3Di in the context of

overall assessment
procedure
Marianna
Marianna Murin
Murin
Highly
HighlySpecialist
Specialist Clinical
Clinical Psychologist
Psychologist
Great
GreatOrmond
OrmondStreet
StreetHospital
Hospitalfor
forChildren
Childrenand
andInstitute
InstituteofofChild
Child Health,
Health,London
LondonUK
UK

Presentation
Presentation plan
plan
 Aim
Aim of
of the
the presentation
presentation is
is to
to discuss
discuss the
the integration
integration
of
of the
the 3di
3di with
with other
other assessment
assessment procedures
procedures used
used
within
within teams
teams
 Overview
Overview of of the
the complexity
complexity ofof ASD
ASD diagnostic
diagnostic
process
process
 Assessment
Assessment procedures
procedures atat the
the SCDC,
SCDC, GOSH
GOSH
 Direct assessment with the child
Direct assessment with the child (ADOS)(ADOS)
 Discussion
Discussion andand question
question and
and answer
answer time
time

24
4

1.
1. Complexity
Complexity of
of the
the
diagnostic
diagnostic process
process

3
 Difficulties
Difficulties with
with diagnostic
diagnostic process
process
 ASD
ASD––heterogeneity
heterogeneityof ofpresentations
presentations
 No
Nobiological
biologicalmarker
marker
 Learned
Learnedcompensatory
compensatorysuperficial
superficialsocial
socialskills
skills
 Family context
Family context
 Viewing
Viewingchild’s
child’sdifficulties
difficultiesthrough
throughaaparticular
particular
perspective/‘lens’
perspective/‘lens’
 Different
Differentthresholds
thresholdsdepending
dependingononthethefamily
familycontext/child’s
context/child’s
overall
overalldevelopmental
developmentallevel
level
 Gender
Genderdifferences
differences

46
6

Furthermore…
Furthermore…
ASD
ASD and
and co-morbidity
co-morbidity
Amongst
Amongst children
children with
with an
an ASD
ASD there
there is
is evidence
evidence forfor increased
increased
incidence
incidence of:
of:
 Specific
Specific learning
learning difficulties
difficulties
 ADHD*
ADHD*
 Social
Social Anxiety
Anxiety
 Conduct
Conduct problems*
problems*
 Anxiety
Anxiety and
and depression*
depression*
 Feeding
Feeding andand eating
eating difficulties*
difficulties*
 Tic disorders*
Tic disorders*
(e.g.
(e.g. Simonoff
Simonoff et et al.,
al., 2008)
2008)
 Subscales
Subscaleshighlighted
highlightedwith
withan
anasterisk
asteriskare
areincluded
includedwithin
withinthe
the 3di
3di
57
7

2.
2. Assessment
Assessment
protocol
protocol

4
ASD
ASD Assessment
Assessment -- General
General
principles
principles (NICE,
(NICE, NAP)
NAP)
 Multidisciplinary
Multidisciplinary
 Multimodal
Multimodal
-- Detailed
Detaileddevelopmental
developmentalhistory
history
-- Direct
Directassessment
assessment(involving
(involvinginteraction
interaction&&observation
observationof
ofCYP)
CYP)
-- Details
DetailsofofCYP
CYPexperiences
experiencesofofhome
homelife,
life,education
education&&social
socialcare
care
 Multifactorial
Multifactorial
-- Medical
Medicalhistory
historyand
andphysical
physicalexamination
examination
-- Consideration
Considerationof
ofthe
thedifferential
differentialDx
Dx
-- Systematic
Systematicassessment
assessmentof ofco-morbid
co-morbidconditions
conditions
-- Development
Developmentof ofaaprofile
profileof
ofCYP’s
CYP’sstrengths,
strengths,skills,
skills,impairments
impairmentsand
andneeds
needs––
creating
creatingneeds
needsbased
basedmanagement
managementplan plan
7
99

Assessment
Assessment triangle
triangle

The
Thechild
child

The
Theparents
parents The
Theschool
school

810
10

Assessment
Assessment
procedure
procedure at
at the
the
SCDC
SCDC

5
 Who
Who do
do we
we see?
see?
 Tier
Tier 44 assessment
assessment and and diagnostic
diagnostic clinic
clinic
 Children
Children referred
referred for
for second
second opinion
opinion
 Referrals
Referrals accepted
accepted from
from local
local CDC
CDC or or CAMHS
CAMHS
services.
services. Complex cases - usually presenting with
Complex cases - usually presenting with aa
number
number of co-morbid disorders (mental health or
of co-morbid disorders (mental health or
behavioural
behavioural problems)
problems) which
which led
led to
to the
the referral
referral
 Children
Children from
from complex
complex family
family backgrounds
backgrounds
(Fabricated
(Fabricated or
or Induced Illness, history
Induced Illness, history of of deprivation
deprivation or
or
severe
severe trauma)
trauma)
10
12 12

Assessment
Assessment procedure
procedure at
at the
the SCDC
SCDC
Initial
Initialtelephone
telephoneconsultation
consultation
Team
Teamdiscussion:
discussion:risk
risk&&support,
support,referral
referraldecision
decision
Often
Oftennetwork
networkliaison
liaison

