If you had four hours for an autism eval, what would you do?

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borne_before

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Here are the parameters:
  • You are bringing them in to the clinic for four hours.
  • This is your first contact with them.
  • Referred by a medical provider at your gig (think neuro/genetics/pediatrician/etc) and you will most likely have access to some history all ready.
  • Most kids will have some genetic or medical condition.
  • You will have 2, 3, 4 hours to write everything up.
  • Ages will be from 2 to ten.
  • No academic testing needed, the goal is more differentiate autism from intellectual disability or dx both, or maybe ADHD kinds of things.
 
Assuming I did an intake and have some background info on developmental history, medical/gentic histories, neonatal history, etc.before testing (if not, add 30 min or so):

Under 2.5yo- Bayley cognitive and language, ADOS-2, Bayley Social Emotional Adaptive Behavior Questionnaire (or Vineland-3). Add Bayley Motor if any concerns for motor skills development. ~2hours direct testing, scoring as i go along. 30 minutes feedback, hour or so write-up. If you're not good at building rapport, dealing with typical toddler separation anxiety and other assorted nonsense, add an hour or so.

2.5-3.5yo- add in an SRS-2. Maybe an additional 15 minutes of scoring and write up time.

3.5- 4yo- WPPS-IV, CASL-2 (receptive and express everything scales at a minimum, sentence level scale if warranted, and grammatical morphemes and pragmatic language if the kids a talker), ADOS-2, SRS-2, Vineland-3, BASC-3 to identify potential internalizing stuff. If nothing comes up to suggest some kind of precocious anxiety/depression, and kid is generally cooperative (50% are, 40% aren't but can be persuaded to participate, 5% make you question your career choices, 5% make you question your life choices) you may be able to get away with 2.5 hours direct testing, 20 minutes scoring, 30 minutes feedback, and then type fast so you take less of a loss on the write-up. If something comes up that makes you think there's some type of internalizing disorder or executive functioning problems, add another 1-2 hours for additional structured diagnostic interview, NEPPSY-2 substances, etc.

4-5yo- getting it done, scored, and written up in 4 hours would be a stretch. Too many other differential diagnoses to look at/test for, and preschoolers and early elementary will often need 2 testing sessions, as cognitive and language in one day can push third limits and thus you may not get accurate data if you do the ADOS on same day.

Over 5 yo- refer out!

There are several client factors that can make things go quicker or slower. Low verbal skills or cognitive skills= hitting those "5 incorrect in row" ceilings much faster than the averagely verbal, average intelligence kid. If you need to use a translator for interview, administration, or feedback, add 10% more time. Very non-compliant, extreme separation anxiety, etc, ad 20%+ more time.

All this assumes that you are very efficient with the admin and scoring of the tests, as well as with your write-ups. Obviously, ymmv in the area.

EDIT- I copied the above from another thread without some of the info @borne_before posted above. If the 4 hours is only the direct contact time, then you should be able to get it done (cognitive, language, and ADOS testing definitely, with an hour or so left over for additional executive functioning testing and/or ruling out internalizing stuff. Have questionnaires completed beforehand by parent/caregiver (ideally online and scored), with maybe a 15-30 minute phone or zoom interview. Template out your write up and stick to the important stuff, and get her written in 2 hours max.
 
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