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Contents

Cover

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Essentials of Psychological Assessment Series

Title Page

Copyright

Dedication

Series Preface

Acknowledgments

Chapter 1: Overview

Diagnostic Criteria

Asperger Syndrome

Pervasive Developmental Disorder, Not Otherwise Specified

Rett's Disorder and Childhood Disintegrative Disorder

DSM-5

Chapter 2: Assessment of Level of Functioning

Selecting Instruments

Developmental and Early Cognitive Measures

Cognitive Assessments

Neuropsychological Assessments

Qualitative Observations

Summary

Chapter 3: Speech, Language, and Communication Assessment

Receptive Language

Expressive Language

Pragmatic Language/Social Communication

Stages of Language Development

Formulation of Findings

Summary

Chapter 4: Assessment of Behavioral Profiles

Standardized Assessments of Behavior

Functional Behavior Assessment

Assessment of Adaptive Behavior

Summary

Chapter 5: Clinical Interview and Record Review

Clinical Interview

Methods of Collecting Information on Current and Historical Presentation

Summary

Chapter 6: Direct Diagnostic Assessment

Direct Observation

Diagnostic Assessment

Semistructured Measures for Diagnostic Assessment

Summary

Chapter 7: Diagnostic Differentials and Comorbidity

Intellectual Disability

Learning Profiles

Specific Language Impairment

Attention Deficit Hyperactivity Disorder

Anxiety and Tic Disorders

Mood Disorders

Psychiatric Conditions in Adulthood

Summary

Chapter 8: Case Conceptualization and Integrated Report Writing

The Parent Conference

The Written Report

Case Samples

Case Sample: Initial Diagnosis—Toddler

Case Sample: School-Aged Child With ASD

Annotated Bibliography

About the Authors

Author Index

Subject Index

Essentials of Psychological Assessment Series

Series Editors, Alan S. Kaufman and Nadeen L. Kaufman

Essentials of 16 PF ® Assessment
by Heather E.-P. Cattell and James M. Schuerger

Essentials of Assessment Report Writing
by Elizabeth O. Lichtenberger, Nancy Mather, Nadeen L. Kaufman, and Alan S. Kaufman

Essentials of Assessment with Brief Intelligence Tests
by Susan R. Homack and Cecil R. Reynolds

Essentials of Autism Spectrum Disorders Evaluation and Assessment
by Celine A. Saulnier and Pamela E. Ventola

Essentials of Bayley Scales of Infant Development–II Assessment
by Maureen M. Black and Kathleen Matula

Essentials of Behavioral Assessment
by Michael C. Ramsay, Cecil R. Reynolds, and R. W. Kamphaus

Essentials of Career Interest Assessment
by Jeffrey P. Prince and Lisa J. Heiser

Essentials of CAS Assessment
by Jack A. Naglieri

Essentials of Cognitive Assessment with KAIT and Other Kaufman Measures
by Elizabeth O. Lichtenberger, Debra Broadbooks, and Alan S. Kaufman

Essentials of Conners Behavior Assessments
by Elizabeth P. Sparrow

Essentials of Creativity Assessment
by James C. Kaufman, Jonathan A. Plucker, and John Baer

Essentials of Cross-Battery Assessment, Second Edition
by Dawn P. Flanagan, Samuel O. Ortiz, and Vincent C. Alfonso

Essentials of DAS-II ® Assessment
by Ron Dumont, John O. Willis, and Colin D. Elliot

Essentials of Dyslexia Assessment and Intervention
by Nancy Mather and Barbara J. Wendling

Essentials of Evidence-Based Academic Interventions
by Barbara J. Wendling and Nancy Mather

Essentials of Forensic Psychological Assessment, Second Edition
by Marc J. Ackerman

Essentials of IDEA for Assessment Professionals
by Guy McBride, Ron Dumont, and John O. Willis

Essentials of Individual Achievement Assessment
by Douglas K. Smith

Essentials of KABC-II Assessment
by Alan S. Kaufman, Elizabeth O. Lichtenberger, Elaine Fletcher-Janzen, and Nadeen L. Kaufman

Essentials of MillonInventories Assessment, Third Edition
by Stephen Strack

Essentials of MMPI-AAssessment
by Robert P. Archer and Radhika Krishnamurthy

Essentials of MMPI-2® Assessment, Second Edition
by David S. Nichols

Essentials of Myers-Briggs Type Indicator ® Assessment, Second Edition
by Naomi Quenk

