Psychometric assessment tools for autism spectrum disorder diagnosis

Psychometric Assessment Autism

Background of Autism

What is autism? Autism is a disease, which poses tons of questions, while providing least of answers. This being said, autism is one of the five diseases coming under Pervasive Developmental Disorder (PDD). It shows in early years of a human and effects the brain's functioning. An autism website states that, 'it's a result of a neurological disorder, which hampers the proper operations of a brain, hindering the social interactions and communications' (Autism Society of America website). Autism asks us millions questions, its origins, its solutions, its causes and symptoms; none of which are answered. The diagnostic and statistical manual of mental disorders (American Psychiatric Association (APA), 2013), states that, autism is basically pervasive developmental disorder otherwise called Autism Spectrum Disorder (ASD). It is described as a condition where the person faces severe problem in social communication, interactions, perception and communication. APA (2013) shows that, autistic people show unwarranted cases of unexpected and unusual interests and activities.

People with autism show different characteristics, they have an intricate personality and unique set of features. This means that some ASD adults have trouble making friends, while some have problem in conversing with others, whereas some have problem communicating.

They have problems listening and talking to people. They are talking to themselves instead of others. For instance, talking about a favourite subject, the ASD adult will keep on talking regardless of someone's interest. The ASD individuals respond to information in different ways. Some inflict damage on others / themselves, while some are violent and show episodes of anger.

Autism is rising day by day as estimates show that 1 person in 150 is autistic (CDC, 2010). So, this means that 1.5 million Americans are suffering from autism. Their form can differ. The mind of an autistic and non-autistic child is different. The doctors are at a loss for an explanation. The researchers have been searching for the last decade for the autism gene, which they haven't found yet. If people look on autistic websites, they can clearly see that which children are autistic and which aren't. Thus, they believe there must be a trigger of some sort which instigates autism. Autism shows up suddenly in a child; in case families of no past record of autism before. The children and adults with ASD have a hard time interacting and communicating with the populace. They can't take part in recreational activities and leisure activities. It affects one portion of the brain, but there aren't any signs of such patterns. It's not a visible disease.

Autism can be checked and verified by the concerned parents. The children with ASD are often acting as deaf and non-respondent because they are trapped in their own mental asylum. Calling them by their name and shouting doesn't work in their case either. They might respond to touch, that could vary from person to person with ASD. Children hate change. While changing schools and homes, children often make commotion. In case of children with ASD, they throw tantrums when things don't go their way. That's a common fact. Often, they like an object which can be given to them to calm them down. Thus, that's one way of calming them down.

It is praiseworthy to note that, according to Piven & Rabins (2011), there is evidence that autism is a permanent condition, not just a childhood disorder. CDC (Center for diseases control and prevention) calculates that autism prevails nearly 1%. Also, there aren't any studies showing the evolution of ASD in an ASD individual's life. But, thousands of ASD adults can give their personal life accounts about ASD on www.autismspeaks.org. They can give great insights and information about their lifelong battles with ASD. The extreme cases of ASD are often suffering from Down syndrome, diabetes and other illnesses. This just complicates matters for ASD adults having complex sensory aberrations (Gense & Gense, 2011).

ASD is being diagnosed on a greater frequency now and is this remains the case then it seems that the adult population is suffering from ASD, which puts the healthcare industry, families and community under strained pressure (Piven & Rabin, 2011). According to Piven and Rabins (2011), more institutions and homes should be equipped to cope with aggressive and violent situations shown by ASD individuals.

Autism is categorized into five different categories. These are namely:

Autistic disorder

Rett's disorder

Childhood disintegrative disorder

Asperger syndrome

Pervasive developmental disorder (PDD)

But, (APA 2013) found out that diagnoses weren't made use of. Thus, they finally decided on diagnosing any one of the five would do the trick for ASD.

Diagnosis and assessing Autism: The concept of best practices

Pandolfi et al. (2010) found that the best practice approach is generally indicates that certain methods and measures are to be used for the most part. The assessment method must be in conjunction with latest literature available on proof based assessment involving procedures and measures. A trend has been ensuring during the last few years, in many fields, including human services as well as human health; a broad variety of multidisciplinary experts review the current academic research studies and after that accumulate all their work experience within a single report, usually a guideline for clinical practice. It is a consensus-based suggestion ((Pandolfi et al., 2010).

