The Developmental Assessment for Young

Children With Possible Autism

A developmental assessment for children under age 3 is an attempt to assess various aspects of the child's
functioning, including areas such as cognition, communication, behavior, social interaction, motor and sensory
abilities, and adaptive skills. Assessment of the family and the child's environment also provides important
contextual information.

Topics covered in this section

This section covers the basic aspects of the general developmental assessment for young children with
suspected developmental problems including possible autism. This section focuses on the general approach to
the developmental assessment, including some specific components of such an assessment, but does not
review information on specific autism assessment instruments.

Basis for guideline recommendations about the general developmental assessment

In the previous section on the use of autism assessment instruments, the guideline recommendations are
based on the panel's interpretation of an extensive and systematic review of the scientific literature. The panel
did not attempt to systematically evaluate the research evidence on effectiveness of the general developmental
assessment methods discussed in this section as this was considered outside the specific scope of the
guideline. Therefore, guideline recommendations in this section are based on the consensus opinion of the
panel, using its collective knowledge and experience in assessing children with autism. In the panel's opinion,
these recommendations reflect appropriate practices for assessing children with possible autism and are
generally consistent with the scientific knowledge in this field.

General Strategies for the Developmental Assessment of Children with Possible

Autism

Evidence Ratings: [A] = Strong [B] = Moderate [C] = Limited [D1] = Opinion/No evidence meeting criteria
[D2] = Literature not reviewed

Recommendations

Importance of the developmental assessment

1. Developmental assessments are usually done because of a concern that the child may have a
developmental delay or disorder. It is important to include a developmental assessment when
evaluating children with possible developmental problems because such assessments can:

help identify possible developmental problems and the need for further diagnostic evaluation

provide an objective description of the child's abilities and deficits (a functional assessment)
 determine eligibility for programs (such as early intervention programs)

aid in planning for appropriate interventions. [D2]

2. In children who are diagnosed with autism, or in whom there is sufficient evidence to suggest a
diagnosis of autism, it is very important to do a general assessment of all developmental domains.
Because children with autism may demonstrate different patterns of strengths and weaknesses, it is
important to individualize the specific components of a developmental assessment. [D2]

Components of the developmental assessment

3. It is recommended that a developmental assessment for a young child provide an adequate functional
evaluation of all developmental domains. Important components of a developmental assessment
include the following:

an objective test of hearing (standardized testing may be less reliable in children under the age
of two)

standardized testing of:

cognitive ability

communication

motor/physical skills

adaptive skills

social, emotional, and behavioral functioning

sensory processing

curriculum-based assessments

observation of the child at informal or structured play and of parent-child interactions

parental interview to elicit their concerns, obtain a history of the child's early development, and
gather information about the child's current level of functioning

review of the child's records (health, education and daycare, etc.) and family medical history [D2]

< EIP v 17

Carrying out the developmental assessment

4. Developmental assessments can be performed by a variety of professionals in a number of settings and

for a number of reasons. Insofar as assessing children with autism is complex, particularly in children
under 3 years of age, it is important that professionals participating in the developmental assessment
 have experience and expertise in assessing young children with autism. [D2]

5. In order to assure quality and consistency, it is recommended that developmental assessments of

young children:

be performed by professionals with experience assessing young children

utilize procedures that are reproducible by other professionals

use age-appropriate testing and scoring methods [D2]

6. It is important the developmental assessment be viewed as an ongoing process that follows the child
over time rather than as a single event. [D2]

7. It is important that the developmental assessment be individualized to the child by:

using age-appropriate testing and scoring methods

focusing on the child's presenting problems (such as suspected delays or deviations in

development or behavioral problems)

assessing specific areas of strength and weakness, including specific discrepancies in

functioning across and within developmental domains [D2]

Considering the cultural context of the family

8. A child's life is embedded within a cultural context. It is essential to consider and respect the family's
culture when assessing children with possible developmental disorders, including autism. [D2]

9. If English is not the primary language of the family, it is important for professionals to look for ways to
communicate effectively with the family, including the use of professionals and/or translators who speak
the child's language. [D2]

Considering the assessment setting

10. When assessing a young child with possible autism, it is important to consider the setting of the
assessment including:

the presence of parents and the resulting effects on the child's behavior

the child's familiarity with the environment

aspects of the test environment that are distracting [D2]

11. It is recommended that the assessment of the child occur in more than one session and in more than
one setting because:

the child's behaviors may vary depending on familiarity with the testing environment and
examiner
 the child's comfort level with the examiner may increase over time

a child's behavior can vary from day to day [D2]

Using the findings of the developmental assessment

12. In some cases a developmental assessment to evaluate a suspected developmental problem may
provide professionals with the first indication that a child may have autism. When this occurs, it is
recommended that further evaluation of possible autism be carried out. [D2]

< EIP v 18

13. It is important to follow up on questionable abnormal findings in the developmental assessment of any
young child. This might include adding elements to the developmental assessment and/or referring the
child to other professionals for more detailed evaluation and specific diagnosis. [D2]

14. It is important that the findings of the developmental assessment be used in developing any intervention
plans for the child. The developmental assessment also provides useful objective anchor points for
monitoring the progress of the child and assessing the outcomes of interventions. [D2]

