News and Notes from The Johnson Center

Assessment Corner: Identifying Autism After Brief Observations

JCCHD | Thu, February 26, 2015 | [Autism Treatment][Assessment Corner][Healthcare][News][Research]

A recent article published by the journal Pediatrics, highlighted the challenges of accurately assessing children with autism spectrum disorders during brief observations. In primary care settings, medical professionals such as pediatricians and neurologists make critical decisions in screening and referring children who present with developmental delays and signs of autism. However, oftentimes the primary care setting only allows for very brief observations. This study analyzed what types of behavior and symptoms, both typical and atypical, can be optimally observed during ten-minute periods. It further investigated whether referrals for autism spectrum evaluations were made based on these observations.

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The study included 42 children ages 15 to 33 months, some of whom were typically developing, and some who screened positive during an autism screening. Further diagnostic evaluations were completed to determine whether the children fit in the autism, language delay, or typical category. Licensed psychologists with expertise in the diagnostic evaluation of autism blindly reviewed two ten-minute video observations of each child and rated the following behaviors: responding, initiating, vocalizing, play, and response to name. Ratings of these behaviors as either “typical” or “atypical” were made. Raters were then asked whether an autism evaluation referral was needed based on the ten-minute observations.

Results showed that children with autism displayed more typical behavior than atypical behavior during the ten-minute observation periods. Furthermore, the psychologist raters made false negatives, and missed nearly 40% of the children in the autism group who would have needed an autism evaluation referral. This study emphasizes how difficult it is to make high-quality observations and form clinical impressions during brief observations of a child, common to primary care settings. It also makes the point that children with autism often display high rates of typical behavior alongside atypical behavior during short time periods, making it easy to miss red flags.

Findings illustrate that it is critical for primary care clinicians to utilize multiple sources of information when screening and making referrals for further autism evaluation, including behavioral observation as well as screening tools and parent report.  Referrals for further assessment should be made when red flags are evident from all sources of information. Furthermore, best practice in the evaluation of autism spectrum disorders also includes the use of multiple sources of data such as comprehensive parent interview, parent questionnaires, and standardized measures (ex. the Autism Diagnostic Observation Schedule). Not only does a thorough evaluation provide a reliable and valid diagnosis, it also provides important information that can be used to identify skills and areas of need, and provide a benchmark for measuring change.

For the full text article see:

Gabrielsen, T. P., Garley, M., Speer, L., Villalobos, M., Baker, C. & Miller, J. (2015). Identifying autism in a brief observation. Pediatrics; 135 (2).