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Pervasive Developmental Disorders

If you encounter an unfamiliar test...don't be embarrassed to ask questions.

Intelligence is a tricky concept, especially that children's IQs can and do change...

Comprehensive speech and language testing is important for designing treatment plans...

[T]est-givers should do their best to make the evaluation a pleasant experience.

Tests Used in Diagnosing PDDs

The following excerpt is taken from Chapter 3 of Pervasive Developmental Disorders: Finding a Diagnosis and Getting Help by Mitzi Waltz, copyright 1999 by O'Reilly & Associates, Inc. For book orders/information, call (800) 998-9938. Permission is granted to print and distribute this excerpt for noncommercial use as long as the above source is included. The information in this article is meant to educate and should not be used as an alternative for professional medical care.

Hundreds of standardized tests, questionnaires, and observation plans are available for rating behaviors, abilities, and other factors that could be related to pervasive developmental disorders. The lists in the next sections provide a little information about some of the most commonly encountered tests, but they are by no means complete.

In the US, most standardized tests are developed by commercial publishers, often in concert with university researchers. There is a great deal of competition between firms that publish tests. In most European and Asian countries, as well as Australia, public schools and medical facilities may be required to use special national assessment tools developed by government bureaus instead of, or in addition to, commercially developed instruments. In the interest of keeping this book's length manageable, these tests have not been listed.

Thankfully, no one will be given all of these tests! The evaluation team members will choose tests that are appropriate for the person's developmental level and that provide the most information about areas of strength and weakness.

If you encounter an unfamiliar test, or if you're not sure how to interpret a test score, don't be embarrassed to ask questions. The results returned by these instruments tend to be nearly incomprehensible unless you've had special training.

Sometimes the results of a test will seem very wrong. Many parents of children with PDD-NOS have been dismayed when their children were rated as retarded on an IQ test, for example, when they appear to have normal or even superior abilities in at least some areas of intellectual function. Although it's true that parents tend to see their own children in the best light, it's also true that they have more information about the child's capabilities than a tester who has met with the child only once. It's often worthwhile to try a different test that measures roughly the same set of capabilities, but in a different way.

Make sure the testing conditions work for the patient. Nonverbal people will obviously score poorly on a test that requires verbal responses, and people with sensory difficulties may be unable to complete a test given in a noisy ward. You'd be surprised at how often such obvious factors are overlooked by evaluators.

Audiological Tests

Audiological tests are used as part of the "differential diagnosis" process, to make sure that communication and social deficits are not being caused by hearing loss or an auditory processing disorder. Autistic-spectrum disorders can also occur in the deaf or hearing-impaired, and the hearing problem will need to be addressed along with other symptoms to achieve progress.

Some audiological tests can also detect auditory over- or under-sensitivity, which is often an issue in people with PDDs.

Acoustic impedance testing
This test measures middle-ear function, and can detect the presence of fluid or abnormal structure. The results are presented as a diagram called a tympanogram.

Auditory brainstem response/brain stem evoked response (ABR/BSER)
For this test, sounds are piped directly into a sleeping patient's ears through headphones. The brain's electrical response to these tones is then measured electronically. It's used most commonly with infants and nonverbal children, and can determine the extent of a hearing loss or auditory processing problem.

Bone conduction
In this basic audiology test, a device called a bone vibrator is placed behind the ear to determine the softest level heard when bypassing the outer and middle ear to stimulate the inner ear directly.

Comprehensive central auditory processing (CAP) testing
These tests determine how thoroughly a person processes auditory information. A comprehensive battery might include one or more central nervous system function tests, such as the ABR, as well as measurements of auditory memory, sequencing, tonal pattern recognition, and information storage.

Conditioned play audiometry (CPA)
This is a basic hearing test for young children, using play activities to check function.

Immittance audiometry
This test is made up of three parts: tympanometry, which checks out how the eardrum moves and the status of the middle and inner ear; acoustic reflex thresholds, which determine if there is a sensorineural or conductive hearing loss; and reflex decay, which determines if there is a hearing loss due to problems in the cochlea or acoustic nerve.

