I have heard some crushing stories from local Thai and Expat parents describing how their child received an Autism Diagnosis in Bangkok. Far too many times, their stories sound like this:
“We were in the room with the doctor for less than five minutes, when suddenly they told us that our child has Autism”.
One parent even told me, “when I asked what this meant, they said Google Floor Time”.
What is even MORE shocking is that, many times, the child DOES NOT actually meet the criteria for Autism!
Parents often ask me, “do you think my child has Autism?”. As a Speech-Language Pathologist and a Certified Autism Specialist, I believe that there is a due Assessment process which must be followed before providing an accurate and reliable diagnosis. If you suspect that your child might have Autism, here are five things your child's Assessment process should involve:
1. Firstly, information will be collected
A reliable diagnosis will consider your child’s skills and ability in a range of environments, not just the clinic. For this reason, information about your child needs to be collected. As a parent, you know your child best and spend the most time with them – you can provide a wealth of insight about them. During a pre-Assessment consultation with the person assessing your child, you will be asked many questions about your child’s development history up to their current skills and ability. Information will also be collected about your child from other people. This is likely to include your child’s classroom teacher and any current or previous therapists who work with your child.
2. Diagnosis is a multi-disciplinary process
It is very likely that either a Pediatrician or a Clinical Psychologist will lead your child’s Assessment and make the diagnosis, as they are specialized to do so. These individuals will ask questions about your child’s overall development, observe your child and administer formal Assessment tools such as checklists and observation scales.
Professionals who specialize in different areas of development should also be involved in the evaluation. The Assessment should involve a Speech-Language Pathologist to evaluate your child’s communication, if there are concerns in this area. Also, an Occupational Therapist can evaluate your child's sensory needs, motor skills and emotional self-regulation.
3. Criteria must be met in two specific areas
For a child to be diagnosed with Autism, they must meet the criteria listed in the Diagnostic and Statistical Manual – Fifth Edition (DSM-V) in BOTH areas outlined below.
A. Social Communication Deficit:
This includes the verbal and non-verbal aspects of social communication or the ‘unspoken rules’ of social interactions.
· These verbal aspects include difficulty with back-and forth conversations, initiating conversations, maintaining conversations or ending conversations. For instance, I have worked with a child who did not give others a chance to speak during conversations.
· The non-verbal aspects which children find difficult include interpreting emotions, making eye-contact, engaging in imaginative play and gestures.
B. Repetitive and Restricted Routines:
This includes verbal and non-verbal repetitions.
· Children with Autism may repeat things over and over verbally, which is referred to as ‘echolalia.’ For instance, I have worked with a child who recited the same YouTube video repeatedly.
· They usually display repetitive movements such as hand-flapping and rocking.
· They tend to become very upset and have very low tolerance for a disruption or change in their routine.
· They are either much more sensitive to sensory stimulus around them, or they do not seem to respond to sensory stimulus. For example, I once worked with a child who repeatedly walked around my office to run their hands across all the furniture.
· They might seem ‘obsessed’ with a certain topic of interest which they insist to keep bringing up and talking about.
It is crucial to understand that if your child has one or more of the characteristics above, this does not necessarily mean that they have Autism. In fact, many children and adults have one or more of the characteristics outlined above. An Assessment is crucial for an accurate and reliable a diagnosis.
4. The Assessment will take a while
The Assessment process is lengthy because as well as formal tools being administered, your child will also be observed informally in the clinic and outside the clinic (e.g. at school). Children behave differently in different settings and different variables must be accounted for (e.g. if they are in an new environment, your child’s mood that day, if they are unwell or tired). Reliable conclusions can be drawn by collecting a wide sample of observations, which can take multiple sessions.
5. Finally, results will be reported and explained
The results of the Assessment will be written in a report, which will also include recommendations for supporting your child in their areas of need. The results and observations will also be discussed with you during a post-Assessment consultation. I understand that this is a very tough discussion for parents to have and can often be emotionally overwhelming. However, it is important to remember that you have taken the first (necessary and brave) step towards helping your child. This post-Assessment consultation will help you further understand your child’s skills and needs as well as how to best support them moving forward. Here are some questions which you can ask during this discussion:
“What does Autism mean?”
“What areas will my child need support in?”
“What are your recommendations?”
“What is my role in intervention?”
“What is the next step to support my child?”
I hope this information has been helpful to you, dear parent, who is reading this post. Please help to empower other parents to understand more about obtaining an Autism diagnosis for their child by sharing this post.
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