Communicating findings to parents and other professionals

15. It is important for professionals assessing children with possible autism to explain the procedures and
findings of the assessment to the parents in terms that are easy to understand. This would include a full
explanation of:

important terms and concepts used in reports

the results and implications of the assessment

a comparison of the child's performance to developmental norms [D2]

16. Explaining assessment results to parents whose children have autism is particularly important because
the characteristically uneven developmental profile can be confusing. For example, a child may have
age-level nonverbal skills and severely impaired communication skills. [D2]

17. It is important that all professionals involved with the assessment of a child with possible autism
communicate with each other regarding their findings and recommendations. [D2]

Assessing Cognition

Evidence Ratings: [A] = Strong [B] = Moderate [C] = Limited [D1] = Opinion/No evidence meeting criteria
[D2] = Literature not reviewed

Recommendations

Importance of assessing cognition in children with possible autism

 1. It is important to assess cognitive ability in children with possible autism because:

information about the child's cognitive ability is useful in the diagnostic process, specifically in
differentiating children with autism alone, children with mental retardation alone, and children
who have both autism and mental retardation

the child's cognitive ability has implications for intervention decisions and has possible
implications for outcome [D2]

< EIP v 19

Methods for assessing cognition in children with possible autism

2. In attempting to assess cognition in children with possible autism, it is important to assess:

verbal and nonverbal cognitive skills as accurately as possible

the child's ability to use skills and information in everyday environments [D2]

3. In determining the nonverbal cognitive level for a young child, it is useful to observe

the child's behaviors during structured and free play

the child's other interactions with people and objects in the immediate environment [D2]

4. It is important to remember that levels of cognitive skills in young children are sometimes estimated
using a standardized test to derive one of the following measures:

developmental quotient (DQ); used mainly for children under 3 years old

mental developmental index (MDI); also used for younger children

intelligence quotient (IQ); used mainly for older or for more verbal younger children [D2]

Challenges in assessing cognition in children with autism

5. It is important to recognize that it is often difficult for professionals to accurately assess the cognitive
level of a child with autism. Children with autism often:

display uneven levels of skills between different developmental domains

have limited language

participate in a very limited way in the assessment process [D2]

Diagnosing mental retardation in children with autism

6. Although mental retardation and autism commonly coexist, it is important that professionals exercise
 caution in making the diagnosis of mental retardation in young children with possible autism. [D2]

7. It is important that professionals not prematurely label the child as having mental retardation until
appropriate standardized and non-standardized testing of cognition has been done. [D2]

8. It is also important that professionals not infer that the child has a higher cognitive level than can
actually be observed and measured. [D2]

Table III-6
Assessing Cognition in Young Children

Definition of Cognition: Cognition includes the processes of the brain that allow us to experience the
environment, remember, think, act, and feel emotions. Cognitive processes are complex, diverse, and highly
inter-related.

Components of Cognition: The components of cognition listed below are particularly important with respect
to autism:

Arousal, orientation, attention, and executive function

Arousal Distributed attention

Orienting Shared attention

Perception Exploration - stimulus seeking

Selective attention Executive functions

Sustained attention

Memory: Short- and long-term memory

Information processing functions

Pattern recognition
Facial/emotion recognition
Processing emotional content
Imitation
Cause and effect association
Deducing rules for responding
Cross-sensory modality information exchange
Processing multiple sources of information simultaneously

Reasoning and concept formation

Response flexibility Language

 Concept formation Perspective taking

Analogous reasoning Social context and rules

Problem solving

How to Measure Cognition in Young Children

Standardized testing designed to arrive at a developmental quotient (DQ)

Criterion-referenced and curriculum-based assessments

Direct observation

References About Cognition and Children with Autism

The following books deal in-depth with issues of cognition in children with autism:

Berkell D (ed.). Autism: Identification, Education, and Treatment. Hillsdale, NJ: Lawrence Erlbaum
Associates, 1992.

Matson JL (ed.). Autism in Children and Adults: Etiology, Assessment, and Intervention. Pacific Grove,
CA: Brooks / Cole, 1994.

Rutter J, Tuma AH, Lann IS (eds.). Assessment and Diagnosis in Child Psychopathology. New York,
NY: Guilford Press, 1998.

Schopler E. Mesibov GB (eds.) Learning and Cognition in Autism. New York, NY: Plenum Press, 1995.

Adapted from: Romanczyk et al., 1998

Assessing Communication

Evidence Ratings: [A] = Strong [B] = Moderate [C] = Limited [D1] = Opinion/No evidence meeting criteria
[D2] = Literature not reviewed

Recommendations

Importance of assessing communication

1. It is important to adequately assess communication in children with possible autism because delayed
and/or atypical communication is one of the critical clinical clues in identifying autism. [D2]

< EIP v 20
 2. Assessing communication in children with autism is also important because of these factors:

its impact on intervention decisions

it provides a baseline for monitoring progress

its implications for outcome [D2]

Components of the assessment of communication

3. In assessing communication in a young child with possible autism, it is important to evaluate the child's:

hearing status

ability to use nonverbal communication strategies (such as, pointing to request or show an item)

atypical or delayed nonverbal communicative behaviors (such as, atypical eye gaze and
gestures)

functional use of spoken language (how children use words and sounds to get what they want)

significant delays in onset of spoken language or loss of language

atypical communication patterns (such as echolalia, perseveration, and use of words without
apparent communicative intent) [D2]

Table III-7
Assessing Communication in Young Children

Definition of Communication: Communication is defined as nonverbal and verbal communication

Nonverbal communication involves all aspects of communication between the child and others except
for spoken language. In young children this may include the use of such things as facial expressions,
pointing, and gesturing to communicate with others. In older children this may include the use of symbol
systems.