Oral myofunctional evaluation
This observation-based test determines the extent of tongue thrust when making some sounds.

Pure tone testing
Using an electronic device called a pure tone audiometer, the audiologist makes a sound. The child is taught to perform some fun activity when she hears that sound. It measures whether children can discriminate between tones.

Visual response evaluation
For this test, the infant or young child is held on a parent's lap in a quiet test booth. While a test assistant tries to get his attention visually, sounds come through a loudspeaker on the other side. Afterward, a visual cue (such as a light or moving toy) activates next to the loudspeaker. (Also called sound field testing).

Autistic behavior and symptom scales

These tests attempt to screen for or diagnose autistic-spectrum disorders. They may also be used to determine the level and severity of autistic behaviors.

Autism Behavior Checklist of the Autism Screening Instrument for Educational Planning (ABC-ASIEP)
The ABC is a subtest of the longer ASIEP and is used alone or in conjunction with four other ASIEP subtests. It consists of fifty-seven behavior descriptions in five areas, and is used to conduct a structured interview with a parent or other caregiver. The score is presented as a scale indicating the existence and severity of autistic behavior, as contrasted to other disorders. It is less effective with high-functioning forms of autism, such as PDD-NOS and atypical PDD, than with "classical" autism.

Autism Diagnostic Interview-Revised (ADI-R)
Used more in the UK and Europe than in the US, the ADI-R is used to conduct a standardized parent interview. It's based on the World Health Organization's definition of autism. (Also called the Wing scale, after developer Lorna Wing.) Score is expressed as a scale.

Autism Diagnostic Observation Schedule (ADOS)
This is a format for conducting a diagnosis via direct observation of the patient.

Autism Research Institute (ARI) Form E-2: Diagnostic Checklist
This questionnaire is reprinted in its entirety in Appendix F, Diagnostic Tools. Parents who send the completed checklist to ARI will receive scaled test results, interpretive information, and information on autistic spectrum disorders at no charge. Form E-2 rates behaviors frequently seen in autism on a scale, and also asks parents to rate the results of any treatments they have tried. It is available in several languages.

An optional ARI questionnaire, Form E-3, asks questions about treatments tried and their results. This is not a diagnostic tool, but part of ARI's efforts to build a large database on autism for research purposes.

Behavior Observation Scale for Autism (BOS)
The BOS checklist is a direct-observation format intended to help evaluators distinguish autistic-spectrum children from normal or mentally retarded patients. Score is expressed as a scale.

Behavior Rating Instrument for Autistic and Other Atypical Children (BRIAC)
This observation-based diagnostic tool looks at the areas of relationship to an adult, communication, drive for mastery, vocalization and expressive speech, sound and speech reception, social responsiveness, and psychobiological development. Additional scales are available for nonverbal and/or hearing impaired children. Scores are expressed as scales.

Childhood Autism Rating Scale (CARS)
The CARS is a direct-observation format for evaluating the behavior of children and adolescents. Results can be scored on two scales, one with a range from "age appropriate" to "severely abnormal," the other with a range from "not autistic" to "mild-moderate autistic" to "severely autistic." An excerpt from the CARS is included in Appendix F.

Gilliam Autism Rating Scale (GARS)
Three GARS subtests cover behaviors and their frequency in the areas of stereotyped behaviors, communication, and social interaction. A third subtest asks parents about developmental disturbances in the child's first three years. Scores are expressed as scales and percentages.

Parent Interviews for Autism (PIA)
This set of questions for parents is frequently used when diagnosing younger or nonverbal children.

Behavioral, psychiatric, and neuropsychiatric tests

Some of these tests are highly clinical instruments used for differential diagnosis (for example, to distinguish autism from childhood schizophrenia), and also to diagnose co-morbid disorders, such as depression, bipolar disorder, and ADHD. Others are more subjective and are used by teachers and other nonphysicians to rank behavior problems or uncover emotional difficulties.

