1. Read Dulcan’s  pages 1 through 5 & 25-76
2. Read DSM-5 TR pages 35-99 and 521 through 541
3. Read Carlat Section 3: Interviewing for Diagnosis: The Psychiatric Review of Symptoms and Section 4: Interviewing for Treatment
4. Read Morrison and Flegel: Chapter 1 and chapter 2 pay attention to table 1:1 Read chapter 15, chapter 23

6. Read Boland, R., & Verduin Kaplan Chapter 18: Disruptive, Impulse-Control, and Conduct Disorders

7. Read Boland, R., & Verduin Kaplan Chapter 2: Child Psychiatry

8. Read Zuckerman,-Review Part 1: Chapters 1-3, pg. 35-50 Mental Status Exam Special emphasis on: • Chapters 2: 2.4, 2.5, 2.6, 2.7, 2.9 Chapter 3: 3.8, 3.18 • Chapter 12: 12.3, 12.4, 12.7, 12.13, 12.14, 12.32

Reply to peer discussion post using APA format

 Discuss the unique challenges associated with the psychiatric interview of a child with Autism spectrum disorder. Describe how you would approach this clinical assessment. 

With as many as one in 36 children being diagnosed with Autism Spectrum Disorder also known as ASD, (Autism Statistics and Facts, 2020) the ability to perform a comprehensive, accurate and thorough exam of these individuals in essential. Other conditions such as Attention Deficit Hyperactivity Disorder (ADHD) or learning disorders may be misdiagnosed as ASD (What Should an Evaluation for Autism Look Like? – Child Mind Institute, n.d.), although they can also occur with ASD.  According to the DSM-5, to meet criteria for autism, all three of the following must be present: deficits in social and emotional reciprocity, difficulties with non-verbal communication such as abnormal eye contact, and difficulty developing and maintaining relationships. Other diagnostic criteria can include insistence on sameness, highly restrictive interests and hyper/hypo reactivity to sensory input or environment (American Psychiatric Association, 2022). These symptoms can make an interview especially challenging.

Creating a therapeutic alliance, when possible, will be beneficial.   This can be achieved in part by showing empathy to the patient and family, gaining trust and getting to know the patient and family as individuals (Carlat, 2023). When feasible, spending time to explain the schedule of the exam may help reduce anxiety for the patient and family and help build the belief that this will be a mutually beneficial experience. This can help the family endorse the treatments and interventions needed in the future (Children’s Hospital of Philadelphia Research Institute, 2020a). As the child may have limited to no verbal skills, this may involve more observation and creation of a safe space, than verbal communication (Children’s Hospital of Philadelphia Research Institute, 2020b).

The psychiatric examination can determine future treatment, academic, language, and social interventions and identify difficulties with functioning and behaviors   A child with suspected autism may have deficits in language, attention, and behavior. Accommodations should be made including adjustment to time, environment, observation, and parental input.  Extra time should be allowed for the exam, and the examination room should be quiet with minimal distractions.  As the patient may be nonverbal or have limited verbal skills, careful observation of behaviors can aid in diagnosis. To evaluate the patient, the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) can be used to aid in diagnosis.  The ADOS-2 allows an experienced clinician to choose from 5 different modules depending on the patient’s age, language and developmental level (Autism Diagnostic Observation Schedule, Second Edition (Ados-2), n.d.). The ADOS-2 may be used for ages 12 months and older, including adults. The clinician then can score the patient based on observations and aspects of social behavior.  The clinician should be trained and experienced in the use of ADOS-2 to determine if the results are consistent with ASD. Those without expertise in using ADOS-2 may misinterpret information (Children’s Hospital of Philadelphia Research Institute, 2020c). 

In addition, information from the parent/caregiver should be incorporated into the formation of the diagnosis.  There are screens and diagnostic tools that can be used to elicit data from the parents or other adults in the child’s life, including the Autism Diagnostic Interview (ADI-R).  The ADI-R is a method of collecting developmental history in systematic method. It can be used for ages 2 and older. The trained clinician should interview the parent/caregiver who is familiar with the patient’s current functional level and developmental history. The clinician should be well trained in ASD as the tool does have standardized questions with decision trees. The clinician must have expertise in ASD and ASD behaviors (Children’s Hospital of Philadelphia Research Institute, 2020b).

The clinician should note the duration of the symptoms, the distress or disability, and note any differential diagnoses. Social communication and restrictive and repetitive behaviors both can be rated from mild to moderate to severe. ASD should be differentiated from communication disorders and repetitive behaviors should be distinguished from movement disorders (Morrison & Flegel, 2016).

In closing, assessing a child with ASD can present with many challenges including deficits in language, attention, and behavior. A careful assessment by a trained clinical can lead to the correct diagnosis to provide a pathway for treatment and interventions.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, text revision dsm-5-tr (5th ed.). Amer Psychiatric Pub Inc.

