Autism for Attorneys:

Practical Information for Legal Professionals

9/29/10

To DuPage County Bar Association CLE Participants:

On behalf of over 30,000 Illinois children with Autism Spectrum Disorders, I want to
thank you for your thoughtful consideration of today’s subject matter. As counsel to the
families of this exceptional group of individuals, your resourcefulness can contribute to
positive outcomes in the home, school, community, and workplace.

At the request of many parents and practitioners, I have compiled resources and links
for further information related to our topic.

These attachments will be available in html “clickable” format and in pdf form at:

http://www.iepguardians.org/WAEDCONSULTING/DCBA.html

Again, thank you for service to the families of these exceptional people!

Sincerely,

Matthew Wanzenberg, Ph.D.

Chief Consultant, Wanzenberg & Associates
 Links

Name HTML
The Council for http://www.disabilityrights.org/index.htm
Disability Rights
The Autism Program http://www.theautismprogram.org/
of Illinois (TAP)
Autism Society of http://www.autismillinois.org/
Illinois
Special Education http://www.disabilityrights.org/glossary.htm
Terms/Abbreviations
Wrightslaw.com http://www.wrightslaw.com/

Autsimlink.com http://www.autismlink.com/

Online Aspergers http://www.oasisautism.org/index.html

Syndrome
Information &
Support (OASIS)
Autism in Plain http://www.actearly.org/site/PageServer?pagename=ans_dsm_intro
Language: The
DSM-IV TR Criteria
Explained
Autism Society of http://www.autism-society.org/site/PageServer
America
Autism Speaks http://www.autismspeaks.org/

Autism Today http://autismtoday.com/

Childnet.tv (Dan http://www.childnett.tv/

Marino Foundation)
OASIS @ MAAP http://aspergersyndrome.org/

National Institute of http://www.ninds.nih.gov/disorders/asperger/asperger.htm

Health: National
Institute of
Neurological
Disorders & Stroke
Department of http://www.dhs.state.il.us/page.aspx?item=40931
Human Services
(DHS)
TalkAutism http://www.talkautism.com/Default.aspx