Parent
Parent Teacher
Teacher
assessment
assessment assessment
assessment
forms
forms forms
forms

SaLT,
SaLT,Cognitive
Cognitiveand
and Team
Team
ADOS
ADOS 3di
3di Neuropsychological
Neuropsychological Discussion
Discussionand
and
Assessmen
Assessmentt Formulation
Formulation

Sometimes
Sometimesschool
school Sometimes
Sometimesfurther
further
observation
observation network
networkliaison
liaison

Sometimes
Sometimes
Feedback
Feedback
appointment
REPORT
REPORT follow-up
follow-up
appointment appointment
appointment
11
31
31

Parent
Parent &
& teacher
teacher assessment
assessment packs
packs
Usefulquestionnaires:
Useful questionnaires:
Children’s
 Children’sCommunication
CommunicationChecklist
Checklist(Bishop,
(Bishop,1998)
1998)
Strengths
 Strengthsand
andDifficulties
DifficultiesQuestionnaire
Questionnaire(Goodman,
(Goodman,1997)
1997)
Social and Communication Disorders Checklist(Skuse,
 Social and Communication Disorders Checklist (Skuse,2005)
2005)
Social
 SocialResponsiveness
ResponsivenessScale
Scale22(Constantino,
(Constantino,2012)
2012)
Conners
 ConnersQuestionnaire
Questionnaire(Conners,
(Conners,1970)
1970)
Behavioral
 BehavioralRating
RatingInventory
Inventoryof
ofExecutive
ExecutiveFunction
Function22(Gioia
(Gioiaet
etal,
al,2016)
2016)
Adaptive
 AdaptiveBehaviour
BehaviourAssessment
AssessmentSystem
System33(Harrison&Oakland,
(Harrison&Oakland,2016)2016)
Relationship
 RelationshipProblem
ProblemQuestionnaire
Questionnaire(Minnis,
(Minnis,2007)
2007)
The
 TheDevelopment
Developmentand
andWell-Being
Well-BeingAssessment
Assessment(Goodman
(Goodmanet
etal.,
al.,2000)
2000)

•Additionally,
•Additionally, teacher
teacherassessment
assessmentpack packcontains:
contains:
–Questions
–Questionsexamining
examiningthe
thechild’s
child’sattainment
attainmentand
andability
abilityand
andattitude
attitude
towards school
towards school
–Questions examining parental involvement with school
–Questions examining parental involvement with school

121414

6
 12

ADOS
ADOS

Assessment
Assessment triangle:
triangle: Direct
Direct
assessment with the child
assessment with the child

Autism
Autism Diagnostic
Diagnostic Observational
Observational
Scale
Scale
 Semi-structured
Semi-structured standardised
standardised measure
measure of
of communication
communication
and
and social
social deficits
deficits and
and play
play associated
associated with
with ASD
ASD

 Developed
Developed by
by Prof
Prof C.
C. Lord,
Lord, Prof
Prof M
M Rutter
Rutter et
et al.
al.
 Series
Series of
of structured
structured and
and unstructured
unstructured activities
activities
 Incorporation
Incorporation of
of ‘social
‘social presses’
presses’
 Diagnostic
Diagnostic algorithm
algorithm

14
16
16

ADOS
ADOS Modules
Modules
•• Expressive
Expressivelanguage
language––affects
affectsalmost
almostevery
everyaspect
aspectof
ofsocial
socialinteraction
interactionand
and
play
play
•• 55Modules
Modules––measure
measureofofsocial
socialand
andcommunicative
communicativeabilities
abilitiesas
asindependent
independentasas
possible
possiblefrom
fromthe
theeffects
effectsof
ofexpressive
expressivelanguage
language

15

7
 ADOS
ADOS Module
Module 11 activities
activities
 Free
Free play
play  Responsive
Responsive social
social smile
smile
 Response
Response to to name
name  Anticipation of a social
Anticipation of a social
 Response
Response to to joint
joint attention
attention routine
routine
 Bubble
Bubble play
play  Functional
Functional and
and symbolic
symbolic
Anticipation imitation
imitation
 Anticipation of
of aa routine
routine with
with
objects
objects  Birthday
Birthday party
party
 Snack
Snack

16
18
18

Module
Module 11 -- Focus
Focus of
of observation
observation
A.
A. Social
SocialCommunication:
Communication: B.
B.Social
Socialinteraction
interaction
 Use
Useofoflanguage
language  Eye
Eye contact
contact
 Direction
Directionofofvocalisations
vocalisations  Direction
Directionofoffacial
facialexpressions
expressions
 Intonation
Intonation of
ofvocalisations
vocalisations  Response
Responseto tojoint
jointattention
attention
 Immediate
Immediateand anddelayed
delayed echolalia
echolalia  Showing
Showing
 Use
Useofofother
otherpeople’s
people’s hand
handto
to  Giving
Giving
communicate
communicate  Sharing
Sharing enjoyment
enjoyment
 Use
Useofofgestures
gestures

