How to better administer psychological assessments to children with autism
This blog was first published on PsychologyToday.com on March 19, 2011
In the past nonverbal children with autism were considered mentally retarded, and those who had difficulties in communication were considered intellectually slow. Now it has become more widely recognized that autism has nothing to do with intelligence.
Studies show that often children who are performing at grade level or above in school, have IQ scores that show them to have below average or even mentally deficient intelligence levels. IQ scores of children on the autism spectrum may not be accurate reflections of their innate intellectual potential.
For a child to perform to their ability on a standard IQ tests such as the WISC-IV and the Stanford-Binet, they must be able to quickly respond to verbal questions and have well developed motor skills. However, these are areas that are difficult for those with autism. In effect, these IQ tests do not tap the true cognitive ability of many children on the autistic spectrum, but rather tell us more about their communication and motor difficulties.
Children and teens with autism spectrum disorders are impacted by sensory processing challenges, and this as well can effect test results. A student may not be able to respond in a room with bright fluorescent lights or in an environment not conducive to someone with sensory processing issues.
Another reason why it is hard to know how much a person on the spectrum understands is that many with Asperger’s Syndrome may do well in answering test questions, but not necessarily realize how the information relates to them personally. For example, a middle school student may be able to tell you what he heard in health class, but he may not not understand or realize how this information (ie sex education) relates to him personally. For this reason, it is important that parents and educators ensure that students really have processed the information on a personal level.
It is important to remember that just because a person cannot talk does not mean that they are not understanding what is going on around them, what they are hearing in class, or reading in books. Conversely, just because a person sits in a class and can repeat to you what was said, does not mean he has internalized and learned it.
Joshua D Feder, MD, Child and Family Psychiatrist has these suggestions to make about administering psychological assessments :
• Think of all the sensory processing difficulties a child may be experiencing. For one-on-one testing, make sure that the room is quiet, has few visual distractions, and is not too brightly lit.
• Consider the difficulties of transitions for those with autism. Sometimes, clear explanations of what you will be doing together, what comes next, and what comes after, makes a big difference. Frequent breaks may be needed.
• Pay attention to regulation and co-regulation issues. Do testing with the child not to the child. Pay attention to joint attention and engagement, and find the balance between having expectations and trying to build rapport.
• Recognize that one-on-one testing may not show a child’s difficulties with same tasks attempted in the classroom. Children with an ASD may have been taught the ‘right’ answers, but ability to utilize the information may is limited. This is especially true with tests of pragmatic language that ask about what to do in social situations. Careful classroom and recess/lunchtime observations are an essential part of the evaluation.
• For younger or nonverbal children, it is important to observe what they chose to play with, and what they initiate in their actions. This initiation is often the key to finding what motivates them and what we can capitalize upon to help a child co-regulate and connect and move forward in social and cognitive growth
• For more verbal children, we often do not do projective testing with these children, however, the rates of depression and other secondary mental health problems are very high, and projectives often give us a way to understand the child’s experience of the world.
• There may be a lot of scatter in the subtests, so that more refined neuropsychiatric testing may be needed
The reality is, It’s hard to know how much a person on the autism spectrum knows because of the communication, motor, and sensory difficulties they may have, as well as the ability some have to repeat information that has not been internalized. All these things need to be considered when doing psychological assessments.