Autism Acronyms http://www.autism-resources.com/autismfaq-glos.html

 Books and Publications

Ten Things Every Child with Every parent, teacher, social worker, therapist, and
Autism Wished You Knew physician should have this succinct and informative
(Ellen Notbohm) book in his/her back pocket. Framed with both humor
and compassion, the book defines the top ten
characteristics that illuminate the minds and hearts of
children with autism. Ellen’s personal experiences as
a parent, an autism columnist, and a contributor to
numerous parenting magazines coalesce to create a
guide for all who come in contact with a child on the
autism spectrum.
Asperger Syndrome and Another great resource for activities and strategies to
Adolescence: Practical teach independence and success in the classroom
Solutions for School Success (and beyond)
(Brenda Smith Myles and Diane
Adreon)
The Syracuse Community- Don’t be overwhelmed by the manual presentation of
Referenced Curriculum Guide this great resource… It is the go to guide on how to
for Students with Moderate and identify, stage, and roll out solid transitional goals for
Severe Disabilities students with Autism as they move from school to
community/workplace.
(Alison Ford, et. al.)
The Eclipse Model: Teaching An excellent curriculum for teaching organizational
Self-Regulation, Executive and soft skills that promote self-awareness and
Function, Attribution, and independence in home, school, and community.
Sensory Awareness to Highly recommended for DIY parents!
Students with Asperger
Syndrome High Functioning
Autism, and Related Disorders
(Sherry Moyer)
Organizing the Disorganized Primarily a parent tool for students with ADHD, this
Child resource can be quite helpful for working with children
(Martin Kutscher & Marcella with ASD who commonly exhibit executive skills
Moran) dysfunction.
Look Me In The Eye: My Life Excellent biographical work on living with Asperger
with Asperger Syndrome. Highly recommended.
(John Elder Robinson)
The Complete Guide to Drawing on case studies and personal accounts from
Asperger Syndrome Attwood's extensive clinical experience, and from his
(Tony Atwood) correspondence with individuals with AS, this book is
both authoritative and extremely accessible. Chapters
examine: causes and indications of the syndrome; the
diagnosis and its effect on the individual; theory of
mind; the perception of emotions in self and others;
social interaction, including friendships; long-term
relationships; teasing, bullying and mental health
issues; the effect of AS on language and cognitive
abilities, sensory sensitivity, movement and co-
ordination skills; and career development.
From Emotions to Advocacy: Wrightslaw: From Emotions to Advocacy, second
The Special Education Survival edition will teach you how to plan, prepare, organize
Guide and get quality special education services. In this
(Peter Wright and Pamela Darr comprehensive, easy-to-read book, you will learn
Wright) your childs disability and educational needs, how to
create a simple method for organizing your childs file
and devising a master plan for your childs special
education. You will understand parent-school conflict,
how to create paper trails and effective letter writing.
This book includes dozens of worksheets, forms and
sample letters that you can tailor to your needs.
Whether you are new to special education or an
experienced advocate this book will provide a clear
roadmap to effective advocacy for your child. You will
use this book again and again.
You're Going to Love This Kid!: Guide to understanding students with autism and
Teaching Students With Autism including them fully in the classroom. Includes
in the Inclusive Classroom specific ideas for enhancing literacy; planning
(Paula Kluth) challenging, multidimensional lessons; supporting
student
behavior; connecting, communicating, and
collaborating; fostering friendships; and adapting the
physical environment. Softcover.
DLC: Autistic children--Education—United States.
The Source for Asperger Although there are many resources on Asperger, The
Syndrome Source for Asperger Syndrome is specifically
(Timothy Kowalski) designed to be a non-technical, yet clinically accurate,
resource for the busy practitioner. You will quickly
grasp the content and begin using the information in
the diagnosis and treatment of clients who exhibit the
symptoms of Asperger Syndrome.
Making a Difference: Advocacy Making a Difference: Advocacy Competencies for
Competencies for Special Special Education Professionals is the only single
Education Professionals comprehensive source on the role and responsibility
(Craig Fiedler) of special education professionals as advocates for
children with disabilities. Most pre-service educational
programs only cursorily cover the topic of advocacy,
leaving many to enter the field without the knowledge
and skills necessary for effective advocacy. This
highly specialized book fills this training void by
presenting the competencies, dispositions,
knowledge, and skills necessary to become an
effective advocate. Pre-service and in-service
educators are introduced to topics such as ethical
disposition, special education law, dispute resolution
mechanisms, interpersonal communication skills,
collaboration skills, and conflict resolution skills.
Resources for Hospital-based Neuropsychological Evaluations
that may be covered by insurance

Private evaluators available upon consultation with Dr. Wanzenberg

Updated 9/25/10

• Loyola Department of Neurology

2160 S First Ave
Maywod IL 60153
888-LUHS-888

http://www.loyolamedicine.org/Medical_Services/Neurosciences/What
_We_Do/Neurobehavioral.cfm

• University of Illinois-Chicago
UIC Behavioral Health Services
912 S. Wood Street
Chicago, IL 60612
312-996-7383

http://www.psych.uic.edu/ijr/patients.asp?p=clinicprograms

• Alexian Brothers Behavioral Health

Pediatric Neuropsychology Clinic
Eberle Building
800 Biesterfield Rd. Ste. 610
Elk Grove Village, IL 60007
847-981-3630

http://www.alexianbrothershealth.org/services/neurosciences/services
/pediatric-neuropsychological/tests-treatments.aspx
• Rush University Medical Center
1653 W. Congress Parkway, 310 Rawson
Chicago, IL 60612
312-942-5932

http://www.rush.edu/rumc/page-1099918804049.html

• Hinsdale Hospital
Salt Creek Therapy Center
Salt Creek Therapy Center
Salt Creek Lane, Suite 206
Hinsdale, IL 60521
630-850-2120