C.
C.Functional
Functional&&creative
creativeplay
play D.
D.Other
Otherbehaviours
behaviours
D.
D.Repetitive
Repetitiveinterests
interests  Overactivity
Overactivity
 Sensory
Sensoryinterests
interests  Anxiety
Anxiety
 Hand
Handand
andbody
bodymannerisms
mannerisms  Negative/oppositional
Negative/oppositional behaviour
behaviour
 Compulsion
Compulsion and
andrituals
rituals

17
19
19

Example
Example of
of Module
Module 11 -- Matthew
Matthew
 Matthew
Matthew aged
aged33years
years 55months
months

 Developmental
Developmental delay
delay

 Main
Mainreasons
reasonsfor forreferral:
referral:
•• speech
speechdelay
delay
•• frustration
frustrationdue
dueto todifficulties
difficultieswith
with
making
makinghis hisneeds
needsknown
known
•• difficulties
difficultieswith
with interacting
interacting with
with
peers
peers

Differential
Differentialdiagnosis
diagnosis (Language
(Language
Disorder/ASD)
Disorder/ASD) requested
requested

18
20
20

8
 Matthew’s 3di scores
min max on
Subscale Score
abnormal scale
reciprocal social interaction
15.8 10 30
skills
language and other social
11.4 8 26
communication skills
gesture and non-verbal play
9.2 7 14
(subset of prior scale)
repetitive/stereotyped
1.5 3 12
behaviours and routines
1921

Matthew
Matthew -- diagnostic
diagnostic conclusions
conclusions
 3di:
3di: Matthew
Matthew metmet Dx
Dx criteria
criteria for
for ASD
ASD
on 2 domains - social interaction
on 2 domains - social interaction
and
and social
social communication
communication skillskill
 ADOS:
ADOS: Matthew
Matthew metmet ASD
ASD DXDX criteria
criteria on
on
all
all domains
domains
 Reports
Reports from
from nursery:
nursery: reported
reported difficulties
difficulties in
in line
line
with
with the
the ASD
ASD diagnosis
diagnosis

 Conclusions:
Conclusions: Diagnosis
Diagnosis of
of Autism
Autism
(language
(language delay
delay present)
present)
20
22
22

ADOS
ADOS Module
Module 22 activities
activities
 Construction
Construction tasktask  Description
Description ofof aa picture
picture
 Response to
Response to namename  Story from a book
Story from a book
 Make-believe
Make-believe play play  Free
Free play
play
 Joint
Joint interactive play
interactive play  Birthday
Birthday party
party
 Conversation
Conversation  Snack
Snack
 Response
Response to to joint
joint  Anticipation
Anticipation of
of aa routine
routine
attention
attention with
with objects
objects
 Demonstration
Demonstration task task  Bubble
Bubble play
play

21
23
23

9
 Module
Module 22 -- Focus
Focus of
of observation
observation
A.
A. Social
SocialCommunication:
Communication: B.
B.Social
Socialinteraction
interaction
 Use
Useofoflanguage
language  Eye
Eye contact
contact
 Intonation
Intonation of
ofvocalisation
vocalisation  Direction
Direction&&range
rangeofoffacial
facial
 Immediate
Immediateandanddelayed
delayed echolalia
echolalia expressions
expressions
 Conversation  Initiation
Initiation of
ofsocial
socialovertures
overtures
Conversation
 Description  Social
Social responsiveness
Description ofofevent
event responsiveness
 Use  Overall
Overall rapport
Useofofgestures
gestures rapport
 Sharing
Sharing enjoyment
enjoyment
C.
C.Functional
Functional&&creative
creativeplay
play
D.
D.Repetitive
Repetitiveinterests
interests D.
D.Other
Otherbehaviours
behaviours
 Sensory  Overactivity
Sensoryinterests
interests Overactivity
 Hand  Anxiety
Handand
andbody
bodymannerisms
mannerisms Anxiety
 Compulsion  Negative/oppositional
Negative/oppositional behaviour
Compulsion and
andrituals
rituals behaviour

22
24
24

Example
Example of
of Module
Module 22 -- Tom
Tom
 Tom
Tom aged
aged 44 years
years 66 months
months
 Above
Above average
average verbal
verbal and
and
non-verbal
non-verbal skills
skills

 Main
Main reasons
reasons for for referral:
referral:
•• selective
selective eater
eater -- identifying
identifying
the
the most
most effective
effective treatment
treatment
•• frustration
frustration is
is things
things dodo not
not
happen
happen ‘his
‘his way’
way’
•• difficulties
difficulties playing
playing with
with
peers
peers

23
25
25

Tom’s 3di scores

min max on
Subscale Score abnormal scale
reciprocal social
20.9 10 30
interaction
skills
language & other social
15.1 8 26
communication skills
gesture and non -verbal play
(subset of prior scale) 11.3 7 14

repetitive/
8.4 3 12
stereotyped
behaviours and routines

2426

10
Tom
Tom -- diagnostic
diagnostic conclusions
conclusions
 3di:
3di: TOM
TOM metmet Dx
Dx criteria
criteria for
for ASD
ASD
on
on all
all three
three domains
domains -- social
social
interaction,
interaction, social
social communication
communication &&
repetitive
repetitive interests
interests and
and behaviours
behaviours
 ADOS:
ADOS: Tom met ASD DX criteria
Tom met ASD DX criteria on
on
all
all domains
domains
 Reports
Reports from
from school:
school: reported
reported difficulties
difficulties in
in line
line
with
with the
the ASDASD diagnosis
diagnosis

