Table Of ContentAutism Spectrum
Disorder and Visual
Impairment Revisited.
How can standardised assessment tests be adapted
to assist in providing a robust diagnosis of Autism
Spectrum Disorder in children who are blind or who
have visual impairments?
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OUTLINE
What is Autism Spectrum Disorder?
Autism Spectrum Disorder and Visual Impairment
ADI-R
ADOS-2
Problems of Access
Problems of Interpretation
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What is Autism Spectrum Disorder?
DSM-V (2013):
A. Persistent deficits in social communication and social interaction across multiple
contexts.
B. Restricted patterns of behaviour, interests, or activities.
C. Symptoms must be present in the early developmental period, (but may not
become fully manifest until social demands exceed limited capabilities, or may
be masked by learned strategies in later life).
D. Symptoms cause clinically significant impairment in social, occupational or other
important areas of current functioning.
E. These disturbances are not better explained by intellectual disability or global
developmental delay. Autism Spectrum Disorder and intellectual disability often
co-occur; to make a co-morbid diagnosis, social communication should be below
that expected for general developmental level.
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A. Deficits in Social Communication and
Social Interaction
1. Deficits in social-emotional reciprocity, such as abnormal social approach, or
failure of normal back-and-forth conversation; reduced sharing of interests,
emotions or affect; failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviours used for social interaction,
such as poorly integrated verbal and nonverbal communication; abnormalities
in eye contact and body language, or deficits in in understanding and use of
gestures; total lack of facial expression and nonverbal communication.
3. Deficits in developing, maintaining and understanding relationships; difficulty
in adjusting behaviour to suit various social contexts; difficulty sharing
imaginative play or making friends; absence of interest in peers.
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B. Restricted, Repetitive Patterns of
Behaviour, Interests, or Activities
Stereotyped or repetitive motor movements; use of objects or speech, such as
simple motor stereotypes, lining up toys or flipping objects, echolalia,
idiosyncratic speech.
Insistence on sameness, inflexible adherence to routines, or ritualized patterns of
verbal or nonverbal behaviour, such as extreme distress at small changes,
difficulty with transitions, rigid thinking patterns, greeting rituals, need to take
same route or eat the same food every day.
Highly restricted, fixated interests that are abnormal in intensity or focus, such as
strong attachment to or preoccupation with unusual objects excessively
circumscribed or perseverative interests.
Hyper-or hypo activity to sensory input or unusual interest in sensory aspects of
the environment, such as indifference to pain/temperature, excessive response to
specific sounds or textures, excessive smelling or touching of objects, visual
fascination with lights or movement.
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Autism Spectrum Disorder and Visual
Impairment.
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Current Incidence of Autism Spectrum
Disorder.
Europe: 1 in 100 (Elsabbagh, 2012)
Ireland: 1 in 100. (Stynes et al.,2010. DCU).
UK: > 1 in 100 (Brugha et al. (NHS), 2012).
US Combined data
2000: 1 in 150
2006: 1 in 110
2012: 1 in 68 (Centers for Disease Control and Prevention)
We can expect at least the same proportion of children with visual
impairments to have co-existing ASD.
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Why Assess Children with Visual
Impairments?
Better understanding of child’s needs. Children at risk of being wrongly
diagnosed either way: all unusual behaviour put down to Visual Impairment,
or unusual behaviours that are consistent with VI are thought to be indicative
of ASD.
Provide some answers for worried parents.
Access to additional resources.
More appropriate interventions, both teaching and therapy.
Better understanding of behaviour.
Hopefully, improve happiness and wellbeing of the child.
Better planning for the child’s future.
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How Assess?
History taking, including medical and ophthalmic history.
Consultation with parents, teachers and therapists.
Observation, including play
Assessment of specific skills, eg communication, adaptive skills.
Cognitive assessment.
Measures of behaviour.
Autism-specific measures: ADI-R
ADOS-2
We focus here on these last two measures.
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Autism Diagnostic Interview
Revised (ADI-R)
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Description:such as poorly integrated verbal and nonverbal communication; abnormalities . Module 4: For adolescents and adults who have fluent speech poor. During ADOS-2 administration, he made little or no direct eye contact with the.
