The diagnosis of a child with an autism spectrum disorder (ASD) is time and
labor intensive and it’s availability is geographically limited. Extensive
parent reports, diagnostic interviews and professional observations are most
commonly used for diagnostic decision making. The Autism Diagnostic Observation
Schedule (ADOS) is a commonly used tool. It is an extensive evaluation and
measures social interaction, communication, play and the imaginative use of
materials. This is done through a variety of structured activities. There are
four modules and each module is directed towards a specific group of individuals
based on their language and developmental level. The first module is directed
to younger children with little or no language. The evaluation is highly
structured, time consuming, labor intensive and must be performed by a
professional trained in the administration of the instrument. Due to these
issues the test is limited to clinical and developmental centers and there are
frequent extended waiting lists for the testing to be performed.
A recent study published online April 10 in the Journal Translational Psychiatry has
abbreviated the assessment to include only 8 of the 29 items from module 1.
Using these 8 items the accuracy of diagnosis was >99% accurate (99.7%
sensitivity and 94% specificity). The advantage to such an approach is to allow
a more rapid accurate diagnosis of the young child with an ASD. The benefits of
more rapid and more easily available early screening would be earlier initiation
of intervention for the child and the family. A facebook page has been launched
by the writers of this article to allow the survey information to be available
to more parents.
The activities used in the observation of a child include the following:
Free Play: A child is allowed to explore a room and toys. The way the child interacts with or plays with the toys is noted as is the way the child interacts with the parent and the examiner.
Bubble Play: The child’s affect, social initiations, shared enjoyment, requesting
behaviors and motor behaviors and mannerisms are observed while the examiner
Anticipation of a Routine With Objects: The child’s affect, initiation of joint attention, shared enjoyment, requesting and motor behavior are observed during a structured routine blowing up a balloon and releasing it.
Responsive Social Smile: The child’s smile is observed for quality and consistency in response to the examiner smiling, the parent smiling, the parent smiling and making a familiar noise or calling in a way that implies physical contact and in being touched.
Anticipation of a Social Routine: The child’s affect and attempts to initiate the repetition of a routine during a peek-a-boo or tickling game are observed in terms of the quality of the child’s behaviors and the child’s ability to integrate gaze, facial expression,
vocalization and gesture as directed to the parent and examiner.
Functional and Symbolic Play: The child’s use of miniature or
representative objects in imitation of familiar actions is performed and the
child’s social awareness and shared enjoyment are recorded.
Birthday Party: The child’s interest and ability to join in a doll’s birthday party is
observed including whether the doll is treated as a a representation of a real
being, whether the child spontaneously participates and contributes to the party
and if involvement is limited, whether the child will imitate the examiner’s
actions or participate when asked or directed to do so.
Snack: A snack activity is used determine if and how the child requests or indicates a
preference for food. The child is observed for gaze, use of gesture, reaching,
facial expression and vocalization to communicate a request to the examiner.