 Conclusions:
Conclusions: Diagnosis
Diagnosis of
of Asperger
Asperger Syndrome
Syndrome
(no
(no language
language delay
delay present)
present)
25
27
27

Example
Example of
of Module
Module 22 -- Jack
Jack
 Jack
Jack aged
aged 44
 No
No developmental delay
developmental delay --
cognitive abilities within
cognitive abilities within
average
average range
range
 Mainstream
Mainstream education
education
 Main
Main reasons
reasons for for
referral:
referral:
Difficulties
Difficultiesin
inplaying
playing with
withother
other
children
children(turn
(turntaking
takingetc.)
etc.)
Behavioural
Behavioural difficulties
difficulties

26
28
28

Jack’s 3di scores

min max on
Subscale Score abnormal scale
reciprocal social
interaction 22.4 10 30
skills
language & other social
communication skills 17.8 8 26

gesture and non -verbal play

(subset of prior scale) 9.4 7 14

repetitive/
stereotyped
behaviours and routines 6.8 3 12

27 29

11
 Jack
Jack -- diagnostic
diagnostic conclusions
conclusions
(example
(exampleof
ofviewing
viewing the
thechild’s
child’s difficulties
difficultiesthrough
throughaa‘particular
‘particular lens’)
lens’)

 3di
3di Over
Over threshold
threshold forfor all
all 33 domains
domains
 ADOS
ADOS Scores
Scores below Dx cutoff in all
below Dx cutoff in all
domains
domains
 School
School Significant
Significant concerns
concerns reported
reported
characteristic
characteristic for
for children
children with
with
ADHD
ADHD
 Conclusions:
Conclusions: Support/behavioural
Support/behavioural strategiesstrategies
for
for children with
children with ADHD
ADHD and and review
review of of
possible
possible Dx
Dx of
of ASD
ASD in in 11 year’s
year’s timetime

28
30
30

ADOS
ADOS Module
Module 33 activities
activities
 Construction
Construction task
task  Story
Story from
from aa book
book
 Make-believe
Make-believe playplay  Social
Social difficulties
difficulties and
and
 Joint
Joint interactive
interactive play
play annoyance
annoyance
 Conversation
Conversation and reporting
and reporting  Emotions
Emotions
 Demonstration
Demonstration task task  Friendship
Friendship andand marriage
marriage
 Description
Description ofof aa picture
picture  Loneliness
Loneliness
 Break
Break
 Creating
Creating aa story
story

29
31
31

Module
Module 33 -- Focus
Focus of
of observation
observation
A.
A.Social
SocialCommunication:
Communication: B.
B.Social
Socialinteraction
interaction
 Use
Useof
oflanguage
language  Eye
Eyecontact
contact
 Unusual
Unusualprosody
prosody  Facial
Facialexpressions
expressions
 Immediate
Immediateand anddelayed
delayedecholalia
echolalia  Empathy
Empathy
 Conversation
Conversation  Insight
Insight
 Description
Descriptionof ofevent
event  Initiation
Initiationof
ofsocial
socialovertures
overtures
 Sharing
Sharinginformation
information  Social
Socialresponsiveness
responsiveness
 Asking
Askingfor
forinformation
information  Social
Socialreciprocity
reciprocity
 Use
Useof
ofgestures
gestures  Overall
Overallrapport
rapport
 Sharing
Sharingenjoyment
enjoyment
C.
C.Creativity
Creativity&&imagination
imagination
D.
D.Repetitive
Repetitiveinterests
interests D.
D.Other
Otherbehaviours
behaviours
 Sensory
Sensoryinterests
interests  Overactivity
Overactivity
 Hand
Handand
andbody
bodymannerisms
mannerisms  Anxiety
Anxiety
 Compulsion
Compulsionandandrituals
rituals  Negative/oppositional
Negative/oppositionalbehaviour
behaviour

30
32
32

12
Example
Example of
of Module
Module 3:
3: Kai
Kai
 Kai:
Kai: aged
aged99

 Cognitive
Cognitive abilities:
abilities: Average
Average

 Mainstream
Mainstreamschool.
school.No
Nospecialist
specialist
educational
educational provision
provision for
forHFA
HFA

 Main
Mainreasons
reasonsforforreferral:
referral:
Relationship
Relationship difficulties,
difficulties,
concentration
concentrationproblems,
problems,poor
pooreye
eye
contact
contact

31
33
33

Kai’s 3di scores

min max on
Subscale Score abnormal scale

reciprocal social interaction skills

9.1 10 30

language and other social

communication skills 9.7 8 26

gesture and non-verbal play

(subset of prior scale) 7.2 7 14

repetitive/stereotyped
and routines
behaviours 4.3 3 12

34
32

Kai - diagnostic
(example of parental and school report underestimating the degree of
difficulties) conclusions
his

