A short guide to diagnostic ASD tests

Tests come in a baffling range of alien sounding names. How do you know which one is right for your child? Here is a ready reckoner for some common tests recommended in India.

Some things you should know before you read on

• The first real tests begin at home. Since Autism Spectrum Disorders, (ASD) are developmental disorders, it is important to follow the milestones in your baby’s growth and be observant of atypical or unusual behaviour.
• Correct evaluation requires a developmental paediatrician, psychologist or a specialist that your doctor recommends. Please don’t be waylaid by other people who offer to diagnose your child’s condition.
• Symptoms of ASD may sometimes be similar to those caused by some other condition, say hearing impairments. An accurate diagnosis is critical to avoid mismanagement.
• Diagnosis can be done at different levels. There are physical assessments (height, weight, head circumference, hearing issues, etc.), behavioural evaluation (reaching developmental milestones, eye contact, inability to understand non-verbal communication, etc.) and a range of medical procedures like scans and genetic testing.
• Siblings of children with any one of the Autism Spectrum Disorders are more likely to have similar conditions. Children from families with a history of developmental disorders have a higher likelihood of being diagnosed with similar conditions.
• Your child may require more than 1 test to zero-in on the exact type and extent of his/her condition.
• Testing your child’s exact condition could be expensive, time consuming and stressful for your little one – talk to your doctor especially about the last point before you proceed.

Genetic testing

1. Fragile X Syndrome Mutation test (Fragile X Syndrome)This test can diagnose if the FMRG gene (Fragile X Mental Retardation gene), which produces a protein called the FMRP (Fragile X Mental Retardation protein), is mutated and hence, not functioning properly. Since this protein promotes cognitive development, its shortage or absence can lead to symptoms common to autism and development delays. This test may be useful to isolate the exact reason for learning disabilities, and hence for a more accurate intervention strategy.
2. Chromosomal Microarray Analysis (CMA)Chromosomal Microarray Analysis (CMA) is a new test which claims to detect even the slightest level of developmental disorder, which may be missed by some of the other tests.

Physical and Behavioural Assessments

There are several assessment tools (like questionnaires for and interviews of parents, as well as play sessions for the child) for testing autism related disorders, that are simple to take, but which have been well developed to identify and analyse developmental delays and atypical social behaviour. Wherever possible, it may be good to take these tests (more than one, just to be sure), since the results can firmly set you on the path of early intervention strategies, uniquely suited to your child.

Here are a few such tests:

1. Autism Diagnostic Observation Schedule (ADOS)Autism Diagnostic Observation Schedule is “a semi-structured assessment of communication, social interaction and play… for individuals suspected of having autism” (quoted from Autism Genetic Resources Exchange, at https://research.agre.org). Besides the generic form, this test is available in variants like the toddler version and the revised version. WPS (Western Psychological Services, USA), the developers of this tool, are engaged in enabling professionals to familiarise themselves with the administration of the test.In India, these tests are done at any professional agency/centre authorised and trained to administer and interpret the test and provide management techniques for children with developmental delays in the autism spectrum.Through a set of activities (both structured and unstructured), the test taker can observe and note symptoms of atypical behaviour, with respect to the age and development of the subject (may be either a child or an adult). An overall assessment is made at the end of the test, which leads to respective diagnosis. A child psychologist usually administers the ADOS.
2. Modified Checklist for Autism in Toddlers (M-CHAT and M-CHAT- R/F)The Modified Checklist for Autism in Toddlers, now in the revised version, is a common and popular tool that diagnoses for autism risk. It is a 2-stage screening tool taken by parents, to assess symptoms of ASD in infants between 16 and 30 months.M-CHAT and M-CHAT -R/F are available on-line for professionals. M-CHAT-R/F is useful since the checklist can throw up a few indications of delayed development that a general paediatrician may not consider as relevant.Usually, a developmental paediatrician or a clinical psychologist administers the checklist. The M-CHAT –R/F can identify the extent of autism (high, medium or low).
3. Ages and Stages Questionnaire (ASQ)Another screening tool is the Ages and Stages Questionnaire. The questionnaire has to be answered by the parents of the child being diagnosed. These are designed for specific age groups. Again available online, the ASQs are easy to take by parents and also easy for a professional to interpret, analyse and score. The results can help the parties concerned to decide on further action plans for the child’s treatment.The ASQ-3 “addresses five development areas: communication, gross motor, fine motor, problem solving and personal-social” (www. agesandstages. com / FAQ)
4. Screening Tool for Autism in Toddlers and Young Children Test (STAT test)The STAT test is a level -2 tool that concentrates on specific development concerns of a child. This tool is useful in recognising the risk of autism in children whose developmental delays have gone undetected.
5. The Bailey Scale of Infant and Toddler DevelopmentThis test evaluates infants on their cognitive ability and motor skills, by observing them at play. Depending on the age of the subject, the score is compared with the Bailey Scale and the results are interpreted.This test may help your paediatrician watch out for possible delays as your child grows.
6. Wechsler Preschool and Primary Scale of Intelligence (WPPSI)The WPPSI is an intelligence assessment tool for slightly older children (2.5 to 7.5 years) in response to delays in development or learning disorders at this age group.

Other tests and their objectives

1. Childhood Autism Rating Scale (CARS) is intended to determine if a child has developmental delays due to autism or some other disorder.
2. The Autism Spectrum Screening Questionnaire (ASSQ) is a screening process to determine if the child has mild mental retardation. It is not a diagnostic test for ASD but is sometimes recommended. The ASSQ is for children between 7 and 16 years.
3. The Pervasive Developmental Disorders Screening Test (PDDST) tries to identify ASD symptoms in infants from 18 to 48 months, on many parameters and in a rational manner, such that the answers given by parents are considered in an unbiased manner.The screener’s expertise is seen in minimising the possible emotional bias from the answers.

This article introduces you to some of the commonly recommended tests in India, but doesn’t claim to be comprehensive in its coverage. Are there tests prescribed for your child that are not covered in this list? Please do let us know in the comments section, so that we can add it to our article.

Have you tried out any of these tips in the past? Did they work for your child? Do let our readers know your own tips in the comment box below.