Like the Rorschach blot interpretation test, which is rarely used anymore, tests for emotional disturbance that ask patients to draw and interpret what they've drawn are highly subjective. These so-called projective tests have little use in diagnosing autistic-spectrum disorders, but are routinely administered nonetheless, especially in school settings. Drawing-based tests don't make proper allowances for the fine- and gross-motor issues that are common in PDD-NOS and atypical PDD, among other things. These tests should never be used as the sole measure of emotional disturbance.

Aberrant Behavior Checklist (ABC)
One of the most popular behavioral checklists, the ABC also has a good reputation for accuracy. Versions are available for children and adults, and it is set up to account for mental retardation when assessing behavior problems in the home, school, or workplace. Scores are expressed as scales in the areas of irritability and agitation, lethargy and social withdrawal, stereotypic behavior, hyperactivity and noncompliance, and inappropriate speech.

Achenbach Child Behavior Checklist (CBC)
The CBC is available in versions for girls and boys of various ages. Six different inventories are used, including a parent report, teacher report, youth report (if practical), and structured direct observation report. It looks at the child's behaviors in several areas, including withdrawal, anxiety, etc. The results are classified as clinically significant or normal.

Attention Deficit Disorders Evaluation Scale
Versions of this questionnaire about behaviors linked with ADD/ADHD are available for parents to fill out at home or in a clinical setting, as well as for direct use with older children and adults. Scores are expressed as a scale.

Behavior Assessment System for Children (BASC)
This set of tests includes a teacher rating scale, parent rating scale, and self-report of personality. The BASC attempts to measure both problem and adaptive behaviors, as well as behaviors linked to ADD/ADHD. Scores are expressed as a scale keyed to a norm.

Conner's Rating Scales (CRS)
Parent and teacher versions of this scale-based test are available, which is intended to uncover behaviors linked to ADD/ADHD, conduct disorders, learning disabilities, psychosomatic complaints, and anxiety, among other conditions. Scores are plotted graphically.

This a projective psychological screening procedure in which the patient is asked to draw three human figures: a man, a woman, and himself. The drawing is then rated on a scale, with differences in ratings according to gender and age. Ratings are subjective interpretations, not objective measures.

House-Tree-Person Projective Drawing Technique
In this projective test, the patient is asked to draw a house, a tree, and a person, and then is asked a series of questions about these drawings. Sometimes these drawings are separate, sometimes they are done on a single page. Ratings are subjective interpretations, not objective measures.

Kinetic Family Drawing System for Family and School
In this projective test, the patient draws her family doing something or her class doing something. Then the patient is asked questions about what's going on in the drawing. Ratings are subjective interpretations, not objective measures.

Luria-Nebraska Neuropsychological Battery (LNNB)
Luria-Nebraska Neuropsychological Battery--Children's Revision (LNNB-CR)
The LNNB-CR contains 11 scales with a total of 149 test items, which are intended to measure motor skills, rhythm, tactile, visual, receptive speech, expressive language, writing, reading, arithmetic, memory, and intelligence. Each test item is scored on a scale, and a total scale for all items is also derived. The adult LNNB also tests the maturation level of the frontal lobe tertiary zones.

Pediatric Symptom Checklist (PSC)
A simple questionnaire about behavioral symptoms, the PSC is commonly used as a screening tool by pediatricians. Score is expressed as a scale.

Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS-ADD)
Used primarily in the UK, this is a self-reporting questionnaire used to assess psychiatric state in people with developmental delay, learning disability, neurobiological disorders, or senility, among other conditions. Score is expressed as a scale.

Reitan-Indiana Neuropsychological Test Battery (RINTB)
Reitan-Indiana Neuropsychological Test Battery for Children (RINTBC)
Halstead-Reitan Neuropsychological Test Battery for Children (HNTBC)
These may be the most widely used neuropsychological tests, and are intended to look for signs of brain damage. The RINTBC contains the following tests: Category, Tactile Performance, Finger Oscillation, Sensory-Perceptual Measures, Aphasia Screening, Grip Strength, Lateral Dominance Examination, Color Form, Progressive Figures, Matching Pictures, Target, Individual Performance, and Marching. The HNTBC adds the Seashore Rhythm Test, Speech Sounds Perception, Finger-Tip Number Writing Perception, and Trail-Making, but omits some other tests. The RINTB is very similar. Results are usually expressed as a scale (the Neuropsychological Deficit Scale or the Halstead Impairment Index). Additional information about right-left dominance or performance patterns may also be derived.