 3di Over threshold for all scales

except ‘Reciprocal Social
Interaction’- Borderline
 ADOS Scores in Autism range
 CCC Home 142 (in the normal range)
School 136 (in the normal range)
 School Behaviour consistent with marked
social communication difficulties
 Conclusion: Asperger Syndrome
(no language delay)
33 35

13
 ADOS
ADOS Module
Module 44 activities
activities
 Construction
Construction Task*
Task*  Emotions
Emotions
 Telling
Telling aa Story
Story from
from aa Book
Book  Demonstration
Demonstration Task
Task
 Description
Description of a Picture*
of a Picture*  Cartoons*
Cartoons*
 Conversation
Conversation and and reporting
reporting  Break
Break
 Current
Current Work or School*
Work or School*  Daily
Daily Living*
Living*
 Social
Social Difficulties
Difficulties and
and  Friends
Friends and
and Marriage
Marriage
annoyance
annoyance  Loneliness
Loneliness
 Plans
Plans and
and Hopes
Hopes
 Activities
Activitieshighlighted
highlightedwith
withasterisk
asteriskare
are
optional  Creating
Creating aa Story
Story
optional

34
36
36

Module
Module 44 -- Focus
Focus of
of observation
observation
A.
A.Social
SocialCommunication:
Communication: B.
B.Social
Socialinteraction
interaction
 Use
Useof
oflanguage
language  Eye
Eyecontact
contact
 Unusual
Unusualprosody
prosody  Facial
Facialexpressions
expressions
 Immediate
Immediateand anddelayed
delayedecholalia
echolalia  Communication
Communicationof ofown
ownaffect
affect
 Conversation
Conversation  Empathy
Empathy
 Description
Descriptionof ofevent
event  Insight
Insight
 Sharing
Sharinginformation
information  Responsibility
Responsibility
 Asking
Askingfor
forinformation
information  Initiation
Initiationof
ofsocial
socialovertures
overtures
 Use
Useof
ofgestures
gestures(descriptive,
(descriptive,  Social
Socialresponsiveness
responsiveness
conventional,
conventional,instrumental
instrumentaland  Social
and Socialreciprocity
reciprocity
empathic/emotional)
empathic/emotional)  Overall
Overallrapport
rapport
 Sharing
Sharingenjoyment
enjoyment
C.
C.Creativity
Creativity&&imagination
imagination
D.
D.Repetitive
Repetitiveinterests
interests E.
E.Other
Otherbehaviours
behaviours
 Sensory
Sensoryinterests
interests  Overactivity
Overactivity
 Hand
Handand
andbody
bodymannerisms
mannerisms  Anxiety
Anxiety
 Excessive
Excessiveinterests
interests  Negative/oppositional
Negative/oppositionalbehaviour
behaviour
 Compulsion
Compulsionandandrituals
rituals 35
37
37

Assessment
Assessment with
with adolescents
adolescents --
example
example of
of Module
Module 4:
4: Lilly
Lilly
 Lilly
Lilly aged:
aged:16 16yy
 Cognitive
Cognitive ability:
ability: high
high average
average
 Reasons
Reasonsfor forreferral:
referral:
 Lilly’s
Lilly’s perception
perceptionof ofbeing
being
‘different’
‘different’
 Significant
Significant difficulties
difficultieswith
with anxiety
anxiety
 Having
Having to todo
dothings
things‘certain
‘certain way’
way’
 **The
Thereferral
referralletter
letterstated
statedthat
thatshe
she
would
wouldprobably
probablynot
notmeet
meetADOS
ADOS
criteria
criteria

36
38
38

14
 Lilly’s 3di scores
min max on
Subscale Score abnormal scale
reciprocal social interaction skills
14.3 10 30

language and other social

communication skills 13.9 8 26

gesture and non-verbal play(subset

of prior scale) 9.8 7 14

repetitive/stereotyped
and routines
behaviours 2.3 3 12

37 39

Lilly
Lilly -- diagnostic
diagnostic conclusions
conclusions
 3di:
 3di: Lilly
Lilly met
met criteria
criteria on
on 22 domains
domains
 ADOS:
 ADOS: Lilly
Lilly met
met criteria
criteria on
on all
all domains
domains
 School
 School report:
report: CCC
CCC scores
scores not
not inin the
the range
range for
for
clinical
clinical concern
concern
 Further
 Further assessment:
assessment: ChoCi
ChoCi
 Diagnostic conclusions: Asperger
 Diagnostic conclusions: Asperger Syndrome
Syndrome
(no
(no language delay) and OCD
language delay) and OCD

38
40
40

Example of Module - Alex

4
 Alex: aged 14 y
 Cognitive abilities: High
average
 Reason for referral:
school concerned about
his ability to initiate and
sustain friendships

