Assessing Autistic Children

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Answer

Assessment, in the broad sense, involves more than the administration of standardized tests. I'll assume you are using the term ''assessment'' in this broad sense, and I'll give you a few ideas in the realms of formal (standardized assessment) and, most importantly, informal assessment. Assessment should ideally be done in the context of an interdisciplinary team.

Standardized tests can be used to qualify children for services, and to give one a general idea of the child's strengths and needs. Informal measures will be more likely to be useful in generating specific therapy objectives for the child. Formal tests you may decide to give (depending on the child's needs and abilities) include: tests specific to children with autism spectrum disorders, tests of expressive and receptive language, tests of learning-related language skills (verbal working memory, phonemic awareness, early literacy, etc.), and tests of pragmatics and pragmatic language. You are probably already familiar with many of these types of tests: The CELF-4, the CASL, the CTOPP, etc.

Some formal tests, measures and screening tools specific to children with autism spectrum disorders include: Autism Behavior Checklist (ABC) by Krug, Arick & Almond, 1993; Childhood Autism Rating Scale (CARS) by Schopler, et al. (1988), Gilliam Autism Rating Scale [GARS] by Gilliam, 1995; Gilliam Asperger's Disorder Scales [GADS] by Gilliam, 1991; and Autism Diagnostic Interview - Revised (ADI-R) by Lord, et al. (1994). Many formal measures such as these may involve observation of the child's social, pragmatic, play, language, and communication behaviors, as well as parent report.

While these formal measures are important, less structured assessment will probably yield the most important information for your assessment. Since the child you inquired about is high functioning, basic language skills may be in place and you may need to focus on the child's social communication and discourse skills (while not neglecting other core areas important for academic success). You will want to note, through observation, the use of idiosyncratic or unconventional forms of communication (echolalia, unconventional behavior, incessant questioning, perseverative speech, etc.). Your observations may then focus on key elements of social communication in real communicative and social contexts. These areas are delineated by Wetherby, Prizant, and Schuler (2000; p. 131) (reference below) and they include: the range of communication functions expressed through language (e.g., asking, answering, requesting, commenting, protesting, providing information, initiating social routine), the ''reciprocity of interaction'' (rate of communicating, use of conversational repair strategies, etc.), ''social-affective signaling'' during interaction (e.g., use of gaze to regulate the interaction), comprehension and expression of emotion, emotional (self) regulation, and communicative competence with different partners and in different communicative contexts.

There are a number of resources to guide your observations. The Assessment of Social and Communication Skills for Children with Autism (by Quill, Bracken, and Fair), for example, provides a compendium of questions to guide your observations in the areas of verbal and nonverbal social communication behaviors. It is published in Do-Watch-Listen-Say by K. Quill (2000) published by Paul H. Brooks. The Functional Communication Profile - Revised by Kleiman (LinguiSystems, 2003) may also be useful to you. It is not a normed test, but rather a checklist of communication, adaptive and sensory/motor behaviors. The Social/Pragmatic section may be particularly helpful in guiding your observations of the child during social interaction. The Assessment of the Pragmatic Aspects of Language (first published in the Journal of Speech and Hearing Disorders, Vol. 52, pp. 105-119, 1987) may also serve as a useful guide to the observational assessment of verbal, nonverbal, and paralinguistic aspects of pragmatics. Examples of items on this rating scale, that are rated as ''appropriate'' or ''inappropriate'' include: conversational initiation, repair, quantity/conciseness; topic selection, maintenance and change; conversational turn-taking skills such as feedback to speakers, making responses contingent on previous utterance, and pause time; lexical specificity and accuracy; vocal prosody, intensity and fluency; and body posture, gestures, facial expression and eye gaze. A similar list of verbal and nonverbal discourse skills can be found in Prizant, et al., 1997 (reference below).

In addition to discourse skills, narrative skills would also be an important area for informal assessment. It is the combination of formal and observational assessment that will give you the most meaningful data from which to formulate functional therapy goals.

References:
Prizant, B. M., Schuler, A. L., Wetherby, A. M. and Rydell, P. (1997). Enhancing language and communication development: Language approaches. In: D. J. Cohen and F. R. Volkmar (Eds.). Handbook of autism and pervasive developmental disorders (pp. 572-605. New York: John Wiley and Sons.

Wetherby, A. M., Prizant, B. M. and Schuler, A. L. (2000). Understanding the nature of communication and language impairments. In: A. M. Wetherby and Prizant, B. M. (Eds.). Autism spectrum disorders: A transactional developmental perspective (pp.109-141. Baltimore, MD: Paul H. Brookes Publishing Co.

BIO:
Suzanne Hungerford, Ph.D., CCC/SLP is an Associate Professor in Communication Disorders and Sciences at Plattsburgh State University of New York. Research and teaching areas include communication disorders in special populations (e.g., selective mutism, autism, psychogenic communication disorders). She may be reached at: suzanne.hungerford@plattsburgh.edu.