Essentials of NEPSY®-II Assessment
by Sally L. Kemp and Marit Korkman

Essentials of Neuropsychological Assessment, Second Edition
by Nancy Hebben and William Milberg

Essentials of Nonverbal Assessment
by Steve McCallum, Bruce Bracken, and John Wasserman

Essentials of PAI ® Assessment
by Leslie C. Morey

Essentials of Processing Assessment
by Milton J. Dehn

Essentials of Response to Intervention
by Amanda M. VanDerHeyden and Matthew K. Burns

Essentials of Rorschach ® Assessment
by Tara Rose, Nancy Kaser-Boyd, and Michael P. Maloney

Essentials of School Neuropsychological Assessment
by Daniel C. Miller

Essentials of Specific Learning Disability Identification
by Dawn Flanagan and Vincent C. Alfonso

Essentials of Stanford-Binet Intelligence Scales (SB5) Assessment
by Gale H. Roid and R. Andrew Barram

Essentials of TAT and Other Storytelling Assessments, Second Edition
by Hedwig Teglasi

Essentials of Temperament Assessment
by Diana Joyce

Essentials of WAIS ®-IV Assessment
by Elizabeth O. Lichtenberger and Alan S. Kaufman

Essentials of WIAT ®-III and KTEA-II Assessment
by Elizabeth O. Lichtenberger and Kristina C. Breaux

Essentials of WISC ®-IV Assessment, Second Edition
by Dawn P. Flanagan and Alan S. Kaufman

Essentials of WJ IIICognitive Abilities Assessment, Second Edition
by Fredrick A. Schrank, Daniel C. Miller, Barbara J. Wendling, and Richard W. Woodcock

Essentials of WJ IIITests of Achievement Assessment
by Nancy Mather, Barbara J. Wendling, and Richard W. Woodcock

Essentials of WMS®-IV Assessment
by Lisa Whipple Drozdick, James A. Holdnack, and Robin C. Hilsabeck

Essentials of WNVAssessment
by Kimberly A. Brunnert, Jack A. Naglieri, and Steven T. Hardy-Braz

Essentials of WPPSI-III Assessment
by Elizabeth O. Lichtenberger and Alan S. Kaufman

Essentials of WRAML2 and TOMAL-2 Assessment
by Wayne Adams and Cecil R. Reynolds

Title Page

To Tony, for your eternal love, support, and patience—You are my everything; and to Lucienne and Vivienne, for being the light of my life. ∼ Celine

To Noah, you are an inspiration; your unfaltering strength, love, and endless encouragement make it all possible; to Madelyn, you are truly the center of my world. ∼ Pam

This book has a very special dedication to our beloved mentor and colleague, Dr. Sara Sparrow, for shaping our knowledge of childhood assessments, particularly the critical role of adaptive behavior in autism spectrum disorders. Working with you was an honor, and we miss you terribly. ∼ Celine and Pam

Series Preface

In the Essentials of Psychological Assessment series, we have attempted to provide the reader with books that will deliver key practical information in the most efficient and accessible style. The series features instruments in a variety of domains, such as cognition, personality, education, and neuropsychology. For the experienced clinician, books in the series will offer a concise yet thorough way to master utilization of the continuously evolving supply of new and revised instruments, as well as a convenient method for keeping up to date on the tried-and-true measures. The novice will find here a prioritized assembly of all the information and techniques that must be at one's fingertips to begin the complicated process of individual psychological diagnosis.

Wherever feasible, visual shortcuts to highlight key points are utilized alongside systematic, step-by-step guidelines. Chapters are focused and succinct. Topics are targeted for an easy understanding of the essentials of administration, scoring, interpretation, and clinical application. Theory and research are continually woven into the fabric of each book, but always to enhance clinical inference, never to sidetrack or overwhelm. We have long been advocates of “intelligent” testing—the notion that a profile of test scores is meaningless unless it is brought to life by the clinical observations and astute detective work of knowledgeable examiners. Test profiles must be used to make a difference in the child's or adult's life, or why bother to test? We want this series to help our readers become the best intelligent testers they can be.