Within the field of autism assessment, two documents have revolutionized the criteria for best practices. These 2 documents belong to New York department of health and American Neurology Academy. The New York Health Department (1999) drafted a board to create a guideline for clinical practice related to diagnosis as well as therapy programs aimed at autistic individuals. Similarly, Filipek et al. (1999) belonging to the American Neurology Academy headed a board of experts from different fields of medicine. They passed on their suggestions for not only premature screening but also assessment standards along with extensive therapeutic programs.

Standard Psychometric Assessments for Autism

Pandolfi et al. (2010) in his study point out that DSM-IV criteria are called the gold standard for diagnosing Autistic Disorder within the medical community. They are used systematically. Every criteria is associated to a developmental level, which has its roots from information garnered from parents and teachers, in multiple instances and sessions (both parents combined and alone for kids and adolescents, significant others alone and combined, structured and semi-structured interviews). In low performing people and young kids, some criteria's can't be matched because they exceed their developmental stage hence declining the denominator of the formula for diagnosis. The diagnostic assessment must be having a report by parents or significant others as well as a collection of prior reports and data accumulated. More observation is required in instances of tough diagnoses and making ambiguous observations. Sometimes collegial consultation is required while sometimes extra testing is needed (Pandolfi et al., 2010).

Johnson and Myers (2007) in their study found that conventional Autism therapy guidlines propose the usage of standard autism assessment measures. For children the most popular and widely used ones are Autism-Rating-Scale-For-Children and the most popular ones for adults is Autism-Diagnostic-Observation-Program. Another standard psychometric autism scale is CARS, which consists of key basic observations as well as prearranged interaction series (to evaluate both verbal and nonverbal communication skills) and collecting information from teachers/staff / parents (Johnson and Myers, 2007).

Ozonoff et al. (2005) found that the results in case of CARS were amazing in terms of both reliability as well as validity (consistency, mutual consent as well as reliability of tests and retests; along with synchronization with clinical analysis) of the not only the adults but also children suffering from autism. In case of CARS, now therapists have their very own training manual with concrete standards for basing reliability, but it ought to be noted that therapists and psychologists don't usually like CARS that much and therefore don't use if very often. Apart from that, there happen to be many parental surveys as well as questionnaires aimed to attain different objectives with differing psychometric assessment functions used frequently by therapist and psychologists (Ozonoff et al.,2005).

Standard Psychometric Assessment Limitations for Autism

There are an assortment of myths and popular beliefs which we have been mentioned below:

If Autism has been diagnosed then intelligence levels carry little relevance

Mental capacity can't be estimated in autistic

People suffering from autism less interested in tests and assessments; however, their intelligence and motivation levels may be higher in normal circumstances.

The autism afflicted people are tough to test in standard tests. To use verbal-based tests for autistic individuals is unfair as one cannot distinguish their intellectual capacity accurately and precisely (Norris et al., 2010).

Sattler (2002) found that the limitations of psychometric assessment shown above are bit wayward, baseless and quite bluntly speaking, do not corroborate the results found in clinical trials. Most of the people suffering from autism (approximately eighty percent) fit the levels fixed for Mental Retardation (MR). The ratio is higher for the adult population suffering from autism in treatment facilities. The learning issues as well as behavioural problems are additionally observed within people suffering from developmental disabilities (from herein referred to as DD) and can be connected to an individual's learning curve instead of autism. Hence it has been considered necessary for people to be examined by means of the guidelines related to DD field to gain an insight into adaptive functioning and mental functioning.

Sattler (2002) additionally argue that clinical guidelines dictate using reliable, standardized and appropriate written and oral and intellectual operations suitable for the sufferer's intellect-level as well as age. The tests must be from recent peer-reviewed journals so as to gurantee not only their validity and reliability but also suitable psychometric functions. Sometimes it's important to make use of assessments, which are suitable for younger kids. This implies that conventional rating systems can't be taken for this child as he is either above the age-group or perhaps he has reduced brain functioning level when compared with his age group. Hence sometimes, therapists make way for age-parallel (for instance Peter attained a score at 5-year on an 10-month level); or ranges (Jill's skill ranges from 2-3-year level) or perhaps descriptive statistics (Paul successfully solved inset puzzles however failed at making geometric designs). These kind of tasks, therapists perform with most children they come in contact with. In such instances, it is necessary to have some set of items within the child's mental range irrespective of their physical age; at least more than three test items should be available.