Vineland Adaptive Behavior Scales
These tests measure personal and social skills from birth to adulthood, using a semi-structured interview with a parent or other caregiver. Versions are available for children of all ages and for low-functioning adults. Social and behavioral maturity in four major areas--communication, daily living skills, socialization, and motor skills--is assessed. Responses are rated on a 100-point scale for each area, and a composite score is also provided. Scores can be translated into developmental or mental ages.

Intelligence, developmental, and academic tests

Intelligence is a tricky concept, especially since repeated studies have shown that children's IQs can and do change when they are measured differently, or when the child is taught differently and then retested. Most IQ tests also carry some cultural, racial, language, and/or gender bias, although testing companies are certainly trying to create better tests. However, because this bias has inappropriately placed nonhandicapped students from ethnic minorities into special education in the past, it is no longer legal to use IQ tests alone as an evaluation tool in US schools.

As a result of misuse, IQ testing is beginning to fall out of favor. It has been supplanted in some school districts by tests that measure adaptive behavior, which can be loosely described as how well and how quickly a person can come up with a solution to a problem and carry it out. These provide a more realistic measure of "intelligence" as most people think of it, as opposed to measuring cultural knowledge.

Developmental tests rank the individual's development against the norm, often resulting in a "mental age" or "developmental age" score. Some of the tests listed in the "Behavior, psychiatric, or neuropsychiatric tests" section in this chapter also chart a patient's developmental stages.

Academic testing is a must during the special education evaluation process. It's also used with older patients to provide clues about undiscovered learning disabilities or to design adult learning programs. Some clinicians like to compare the results of these three types of tests, a practice that provides a picture of actual achievement against the background of supposed innate capability.

Sometimes a local, state, or national academic test is used to rate a child by grade level instead of one of the commercial tests listed.

Although many IQ tests are in use today, you are most likely to encounter one of the Weschler Scales, also called a WISC.

Adaptive Behavior Inventory for Children (ABIC)
This standardized measure of adaptive behavior uses a questionnaire format, with a parent or other caregiver providing the answers. It includes subtests called Family, Community, Peer Relations, Nonacademic School Roles, Earner/Consumer, and Self-Maintenance. Used with the WISC-III IQ test and a special grading scale, ABIC is part of the System of Multicultural Pluralistic Assessment used by some districts to make more sensitive assessments of racial minority children. Results are expressed on a scale.

Battelle Developmental Inventory
This test ranks children's self-adaptive skills (self-feeding, dressing, etc.) as a percentage of his chronological age. The score may be expressed as a percentage, such as "between 40 percent and 55 percent of his/her chronological age," or as a single-number standard deviation.

Cattell Scales
This test rates the person's developmental level. The score is expressed as a Mental Age (MA).

Children's Memory Scale (CMS)
The CMS test is intended to provide a complete picture of a child or adolescent's cognitive ability, and is often used with children who have acquired or innate neurological problems. Areas screened in six subtests include verbal and visual memory; short-delay and long-delay memory; recall, recognition, and working memory; learning characteristics; and attentional functions. It rates skills in all areas and links them to an IQ score.

Developmental Assessment Screening Inventory II (DASI-II)
This screening and assessment tool for preschool children does not rely heavily on verbal or language-based skills. Its scores rate the patient's developmental level.

Developmental Profile II
This developmental skill inventory for children up to nine years old (or older people whose developmental levels fall within that range) is based on an interview with a parent or other caregiver. It covers physical, self-help, social-emotional, communication, and academic skills. Scores are provided as an individual profile depicting the functional developmental age level in each area.

Kaufman Assessment Battery for Children (Kaufman-ABC)
A nonverbal IQ test, the Kaufman-ABC measures cognitive intellectual abilities in children aged two-and-a-half to twelve. It's one of the best tests for use with nonverbal children without significant fine-motor problems. Scaled scores are provided for overall ability (the mental processing composite) and for simultaneous and sequential processing.