http://www.saltcreektherapy.com/services/

• Central Dupage Hospital

Department of Neuroscience/Behavioral Health Services
25 North Winfield Road
Winfield, IL 60190
630-933-4000

http://www.cdh.org/MedicalServices/Neurosciences/Neuropsychology
.aspx

• University of Chicago: Child Psychiatric Services

773-702-6826 (reception)
773-702-3858 (child intake)

http://psychiatry.uchicago.edu/clinical/cl_services.html#neuro
 2010-2011 School Year
Evaluative Timeline

Please note: school calendars vary and this tool is a general resource for the 60 school
day evaluative timeline associated with initial evaluations and re-evaluations
 SAMPLE LETTER FOR INITIAL CASE STUDY EVALUATION

Notes on use:

• Always send in written form and try to hand deliver (or at a minimum certify mail)
this request
• Always confirm receipt of this request
• School must contact you within 10 days if the request is in order
• If declined, response should be formalized in writing with rationale and copy of
SA
parentʼs rights

Date
M
Name of Administrative School Contact
Name of School
Street Address
PL
City, State Zip Code

Name of Administrative School Contact:

E
We are the parents of CHILDS NAME (DOB or STUDENT ID NUMBER), a student
attending SCHOOL.

We are requesting an initial case study evaluation to determine if CHILD is eligible for
special education services.

The reasons for this request include:

• Difficulty in school, specifically LIST AREA OF SCHOOL NEED which has been
observed for DURATION OF EDUCATIONALLY RELEVANT SYMPTOM
• ADD OTHER INFORMATION RELATED TO REQUEST HERE

OPTIONAL: To date, we are aware of the following interventions that have been
employed to assist CHILD in school:

OPTIONAL: CHILD maintains a diagnosis of LIST DIAGNOSIS/DIAGNOSES HERE

which impact his/her education at SCHOOL.
OPTIONAL: CHILD has been evaluated by THIRD PARTY and we wish the referral
team to fully consider the findings and recommendations outlined in the attached
evaluation.

Please forward forms related to release of confidential information so CHILDʼs service

providers in the community are included in this process.

Please contact us to discuss the next steps in this process, including any dates which
might be set aside for CHILDʼs domain meeting.

We look forward to working with the school team on CHILDʼs behalf.

Sincerely,
SA
M
____________________________ __________
SIGNATURE DATE
PL
Parents
Address
City, State Zip Code
Phone
E
(if child is subject to joint custody, complete with both parental signatures)

____________________________ __________
SIGNATURE DATE

Parents
Address
City, State Zip Code
Phone

Att: SUPPORTING DOCUMENTATION

 Ecological Assessment/Survey
Directions: enter task code(s) in cell and tally total minutes in highlighted cell at bottom

Interval Monday Tuesday Wednesday Thursday Friday

8:00a-8:15a
8:15a-8:30a
8:30a-8:45a
8:45a-9:00a
9:00a-9:15a
9:15a-9:30a
9:30a-9:45a
9:45a-10:00a
10:00a-10:15a
10:15a-10:30a
10:30a-10:45a
10:45a-11:00a
11:00a-11:15a
11:15a-11:30a
11:30a-11:45a
11:45a-12:00p
12:00p-12:15p
12:15p-12:30p
12:30p-12:45p
12:45p-1:00p
1:00p-1:15p
1:15p-1:30p
1:30p-1:45p
1:45p-2:00p
2:00p-2:15p
2:15p-2:30p
2:30p-2:45p
2:45p-3:00p
3:00p-3:15p
Minutes Task Notes/Personnel CODE
Transitioning to/from activity/classroom
1
Classroom instruction alongside nondisabled peers
2
Classroom instruction outside of non-disabled student
lesson (e.g., back table, parallel group of disabled
students, etc.)
Time with pull out service
3
Time with 1:1 para (instr.)
4
Socializing with non dis. peers
5
Other (specify)
6
 105 ILCS 5-14-8.02g
Pertaining to access to classroom for observation and data collection
(g-5) For purposes of this subsection (g-5), "qualified professional" means an individual who holds
credentials to evaluate the child in the domain or domains for which an evaluation is sought or an intern
working under the direct supervision of a qualified professional, including a master's or doctoral degree
candidate.