39 41

15
 Alex’s 3DI Scores
min max on
Subscale Score abnormal scale
reciprocal social interaction skills
16.9 10 30

language and other social

communication skills 12.5 8 26

gesture and non-verbal play(subset

of prior scale) 6.3 7 14

repetitive/stereotyped
and routines
behaviours 9.3 3 12

40 42

Alex - Diagnostic conclusions

 3di: above cutoff in all domains
 ADOS: above diagnostic cutoff in all domains
 CCC parents (in the abnormal range)
School (in the normal )
 Further assessment: BYI range
- scores on the 99th Percentile
in the subscales of anxiety, depression and
anger
 Diagnostic conclusion: Asperger Syndrome (no
delay) and co -morbid anxiety and
language
depression

41 43

ASD
ASD and
and co-morbid
co-morbid
mental
mental health
health
problems
problems

16
 ASD
ASD Assessment
Assessment -- General
General
principles
principles (NICE,
(NICE, NAP)
NAP)
 Multidisciplinary
Multidisciplinary
 Multimodal
Multimodal
-- Detailed
Detaileddevelopmental
developmentalhistory
history
-- Direct
Directassessment
assessment(involving
(involvinginteraction
interaction&&observation
observationof
ofCYP)
CYP)
-- Details
DetailsofofCYP
CYPexperiences
experiencesofofhome
homelife,
life,education
education&&social
socialcare
care
 Multifactorial
Multifactorial
-- Medical
Medicalhistory
historyand
andphysical
physicalexamination
examination
-- Consideration
Considerationof
ofthe
thedifferential
differentialDx
Dx
-- Systematic
Systematicassessment
assessmentof ofco-morbid
co-morbidconditions
conditions
-- Development
Developmentof ofaaprofile
profileof
ofCYP’s
CYP’sstrengths,
strengths,skills,
skills,impairments
impairmentsand
andneeds
needs––
creating
creatingneeds
needsbased
basedmanagement
managementplan plan
43
45
45

Prevalence
Prevalence of
of MH
MH problems
problems in
in ASD
ASD
population
population
 Any
Any disorder:
disorder: 71%
71%
 Any
Any emotional
emotional disorder:
disorder: 44%
44%
 Any
Any anxiety
anxiety disorder:
disorder: 41%41%
 Behaviour
Behaviour disorders:
disorders: ADHD
ADHD (28%),
(28%), ODD
ODD (28%),
(28%),
CD
CD (3%)
(3%)
 40%
40% ofof children
children had
had two
two or
or more
more disorders
disorders
 Few
Few risk factors: not severity of
risk factors: not severity of ASD,
ASD, IQ
IQ or
or adaptive
adaptive
functioning
functioning

44
46
46

Recognition
Recognition of
of MH
MH problems
problems in
in
children
children &
& adolescents
adolescents with
with ASD
ASD
 May
Maybe bedifficult
difficultto
torecognise
recognisedueduetotodifficulty
difficultycommunicating
communicating
feelings
feelingsof
ofdistress
distress
(verbally or non-verbally)
(verbally or non-verbally)
 Screening
Screeningfor forpossible
possibleco-morbid
co-morbidMH MHproblems
problemsboth
bothdirectly
directly
with
withthe
thechild/adolescent
child/adolescent as aswell
well as
asparents/carers
parents/carersimportant
important
 Behavioural
Behavioural indicators
indicators(such
(suchas
aschanges
changesin insleep
sleepor
orappetite
appetiteor
or
increase
increaseofofrepetitive,
repetitive, challenging
challenging behaviour
behaviour or orself-care…)
self-care…)

45
47
47

17
 Mental
Mental Health
Health in
in ASD
ASD

46
48 48

3di
3di in
in the
the context
context of
of
overall
overall assessment
assessment
procedure:
procedure:
additional
additional slides
slides
Kathryn
Kathryn Stevenson
Stevenson
Senior
Senior Clinical
Clinical Psychologist
Psychologist
Great
GreatOrmond
OrmondStreet
StreetHospital
Hospital

Useful
Useful screening
screening questionnaires
questionnaires for
for
ASD:
ASD:
 AQ
AQ (Baron-Cohen
(Baron-Cohen et et al,
al, 2001)
2001)
Available
Available online
online
 CAST
CAST (Williams
(Williams et
et al,
al, 2002)
2002)
Available
Available online
online
 SCQ
SCQ (Rutter
(Rutter && Bailey
Bailey etet al.,
al., 2003)
2003)
 GARS-3
GARS-3 (Gilliam,
(Gilliam, 2013)
2013)
 CARS-2
CARS-2 (Schopler
(Schopler etet al,
al, 2010)
2010)
48
45
45

18
 Preschool
Preschool measures
measures
 Parents’
Parents’ Evaluation
Evaluation of
of Developmental
Developmental Status
Status
(Glascoe, 2013)
(Glascoe, 2013)
 First
First Year
Year Inventory
Inventory (Watson
(Watson et et al
al 2007)
2007)
 M-CHAT
M-CHAT (Robins
(Robins et
et al
al 2009).
2009). Available
Available online
online
at
at m-chat.org
m-chat.org
 SCDC
SCDC (Skuse
(Skuse 2005).
2005). InIn 3di5
3di5 PreEntry
PreEntry folder.
folder.
 BRIEF
BRIEF preschool
preschool (Gioia
(Gioia etet al
al 2013)
2013)
 Conners
Conners Early
Early Childhood
Childhood (Conners,
(Conners, 2009)
2009)
 Anecdotal
Anecdotal reports that thorough referral info
reports that thorough referral info can
can
be as helpful as questionnaires.....
be as helpful as questionnaires.....
494646