Learning Potential Assessment Device (LPAD)
This test of cognitive function uses different assumptions from some of the other IQ tests, and was designed for use primarily with learning disabled or developmentally disabled children. It provides several scaled scores, with interesting ideas about interpreting and using them.

Leiter International Performance Scale--Revised (Leiter-R)
This nonverbal IQ test has puzzle-type problems only covering the areas of visual, spatial, and (in a few cases) language-based reasoning. It produces scaled results.

Peabody Developmental and Motor Scales (PDMS)
These tests use activities, such as threading beads or catching a ball, to gauge the level of physical development, as well as motor capabilities and coordination. They can be used to test large groups of children. Scores are expressed on a scale interpreted as an age level, so raw numbers may be followed by notations like "below age level by five percentiles" or "above age level."

Peabody Individual Achievement Test (PIAT)
These short tests measure performance in reading, writing, spelling, and math. Scores are expressed as a grade level.

Stanford-Binet Intelligence Test Fourth Edition (S-B IV)
An intelligence test sometimes used with young or nonverbal children, although not preferred by most clinicians. The score is expressed as an IQ number or as a scale.

Test of Nonverbal Intelligence 3 (TONI-3)
This short, nonverbal IQ test for children over five presents a series of increasingly difficult problem-solving tasks, such as locating the missing part of a figure. The score is expressed as an IQ number or age equivalent.

Vineland Adaptive Behavior Scales
A standardized measure of adaptive behavior, the Vineland scale tests problem-solving and cognitive skills. Scores are presented as a scale, IQ-style number, or age equivalent.

Weschler Preschool and Prima Scale of Intelligence (WPPSI)
Weschler Intelligence Scale for Children-Revised (WISC-R)
Weschler Intelligence Scale for Children-Third Edition (WISC-III)
Weschler Adult Intelligence Scale (WAIS-R)
All of the Weschler Scales are intelligence tests that use age-appropriate word-based activities and mechanical, puzzle-like activities to test problem-solving skills. They return scores for verbal IQ and performance IQ, which may be broken down into several categories. This test is probably the most frequently used IQ test for diagnosing autistic-spectrum disorders, because a significant discrepancy between verbal and performance IQ is considered symptomatic of PDDs.

Wide Range of Assessment Test--Revision 3 (WRAT 3)
This standardized test determines academic level in reading, writing, spelling, and math. Scores are expressed as raw numbers or grade level equivalents.

Woodcock-Johnson Psycho Educational Battery--Revised (WJPEB-R, WJ-R)
An individual test of educational achievement in reading, writing, spelling, and math, the WJ-R has many subtests that can be given as a group or separately. Standard scores are derived that compare the test-taker against US norms and that can also be expressed as an age or grade-level equivalency. One popular subtest, the Scales of Independent Behavior-Revised (SIB-R/Woodcock, Johnson Battery, Part IV), is a standardized measure of adaptive behavior. SIB-R scores are raw numbers similar to IQ scores, but may be shown as a grade or age equivalency.

Occupational therapy tests, including sensory integration

Occupational therapists for children usually evaluate life or school-related skills, such as the ability to hold a pencil and write. OTs for adults may look at life skills or work-related skills. Much of this evaluation will be based on direct observation rather than standardized instruments. For example, the OT might ask the patient for a handwriting sample, or watch her perform typical daily tasks such as opening a door.

Sensory integration (SI) evaluations determine how well the body's sensory systems process information and how they regulate sensation and movement. These tests are usually administered by an OT. The majority of school OTs will use informal, observational measures to look at SI issues.

Developmental Test of Visual-Motor Integration (Berry-Buktenica Test)
This test consists of geometric figures, arranged in order of increasing difficulty, which children have to copy. It works well with kids who have short attention spans. Scores are expressed as a raw number and can be translated into a percentile.

