Assessment Interventions for Autism
Clinical psychology continues to rely on the DSM-IV criteria of the main core deficits of autism for diagnosis of autistic disorder. The criteria outlines impairments in communication, socialization, spontaneous pretend play as well as displays of repetitive stereotypical behaviors.
The main categories the DSM-IV uses to classify the various impairments that individuals with autism spectrum disorders may display communication, socialization, play and behavior. The first category addresses the impairments in social interaction that are observed in most children with autism. This impairment can be determined by demonstrating a deficit in the use of multiple nonverbal behaviors such as eye-to-eye gaze, body postures, facial expression, and gestures to regulate social interaction (American Psychiatric Association, 2000).
Additionally, a failure to develop peer relationships, a lack of interest in seeking shared enjoyment in interests or achievements, and/or a lack of social and emotional reciprocity is typical in autism cases. Sigman and Capps (1997) conducted a study through which they hoped to understand the emotional expressions of children with autism. Most of the children diagnosed with autism smiled when they mastered a task (completing a puzzle), but did not look up at observers for acknowledgement of their success, whereas children without autism seek praise from adults when they succeed in a task. All of these behaviors show a dramatic impairment in the social context compared to normally developing individuals. It is a fundamental cognitive component that is often characterized as being an accurate predictor of autism. Early intervention for autism should include strategies to address the core deficits in social understanding.
The second category of deficit the DSM-IV presents is impairments in communication (American Psychiatric Association, 2000). This is a central feature of autism and almost half of children with autism never fully acquire functional language (Sigman & Capps, 1997). Assessment in this area may reveal a delay in, or lack of development of, spoken language that is not accompanied by gestures. Furthermore, if individuals do have adequate speech, there may be impairment in the ability to engage in conversations with others.
Other clear indicators of communication impairments are stereotyped and repetitive use of language, often referred to as echolalia. Individuals with autism engage in parrot-like echoing, which is one of the most prominent behaviors of autism. Speech with echolalia emphasizes the lack of comprehension of language that is displayed by many people with autism. Researchers claim that echolalia is the “manifestation of misconnection between the more peripheral processing systems and a central system that is concerned with meaning” (Sigman & Capps, 1997, p.82). This suggests that individuals with autism may be able to produce language, but still lack the ability to fully comprehend what is being communicated. Autism program interventions should include a focus on improving the communication skills of students with autism.
Lastly, the lack of varied, spontaneous make-believe play may indicate communication impairment that may indicate an autism spectrum disorder. Many children with autism show extremely limited symbolic play not only compared to normal children their age, but also compared to children much younger in age who are developmentally disabled as well as normally developing individuals. This is often the first feature that is identified when clinicians are trying to diagnose autism because it is a trademark of autism. Autism program interventions should address delays in the development of play skills.
The final category of deficits described in the DSM-IV and to be targeted by interventions for autism is restricted, repetitive and stereotyped patterns of behavior, activities, and interests (American Psychiatry Association, 2000). This can be manifested in multiple ways such as having a preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal in intensity. An example of a restricted pattern of interest would be a fixation on having objects lined up precisely in order, or an obsession with opening and shutting a door. Another manifestation is having inflexible devotion to specific routines or rituals and/or stereotyped and repetitive motor mannerisms (hand flapping).
Lastly, persistent fixation with distinct parts of objects marks an abnormal obsession that is often shown in an autism disorder. Interventions for autism should incorporate strategies and instruction to improve the main core deficit skills of communication, socialization and stereotypical patterns of behavior in children with autism.