Expert: Dr. Sharon A. Mitchell - 8/13/2009

Question
I have a 5 year old client, diagnosed by her GP as Autisic,she is in grade one. I, the student psych, have no idea on how to carry on from here excepy to issue out intelligence tests and to refer her to a remidial school. Are these interventions appropriat? I am also failing to connect with her as she is always aloof and distarcted.

Answer
You are on the right track with the interventions you're proposing.

But if you are not used to assessing kids with autism spectrum disorders, there are a few things you may want to consider.

First, the normal tactics of engaging a child before testing may not work as well as usual. Even though you may not feel that you have established a personal rapport with the child, does not mean that she will not participate in the evaluation. Generally you might judge rapport through eye contact, smiles, facial expressions, shared exchange of information, etc. You might not get these signs for a child with autism spectrum disorder (ASD).

If you try to insist on eye contact, the child may withdraw further from you. Eye contact can be uncomfortable for some ASD people (but not all). You might have better success sitting on an angle from the testee rather than across the table so that both of you focus on the test materials and there is less requirement of direct eye contact.

Standardized tests limit your verbal explanations but whenever possible, without compromising standardization you may want to supplement any verbal directions with demonstrations as most people with ASD have auditory processing difficulties and stronger visual skills. Along with the auditory processing weakness, comes otherlanguage-related difficulties. Some verbal kids have odd voice intonation, prosody and do not understand language pragmatics. Rather than being rude, uninterested or manipulative then may genuinely not have picked up on the niceties of our language.

A typical WISC or WPSII profile for an ASD child would show verbal weaknesses and relative strengths in visual processing. But that is just a generalization as each child has a unique profile. Kids with Asperger's may have high verbal scores but with an uneven profile. Wide subtest score spreads are not unusual with ASDs.

Since kids with ASDs neither interpret nor present well with body language, it may be more difficult for you to recognize the signs of fatigue. Increased withdrawal, refusals, increased activity, agitation or meltdowns may result. You might need to break your testing into more sessions than is your norm. On the other hand, some kids may become totally engaged with the process and you could accomplish more in one session that anticipated.

Being aware of the sensory sensitivities that are common in autism might help. She may be uncomfortable handling or looking at some of the test stimulus objects. Or she may relish them and be unwilling to give them up. Perseverations are a common feature in autism and she may get stuck on some picture or activity.

Some kids will focus better during the testing if they are allowed to hold a fidget object. Some may remain calmer with their vestibular or proprioceptive needs being met through weighted products, pressure apparel, and body breaks that allow for movements such as jumping, pulling, swinging, etc.

People with autism have trouble making sense of their world. Some of what may appear to be bad behavior can be a reaction to being overwhelmed by sensory issues or by not understanding what is happening and what is expected of them.  Social stories are one way of preparing a child for what will happen. Here's an example of some http://www.autisminspiration.com/public/department47.cfm You can find out lots of information about social stories through sites such as this and http://www.thegraycenter.org/store/index.cfm?fuseaction=page.display&page_id=30

You may find it helpful to let her know that, "The rule is...." And try a card that says "First______________________, Then ____________________", supplying appropriate pictures.

Keep in mind the Triad of Social Impairments when assessing a child with autism. There is much written online about this triad which is comprised of Executive Functioning, Central Coherence and Theory of Mind. Understanding these difficulties will help when you are observing the child.

Being a spectrum disorder, there can be a wide range of abilities. Some people with ASD have severe mental retardation. Others may complete advanced degrees. When a child is nonverbal we generally assume lower ability. There are some (rare) cases though where this assumption have been proved to be erroneous. I do not want to give any families false hope and these instances are rare but it is good to keep in mind when making pronouncements. Here are a couple examples:

http://carlysvoice.com/?p=247

http://www.youtube.com/watch?v=4c5_3wqZ3Lk&feature=related

Here's an article on testing kids with ASDs: http://autism.about.com/od/whatisautism/a/IQTesting.htm?nl=1 And here is a video: http://www.actcommunity.net/AI/Diagnosis/DiagnosisWebcast.htm

As you well know, an assessment is a relatively accurate reflection of how that child does on those tasks on those days. While performance can vary day to day for all of us, this is far truer of a child with an ASD. Even your best efforts at getting a valid IQ score may be only a very rough estimate and not a true indication of the little girl's ability. But the profile of strengths and weaknesses and your clinical observations could offer staff insight into how to motivate the girl, areas of remediation to begin with and how to work through her strengths. While it is true with all assessments, never more than with ASD is it important to triangulate your data before writing your report as she may perform very differently with different people, in different situations and on different days.

You will find this assessment very interesting and it is best to become comfortable assessing kids with autism as the prevalence rate is increasing significantly world-wide and you will likely be asked to see many more such children.

Best wishes,

Sharon A. Mitchell, B.A., B.Ed., M.A., PhD. Candidate
www.autismsite.ca