Evaluation and Assessment

Autism is a neurological disorder affecting all major areas of a young child’s functioning: communication, social interaction, and behavior. The severity of impact on a child’s development varies from mild to severe. Some children may have communication skills in the average range, but have severe disabilities in the areas of social interaction and behavior. Some children may be nonverbal, have difficulty in relating to people, and have significant behavioral challenges. There are several defining characteristics of autism:

Severe delays in development of language/communication skills.
Severe delays in development of social interaction and play skills.
Behavioral issues such as repeated body movements (hand flapping, rocking, etc.) and including repetitive patterns of behavior and interests; unusual responses to people or attachments to objects; resisting any changes in routine; or injurious behavior.
Onset prior to age three.

In this document, the term “autism” refers to all possible categories under Autism Spectrum Disorder listed in the Diagnostic and Statistical Manual IV (DSM, 1994). The DSM-IV lists diagnostic criteria for Pervasive Developmental Disorders including, Autistic Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) and can be found in Appendix A of this document. Historically, children could not be reliably diagnosed with autism until after age three. Recent research demonstrates, however, that a very young child can be identified as having autism and a number of key symptoms of autism can be present as early as age 18 months. Studies show that autism can be reliably identified by an experienced clinician when a child is between the ages of 24 and 30 months (California Department of Developmental Services, 2002).

Research clearly demonstrates the importance of early intervention in order for children to have the best developmental, behavioral, and adaptive outcomes, so early diagnosis and treatment are critical. It is essential, however, that only individuals trained and experienced with children with autism make a diagnosis. State licensure in a medical or mental health field is required to render a diagnosis of autism (ie. psychologists, pediatricians, etc.).

Identification

Identification frequently begins with parents, caregivers, and professionals noticing a speech delay with a young child. A developmental evaluation may identify delays in several other areas. There are several screening tools that can be used by early childhood professionals to determine whether further assessment and evaluation should be conducted. (See Appendix C for a list of assessment tools.)

If family members and professionals suspect that the child’s developmental delays may fall within the Autism Spectrum Disorder then a medical and/or psychological evaluation should be conducted to ascertain the nature and severity of the disorder and to rule out other possible disorders which may be affecting the child’s development. Further evaluation and assessment should only be conducted by professionals who have specialized training and knowledge of Autism Spectrum Disorders.

Diagnostic evaluations should:

Elicit, value, and address parental concerns,
Be undertaken by a multidisciplinary team,
Review the child’s developmental history,
Include a direct behavior observation,
Assess cognitive functioning, and
Evaluate adaptive functioning in the areas of communication, socialization, fine and
gross motor development, self help/daily living skills, and social-emotional functioning.

(California Department of Developmental Services, 2002).

Families should be referred to their pediatrician to obtain a medical evaluation to rule out associated medical conditions. There are no specific medical tests that can confirm the diagnosis of autism. Autism is diagnosed by trained professionals who use highly structured and systematic observation, and the prognosis for any given child is uncertain. Some, but not all children, may derive some benefit from various biomedical interventions. Intervention services that address the developmental domains and educational needs of the child are most often recommended by medical, educational, and developmental professionals.

Evaluation and Assessment

A child under age three suspected of having autism or a developmental delay can be assessed and evaluated either at an early intervention program, the family’s home, or at a childcare provider’s home or center. The decision about location and time of the assessment should be made in conjunction with the family. During the assessment, Infants and Toddlers Program personnel look for detailed information about the child’s strengths and needs, as well as family information that would impact on the child’s development. Assessment is ongoing throughout the child and family’s participation in the Infants and Toddlers program. The assessment should:

Detail the child’s strengths and areas of need;
Establish the child’s health and developmental patterns, and profile family resources and needs within the community context;
Determine areas in which additional information is needed; and
Establish the foundation for development of an early intervention plan known as an Individualized Family Service Plan (IFSP) that meets the needs of the child and family.

As with diagnostic evaluations, an interdisciplinary team should undertake the assessment with input from the family with regard to their values, needs, beliefs, fears, and expectations.

Eligibility for Services

A child under three years of age who has been identified through a developmental evaluation to have deficits consistent with Autism Spectrum Disorder will qualify for early intervention services through the local Infants and Toddlers Program in the jurisdiction in which the child and family resides. No formal diagnosis is required to receive services. Depending on the extent and type of information obtained from the evaluation and assessment, infants and toddlers may be eligible under one of three
eligibility categories:

(a) Are experiencing at least a 25 percent delay, as measured and verified by appropriate diagnostic
instruments and procedures, in one or more of the following developmental areas:

(i) Cognitive development,
(ii) Physical development, including vision and hearing,
(iii) Communication development,
(iv) Social or emotional development,
(v) Adaptive development; or

(b) Manifest atypical development or behavior, which is demonstrated by abnormal quality of performance and function in one or more of the above specified developmental areas, interferes with current development, and is likely to result in subsequent delay (even when diagnostic instruments or procedures do not document a 25 percent delay); or

(c) Have a diagnosed physical or mental condition that has a high probability of resulting in developmental delay, with examples of these conditions including chromosomal abnormalities, genetic or congenital disorders, severe sensory impairments, inborn errors of metabolism, disorders reflecting disturbance of the development of the nervous system, congenital infections, disorders secondary to exposure to toxic substances, including fetal alcohol syndrome, and severe attachment disorders.

(COMAR 13A.13.01.02)

A child over age three who has been screened through a local school system’s Child Find Office will qualify for special education and related services if the child has a formal diagnosis of autism as defined in Maryland’s regulations(COMAR 13A.05.01.03):
"Autism" means a developmental disability which:

(a) Does not include emotional disturbance as defined in §B(20) of this regulation;
(b) Significantly affects verbal and nonverbal communication and social interaction;
(c) Is generally evident before three years old;
(d) Adversely affects a student's educational performance; and
(e) May be characterized by:
(i) Engagement in repetitive activities and stereotyped movements,
(ii) Resistance to environmental change or change in daily routines, and
(iii) Unusual responses to sensory experiences.

Alternatively, a child will qualify for special education and related services if the child is designated as a student with a developmental delay. Students with developmental delay must meet one of the following criteria:

A 25 percent or greater delay in adaptive, cognitive, communicative, emotional,
physical, or social development, as measured and verified by appropriate diagnostic
instruments and procedures; or
A typical development or behavior; this can be demonstrated by abnormal quality of
performance and function in one or more of the specified developmental areas, which
interferes with current development and is likely to result in subsequent delay, even
when diagnostic instruments and procedures do not document a 25 percent delay; or
A diagnosed physical or mental condition as defined in COMAR 13A.13.01.02B(21)(c),
which has a high probability of resulting in a developmental delay, including, but not limited to students with sensory impairments, inborn errors of metabolism, microcephaly, fetal alcohol syndrome, epilepsy, and Down Syndrome, and other chromosomal abnormalities (COMAR 13A.05.01.03)

The categorical option of Developmental Delay may be used at local discretion for preschool and young students ages three through nine, but not beyond age nine. Whether under or over age three, family members and professionals may request a medical evaluation from a qualified professional to rule out other disorders and to more fully describe the child’s current development.

Dependent upon specific circumstances, this medical evaluation may or may not be paid for by the local Infants and Toddlers Program or school system. Families are advised to discuss any medical evaluation with the Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP) team prior to its scheduling.