Diagnosis of ASD

An ASD diagnosis is made by a psychologist or physician (e.g., psychiatrist or  paediatrician) who has a specialism/expertise in the area of autism. The clinical professional may be employed by the HSE (or another State-funded service), or they may work in an independent private practice. The online directories of the clinicians’ respective professional bodies can be checked to ascertain their current membership status. For example:

• Psychologists who are Chartered Members of the Psychological Society of Ireland (PSI) or the British Psychological Society (BPS) can be found here and here, respectively.
• Physicians (Medical Doctors) registered with the Irish Medical Council (IMC) can be found here.

Important Note: A diagnosis of ASD should be made in accordance with either DSM-5 or ICD-11 criteria¹, and the diagnostic criteria utilised should be stated clearly in the formal diagnostic report. It should also be ensured that the correct diagnostic term (i.e., “Autism Spectrum Disorder”) is stated in the report. Not specifying the diagnostic criteria used, and/or using an alternative term for ASD can run the risk of invalidating the diagnosis or the report not being accepted by various public or private services.

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The Assessment of ASD

An ASD assessment is a multidisciplinary process typically involving input from a number of different professionals. However, the formal diagnosis of ASD itself is made by either a psychologist or physician. The assessment process involves a number of stages^2,3, as per the example below, although it can vary somewhat between services.

1. Initial Consultation: The assessment process will typically begin with an initial consultation with the psychologist(s), which can take place either online or in person. In advance of the consultation the parent(s) (or adult who is seeking an assessment) will usually be asked to (a) complete certain forms and questionnaires, and (b) to provide copies of any existing relevant reports/letters from other professionals. The psychologist will gather more information and make observations during the consultation period. Based on the information available at the time of the initial consultation, the psychologist will advise the parent(s) (or adult) whether an assessment for ASD should be considered. If so, and depending on the individual’s history and presentation, the psychologist will usually request written reports from other professionals before proceeding with a clinical assessment for ASD, and for any potential coexisting conditions (e.g., ADHD, anxiety, dyslexia).

• • Input from other Professionals: The other professionals the child/adult might need to see in advance of the formal ASD assessment will depend on a number of factors, including the individual’s age, developmental/medical history, current behavioural presentation, and language skills etc. For example, the psychologist(s) may request written reports from a medical doctor such as a paediatrician, GP, or psychiatrist (regarding the child/adult’s medical history), an audiologist (re: the child’s hearing), a speech and language therapist (re: the child’s expressive, receptive, or pragmatic language skills,), or an occupational therapist (re: the child’s fine/gross motor skills, sensory processing, spatial awareness/orientation, and adaptive functioning abilities).
  • If there are any concerns about possible ADHD, or if there is a history of depression and/or anxiety, the psychologist will usually advise (in accordance with best practice guidelines) that the child/adult sees their GP for a medical evaluation (incl. blood tests for thyroid function, vitamin B12, and iron levels etc.). The purpose of this medical evaluation is to rule in or out any medical conditions that may be causing or contributing to the individual’s attention/concentration issues and/or anxiety and mood symptoms.
  • If there are any specific genetic disorders suspected (e.g., Fragile X Syndrome, Prader-Willi Syndrome etc.) the psychologist will recommend that the child’s parents talk to the G.P. who can make a referral for the relevant genetic testing.

2. The Clinical Assessment: When an appointment date for the clinical assessment has been agreed, the psychologist will forward selected forms, questionnaires and psychometric rating scales to the child’s parents, or the adult who is seeking the assessment. These forms and questionnaires, which will include measures to quantify autistic traits/characteristics, adaptive functioning (daily living skills) and any potential emotional/anxiety issues etc, will be completed by the relevant parties (e.g., the child’s parents, childminder/teacher etc.) and returned to the psychologist prior to the clinical assessment.

• • The clinical assessment itself is conducted in person by the psychologist, and will usually take a number of hours to complete. This part of the assessment process includes the administering of various tests, clinical observations, and further information gathering. Note: the information provided by the child’s parent(s) is a crucial component of the autism assessment, and is weighed heavily when deciding whether the child meets the diagnostic criteria for ASD. Therefore, it is vital that parents provide accurate information throughout the assessment process.
  • The most commonly used tests and measures administered during the clinical part of the assessment include the Autism Diagnostic Interview-Revised (ADI-R) or Diagnostic Interview for Social and Communication Disorders (DISCO), the Autism Diagnostic Observation Schedule, 2^nd edition (ADOS-2), and a test of cognitive ability (IQ). The psychologist might also administer tests that measure the individual’s academic attainments/or academic readiness.
  • The psychologist will also typically conduct a comprehensive evaluation to identify any co-occurring conditions, such as ADHD or mood and anxiety disorders.

3. Scoring, Analysis, Diagnostic Impressions and Report Writing: This part of the assessment process requires considerable time, and will typically take the psychologist between 1 to 2 weeks to complete. The following is a brief outline of the various stages within this part of the process:

• • (a) Involves the scoring and interpretation of all the psychometric tests and rating scales administered by the psychologist(s).
  • (b) A review and analysis of all the available information/data, including the reports received from other professionals.
  • (c) Diagnostic impressions and conclusions. The psychologist will determine whether the individual meets DSM-5 or ICD-11 diagnostic criteria for ASD and/or any co-occurring conditions, such as ADHD. This determination is made based on all available information.
  • (d) Writing a comprehensive assessment report. Through the assessment process, the psychologist will obtain a detailed profile of the individual’s strengths and needs, which helps guide the recommendations for tailored supports and  interventions.

4. Feedback Meeting: When the written report has been completed, the psychologist will arrange a feedback meeting with the child’s parents (or adult client) to discuss the findings of the assessment and to provide them with a copy of the report. The psychologist will make various recommendations based on the assessment findings, which will typically include evidence-based clinical interventions, as well as supports for home, school, college, or in the work environment.

Helpful tip: Waiting lists for diagnostic services for ASD in Ireland can be quite lengthy. When contacting a clinical service, it is recommended that you inquire about the possibility of placing your child on a “cancellation list.” This way, if there are any cancellations or openings, your child may have the opportunity to be seen for assessment sooner.

References

1. The Psychological Society of Ireland (2022). Professional practice guidelines for the assessment, formulation, and diagnosis of autism in children and adolescents, 2nd edition. The Psychological Society of Ireland. Dublin.
2. Goldstein, S. & Ozonoff, S. (Eds.) (2018). Assessment of autism spectrum disorder, 2nd edition. The Guilford Press. New York, NY.
3. National Institute for Health and Care Excellence (NICE). (2011, updated December 2017). Autism spectrum disorder in under-19s: Recognition, referral and diagnosis. Clinical Guideline (CG 128).

Author: digitallysound