Verbal communication is the use of spoken language or other verbal utterances to communicate.

Components of Language: Language is the use of sounds, words, and phrases to verbally communicate
between individuals. Language has the following five main elements:

Phonology is the sound system of spoken language

Morphology is the system that governs the structure of words and construction of word forms

Syntax is the system governing the order and combination of words to form phrases or sentences

Semantics is the system that governs the meaning of words and sentences
 Pragmatics is the system that combines all other language components in functional use of language

Adapted from:

1. American Speech-Language-Hearing Association, 1993

2. New York Department of Health, Early Intervention Program, Communication Disorders Clinical Practice
Guideline, 1999

Definition of Communication Disorders

Communication disorder is a broad term that encompasses any impairment in the ability to receive,
send, process, and comprehend concepts, or verbal, nonverbal and graphic symbol systems. A
communication disorder may involve hearing, language, or speech. Communication disorders may
range in severity from mild to profound.

Communication delay refers to a quantitative delay in meeting certain age-specific developmental

milestones for communication (the normal language milestones). Language delay is sometimes
determined by test scores for a particular language development measure (such as vocabulary size)
that are significantly below the mean for typically developing children of that age.

Types of Communication Disorders

Communication disorders in young children can be classified as hearing disorders, language disorders, or
speech disorders.

< Hearing disorders

articulation disorders, which involve the atypical production of speech sounds (such as problems
with pronunciation)

fluency disorders, which involve an interruption in the flow of speech, including abnormal rate
and rhythm, and unintentional repeating of sounds as in stuttering

voice disorders, which involve the abnormal production of vocal quality, pitch loudness, or
resonance

How to Measure Communication in Young Children

Methods to assess hearing disorders in young children include:

audiometry

brainstem evoked-response testing

Methods to assess speech and language disorders include:

standardized testing designed to assess speech and language development

direct observation of the child, especially when interacting with parents, other children, or
professionals
 Assessment of hearing is covered
in the health evaluation section.

Assessing Social Interactions and Relationships

Evidence Ratings: [A] = Strong [B] = Moderate [C] = Limited [D1] = Opinion/No evidence meeting criteria
[D2] = Literature not reviewed

Recommendations

Importance of assessing social interactions and relationships

1. Assessing social interactions and relationships is important in young children with possible autism
because an inability to form social relationships is one of the primary characteristics of autism. [D2]

Components of the assessment of social interactions and relationships

2. Assessment of social interactions and relationships includes evaluation of:

social initiation (showing or giving objects to others for social purposes)

social imitation (imitating actions of others)

age-expected reciprocity (turn-taking during play)

the child's attachment patterns in the presence of a caregiver (neutrality, excessive clinging, or
avoidance of parent)

the child's tendency for social isolation or preference to be alone

the child's use of people as tools to obtain desired ends (taking adult's hand to reach for a toy)

social interactions with familiar as well as unfamiliar adults and peers [D2]

Assessing Behavior and Responses to the Environment

Recommendations

Importance of assessing behavior and responses to the environment

1. When assessing young children with autism, it is important to assess their behavior and responses to
the environment because these factors may impact intervention decisions and provide baselines for
monitoring progress. [D2]

Components of the assessment of behavior and responses to the environment

2. In assessing a child with possible autism, it is important to identify behavior patterns, relative strengths,
and problem areas. [D2]

3. Assessment of a child's behavior and responses to the environment may include evaluation of:

behavior patterns and problem behaviors

unusual responses to sensory experiences

motor skills

play skills
 adaptive behaviors

self-help skills [D2]

Assessing the Family and the Child's Environment

Evidence Ratings: [A] = Strong [B] = Moderate [C] = Limited [D1] = Opinion/No evidence meeting criteria
[D2] = Literature not reviewed

Recommendations

Importance of assessing the family and the child's environment

1. It is important for the family of a young child with autism to participate in a family assessment because
factors relating to the family can impact intervention and management decisions and may have
implications for outcomes. [D2]

< EIP v 21

Components of an assessment of the family and the child's environment

2. Assessment of the strengths and limitations of the family and the child's environment may include
observation and/or discussion of:

the family's stressors, tolerance for stress, and coping mechanisms and styles

the family's current support systems

education experiences of family members

family composition, demographics, and specific circumstances

family interaction and patterns of discipline

emotional expression of family members

caregiving skills and sharing of caregiving responsibilities

knowledge about autism [D2]

Health Evaluations for

Young Children with Possible Autism

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