To ensure that a parent can participate fully and effectively with school personnel in the development of
appropriate educational and related services for his or her child, the parent, an independent educational
evaluator, or a qualified professional retained by or on behalf of a parent or child must be afforded
reasonable access to educational facilities, personnel, classrooms, and buildings and to the child as provided
in this subsection (g-5). The requirements of this subsection (g-5) apply to any public school facility,
building, or program and to any facility, building, or program supported in whole or in part by public funds.
Prior to visiting a school, school building, or school facility, the parent, independent educational evaluator, or
qualified professional may be required by the school district to inform the building principal or supervisor in
writing of the proposed visit, the purpose of the visit, and the approximate duration of the visit. The visitor
and the school district shall arrange the visit or visits at times that are mutually agreeable. Visitors shall
comply with school safety, security, and visitation policies at all times. School district visitation policies must
not conflict with this subsection (g-5). Visitors shall be required to comply with the requirements of
applicable privacy laws, including those laws protecting the confidentiality of education records such as the
federal Family Educational Rights and Privacy Act and the Illinois School Student Records Act. The visitor
shall not disrupt the educational process.

(1) A parent must be afforded reasonable access of

sufficient duration and scope for the purpose of observing his or her child in the child's current
educational placement, services, or program or for the purpose of visiting an educational placement or
program proposed for the child.

(2) An independent educational evaluator or a

qualified professional retained by or on behalf of a parent or child must be afforded reasonable access
of sufficient duration and scope for the purpose of conducting an evaluation of the child, the child's
performance, the child's current educational program, placement, services, or environment, or any
educational program, placement, services, or environment proposed for the child, including interviews of
educational personnel, child observations, assessments, tests or assessments of the child's educational
program, services, or placement or of any proposed educational program, services, or placement. If one or
more interviews of school personnel are part of the evaluation, the interviews must be conducted at a
mutually agreed upon time, date, and place that do not interfere with the school employee's school duties.
The school district may limit interviews to personnel having information relevant to the child's current
educational services, program, or placement or to a proposed educational service, program, or placement.
 Questions to ask during analysis of current interventions/supports

Proper Instruction.
Is the instruction research-based and/or appropriate?
Does the instruction match the skill level of the student?
Is the instruction motivating and rewarding?
Is the instruction being provided by qualified teachers?
Behavioral Issues.
Were appropriate interventions planned?
Are the interventions being carried out?
Is the process for developing and implementing FBAs and BIPs reasonably likely to enable staff to decrease problem
behaviors
Progress Monitoring.
Are there charts, graphs or plans to exhibit student performance at the beginning and throughout the interventions?
Have standards and implementations enabled staff to use data to drive decision-making for improved teaching and
learning?
Interaction with Parents.
Were a sufficient number of meetings held?
Did a parent attend the meetings, or was there evidence of reasonable contacts?
Clear Standards.
Do clear standards delineate sufficiency of progress?
Are the standards followed consistently?
Is there sufficient time given for interventions to succeed?
Are the interventions changed based on performance?
Referral Process.
Do referrals for special education services seem to be appropriate?
Are there standards for referrals?
Are continued interventions appropriate?
Are the interventions modified and reasonable?
Were any referrals without prior general education interventions reasonable?