Bruiniks-Oseretsky Test of Motor Proficiency
In this standardized test of gross- and fine-motor proficiency, the tester asks the patient to try a number of simple physical activities and puzzle-like tests, including running, walking on a balance beam, and catching a ball. Results are scored, and then scaled from "much below average" on up.

McCarthy Scales
This simple set of tests rates arm and leg coordination. The raw score is scaled to a percentile.

Sensory Integration and Praxis Tests (SIPT)
Combining standardized testing, parent interviews, and structured observations, the SIPT examines how the child responds to sensory stimulation. It collects information related to posture, balance, coordination, eye movements and play. This battery of tests takes from one-and-a-half to three hours, and is too long and difficult for most children under age six. The SIPT test was developed by Sensory Integration International, and can be legally administered only by an SII-certified evaluator. Results are expressed numerically, and usually also in a narrative report.

Southern California Sensory Integration Test (SCSIT)
This earlier version of the SIPT test is still in use by some OTs. Results are expressed numerically, and usually also in a narrative report.

Speech and language tests

These tests are usually administered by speech and language pathologists (SLPs). Pervasive developmental disorders can coexist with speech and communication disorders, or one can be mistaken for the other. Comprehensive speech and language testing is important for designing treatment plans, no matter what the eventual diagnosis is. Standardized, qualitative measures like the ones listed here are usually accompanied by informal observations and attempts at conversation (qualitative assessments). These are intended to find out how the person uses speech in a more natural setting, and may be presented in the report under the heading "language sample analysis" or something similar.

Along with test scores and a language sample, the speech and language evaluation will probably include observations made by the SLP about issues such as vocal tone (nasal or otherwise unusual voice qualities), stuttering and other fluency problems observed, and any abnormalities seen in the physical structures used to produce speech.

It is possible to do speech and language testing with nonverbal people. In these cases, the examiner looks at other forms of functional communication, including the use of gestures, formal sign language, pictures, and augmentative communication devices.

Standardized tests help the SLP rate various components of speech and language, including the domains of pragmatics (rules that govern the use of functional language to communicate), semantics (the rules that govern language content, including word meaning and word order), syntax (grammatical rules), morphology (rules governing the formation of words from smaller parts), and phonology (rules associated with a particular language's sound system).

Comprehensive testing will look for problems in both expressive and receptive speech, and also for discrepancies between the two. Tests you may encounter include:

Assessment Link between Phonology and Articulation Test (ALPHA)
This verbal test assesses speech sound production skills. The tester notes pronunciation and other errors as the patient says common words. Results are returned as a raw score, percentile, performance rank (from "profound disability" on up), and scaled against a norm.

Boston Naming Test
This test assesses expressive vocabulary knowledge, as well as the ability to recall and retrieve word labels. Results are returned as both a raw score and an age equivalency.

Clinical Evaluation of Language Fundamentals--3 (CELF-3)
This is a standardized test of basic communication capabilities. Results are expressed as a raw score, which can be interpreted further with help from the test guide.

Hiskev-Nebraska Test of Learning Aptitude
Developed for assessing the communication capabilities of deaf children, this nonverbal test is also useful for some autistic-spectrum children who do not speak. Directions are pantomimed.

Mayo Test for Apraxia of Speech and Oral Apraxia--Children's Battery
This checklist helps SLPs assess motor speech skills, such as the ability to blow, move the lips, and make other movements that generate sound.

Peabody Picture Vocabulary Test--Revised (PPVT-R)
This standardized test measures receptive vocabulary knowledge. Scores are returned as raw numbers, percentile, and age equivalent, and can be interpreted further.

Preschool Language Scale
This test for children under seven requires picture-identification skills, and assesses receptive as well as expressive speech. Scores are expressed as a scale, and can be translated into a language age.

Sequenced Inventory of Communication Development (SICD-R)
Generally used as a screening tool, the SICD-R works with children of all developmental levels. Kids like it because it employs a box of miniature real objects, such as a tiny basket and a little car, to elicit speech or signs of recognition. The test instructions include hints for assessing autistic, hyperactive, and other "difficult" children. Subtests in three areas of receptive speech (awareness, discrimination, and understanding) and five areas of expressive speech (imitation, initiation, response, verbal output, and articulation) can be given together or separately. Scores are scaled against a norm.

