Second part on evaluations)
The Evaluation Process
Evaluations are organized differently in that some facilities utilize a team approach with professionals from various specialties all meeting together with the parents and child for the initial interview and then again to discuss their findings and recommendations. Others will operate by having the child seen by one primary specialist (usually a medical doctor) who makes referrals to other professionals and then takes their findings into consideration when making a final diagnosis. Either arrangement is fine and it is likely that you wont have a choice. Also, be prepared to travel up to a few hours drive away unless you live in community with a large medical facility.
In general you want to make sure that all of the following basic areas are covered: assessments for Autistic Spectrum Disorders, speech-language, hearing, and occupational therapy for motor skill and sensory issues.
Assessment for Autistic Spectrum Disorders:
You will want to have your child evaluated for Autism by a professional who has experience in pediatric Autism assessment. Which type of professional may depend upon whats available in your region and upon your financial resources or medical plan.
The most common options (using US terminology) would include:
1)Developmental & Behavioral Pediatriciana developmental pediatrician trains first as a regular pediatrician and then goes on for advanced work in pediatric developmental issues. Many parents find this route to be a good choice because a) they are likely to get accurate diagnoses, b) theyre usually good about referring on to other specialists as needed, c) a medical opinion can carry considerable weight with school districts that are reluctant to provide services, and d) it establishes an ongoing relationship with a medical doctor should medications become necessary.
2)Pediatric NeuropsychologistA neuropsychologist is a psychologist that has advanced training in assessing neurological/mental health issues. Referrals to neuropsychologists for diagnosing and ruling out Autism are becoming more common because of the acute shortage of developmental pediatricians in the US. Most parents are reporting that they are getting accurate diagnoses and sufficient leverage for needed services from this specialty area. Neuropsychs tend to delve more deeply into diagnostics and seek not only identify the primary underlying cause but also to surface more about the childs specific strengths and weaknesses. Typically they are involved with the child during the assessment phase only and cannot prescribe prescription medications because they are not medical doctors. If you are being referred to a psychologist for an evaluation, be sure that its specifically a neuropsychologist and not a regular child psychologist unless they specialize in Autistic Spectrum Disorders (such as might be found on staff at an Autism Clinic).
3)Pediatric NeurologistPediatric neurology is a third option for Autism Spectrum Disorders (ASD) assessment. This route may result in an accurate diagnoses but it should be noted that if the child is atypical (ie on the fence criteria-wise or more social/verbal than what might be expected of Autism Spectrum Disorders (ASD) kids) one of the above options would be preferable.
There are two important things to remember when seeking out a diagnosis. The first is that there is a difference between recognizing Autistic Spectrum Disorders and being qualified to diagnose Autistic Spectrum Disorders. Other parents, teachers, therapists, and school psychologists may indeed recognize an Autism Spectrum Disorders (ASD) child but only certain professionals have the qualifications to diagnose your child. The second thing to remember is that not all diagnosticians are created equal and there are those that are more experienced and skilled at diagnosing and ruling out ASDs. Dont be afraid to
ask about a professionals qualifications before you schedule an appointment, both through inquiring at their office and through parents of special needs kids in your area.
What to expect: Anticipate filling out a lot of paperwork in advance including family, medical, and developmental history. Make copies of all paperwork before sending it in because it will save you time later. Plan on first time appointments being around
1-2 hours in length and to include some observation of the child but to consist mostly of parent interview. Testing (such as IQ) may be scheduled for a later appointment. A final diagnosis is usually given at a follow-up appointment and a report is sent to the parents including a summary of the childs history, diagnosis, and recommendations for services.
Speech-Language Assessment
What to expect: Speech-language testing varies widely based on many factors (including age of the child and extent of the problems) but typically would consist of providing written developmental history in advance, 1-2 diagnostic appointments in a clinical setting, plus a follow-up appointment to discuss any diagnosis and recommendations.
Hearing Examination
All children who have speech-language issues should have a basic hearing test performed by a certified audiologist. If your child is age five or older plus reading well, at the conclusion of that appointment ask the audiologist if your child is ready to be scheduled for an evaluation for auditory processing problems. Typically this is not done until age 7, but exceptions can be made for younger exceptional readers who can follow verbal or written instructions well.
What to expect: A short appointment in which the audiologist will do a few diagnostic tests to check the childs ability to recognize sound input.
Occupational Therapy Evaluation
Many Autism Spectrum Disorders (ASD) children have challenges with motor skills and in handling normal sensory input (
http://www.tsbvi.edu/seehear/fall97/sensory.htm). For this reason it is recommended that a private occupational therapy (Occupational Therapist (OT)) evaluation also be included as part of the initial round of evaluations. An Occupational Therapist (OT) evaluation isnt always included unless problems are very pronounced and because many parents on our forum have regretted that later on, we highly recommend it be done while the child is still young and most likely to benefit from therapy. Its important to be aware of the fact that in the US, public schools are only required to assess and treat occupational therapy issues that impact the child in the educational setting so a private evaluation is a good option if you have the resources.
What to expect: An occupational therapy evaluation will vary depending on the age of the child and extent of their challenges. Expect to provide a developmental history in advance and for the child to take part in 1-3 hours of assessment in a clinical setting during which time the occupational therapist will interview the parent. A follow-up appointment is typically scheduled to discuss the results of the evaluation and to go over treatment recommendations, if indicated.
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