Reprinted with permission from Special Education Connection/LRP

 IEP’s, 504 plans, RTI plans, and Post-High School Supports
K-12 Individualized Education Program K-12 Section Response to Intervention Plans College and Agency (Section 504 and Americans
(IEP) 504 of Rehabilitation Act (RTI) with Disabilities Act)
School The student’s public school is responsible The student’s public school is not held The school is required to monitor The student is responsible for his/her own academic
accountability for the student’s performance as long as accountable for specific areas of student’s performance in interventions performance. The school or agency is only required
goals are identified in the IEP performance to consider supporting documentation
Identification Public schools have a responsibility to find Parents must provide supporting Any school member or parent can The student provides supporting documentation for
and evaluate students with disabilities that documentation that meet federal initiate a request for an intervention disability and need for basic accommodations which
impact school performance guidelines for accommodation plan may or may not be provided by college or agency
Costs of School districts bear the responsibility for a In most cases, the family bears the costs School district bears the responsibility The student is responsible for all costs associated
Identification case study evaluation of the eligibility evaluation for 504 services to design, implement, and monitor the with eligibility for supports at the school or agency
intervention plan
Termination Services terminate at graduation or day after School services terminate upon Intervention plan terminates at team 504 plan terminates upon completion of program or
student’s 22nd birthday if still in high school. graduation, but 504 plan may generalize to discretion or upon graduation from degree
adult world high school
Plan development A multidisciplinary team of specialists A limited committee of school team No requirement for specific team Student identifies needed accommodations; school
develop and monitor the IEP members develops and reviews the 504 member, but casemanager is or agency committee will review and determine if
plan designated to monitor results of these are feasible in higher education
interventions
Entitlement Student is subject to a free and appropriate Student is subject to a free and No specific rights exist for student or Schools and agencies may determine eligibility for
public education outlined in IEP at no cost to appropriate public education outlined in parent services with limited due process for student
parent. Due process rights allow for appeal. 504 plan at no cost to parent. Due process
rights allow for appeal.
Advocacy Family is advocate Family is advocate School staff are the advocates Student is advocate and seeks out supports needed
Changes allowed to Extensive and individualized modifications Accommodations cannot fundamentally No specific requirements, only that Accommodations cannot fundamentally alter the
course of study to course of study are allowed alter the nature of the course of study interventions must be established in nature of the course of study or cause undo hardship
research as effective interventions to school, agency, or employer.
Confidentiality Strict confidentiality limited to school staff Strict confidentiality limited to school staff No specific requirements relating to Confidentiality between school/agency and student
and specialists and specialists achievement under FERPA
Funding Federal, State, and Local funds No funding No funding No funding; colleges may assess a “support fee” to
offset costs of supports
Generalization Carries over each year in public schools, Carries over each year in public education, No specific requirement: may be short Plan is reviewed by college/agency at least yearly
K-12. Yearly progress updates and a re- K-12. A brief yearly review is required. term and not subject to carry-over in and renewed until program is completed
evaluation each three years for continued public school. Plans often do not
eligibility. Meetings can be called at any generalize from elementary to middle
time, as frequently as requested by school to high schools
or parent
Adapted from: Brinckerhoff, L.B., Shaw, S.F., & McGuire, JM (2000)
 SCREENING TESTS FOR AUTISM

Screening tests for autism are often used if there is a heightened concern about possible autism, or as part of a general
assessment of a child's development. Screening for autism is often done prior to a more specific in-depth assessment for
autism. Screening may be used as a part of the assessment process as a method intended to lead to a yes/no decision
that autism is either unlikely or is possible and requires further evaluation. Most screening tests are designed to be brief
and easy to administer.

Many simple screening tests for autism are available to the public through a variety of sources and claim to be useful in
identifying children with autism. Most of these tests have not been evaluated using standard research methods. The
literature review found only one screening test for autism in young children, the Checklist for Autism in Toddlers (CHAT),
that had been evaluated in studies meeting criteria for adequate evidence about efficacy.

