Clinical Psychology Service Summary
Children with developmental concerns are commonly referred to health care providers and specialists for diagnostic evaluations. The diagnostic examination process for many developmental disorders (including Autism) involves the administration of specific tests that are used to provide information and clarity about the nature, scope, and impact a particular symptom or collection of symptoms is having on the child’s well being and development as well as what the cause of such symptoms may be. After an initial intake interview that gathers information about a variety of functional characteristics across many domains (e.g., developmental history, symptoms, previous testing, medications) the psychologist selects the appropriate instruments to use in order to accurately examine symptomatic areas of concern. In the case of Autism, this often includes tests of cognitive ability and intelligence, adaptive behavior skills, symptom specific tests (e.g., ADOS, ADI-R, STAT), behavior observation, academic performance, and social skills.
After administering these tests, the psychologist then interprets the results and reviews all of the relevant information gathered collectively in order to answer the diagnostic question. Once the information has been integrated, a feedback meeting is scheduled. During the feedback meeting, the psychologist meets with parents/caregivers and/or the individual to discuss the results of the evaluation. This includes specific strengths and weaknesses that were apparent during the testing process as well as a comprehensive overview of the examination with the provision of a diagnosis or diagnoses for the child if applicable. Treatment recommendations based on the diagnostic evaluation results are then provided and discussed. Due to the nature and length of many of the tests provided, a diagnostic evaluation may take several different appointments to complete. This is necessary to provide the most accurate and specific diagnosis possible which, in turn, yield the most effective treatment recommendations and results. The time it takes to complete a diagnostic evaluation will vary from child to child and is at the discretion of the attending psychologist and/or diagnostic team.
What is the ADOS?
The Autism Diagnostic Observation Schedule (ADOS) is considered to be the gold standard instrument for diagnosing autism spectrum disorders including pervasive developmental disorder (PDD) and Asperger’s Syndrome across a wide range of ages and developmental levels, regardless of language skill or level of adaptive functioning. It can be quickly and reliably administered to subjects ranging from children as young as 18 months old through adolescence and adulthood. Due to its rigorous empirical validation and support in a tremendous amount of studies, the ADOS has become the leading tool used by clinicians when an autism spectrum disorder is suspected. The ADOS is comprised of four modules; each adjusted to differing developmental and language levels, ranging from little to no expressive or receptive language to verbally fluent adults. Each module takes just 30-45 minutes to administer. The psychologist selects the module based upon the age of the child and how well he or she can talk. Each module consists of approximately ten tasks that are designed to evoke different kinds of social behaviors, such as sharing and requesting, playing with someone and following, and enjoying attention. The examiner codes the observed behaviors during the ADOS and those codes are entered into a specific algorithm that yields diagnostic cutoff scores. Reliability certification for the administration and interpretation of the ADOS involves extensive training and observation that includes verification of standardized task administration as well as accurate coding of behaviors.
Children progress through developmental stages at different rates and pacing. Sometimes during early (younger than 24 months) phases when important social, cognitive, and adaptive skills are developing more increasingly parents and caregivers have concerns about aspects of this progression and desire to know if any symptomatic areas of concern or “red flags” are evident and if early intervention services would be beneficial. The purpose of an early diagnostic screening assessment is to determine and outline the severity of these early areas of concern as they pertain to developmental disorders. A host of research provides evidence that earlier intervention produces more effective and lasting treatment gains for children on the Autism spectrum than those who initiate services at later stages and a diagnostic screening seeks to identify that need as early as possible. Much like a diagnostic evaluation, during a diagnostic screening the psychologist selects a variety of tests to examine areas of development and outlines relative strengths and weaknesses that the child possesses. The results of these tests are interpreted and a feedback meeting is scheduled with parents/caregivers to review the results. Results are discussed in terms of risk severity for developing a pervasive developmental disorder and target areas for intervention that will produce the most effective treatment gains. While specific diagnoses are not provided, as the child is too young to meet diagnostic criteria, an early screening allows for the ability to track gains, symptom progression, and treatment responsiveness if a diagnostic evaluation becomes necessary in the future at a later point in time.
Supportive-Integrative Psychotherapy (SIP)
Supportive-integrative psychotherapy (SIP) at Lakeside Center for Autism is a mental health service dedicated to providing psychotherapy to the primary caregiver of a child with developmental needs who is experiencing significant challenge and impact in emotional, cognitive, relational, or behavioral domains adjusting to the significant challenges and opportunities of coordinating care and supporting a child with developmental needs. Evidence based solution-focused, interpersonal, and cognitive-behavioral therapy treatments are utilized in a synthesized way to help a primary caregiver in an integrated fashion. This can involve individual support, collaborative strategies and exercises with partners to help serve primary caregiver needs, development of self-care and coping skills, or any treatment that benefits the individual adjusting to the dynamics of serving a child with special needs.
Treatment outcomes for children with Autism Spectrum Disorders (ASD) and other childhood disorders are more positive now than in past decades. Advances in psychological research have improved our understanding of the fundamental challenges faced by people with autism and have contributed to improving methods of recognizing, assessing, and treating it. Psychological assessment of children’s abilities is used to guide the development of appropriate programs for children with ASD, and treatments based on psychological principles are at the leading edge of autism intervention. Evidence shows that early, intensive interventions based on the teaching principles of Applied Behavior Analysis (ABA) help children with ASD as part of a comprehensive, individualized treatment program. Key areas for intervention include social skills, communication, daily living skills, academics, self-management or coping skills, and family support.
A variety of psychological interventions may be integrated with ABA approaches to meet an individual child’s needs. These include incidental teaching (using teaching opportunities that naturally arise every day in the home and community) and structured teaching, which emphasizes organizing the person’s environment (schedules, materials and settings) to optimize the individual’s ability to learn and function. Peer-mediated interventions in which other children (e.g., siblings, classmates) are taught effective ways to interact with a child with ASD can also promote more positive social opportunities. For older and more able individuals with ASD, modified cognitive-behavioral strategies in which behavior is modified by changing the way the person thinks and feels, as well as systematic relaxation therapies, can be used to help manage the anxiety and depressed mood that is often associated with social situations and the unpredictable challenges of daily living. Psychological intervention can occur with the child in a specific intervention modality, with caregivers as a means of developing effective parenting styles and home programming, in an augmented fashion to reduce problematic behaviors (e.g., anxiety, tantrums, inattention, hyperactivity) interfering with other treatment gains, or a combination of options based on the need of the child.
If you are interested in pediatric clinical services, you can get on our interest list by clicking here to access our pediatric clinical psychology interest form, or by calling us directly at 425-657-0620.