Assessing
Assessing Girls
Girls
 Lots
Lots of
of recent
recent research
research highlighting
highlighting sex
sex
differences
differences in
in ASD
ASD presentation
presentation (eg
(eg Lai
Lai etet al,
al,
2011;
2011; Mandy
Mandy etet al,
al, 2015;
2015; Williams
Williams et
et al,
al, 2008)
2008)
 Need
Need toto be
be mindful
mindful ofof differences
differences when
when
assessing:
assessing:
ADOS/3di
 ADOS/3di that
that involves
involves “digging”
“digging”
 Autism Spectrum Quotient (AQ
 Autism Spectrum Quotient (AQ -- good
good at
at spotting
spotting the
the
camouflaging
camouflaging of
of gaps
gaps in
in ADOS)
ADOS) (Rynkiewicz,
(Rynkiewicz, 2016)
2016)
ASSQ-REV
 ASSQ-REV –– (Kopp
(Kopp && Gillberg,
Gillberg, 2007)
2007) -- specific
specific to
to
assess
assess girl
girl phenotype
phenotype

5047
47

References
References (slide1
(slide1of
of2)
2)
 Sven
SvenBölte,
Bölte,Eva
EvaWesterwald,
Westerwald,Martin
MartinHoltmann,
Holtmann,Christine
ChristineFreitag
Freitag&&Fritz
FritzPoustk
Poustk Autistic
AutisticTraits
Traitsand
and
Autism
AutismSpectrum
SpectrumDisorders:
Disorders:TheTheClinical
ClinicalValidity
Validityof ofTwo
TwoMeasures
MeasuresPresuming
PresumingaaContinuum
Continuumof of
Social Communication Skills J Autism Dev Disord (2011)
Social Communication Skills J Autism Dev Disord (2011) 41:66–72 41:66–72
 Chlebowski,
Chlebowski,Colby
Colby 1; ;Robins,
1
Robins,Diana
DianaL;L;Barton,
Barton,Marianne
MarianneL;L;Fein,
Fein,Deborah
Deborah 1Dept.
1
Dept.ofofPsychiatry,
Psychiatry,
University
UniversityofofCalifornia,
California,San
SanDiego,
Diego,California,
California,USA.
USA.Large-scale
Large-scaleuseuseof ofthe
themodified
modifiedchecklist
checklistfor
for
autism
autismininlow-risk
low-risktoddlers.
toddlers. Pediatrics
PediatricsVol
Vol131
131(4)
(4)2013.
2013.
 Kopp,
Kopp,S,S,Gillberg,
Gillberg,C.C. The
TheAutism
AutismSpectrum
SpectrumScreening
ScreeningQuestionnaire
Questionnaire(ASSQ)-Revised
(ASSQ)-RevisedExtended
Extended
Version
Version(ASSQ-REV):
(ASSQ-REV):An Aninstrument
instrumentfor forbetter
bettercapturing
capturingthetheautism
autismphenotype
phenotypein ingirls?
girls?AA
preliminary
preliminarystudy
studyinvolving
involving191191clinical
clinicalcases
casesandandcommunity
communitycontrols
controlsResearch
Researchinin
Developmental
DevelopmentalDisabilities,
Disabilities,Volume
Volume32, 32,Issue
Issue6,6,November-December
November-December2011, 2011,Pages
Pages2875-2888
2875-2888
 Lai
LaiM-C,
M-C,Lombardo
LombardoMV, MV,Pasco
PascoG, G,Ruigrok
RuigrokANV,
ANV,Wheelwright
WheelwrightSJ, SJ,etetal.
al.(2011)
(2011)AABehavioral
Behavioral
Comparison
Comparisonof ofMale
Maleand andFemale
FemaleAdults
Adultswith
withHigh
HighFunctioning
FunctioningAutism
AutismSpectrum
SpectrumConditions.
Conditions.
PLoS
PLoSONE
ONE6(6):
6(6):e20835.
e20835.
 E.
E.M.
M.Mahone
Mahone&&H. H.E.E.Schneider
Schneider Assessment
Assessmentof ofAttention
AttentionininPreschoolers.
Preschoolers.Neuropsychol
NeuropsycholRev Rev
(2012)
(2012)22:361–383
22:361–383
 William
WilliamMandy,
Mandy,Rebecca
RebeccaChilvers,
Chilvers,Uttom
UttomChowdhury,
Chowdhury,GemmaGemmaSalter,
Salter,Anna
AnnaSeigal
Seigal&&David
DavidSkuse
SkuseSex
Sex
Differences
Differencesin inAutism
AutismSpectrum
SpectrumDisorder:
Disorder:Evidence
Evidencefrom fromaaLarge
LargeSample
Sampleof ofChildren
Childrenand and
Adolescents
Adolescents JJAutism
AutismDevDevDisord
Disord(2012)
(2012)42:1304–1313
42:1304–1313
 Mandy
MandyW. W.a··Murin
a
MurinM. M.b··Skuse
b
SkuseD. D.b The
b
TheCognitive
CognitiveProfile
Profilein
inAutism
AutismSpectrum
SpectrumDisorders
Disordersin in
Leboyer
LeboyerM,M,Chaste
ChastePP(eds):
(eds):Autism
AutismSpectrum
SpectrumDisorders.
Disorders.Phenotypes,
Phenotypes,Mechanisms
Mechanismsand andTreatments.
Treatments.
Key Issues Mental Health. Basel, Karger, 2015, vol 180,
Key Issues Mental Health. Basel, Karger, 2015, vol 180, pp 34-45pp 34-45
51 48
48