In Essentials of Autism Spectrum Disorders Evaluation and Assessment, the authors illustrate a comprehensive developmental model for multidisciplinary diagnostic evaluations. They derived this model from years of experience in conducting diagnostic evaluations for ASD following standards of best practice. Given the neurodevelopmental nature of ASD, symptoms unfold over the course of early development and subsequently affect multiple areas of functioning. For these reasons, the developmental skills that need to be assessed often require clinicians with different disciplinary expertise. Thus, in this Essentials text, the authors outline the components of a state-of-the-art diagnostic evaluation for ASD and also highlight the necessity of integrating findings from multiple sources. The end goal is to provide one comprehensive and cohesive diagnostic formulation for an individual's optimal care.

Alan S. Kaufman, Ph.D., and Nadeen L. Kaufman, Ed.D., Series Editors
Yale University School of Medicine

Acknowledgments

The completion of this book would not have been possible without the help and support from a host of people. This publication exemplifies the knowledge and expertise in autism spectrum and related disorders, diagnostic evaluation, and childhood development that was acquired over many years thanks to the teachings and collaborations of our incredible mentors and colleagues. They include, but are certainly not limited to, the following:

Ami Klin, Ph.D., our extraordinary leader—A million thanks for teaching us the art of the comprehensive developmental approach to diagnostic evaluations in ASD. We have been incredibly fortunate to witness and learn from your clinical magic firsthand. This book hopefully embodies your approach to fully understanding the unique needs and gifts of the children that we serve each day. Your leadership, mentorship, and most importantly support of our careers are unparalleled. You are and continue to be an inspiration. Muito obrigado!

Deborah Fein, Ph.D., and Marianne Barton, Ph.D., our beloved graduate school advisors, mentors, and friends from the University of Connecticut—Words cannot express our gratitude and appreciation for all that you have taught us. You both are undeniably responsible for shaping our knowledge of autism and diagnostic assessment, and for single-handedly launching our careers. We will never forget the nest from which we came!

Julie Wolf, Ph.D., and Leah Booth, MA, CCC-SLP, our dear friends and colleagues—We cannot thank you enough for your generous contributions to the chapters on diagnostic differentials and speech, language, and communication. We are privileged to have your respective areas of expertise reflected in this book. The opportunity to work alongside both of you for years has been an absolute gift, and one of these authors misses you both very much!

To Michelle Levine, Kelly Caravella, and Yael Stern, our bourgeoning experts in autism—Thank you for your efforts in helping us to put the finishing touches on this book at the 11th hour! We could never have reached our deadline without you. We look forward to saying we knew you when.

To our colleagues and mentors at the Yale Child Study Center, Kasia Chawarska, Ph.D.; Karyn Bailey, LCSW; Rhea Paul, CCC-SLP, Ph.D.; Kathy Koenig, MSN; Fred Volkmar, MD; and Domenic Cicchetti, Ph.D.—Your teachings, clinical expertise, and guidance are not only reflected throughout this book, but will continue to influence the work that we do on a daily basis. Forever thanks.

A very special thank you to our editors, Marquita Flemming and Kim Nir—without your patience, tolerance, and support throughout this entire process, this book would never have become a reality. Numerous obstacles on our end made any deadline seem impossible; thus, we thank you for your faith in us and your willingness to see this book through to fruition. Furthermore, we are indebted to Wiley and Alan and Nadeen Kaufman for recognizing the utility and necessity for including the topic of autism assessments within the Essentials series. We believe that this will offer a unique contribution to clinicians in the field, and we are honored to be a part of it.

Finally, our overwhelming gratitude to the children and families from whom we learn every day. Thank you for sharing your lives with us.

Chapter 1

Overview

Autism spectrum disorders (ASD) are among the most common childhood disorders, with prevalence rates reaching near 1% of the population (CDC, 2007a, 2007b). Defined as a lifelong neurodevelopmental disorder with a complex genetic etiology, ASD's symptoms tend to unfold over the course of early development. Research indicates that 80% to 90% of parents report their first concerns about their child's development by the second birthday and often earlier. However, the mean age of diagnosis continues to be well over the age of three despite these concerns (Chawarska et al., 2007). Moreover, when experienced clinicians make a diagnosis of ASD at 18 to 24 months, the stability of diagnosis is quite strong, also around 80% to 90% (Chawarska et al., 2009). This highlights an extremely concerning gap between when first concerns are raised and when something is actually done to help the child; often because of a limited awareness of the early markers of ASD by professionals on the front line. These facts underscore the necessity for clinicians of all disciplines to learn about and be vigilant for the early signs of ASD, so that children can be effectively evaluated and efficiently diagnosed. Only then can these children subsequently receive the critical early and intensive intervention that is associated with optimal outcome (National Research Council, 2001).

