrum and the more traditional, narrower concept of autism. By offering standardized materials and ratings, the ADOS provides an evaluation of autism spectrum disorders that remains independent of language capabilities.

Autism Diagnostic Interview, Revised (ADI-R) - (ADI-R; Couteur, Lord, Rutter, 2003)

The Autism Diagnostic Interview, Revised (ADI-R) is a structured interview employed for the purpose of diagnosing autism, planning treatment strategies, and distinguishing autism from other developmental disorders. Having been used in research studies for many years, this comprehensive interview is an invaluable tool for conducting a thorough assessment of individuals suspected of having autism or related autism spectrum disorders. The administration and scoring of the ADI-R typically take between 1 1/2 to 2 1/2 hours.

To administer the ADI-R, a skilled clinical interviewer engages in a structured dialogue with a parent or caretaker who possesses in-depth knowledge of the developmental history and current behaviors of the individual being assessed. This interview can be utilized for assessing both children and adults, provided their mental age is above 2 years and 0 months.

The ADI-R consists of 93 items and focuses on three key functional domains: Language/Communication Reciprocal Social Interactions Restricted, Repetitive, and Stereotyped Behaviors and Interests

Following highly standardized procedures, the interviewer records and codes the responses provided by the informant. The interview questions cover eight distinct content areas:

• The subject's background, including family, educational history, previous diagnoses, and medication use.
• An overview of the subject's behavior.
• Early development and achievement of developmental milestones.
• Language acquisition and potential loss of language or other skills.
• Current functioning related to language and communication.
• Social development and play.
• Interests and behaviors.
• Clinically relevant behaviors, such as aggression, self-injury, and possible epileptic features.

Unlike tests, the ADI-R is an interview process that focuses on behaviors that are uncommon in individuals not affected by autism. As a result, it yields specific results rather than relying on scales or norms. These results can be used to support a diagnosis of autism or to determine the clinical needs of various groups in which a high prevalence of autism spectrum disorders might be expected. This includes individuals with severe language impairments, certain medical conditions, congenital blindness, or those who have experienced institutional deprivation.

Here is a comprehensive note on autism assessment, screening tools and communicating with parents.