Checklist for Autism in Toddlers (CHAT)

The Checklist for Autism in Toddlers (CHAT) is a brief screening instrument that is intended to detect possible autism in
toddlers. Since it is a screening test, the CHAT provides a first level of evaluation leading to a yes/no decision that, at the
current time, autism is either unlikely or is possible (and requires further evaluation). The CHAT was published in 1992
(Baron-Cohen, et. al., 1992). The CHAT takes only about five to 10 minutes to administer and score. Specific training is
not required, and it can be administered by a variety of individuals. The CHAT is designed to be used with toddlers as
young as 18 months of age.

The CHAT consists of nine yes/no questions to be answered by the child's parent. These questions ask if the child
exhibits specific behaviors, including: social play, social interest in other children, pretend play, joint attention, pointing to
ask for something, pointing to indicate interest in something, rough and tumble play, motor development, and functional
play. The CHAT also includes observations of five brief interactions between the child and the examiner, which enable the
clinician to compare the child's actual behavior with the parental reports.

Evidence Ratings: [A] = Strong [B] = Moderate [C] = Limited [D1] = Opinion/No evidence meeting criteria [D2] =
Literature not reviewed

Recommendations

1. It is important to identify children with autism as early as possible. The CHAT is a useful first-level screening
method for children from 18 to 36 months of age in which there is any level of concern about possible autism. [A]

2. If screening using the CHAT suggests possible autism, further assessment is needed to determine a diagnosis. [A]

3. If screening using the CHAT suggests autism is unlikely, it is still important to:

○ assess the child for other developmental or medical problems that may have caused the initial concern.

○ continue regular periodic surveillance for problems that may be related to the cause of the initial concern. [A]
4. It is important to remember that not all children with autism can be identified early. Because the time of onset and
severity of symptoms vary, it is recommended that screening be repeated at various age levels when concerns for
autism persist. [D1]

AUTISM ASSESSMENT INSTRUMENTS

Several standardized tests and checklists have been developed to help assess the behavior of children with possible
autism. These tests are also intended to further evaluate children in whom autism is considered possible (due to parent
concerns, clinical clues, and/or positive screening test results).

These assessment instruments can be used in various ways in assessing children with possible autism. Sometimes these
instruments can be used to determine if autism is likely, so that a decision can be made to seek a specific diagnosis. At
other times, some of these assessment instruments may be used as part of the formal diagnostic process. Finally, in
certain instances some of these instruments may be used to rate the severity of symptoms, which may be useful in
assessing interventions, periodic monitoring of the child's progress, and assessing outcomes.

This section is divided into the following six parts:

● Autism Behavior Checklist (ABC): a behavior checklist completed by a parent.

● Autism Diagnostic Interview-Revised (ADI-R): a structured interview.

● Childhood Autism Rating Scale (CARS): a test combining parent reports and direct observation by the professional.

● Pre-Linguistic Autism Diagnostic Observation Schedule (PL-ADOS), a test using direct observation of the child's
behavior as elicited by the examiner.

● Reviews of other evidence about behavior rating scales.

● Reviews of other evidence about structured interviews.

The first four tests reviewed in this section (ABC, ADI-R, CARS, and PL-ADOS) are individual autism assessment
instruments (or tests) that have been specifically designed to assess children with possible autism and which are currently
available for use by U.S. clinicians. All of these tests rely on either historical information about the child's behavior (usually
provided by a parent), direct observation of the child by a professional, or a combination of these methods.

Tests that rely on historical information may be in the form of behavior checklists or structured interviews. Behavior
checklists (such as the ABC) are lists of questions to be completed by parents and later scored by a professional.
Structured interviews (such as the various versions of the ADI) are composed of a prescribed set of questions and
interview protocol that the professional uses to question the parents.

Tests that rely on direct observation of the child by a professional (such as the PL-ADOS) often prescribe specific ways
for the examiner to elicit responses from the child. These tests also have a standardized method for scoring the observed
behaviors. The CARS was the only autism assessment instrument reviewed that combines both historical information from
a parent and direct observation of the child by the professional. The CARS also provides a total score that can rate the
severity of behavior.