Caution

Most parents of children who develop ASD express concerns regarding their child's development prior to the second birthday, well over a year before diagnostic evaluations take place, on average. Professionals need to be extra vigilant in not only validating concerns, but also in taking immediate action to assess and identify potential risk for ASD.

Diagnostic Criteria

Although the causes of ASD are likely neurobiological in nature, the spectrum of disorders still requires diagnosis based on behavioral symptomatology. The current diagnostic criteria put forth in the Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IV-TR; APA, 2000) fall under the category of Pervasive Developmental Disorders (PDD), which includes Autistic Disorder, or autism; Asperger's Disorder, or Asperger syndrome, Rett's Disorder, Childhood Disintegrative Disorder (CDD), and Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS). The behavioral features of all five PDDs fall within the following subcategories: (1) impairments in social interaction; (2) impairments in communication; and (3) restricted, repetitive, and stereotyped patterns of behavior, interests, and activities. A diagnosis of Autistic Disorder, the most prototypical of the PDDs, requires onset of delays or deviance in development prior to the age of three and a total of at least six impairments in all subcategories, with at least two falling within the area of social interaction.

Rapid Reference 1.1

Pervasive Developmental Disorders in the DSM-IV-TR

Autistic Disorder

Asperger's Disorder

Rett's Disorder

Childhood Disintegrative Disorder

Pervasive Developmental Disorder, Not Otherwise Specified

Asperger Syndrome

The description of Asperger syndrome is more complicated. The DSM-IV-TR defines the disorder as having impairment in at least two areas of social interaction and one restricted, repetitive, and stereotyped pattern of behavior, but not meeting full criteria for Autistic Disorder. The criteria further stipulate that there can be no clinically significant delays in the development of language, cognition, and self-help adaptive skills during the first three years of life (APA, 2000). However, many clinicians overlook the text of the DSM-IV-TR and resort only to the charts. In this case, the text signifying “during the first three years of life” would be missed, resulting in misdiagnoses of older individuals with Asperger syndrome who most certainly do present with areas of deficit in cognitive, adaptive, and language abilities (e.g., Klin et al., 2007; Saulnier & Klin, 2007).

Furthermore, if one refers only to the charts and not the text, the description of circumscribed interests—the all-encompassing preoccupations with topics of interest that tend to be more specific to Asperger syndrome than the other PDDs—would be similarly overlooked. These criteria have generated a great deal of controversy, resulting in tremendous variation in the diagnosis of Asperger syndrome, both clinically and in research. This variability and lack of consistency in defining the disorder has ultimately resulted in removal of the subtype from the forthcoming DSM-5 (APA, 2010), which is not without controversy (e.g., Wing, Gould, & Gillberg, 2011).

Caution

Clinicians are cautioned against merely relying on the DSM-IV-TR charts for determining diagnostic criteria for the PDDs, as the descriptions of the most differentiating features of Asperger syndrome are included within the text of the DSM-IV-TR but not within the charts.

Clinicians and researchers who have closely studied and worked with individuals with Asperger syndrome invariably view this subtype as qualitatively distinct from the other PDDs, given the verbosity, social motivation, and fixation on topics of interest in these individuals. Ironically, these same symptoms can cause the most confusion in differential diagnosis. Common misconceptions propose those with Asperger's to be individuals without cognitive impairment; individuals with higher verbal than nonverbal IQ scores; individuals who have social intent; individuals who have mild or subtle social impairments; or individuals with perseverative interests, such as Thomas the Tank Engine—confusing getting “stuck” on a character or video rather than wanting to obsessively collect details about the topic of, for instance, trains. These misconceptions can have negative implications on outcome for individuals with Asperger syndrome because they are assumed to be less impaired and more able to navigate the world without supports—which is certainly not the case for many individuals.

