Positive Behaviour Change

What is Autism Spectrum Disorder (ASD)?

Autism Spectrum Disorder (ASD) is a lifelong developmental condition thought to affect around 1 in 100 children. ASD is diagnosed more frequently in boys, currently at a ratio of around 4:1. The exact causes of ASD are unclear; research strongly suggests there is a genetic basis to ASD, however environmental factors may also play a role in the onset and development of ASD symptoms in a genetically predisposed child.

The autism spectrum encompasses a wide range of symptoms, and no single symptom necessarily indicates that a child has autism. A child with autism will display several behaviours from some of the following categories:

Social Development

• Limited use of eye contact
• Limited use of non-verbal      communication (e.g., pointing, waving)
• Finds it difficult to      understand facial expressions and gestures
• Difficulty forming and      maintaining friendships
• Seems not to be interested      in other children

Emotional Development

• Finds it difficult to      understand, communicate, and regulate his/her emotions (e.g., frequent      ‘meltdowns’)
• Finds it difficult to      understand the thoughts, emotions, and needs of others

Behavioural Development

• Unusual and/or restricted      interests, or attachments to certain objects or toys
• Unusual body movements, such      as flapping hands or spinning
• Finds it very difficult to      cope with change

Sensory Profile

• Sensitive to sound or touch,      may be easily overwhelmed
• Unusual sensory interests      (e.g., textures, moving objects)
• High tolerance for pain and/or      temperature

Language Development

• Not responding as expected      to his/her name by 12 months of age
• Not using simple non-verbal      gestures by 12 months of age (e.g., pointing or waving)
• Not speaking at all by 18      months of age
• Not using spontaneous      phrases by two years of age
• Unusual patterns of speech      (e.g., tends to echo the speech of others, repetitive)
• Loss of language
• Appears not to hear others      speaking to him/her

How will an assessment for Autism Spectrum Disorder be helpful?

Most parents find that the assessment and diagnosis of Autism Spectrum Disorder is helpful in the following ways:

Understanding your child: A diagnosis of autism can be the first step for parents in understanding why their child is not achieving developmental milestones or is displaying unusual interests or behaviours.

Supporting your child: The earlier a child is accurately diagnosed with ASD and starts effective intervention, the better the developmental outcomes for the child. The recommendations arising from the assessment process can help parents and teachers to develop individualised behaviour management and learning support plans, to ensure that a child’s specific needs are being met at home and school.

Accessing Services: Once a child is diagnosed with autism, financial and community support may be available (e.g., Medicare, Centrelink, or the National Disability Insurance Scheme). A diagnosis can also assist with applying for school-based funding for special support teachers in the classroom. Please note: Government funding is constantly being reviewed and updated, and these changes may affect the availability of support for your family.

What is involved with an assessment for ASD?

The diagnosis of ASD requires a comprehensive assessment process and involves gathering information from a range of people involved in the child’s life. The aim is to better understand a child’s unique strengths and difficulties, with particular focus on their social development, communication, and any restricted or repetitive behaviours. Usually, this information is obtained through clinical interview with parents, observation of the child, and discussion with other significant people in the child’s life (e.g., teachers). Best practice assessment guidelines both in Australia and Internationally suggest using the following standardised assessment tools:

• The Autism Diagnostic      Observation Schedule- Second Edition (ADOS – 2). This has been rated as      the most reliable diagnostic tool currently recognised by International      ASD experts.
• The Autism Diagnostic      Interview – Revised (ADI-R). This is a gold standard, structured,      parent interview that assists in the reliable diagnosis of ASD.

In addition to these tools some Parent and Teacher questionnaires are also used to assess adaptive functioning, and to screen for co-occurring mental health concerns (e.g., ADHD, anxiety, depression). 

Note: Although ASD is typically diagnosed in early childhood, an assessment can be undertaken at any age. Many adolescents and adults find that receiving a diagnosis helps them to better understand themselves, and helps improve the quality of their relationships and day-to-day functioning.  

The complete diagnostic assessment process typically involves:

1. An initial consultation to      gather developmental history and background information and determine      whether it will be helpful to proceed with the assessment process.
2. A review of any previous      assessment previous reports, and consultation with the child’s school and      referring specialist, where appropriate.
3. Completion of standardised      questionnaires by the individual being assessed (for adolescents and      adults), and/or their parents and caregivers.
4. A one-hour assessment      session with the child, using the ADOS-2. For younger children and      individuals with minimal speech, a parent or caregiver is present during      this session. Older children and adolescents are usually assessed without      a parent present.
5. A structured interview with      parents or caregivers, using the ADI-R. This generally takes around 2      hours.
6. Scoring, interpretation, and      report preparation.
7. A one-hour feedback session      to discuss the results of assessment, and all recommendations arising from      the results.

Best practice guidelines state that for an accurate and confident diagnosis, the assessment process needs a minimum of four appointments. The total face-to-face appointment time is generally 5 hours, although this may be longer in complex cases. The fee includes the time taken for reviewing previous reports, phone consultations with the child’s school and referring doctor, scoring and interpretation of assessments, and report preparation. If a school visit is required, this may incur an additional fee.

What is the cost involved with an assessment for ASD?

Breakdown of Fees:

FREE OR BULK BILLED FOR ANY HEALTH CARE CARD HOLDER

• Initial Consultation (1 hour) $214.41
• ADOS-2 (1 hour, plus 2 hours scoring, interpretation and report preparation) $643.23
• ADI-R (2 hours, plus 2  hours scoring, interpretation, and report preparation) $428.82
• Feedback and Recommendations      (1 hour) $214.41

Total Cost $1500.87

Fees can be paid by session, or in full at the first session. Children referred for assessment by a paediatrician or child psychiatrist under the Helping Children with Autism Initiative are eligible for Medicare rebates of up to $339.40. Medicare rebates can only be claimed after services have been provided so it is recommended that parent of children with a specialist referral pay by session. Alternatively, a receipt will be provided, and a claim can be lodged with Medicare after completion of the assessment process.

Additional Information

It is recommended that the ADOS-2 and ADI-R assessments be carried out on different days. Where necessary, it is possible to complete all assessment sessions on one day, and to schedule the feedback session for 2 weeks later, via Skype or Zoom if needed. In this case, parents will need to organise someone to look after young children during the interview, and during the feedback session. Older adolescents are welcome to attend all sessions.