Autism diagnostic observation schedule, second edition (ados-2). (n.d.). Massachusetts General Hospital. https://www.massgeneral.org/children/autism/lurie-center/autism-diagnostic-observation-schedulesecond-edition-ados2Links to an external site.

Autism statistics and facts. (2020). Autism Speaks. Retrieved May 21, 2024, from

Carlat, D. J. (2023). The psychiatric interview (Fifth ed.). LWW.

Children’s Hospital of Philadelphia Research Institute. (2020a, June 9). Diagnostic criteria for autism spectrum disorder in the DSM-5. CAR Autism Roadmap. Retrieved May 21, 2024, from https://www.research.chop.edu/car-autism-roadmap/diagnostic-criteria-for-autism-spectrum-disorder-in-the-dsm-5Links to an external site.

Children’s Hospital of Philadelphia Research Institute. (2020b, June 23). Autism diagnostic interview-revised (ADI-R). CAR Autism Roadmap. Retrieved May 20, 2024, from ttps://www.research.chop.edu/car-autism-roadmap/autism-diagnostic-interview-revised-adi-r

Children’s Hospital of Philadelphia Research Institute. (2020c, June 23). Autism diagnostic observation schedule. CARS Autism Roadmap. Retrieved May 21, 2024, from https://www.research.chop.edu/car-autism-roadmap/autism-diagnostic-observation-schedule-2nd-edition-ados-2Links to an external site.

Hollander, E., & Jean Ferretti, C. (2019). Assessment and treatment of autism spectrum disorder. Psychiatric News, 54(1). https://doi.org/10.1176/appi.pn.2019.1a21Links to an external site.

Merrill, A., Ph.D. (2019). Psychological evaluation and autism spectrum disorder: Considerations for standardized testing: Articles: Indiana resource center for autism: Indiana university bloomington. Indiana Resource Center for Autism. https://www.iidc.indiana.edu/irca/articles/psychological-evaluation-and-autism-spectrum-disorder.htmlLinks to an external site.

Morrison, J., & Flegel, K. (2016). Interviewing children and adolescents: Skills and strategies for effective dsm-5® diagnosis (Second ed.). The Guilford Press.

What should an evaluation for autism look like? – child mind institute. (n.d.). Child Mind Institute. Retrieved May 20, 2024, from https://childmind.org/article/what-should-evaluation-autism-look-like/Links to an external site.

1. Read Dulcan’s  pages 1 through 5 & 25-76
2. Read DSM-5 TR pages 35-99 and 521 through 541
3. Read Carlat Section 3: Interviewing for Diagnosis: The Psychiatric Review of Symptoms and Section 4: Interviewing for Treatment
4. Read Morrison and Flegel: Chapter 1 and chapter 2 pay attention to table 1:1 Read chapter 15, chapter 23

6. Read Boland, R., & Verduin Kaplan Chapter 18: Disruptive, Impulse-Control, and Conduct Disorders

7. Read Boland, R., & Verduin Kaplan Chapter 2: Child Psychiatry

8. Read Zuckerman,-Review Part 1: Chapters 1-3, pg. 35-50 Mental Status Exam Special emphasis on: • Chapters 2: 2.4, 2.5, 2.6, 2.7, 2.9 Chapter 3: 3.8, 3.18 • Chapter 12: 12.3, 12.4, 12.7, 12.13, 12.14, 12.32

Reply to peer discussion post using APA format

 Discuss the unique challenges associated with the psychiatric interview of a child with Autism spectrum disorder. Describe how you would approach this clinical assessment. 

With as many as one in 36 children being diagnosed with Autism Spectrum Disorder also known as ASD, (Autism Statistics and Facts, 2020) the ability to perform a comprehensive, accurate and thorough exam of these individuals in essential. Other conditions such as Attention Deficit Hyperactivity Disorder (ADHD) or learning disorders may be misdiagnosed as ASD (What Should an Evaluation for Autism Look Like? – Child Mind Institute, n.d.), although they can also occur with ASD.  According to the DSM-5, to meet criteria for autism, all three of the following must be present: deficits in social and emotional reciprocity, difficulties with non-verbal communication such as abnormal eye contact, and difficulty developing and maintaining relationships. Other diagnostic criteria can include insistence on sameness, highly restrictive interests and hyper/hypo reactivity to sensory input or environment (American Psychiatric Association, 2022). These symptoms can make an interview especially challenging.

Creating a therapeutic alliance, when possible, will be beneficial.   This can be achieved in part by showing empathy to the patient and family, gaining trust and getting to know the patient and family as individuals (Carlat, 2023). When feasible, spending time to explain the schedule of the exam may help reduce anxiety for the patient and family and help build the belief that this will be a mutually beneficial experience. This can help the family endorse the treatments and interventions needed in the future (Children’s Hospital of Philadelphia Research Institute, 2020a). As the child may have limited to no verbal skills, this may involve more observation and creation of a safe space, than verbal communication (Children’s Hospital of Philadelphia Research Institute, 2020b).