19
 References
References (slide
(slide22of
of2)
2)
 Nuria
Nuriade
delalaOsa,
Osa,Roser
RoserGranero,
Granero,Eva EvaPenelo,
Penelo,Lourdes
LourdesEzpeleta.
Ezpeleta.Usefulness
Usefulnessof ofthe
theSocial
Socialand
and
Communication
CommunicationDisorders
DisordersChecklist
Checklistforforthe
theAssessment
Assessmentof ofSocial
SocialCognition
CognitionininPreschoolers.
Preschoolers.
European Journal of Psychological Assessment (2014), 30,
European Journal of Psychological Assessment (2014), 30, pp. 296-303.pp. 296-303.
 Rynkiewicz,
Rynkiewicz,A; A;Schuller,
Schuller,B;B;Marchi,
Marchi,E; E;Piana,
Piana,S; S;Camurri,
Camurri,A;A;Lassalle,
Lassalle,A;A;Baron-Cohen,
Baron-Cohen,S; S;An
An
investigation
investigationof ofthe
the‘female
‘femalecamouflage
camouflageeffect’
effect’in
inautism
autismusing
usingaacomputerized
computerizedADOS-2
ADOS-2andandaa
test
testof
ofsex/gender
sex/genderdifferences.
differences.Molecular
MolecularAutism
Autism(2016)
(2016)7:10
7:10
 Simonoff,
Simonoff,E.;
E.;Pickles,
Pickles,A;A;Charman,
Charman,T; T;Chandler,
Chandler,S; S;Loucas,
Loucas,T; T;Baird,
Baird,G.
G.Psychiatric
PsychiatricDisorders
Disordersin in
Children
ChildrenWith
WithAutism
AutismSpectrum
SpectrumDisorders:
Disorders:Prevalence,
Prevalence,Comorbidity,
Comorbidity,andandAssociated
AssociatedFactors
Factorsinin
aaPopulation-Derived
Population-DerivedSample Sample Journal
JournalofofAmerican
AmericanAcademic
AcademicChild
Childand
andAdolescent
AdolescentPsychiatry,
Psychiatry,
(August
(August2008)
2008)Volume
Volume47(8)
47(8)
 Turner-Brown,
Turner-Brown,Lauren;
Lauren;M. M.Baranek,
Baranek,GraceGraceT.;T.;Reznick,
Reznick,J.J.Stevenn;
Stevenn;Watson,
Watson,Linda
LindaR.;
R.;Crais,
Crais,Elizabeth
Elizabeth
R.
R.The
TheFirst
FirstYear
YearInventory:
Inventory:AAlongitudinal
longitudinalfollow-up
follow-upof of12-month-old
12-month-oldto to3-year-old
3-year-oldchildren
children
Autism (Sept 2013) Volume: 17 (5) Pages:
Autism (Sept 2013) Volume: 17 (5) Pages: 527-540 527-540
 Wiggins,
Wiggins,Lisa
LisaD.
D.; ;Piazza,
Piazza,Vivian
Vivian; ;Robins,
Robins,Diana
DianaLL. .Comparison
Comparisonof ofaabroad-based
broad-basedscreen
screenversus
versus
disorder-specific
disorder-specificscreen
screenin indetecting
detectingyoung
youngchildren
childrenwith
withananautism
autismspectrum
spectrumdisorder
disorderAutism
Autism
(Feb
(Feb2014)
2014)Volume:
Volume:18 18(2)
(2)Pages:
Pages:76-84
76-84
 Joanna
JoannaG.G.Williams,
Williams,Carrie
CarrieAllison,
Allison,Fiona
FionaJ.J.Scott,
Scott,Patrick
PatrickF.F.Bolton,
Bolton,Simon
SimonBaron-Cohen,
Baron-Cohen,Fiona
FionaE. E.
Matthews,
Matthews,Carol
CarolBrayne
Brayne TheTheChildhood
ChildhoodAutism
AutismSpectrum
SpectrumTestTest(CAST):
(CAST):Sex
SexDifferences
Differences JJAutism
Autism
Dev
DevDisord
Disord(2008)
(2008)38:1731–1739
38:1731–1739

52
49
49

20