Caution

Common misconceptions of Asperger Syndrome include the following characteristics interpreted in isolation:

It is not one of these behaviors, in isolation, that defines Asperger syndrome, but the overall profile of behavior, including developmental history. In early childhood, the social vulnerabilities of toddlers with Asperger syndrome are often masked by their relative strengths in other areas—such as their often precocious language; fixation on numbers and letters to the point of self-reading; and bourgeoning circumscribed interests. It is typically not until these children are immersed in social settings, where the social demands far outweigh their capacity to engage, that red flags are raised.

During the school-age years, individuals with Asperger syndrome tend to have more social motivation to interact with their peers, often inserting themselves into interactions inappropriately and/or lacking the appropriate social awareness to effectively navigate an interaction. Yet, they can have just enough awareness to understand the failed nature of their attempts, placing them at great risk for anxiety, depression, and isolation. In autism, individuals tend to be more socially passive; they certainly may respond to direct interaction, often even appropriately, but they are less likely to initiate interactions with their peers. Furthermore, self-awareness in autism can be more impaired, acting as a buffer in that individuals might not be as cognizant of their failed social experiences. Nevertheless, as stressed previously, social motivation should not be interpreted in isolation when distinguishing Asperger syndrome from other PDDs.

Caution

Unlike autism, Asperger syndrome is often not detected in the first few years of life because in early childhood, the social vulnerabilities of toddlers with Asperger syndrome are often masked by their precocious language, affinity for numbers and letters, and regurgitation of facts on topics of interest. It is not until these children are immersed in social settings, such as preschool, that their true social impairments are recognized. For this reason, clinicians need to be extra vigilant in screening for social impairments in young children who have strong language and cognitive skills.

Don't Forget

Individuals with ASD, particularly those with Asperger Syndrome who tend to have a modicum of social awareness, are at great risk for mood disorders such as anxiety and depression. These symptoms can emerge as early as school age, but are most prominent in adolescents and adults and, therefore, should be monitored and treated accordingly.

Rapid Reference 1.2

Distinctions Between Asperger Syndrome and Other PDDs

Asperger Syndrome Autism, PDD-NOS
• Early history marked by intact or precocious speech development • Early history marked by significant language delays/impairments
• Extreme verbosity and one-sided conversations • Limited speech and/or stereotyped language (e.g., echolalia, scripting)
• Social motivation in the absence of ability to effectively navigate social interactions • Social passivity—more apt to monitor peers rather than initiate interaction
• May have stronger rote verbal than nonverbal cognitive scores—though not diagnostic! • Tend to have stronger rote nonverbal than verbal cognitive scores
• Circumscribed interests—all-absorbing interest on a topic, including collecting facts on the topic, and this interest pervades and dominates conversations • Perseverative interests—fixations on objects/movies/activities that become overly repetitive, and the individual has difficulty disengaging from the interest

Pervasive Developmental Disorder, Not Otherwise Specified

A diagnosis of PDD-NOS requires impairment in reciprocal social interaction (i.e., symptoms in subcategory 1) with associated impairments in at least one of the remaining two subcategories. Therefore, under the current taxonomy, an individual does not necessarily have to present with stereotypical behaviors (i.e., symptoms falling under subcategory 3) to carry a diagnosis of PDD-NOS. The proposed diagnostic criteria for a DSM-5 diagnosis of ASD, however, require at least two stereotyped behaviors (see Table 1.1). This will most certainly impact many individuals who currently hold the label of PDD-NOS, as it raises the question as to what label, if any, will be appropriate to merit the same degree of services for these individuals.

Table 1.1 Comparison Between DSM-IV and Proposed DSM-5 Diagnostic Criteria for Autism Spectrum Disorders.

DSM-IV DSM-5
Category Pervasive Developmental Disorders Autism Spectrum Disorder
Category
Subtypes

1. Autistic Disorder

2. Asperger's Disorder

3. Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS)

4. Rett's Disorder

5. Childhood Disintegrative Disorder

None
Symptom Subcategories

1. Impairments in Social Interaction

2. Impairments in Communication

3. Restricted, Repetitive, and Stereotyped Patterns of Behavior, Interests, and Activities

1. Deficits in Social Communication and Social Interaction

2. Restricted, Repetitive Patterns of Behavior, Interests, or Activities

Diagnostic
Criteria

1. Autistic Disorder = at least six total symptoms across all three subcategories, at least two of which are in social interaction