Test of Language Competence (TLC)
This test for school-age children assesses an individual's understanding of semantics, syntax, and pragmatics in communication. It's said to be especially good at picking up the subtle deficits in understanding figurative or abstract language that are common in people with PDDs. Scaled scores compare the test-taker to a norm.

Test of Language Development--2 Primary (TOLD-2)
This rather laborious test for children ages four through nine assesses both receptive and expressive language, including vocabulary, phonology, syntax, and semantics. A composite score is generated, as are scores for each of several subtests.

Test of Language Development--2 Intermediate (TOLD-2)
Similar to the Primary TOLD-2 test, this is for older school-age children. It covers more-advanced language use and includes subtests on sentence combining, vocabulary, word ordering, generals, grammatical comprehension, and malapropisms. A composite score is generated, as are scores for each of several subtests.

Making the most of test time

Environmental factors have an impact on test scores, so test-givers should do their best to make the evaluation a pleasant experience. Proper lighting, good sound, comfortable seating arrangements, a low level of visual or auditory distractions, and many other factors can improve performance. Needless to say, the corner of a noisy classroom or an echoing gymnasium is not an ideal testing environment for anyone.

Despite the team's best efforts, your evaluation experience may not be very enjoyable. It's stressful to take the tests, there may be long waits between tests, and nerves soon start to fray. The situation will really deteriorate if the person being tested hits the sensory-overload threshold. For people with severe sensory issues, be sure to build in extra time to relax and calm down between tests, or even during long tests. The more prepared parents, patients, and evaluation team members are, the better it will be.

It's essential that the team leader have all medical, social, and school (if applicable) files needed at hand, permitting team members to get background information quickly.

Parents need to receive a schedule for the evaluation in advance, allowing them to prepare the child for this sequence of unfamiliar events. Finally, parents should pack a big bag of tricks to help their child participate as much as possible. Most kids get balky and uncooperative well before lunch, but the promise of carrying along a favorite toy or getting a treat can make a big difference. Small snacks, such as M&Ms or crackers, may also prove useful for reinforcing good behavior. Some children perform more readily when held in a parent's lap or when the parent is in the same room. Some, however, act out more when the parent is present. If the latter occurs, it's no indictment of parenting skills--it probably just means that, when alone with a tester, the child feels more inhibited.

Sometimes neither parents nor testers are successful at gaining a child's cooperation. One of the hallmarks of PDDs is "shutting down" when overwhelmed, so this should be no surprise. It's a good idea to talk to the team leader in advance about what will happen if an evaluation can't be finished due to noncompliance. Don't let the team simply blow off part of the evaluation because it's "too hard on the child." Brainstorm some solutions to the problem instead, such as breaking the process down into small parts with play or rest in between.


Narrative histories, written either by the patient, a caregiver, or a practitioner as a result of interviews, are also an important element in most multidisciplinary evaluations.
  • A developmental history talks about when and how the person met common developmental milestones, such as walking, talking, and tying shoes. For adults, the developmental history may get into social-emotional development issues as well.

  • A family history includes information about current family structure, such as who lives in the home and who the patient is closest to. In addition, someone on the team will probably ask a long list of questions about psychiatric problems and developmental disorders experienced by other people in the extended family. Because autistic-spectrum conditions have a definite genetic background, these questions are very necessary.

  • A complete medical history collects information about all medical conditions, not just psychiatric diagnoses. It should include lists of current and past medications, treatments, and hospitalizations.

  • Sometimes a school team will prepare a school history, which concentrates on how well a child has done in school academically and socially. It will generally include information about any significant behavior, learning, or interpersonal problems observed over the years.

  • A social history tries to put the patient's life in context, and may include aspects of any of the other reports. Social histories tend to read like a brief biography, starting out with the circumstances of birth and touching on developmental milestones, problems and accomplishments of childhood, family structure and stresses, and socioeconomic, ethnic, religious, and other cultural issues, if relevant.

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