In the absence of verbal responses, the rating score and items shouldn't be impeded, particularly in area of expressive and responsive communication. This is because they form a constituent of the intelligence part therapists intend to measure in the first place. Hence they shouldn't be any less than other sufferers they examine. Even though, isolated scores in both vocal and non-vocal fields are useful clinically, but in situations where high level vocal communication retardation is found, more non-vocal assessment tools are employed (it occurs quite less on a positive note). A pattern of definite cognitive strong-points and cognitive flaws are found in individuals who are capable in finishing the WISC -- III (or comparable assessments) as they are mentally capable enough. Their strength lies in:

Rote learning

Good hand eye connection

Spatial visualization capabilities

Their flaws are found in:

Social understanding

Language understanding

Expressing self-emotions and thoughts

Reasoning and rationalizing properly

For an individual who possesses an intense pattern of strong points, flaws and vocal communication flaws; The scale with complete range and items is usually not taken in consideration. Therapists also cannot oversimplify a strong point centered on one particular skill alone (for example, having great memory of movies he has seen). Sattler (2002) argues that this doesn't mean he was born intelligent as that's rarely the case (Sattler, 2002). Therapists and Psychologists make use of different tests that comprise the following:

Stanford-Binet

Bayley Ratings of Development

Weshsler Intelligence Scale for children

Therapists usually commence their psychometric assessment using a test according to the individual's age then move on to tests intended for young adults, depending on the age and mental level of the patient. Sometimes cognitive, neuropsychological and memory tests are needed to help testing and sometimes academic accomplishment testing is done. Apart from the cognitive assessments, for diagnosing DD or ADD, an individual's adaptive performance must be calculated in daily life situations. The sources of information in these cases are obviously teachers, friends and family members (it's not a viable practice to take information only from IQ tests). In case of preliminary diagnosis, therapists are compelled to use Vineland-Adaptive-Behaviour-Scales (VABS) in which parents are interviewed. Apart from that Classroom-Version is concluded by teachers and staff for further evaluation of the test subject. Vineland-Adaptive-Behaviour-Scales is highly recommended for usage for autistic individuals as it synchronizes well with the Adaptive Behaviour Scales. Gilliam (2006) point out that there are however problems with the use of VABS. It isn't that reliable with large scale errors occurring creating two categories sometimes (Gilliam, 2006).Apart from that, sadly the scores and age equivalents for this scale don't match that well. It means some strong points as well as some flaws exist, while one utilizes the scores (speaking from a statistical point-of-view, standard scores are taken in consideration for tests and scales), the profile is flat. For instance, a three-year-old child and a three-month infant may attain same score on this test while the age counterpart results could be relatively different. Similarly, in between these two score units, the actual four domains seize to be dependable (Gilliam, 2006).

Therapists can also make use of some curriculum centred methods in case of developmental planning. Sometimes it's important to take in consideration the behavioural evaluation of disturbing behaviour (for instance anger issues and self-injury). They might sometime assess the biological (if the sufferer has an ear ache?) or environmental issues (how's the current home and work/school environment helping the autistic patient?), analysing the impacts of disturbing behaviour and its consequences as well (for instance, can the child gain peer attention). The evaluation methods are designed with the aim of ensuring that prevention methods/treatment methodologies are made with the help of certain assessment methods or maybe by informal methods. It all relies on the circumstances and condition of the child in question here.

Conclusion

The standardization of test management of autistic individuals demands higher levels of skill-set as well as clinical judgment pertaining suitable adjustments to standardizing tests. The Standards for Psychometirc and Cognitive Testing indicate that shifting away from the standardization will influence the test to some uncertain level. Apart from that, ethical obligations exist while managing special cases to make alterations which are admissible clinically to lessen the influence of the autistic individual's qualities. Hence their job is to develop a proper construct suitable for the individual's interest. Some alterations are required in the presentation layout, time, format answer scale, test substitutes and the test environment as well as using segments of tests. Some guidelines exist which are admissible but no comprehensive empirical data exists (Constantino, 2002). Furthermore, the testing environment and criteria ought to be wondrous for the individual. It should depend on the individual's age as well as session's venue as most therapists encourage having a parent / family member / guardian close by. The examination can be conducted in a place wherein the autistic patient feels safe such classroom, home or a day care centre. Once again, it depends on the venue and the assessor, can form a friendship with the patient and become more professional afterwards.