2. Asperger's Disorder = symptoms in social interaction and restricted behaviors, with no delays in the development of language, cognition, or adaptive self-help skills in first three years of life; but not to full criteria for Autistic Disorder

3. PDD-NOS = social impairments and symptoms in either communication and/or restricted behaviors; but not to full criteria for Autistic Disorder

1. ASD = three required criteria in social communication and social interaction and at least two out of four restricted and repetitive patterns of behavior

2. Symptoms must be present in early childhood (even if not fully manifested until social demands exceed the child's level of social functioning)

Rett's Disorder and Childhood Disintegrative Disorder

Rett's Disorder and CDD are rare, regressive-type disorders where at the outset of the respective regressions in development, the individual's behavioral presentation is similar to autism. In Rett's Disorder, pre- and perinatal development are apparently normal, followed by a regression in psychomotor development and social engagement between the ages of 5 and 48 months. There is also a deceleration of head circumference and progression of hand washing/hand wringing mannerisms. What differentiates Rett's from all other PDDs is that Rett's, to date, is predominantly prevalent in females, whereas the remaining PDDs are, overall, four to five times more prevalent in males. A genetic mutation on the MECP2 gene has also been identified in the majority of Rett's cases (Van Acker, Loncola, & Van Acker, 2005).

Don't Forget

Rett's syndrome is differentiated by ASD in that it is more prevalent in girls than boys; it is associated with a mutation in the MECP2 gene; there is early regression of psychomotor development in the first year of life; and there is a deceleration of head circumference.

In CDD, early development is spared for the first two to three years, after which there is a clinically significant loss of previously acquired skills in at least two of the following areas: receptive or expressive language, social skills, adaptive skills, toileting skills, play skills, or motor development. The regression must take place before age 10, but in most cases, the regression occurs between ages 2 and 3 (Volkmar, Koenig, & State, 2005). At the outset of the regression, individuals with CDD often are afflicted with severe or profound intellectual disability in addition to the autism symptomatology. Very little is known about the etiology of CDD or the triggers of the regression, although research suggests that triggers can be associated with (but not caused by) psychosocial stressors, such as those that are common to preschool-age children. These could include birth of a sibling, death of a family member, or a significant hospitalization (Volkmar, Koenig, & State, 2005). CDD should not be confused with regressive autism, which occurs in about 10% of cases of ASD and where there is a reported loss of or plateau in development of skills prior to the age of 2. Children with regressive autism do not appear to be as impaired as children with CDD at the outset of their regression; yet, just as little is known about regressive autism and how it is differentiated from autism without regression. To reiterate, ASD is a neurodevelopmental disorder and, as such, the symptoms unfold over the first few years of life. Thus, deviance in the developmental course of social communication and behavioral skills around 18 to 24 months of age is anticipated in ASD but can often be misconstrued as regression.

Don't Forget

Childhood Disintegrative Disorder is distinct from regressive autism in that the regression of skills in CDD occurs after the age of 2, and substantial delays are evident at the outset of the regression in CDD in many areas of development, including language, social functioning, self-help skills, motor skills, and play skills.

Caution

Autism is a neurodevelopmental disorder where symptoms (i.e., deviance in behavioral development) tend to manifest in the second year of life. This unfolding of symptomatology can be misinterpreted as a regression in the development of skills.

DSM-5

Recent nomenclature has moved in the direction of considering the PDDs a spectrum of disorders; that is, taking more of a dimensional rather than categorical approach to diagnostic conceptualization. Thus, more common terminology refers to Autism Spectrum Disorders (ASD), typically signifying Autistic Disorder, Asperger syndrome, and PDD-NOS (given the rarity and relatively limited public awareness of Rett's Disorder and CDD). The DSM-5, slated to be published in 2013, is proposing to change the diagnostic category to Autism Spectrum Disorder, eliminating the subtypes altogether (see Table 1.1; APA, (2010)). Given these forthcoming changes, this book will focus on the broad spectrum of autism rather than on specific subtypes. Nevertheless, the authors will highlight when specific features that are more relevant to one subtype than another merit analysis (e.g., in Asperger syndrome).

