Can a child be diagnosed with AD/HD prior to the age of six years old?
Yes, although this is not typical practice. As many parents will understand, many AD/HD-like behaviors are actually typical of preschoolers! Therefore, if a younger child is being assessed, the clinician needs to exercise extreme caution in determining what symptoms are developmentally appropriate vs. suggestive of AD/HD. If the symptoms and impact are not severe, we recommend waiting until at least Grade One to investigate.
What is the Autism Diagnostic Observation Schedule (ADOS)?
The ADOS is a standardized behavioral observation system used to diagnose Autism. It is used by many clinics, including Alberta Children’s Hospital. When using the ADOS, the child is engaged in specific tasks and activities and then rated by the examiner for their presentation of autistic tendencies during the social exchange with the examiner.
Strengths: It is a well-respected tool in the field. It has great utility for children with more significant symptoms of Autism Spectrum Disorder.
Weaknesses: It is conducted 1:1 with an adult therapist in an office setting. It does not include observations in real-life settings and with peers. It does not always pick up milder forms of Autism Spectrum Disorder, such as what was previously known as Asperger’s Disorder.
Why do you not use the ADOS at Eckert Centre?
Many children with moderate to severe Autism Spectrum Disorder (previously called Autism) are identified early by their medical doctor and assessed through Alberta Children’s Hospital. Individuals who come to Eckert Centre tend to be older and have milder symptoms. According to Tony Attwood, a leading expert in the area of Asperger’s Disorder, the ADOS is not particularly useful for diagnosing milder forms of Autism Spectrum Disorder (previously known as Asperger’s). It should be noted that ‘Autism’ is easier to diagnose than ‘Asperger’s’ because the symptoms are more severe. At Eckert Centre, we specialize in the ‘grey’ cases. Because of this, our assessments extend outside of the office. Thus, not only do we get to observe interactions in a formal setting with a psychologist, but we also have the opportunity to observe the child in the school and home setting with peers and family members. While in office, we also complete tasks that tend to be challenging for someone with ‘Asperger’s,’ such as reading/understanding/portraying emotions, understanding humor, reciprocal communication, and perspective taking. In addition to exploring their social/emotional functioning, we also measure the child’s learning profile. Finally, we interview critical members of the child’s life – teachers, parents, and, if appropriate, other service providers.
What are adaptive skills?
Adaptive skills, or adaptive living skills, refer to general life skills. These may include skills related to dressing/grooming, eating/meal preparation, money management, understanding of time, community orientation, etc. When considering whether a client has an Intellectual Disability, adaptive living skills must be assessed. It would be expected that an individual’s Cognitive Function (IQ score) would be comparable to an individual’s Adaptive Skill level. Adaptive living skills can be taught; Eckert Centre’s Cognitive Coaching program can target such goals.
Can you assess a child with sensory integration issues? How would you test them if they are unable to write?
Yes. We cannot assess for the presence of sensory integration issues (that is an area of expertise addressed by Occupational Therapists) but we can complete a psychoeducational assessment on a child with sensory integration issues – we would just want to be aware of their triggers and sensitivities. If, for example, they are unable to write, we would have them type their written responses. This is not standardized procedure, and so this deviation would be noted in the report.
What happens to the written report when it is submitted to Human Services?
Human Services is the government agency that funds psychoeducational assessments for post-secondary students. Funding is accessed through the school’s disability services department, and assessments are then assigned to clinics such as Eckert Centre. Upon completion of the assessment:
- The student submits the report to their disability services department
- The report is then forwarded to Human Services and retained by them; Human Services is guided by FOIP
- Data from the report gets put into a provincial database including:
- Who completed the assessment
- Diagnoses (if conferred)
- Recommendations (sometimes retained)
- The purpose of the provincial database is to:
- Inform counselors in case the student returns for academic or psychological counseling
- Inform Student Loans in case the student applies for a student loan and asks for disability support
What are standardized tests? How are they different than cognitive tests?
Standardized tests and cognitive tests are not two different kinds of tests. A standardized test is ANY test that has gone through a standardized process, and that requires the administrator to follow standardized procedures. The standardized process involves developing a test, and then administering it to a large population to develop “norms” (i.e., determining how many students of a given age answered that question correctly, etc.). Essentially, they are formal tests that allow us to compare a student with their age-mates across a large sample (often norm groups are North America, United States, or Canada). Cognitive tests are standardized and measure brain functions (e.g. reasoning, memory, speed, etc.). This is sometimes referred to as IQ testing. Most Eckert Centre assessments include cognitive testing.
Who should attend the feedback conference?
At Eckert Centre, parents/adults participate in a feedback conference at the end of the assessment process. The meeting is designed to explain the results, share recommendations, and answer questions that the adults might have. Children are not invited to these sessions; teens are welcome if parents are in agreement. Typically, we recommend that these meetings be for adults only, as they are long, the information is discussed at an adult level, and the privacy allows for adults/parents to have their own emotional reactions and/or ask questions without being concerned about the impact on the teen. In addition, we offer separate feedback sessions (optional) for children and teens. The child/teen sessions are much briefer and include less content. They may or may not include diagnostic labels; this will depend on what the adults and clinician determine would be in the best interest of the child/teen. We often recommend that parents join these sessions so that they can hear the information again (reinforce their prior learning), be exposed to the language we used with the child/teen (to support ongoing discussions at home), and be available for emotional support to the child/teen if needed.
Is a Standard Assessment adequate for individuals who are presenting academic challenges and emotional issues such as anxiety?
A standard assessment will explore one’s learning profile and can confirm social/emotional diagnoses such as AD/HD, Anxiety Disorders, and Mood Disorders (i.e., depression). For some individuals, more interview time may be required to confirm a diagnosis. If social/emotional/behavioral issues are a primary concern, a more comprehensive assessment is encouraged.