Asperger’s and High Functioning Autism (HFA) involve delays and deviant patterns of behavior in multiple areas of functioning that often require the input of specialists with different areas of expertise, particularly overall developmental functioning, neuropsychological features, and behavioral status. Thus, the clinical assessment of children with Asperger’s and HFA is most effectively conducted by an experienced interdisciplinary team.
Let’s look at a few important points that should be made clear before we discuss the various areas of assessment…
First, most children with Asperger’s and HFA have average- to above average- levels of Full Scale IQ. As a result, they are often not thought of as in need for special programming. All too often, people view the “special needs” child as a person who is simply experiencing difficulties in behavior, social interaction, or in peer relationships. This is a true down-play of what is really going on. Asperger’s and HFA is a serious and debilitating developmental disorder impairing the child's capacity for socialization. It is NOT a transient or mild condition. Moms and dads need to be aware of the current lack of knowledge about Asperger’s and HFA, and the common confusions of use and abuse of the disorder currently prevailing in today's society.
Second, given the complexity of the disorder, the importance of developmental history, and the common difficulties in securing adequate services for kids on the autism spectrum, it is very important that moms and dads observe and participate in the assessment.
Third, assessment findings should be translated into a single, coherent view of the child (i.e., easily understood, detailed and concrete – with realistic recommendations). When writing their reports, specialists should strive to express the implications of their findings to the child's day-to-day adaptation, learning, and vocational training.
In the majority of cases, a comprehensive assessment will involve the following components: psychological assessment, neuropsychological assessment, psychiatric examination, history, and communication assessment.
Psychological Assessment—
This component attempts to establish the overall level of intellectual functioning, profiles of strengths and weaknesses, and style of learning. The specific areas to be examined and measured include:
academic achievement
adaptive functioning (e.g., degree of self-sufficiency in real-life situations)
neuropsychological functioning (e.g., problem-solving, concept formation, visual-perceptual skills, motor and psychomotor skills, memory, executive functions)
personality assessment (e.g., mood presentation, common preoccupations, compensatory strategies of adaptation)
Neuropsychological Assessment—
The neuropsychological assessment of children with Asperger’s and HFA involves certain procedures of specific interest. Whether or not a Verbal-Performance IQ discrepancy is obtained in intelligence testing, it is advisable to conduct a fairly comprehensive neuropsychological assessment including:
concept formation (both verbal and nonverbal)
executive functions
facial recognition
gestalt perception
measures of motor skills (e.g., coordination of the large muscles, manipulative skills, visual-motor coordination, visual-perceptual skills)
parts-whole relationships
spatial orientation
visual memory
A recommended protocol would include the measures used in the assessment of children with Nonverbal Learning Disabilities. Particular attention should be given to demonstrated or potential compensatory strategies (e.g., children with significant visual-spatial deficits may translate the task or mediate their responses by means of verbal strategies or verbal guidance, which may be important for educational programming).
Psychiatric Examination—
The psychiatric examination should include observations of the child during more and less structured periods (e.g., while interacting with the mother or father, while engaged in assessment by other members of the evaluation team). Specific areas for observation and inquiry include:
ability to intuit other's feelings
ability to infer other's intentions and beliefs
capacities for self-awareness
development of peer relationships and friendships
level of insight into social and behavioral problems
patterns of special interest and leisure time
perspective-taking
quality of attachment to family members
social and affective presentation
typical reactions in novel situations
Problem behaviors that are likely to interfere with remedial programming should be noted (e.g., marked aggression). The child's ability to understand ambiguous nonliteral communications (e.g., teasing and sarcasm) should be examined, because misunderstandings of such communications may elicit aggressive behaviors. Other areas of observation involve:
anxiety
coherence of thought
depression
panic attacks
presence of obsessions or compulsions
History—
A careful history should be obtained (e.g., information related to pregnancy and neonatal period, early development and characteristics of development, medical and family history). A review of previous records including previous evaluations should be performed. Also, several other specific areas should be directly examined because of their importance in the diagnosis of Asperger’s and HFA, including:
areas of special interest (e.g., favorite occupations, unusual skills, collections)
development of friendships
development of motor skills
emotional development
history of onset/recognition of the problems
language patterns
mood presentation
past and present problems in social interaction
patterns of attachment of family members
self-concept
social development
Communication Assessment—
The communication assessment attempts to obtain both quantitative and qualitative information regarding the various aspects of the child's communication skills. It should go beyond the testing of speech and formal language (e.g., vocabulary, articulation, sentence construction, comprehension), which are often areas of strength. The assessment should examine:
content, coherence, and contingency of conversation
nonliteral language (e.g., humor, metaphor, irony, absurdities)
nonverbal forms of communication (e.g., gestures, gaze)
pragmatics (e.g., adherence to typical rules of conversation, turn-taking, sensitivity to cues provided by the speaker)
prosody of speech (e.g., pitch, melody, volume, stress)
Asperger’s can be diagnosed through several different assessment tools, most of which are targeted toward kids and young adults (e.g., Australian Scale for Asperger's Syndrome, Asperger's Syndrome Diagnostic Scale, Childhood Autism Spectrum Test, Adult Asperger Assessment). Asperger's assessment tests are performed in conjunction with behavioral evaluations and analysis of intake information provided by moms and dads, educators, and the child himself or herself. These assessments help to ensure accuracy in diagnosing Asperger's so that future treatments and accommodations can be implemented.
The Aspergers Comprehensive Handbook