The psychiatric examination can determine future treatment, academic, language, and social interventions and identify difficulties with functioning and behaviors   A child with suspected autism may have deficits in language, attention, and behavior. Accommodations should be made including adjustment to time, environment, observation, and parental input.  Extra time should be allowed for the exam, and the examination room should be quiet with minimal distractions.  As the patient may be nonverbal or have limited verbal skills, careful observation of behaviors can aid in diagnosis. To evaluate the patient, the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) can be used to aid in diagnosis.  The ADOS-2 allows an experienced clinician to choose from 5 different modules depending on the patient’s age, language and developmental level (Autism Diagnostic Observation Schedule, Second Edition (Ados-2), n.d.). The ADOS-2 may be used for ages 12 months and older, including adults. The clinician then can score the patient based on observations and aspects of social behavior.  The clinician should be trained and experienced in the use of ADOS-2 to determine if the results are consistent with ASD. Those without expertise in using ADOS-2 may misinterpret information (Children’s Hospital of Philadelphia Research Institute, 2020c). 

In addition, information from the parent/caregiver should be incorporated into the formation of the diagnosis.  There are screens and diagnostic tools that can be used to elicit data from the parents or other adults in the child’s life, including the Autism Diagnostic Interview (ADI-R).  The ADI-R is a method of collecting developmental history in systematic method. It can be used for ages 2 and older. The trained clinician should interview the parent/caregiver who is familiar with the patient’s current functional level and developmental history. The clinician should be well trained in ASD as the tool does have standardized questions with decision trees. The clinician must have expertise in ASD and ASD behaviors (Children’s Hospital of Philadelphia Research Institute, 2020b).

The clinician should note the duration of the symptoms, the distress or disability, and note any differential diagnoses. Social communication and restrictive and repetitive behaviors both can be rated from mild to moderate to severe. ASD should be differentiated from communication disorders and repetitive behaviors should be distinguished from movement disorders (Morrison & Flegel, 2016).

In closing, assessing a child with ASD can present with many challenges including deficits in language, attention, and behavior. A careful assessment by a trained clinical can lead to the correct diagnosis to provide a pathway for treatment and interventions.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, text revision dsm-5-tr (5th ed.). Amer Psychiatric Pub Inc.

Autism diagnostic observation schedule, second edition (ados-2). (n.d.). Massachusetts General Hospital. https://www.massgeneral.org/children/autism/lurie-center/autism-diagnostic-observation-schedulesecond-edition-ados2Links to an external site.

Autism statistics and facts. (2020). Autism Speaks. Retrieved May 21, 2024, from

Carlat, D. J. (2023). The psychiatric interview (Fifth ed.). LWW.

Children’s Hospital of Philadelphia Research Institute. (2020a, June 9). Diagnostic criteria for autism spectrum disorder in the DSM-5. CAR Autism Roadmap. Retrieved May 21, 2024, from https://www.research.chop.edu/car-autism-roadmap/diagnostic-criteria-for-autism-spectrum-disorder-in-the-dsm-5Links to an external site.

Children’s Hospital of Philadelphia Research Institute. (2020b, June 23). Autism diagnostic interview-revised (ADI-R). CAR Autism Roadmap. Retrieved May 20, 2024, from ttps://www.research.chop.edu/car-autism-roadmap/autism-diagnostic-interview-revised-adi-r

Children’s Hospital of Philadelphia Research Institute. (2020c, June 23). Autism diagnostic observation schedule. CARS Autism Roadmap. Retrieved May 21, 2024, from https://www.research.chop.edu/car-autism-roadmap/autism-diagnostic-observation-schedule-2nd-edition-ados-2Links to an external site.

Hollander, E., & Jean Ferretti, C. (2019). Assessment and treatment of autism spectrum disorder. Psychiatric News, 54(1). https://doi.org/10.1176/appi.pn.2019.1a21Links to an external site.

Merrill, A., Ph.D. (2019). Psychological evaluation and autism spectrum disorder: Considerations for standardized testing: Articles: Indiana resource center for autism: Indiana university bloomington. Indiana Resource Center for Autism. https://www.iidc.indiana.edu/irca/articles/psychological-evaluation-and-autism-spectrum-disorder.htmlLinks to an external site.

Morrison, J., & Flegel, K. (2016). Interviewing children and adolescents: Skills and strategies for effective dsm-5® diagnosis (Second ed.). The Guilford Press.

What should an evaluation for autism look like? – child mind institute. (n.d.). Child Mind Institute. Retrieved May 20, 2024, from https://childmind.org/article/what-should-evaluation-autism-look-like/Links to an external site.