Understanding autism
Understanding autism

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2.3 How is diagnosis carried out?

Diagnostic practice depends on the professionals involved, how they work, geographical area and country. In the UK, a school educational psychologist, GP or paediatrician may be involved in the early stages; a clinical psychologist or psychiatrist may make the diagnosis alone, but diagnosis will typically involve different specialists working as a team. An individual’s journey to diagnosis can involve problems, delays, distress and conflicting information. In the UK, most local authorities have defined procedures or ‘pathways’, that specify the process by which children suspected of having a special educational need are referred for specialist assessment and/or diagnostic evaluation. The National Autism Plan for Children (NAPC) is a UK framework containing guidelines and recommendations for good practice in relation to the identification and diagnosis of children with autism (NIASA, 2003). Pathways for adult diagnosis are less well-developed but the Autism Act (2009) has required all local authorities to develop them.

The process of assessing a child or adult usually involves a diagnostic instrument or tool, designed to ensure consistent application of the diagnostic criteria themselves. One is the Autism Diagnostic Observation Schedule (ADOS), comprising ‘modules’ for assessing children of different age groups. A trained practitioner selects the appropriate module (e.g. toys and games for age 2) and uses it to assess whether the individual has ‘age appropriate skills and behaviour’ – for instance, for a 2 year old, these will involve play, joint attention and language. The Autism Diagnostic Interview - Revised (ADI-R) comprises questions for parents about their child’s current skills and past behaviour. Alternative instruments include the Diagnostic Interview for Social and Communication Disorders (DISCO), and the Developmental, Dimensional and Diagnostic Interview (3di). Multiple tools may be used in an assessment.

A photograph of a box containing all kinds of toys and games
Figure 1 Equipment used in the ADOS.

Activity 3 A diagnostic tool in action

Timing: Allow about 10 minutes

The following two clips feature expert Dr Amitta Shah using the DISCO in a diagnostic session with a young boy and his parents. Attending the session and providing commentary is clinical psychologist, Dr Laverne Antrobus. The interview itself focuses on the parents’ recall of their child’s early behaviour and their current concerns. As you watch the clips, note three other sources of evidence that Dr Shah says she has used in making the diagnosis.

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Discussion

Dr Shah mentions reports from the paediatrician, DVDs and also meeting the child himself, which has enabled her to observe him directly. This integration of different evidence sources is typical of diagnostic tools for autism and is a key feature of the DISCO.

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