No two individuals under the umbrella of the autism spectrum have identical presentations. There is more heterogeneity than similarity of symptom expression, which has resulted in a host of theories as to what the causes might be. Nonetheless, the common thread of all five PDDs, or ASDs, is the resulting social disability and the limited capacity to independently navigate the social world, whether expressed as substantial deficits in rudimentary social skills, more subtle vulnerabilities in interpreting the nuances of social interactions, or any variation in between. These social impairments are qualitatively different from and more severe than the vulnerabilities in social development that can be observed in other developmental disorders.

Don't Forget

Despite the vast heterogeneity observed between individuals across the autism spectrum, the common thread among the five Pervasive Developmental Disorders is that they are all social disabilities.

With the following book, we present a model process for identifying the symptoms of ASD while accurately differentiating the nature of social disabilities from mere delays in social development. As such, the focus is more on the differentials between ASD and other neurodevelopmental disorders rather than on distinguishing among the ASD subtypes, especially given the aforementioned DSM-5 changes. Having obtained extensive experience in multidisciplinary diagnostic evaluations, we adopt the comprehensive developmental approach to assessment, diagnosis, interpretation, and report writing. Beginning with Chapter 2, the necessity for obtaining a baseline of cognitive and developmental functioning is discussed. Because the essence of social interaction is communication, Chapter 3 then outlines how the speech, language, and communication assessment informs the diagnostic process. This naturally transitions to Chapter 4, where aberrant or problematic behaviors are often the result of impaired communicative functioning, thus highlighting the need to functionally assess these behaviors and then replace them with more adaptive means of communicating.

Chapters 5 and 6 collectively outline the diagnostic assessment, which entails the gathering of historic information, observing the individual in natural contexts, and directly assessing behaviors through interaction and play. Chapter 7 focuses on the common differentials and comorbidities that arise through referrals for diagnostic evaluations in ASD throughout the life span. Finally, Chapter 8 ties the process together with two samples of integrated reports from model comprehensive diagnostic evaluations—one of a toddler and one of a school-aged child. Our hope is that this model will be useful in informing both burgeoning clinicians just starting out in the field, as well as seasoned professionals who are experiencing an increased exposure to ASDs and, subsequently, are seeking knowledge of how to effectively identify, diagnose, and/or refer patients at risk.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

American Psychiatric Association. (2010). DSM-5 development: Autism spectrum disorder. Retrieved September 28, 2011 from http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=94

Centers for Disease Control and Prevention. (2007a). Prevalence of autism spectrum disorders: Autism and developmental disabilities monitoring network, 6 sites, United States, 2000. MMWR Surveillance Summaries 56:1–11.

Centers for Disease Control and Prevention. (2007b). Prevalence of autism spectrum disorders: Autism and developmental disabilities monitoring network, 14 sites, United States, 2002. MMWR Surveillance Summaries 56:12–28.

Chawarska, K., Klin, A., Paul, R., Macari, S., & Volkmar, F. (2009). A prospective study of toddlers with ASD: Short-term diagnostic and cognitive outcomes. Journal of Child Psychology and Psychiatry, 50(10), 1235–1245.

Chawarska, K., Paul, R., Klin, A., Hannigen, S., Dichtel, L. E., & Volkmar, F. (2007). Parental recognition of developmental problems in toddlers with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37(1), 62–73.

Klin, A., Saulnier, C. A., Sparrow, S. S., Cicchetti, D. V., Volkmar, F. R., & Lord, C. (2007). Social and communication abilities and disabilities in higher functioning individuals with autism spectrum disorders: The Vineland and the ADOS. Journal of Autism and Developmental Disorders, 37, 748–759.

National Research Council. (2001). Educating children with autism. Washington, DC: National Academy Press.

Saulnier, C. A., & Klin, A. (2007). Brief report: Social and communication abilities and disabilities in higher functioning individuals with autism and Asperger syndrome. Journal of Autism and Developmental Disorders, 37, 788–793.

Van Acker, R., Loncola, J. A., & Van Acker, E. Y. (2005). Rett syndrome: A pervasive developmental disorder. In F. R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (pp. 126–164). Hoboken, NJ: Wiley.

Volkmar, F. R., Koenig, K., & State, M. (2005). Childhood disintegrative disorder. In F. R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders (pp. 70–87). Hoboken, NJ: Wiley.

Wing, L., Gould, J., & Gillberg, C. (2011). Autism spectrum disorders in the DSM-V: Better or worse than the DSM-IV? Research in Developmental Disabilities, 32(2), 768–773.