Tests reviewed that are not readily available in the US

This section also includes additional evidence about the efficacy of two autism assessment instruments that are not
readily available to U.S. clinicians. The instruments evaluated include several versions of the Behavioral Summarized
Evaluation (BSE), which is a behavior rating scale, and the Parent Interview for Autism (PIA), which is a structured
interview. Those studies which used the BSE (and met criteria for adequate evidence about efficacy) were done in France
or Italy. The BSE is not commonly used in the U.S. as an assessment instrument. Although the PIA was developed in the
U.S., it is described only in a few research studies, and is apparently not currently widely available to clinicians.

The panel considered the evidence regarding the PIA and BSE to be useful for supporting some general
recommendations about the use of autism assessment instruments. However, since the BSE and PIA are not readily
available in the U.S. at this time, the panel chose not to make any specific recommendation regarding these specific
testing instruments.

Autism Behavior Checklist (ABC)

The Autism Behavior Checklist (ABC) is a list of questions about a child's behaviors. The ABC was published in 1980
(Krug et al., 1980) and is part of a broader tool, the Autism Screening Instrument for Educational Planning (ASIEP) (Krug
et al., 1978). The ABC is designed to be completed independently by a parent or a teacher familiar with the child who then
returns it to a trained professional for scoring and interpretation. Although it is primarily designed to identify children with
autism within a population of school-age children with severe disabilities, the ABC has been used with children as young
as 3 years of age.

The ABC has 57 questions divided into five categories: (1) sensory, (2) relating, (3) body and object use, (4) language,
and (5) social and self-help.

Evidence Ratings: [A] = Strong [B] = Moderate [C] = Limited [D1] = Opinion/No evidence meeting criteria [D2] =
Literature not reviewed

Recommendations

1. The ABC appears to have limited usefulness in identifying children with autism who are under the age of 3. [A]

2. When used in conjunction with other diagnostic instruments and methods, the ABC may have some usefulness as a
symptom inventory to be completed by parents or teachers. Clinicians could utilize this inventory in structuring their
evaluation. [D1]

Autism Diagnostic Interview - Revised (ADI-R)

The Autism Diagnostic Interview-Revised (ADI-R) is a semi-structured interview for a clinician to use with the child's
parent or principal caregiver. The original version of this test, the Autism Diagnostic Interview (ADI) was published in 1989
(LeCouteur et al., 1989) and was correlated to the ICD-10 definition of autism. The original ADI was intended primarily for
research purposes, providing behavioral assessment for subjects with a chronological age of at least five years and a
mental age of at least two years. The ADI-R (Lord et al., 1994) is a shorter version of the ADI, which has been developed
for clinical use. It is intended to be briefer and more appropriate for younger children than the ADI. The ADI-R takes from
11/2 to 2 hours to administer and can be used with children as young as two years of age (with a mental age greater than
18 months). The ADI and the ADI-R focus on getting maximal information from the parent about the three key areas
defining autism: (1) reciprocal social interaction; (2) communication and language; and (3) repetitive, stereotyped
behaviors.
Recommendations

1. The ADI-R may be useful as part of a multidisciplinary intake assessment in diagnosing young children with possible
autism. [C]

2. Because of the time needed to administer the ADI-R, and the extensive training needed, this test may not be a
practical assessment method in all clinical situations. [D1]

3. A structured parent interview, such as the ADI-R, is a method that can help maximize parental recall but is not a
substitute for direct observation of the child by a professional assessing the child. Therefore, it is important to
supplement structured parent interviews with direct observation of the child. [D1]

Childhood Autism Rating Scale (CARS)

The Childhood Autism Rating Scale (CARS) is the most widely used standardized instrument specifically designed to aid
in the diagnosis of autism for use with children as young as 2 years of age. Published in 1980 (Schopler et al., 1980), the
CARS was originally correlated to the DSM-III and then to the DSM-III-R. The CARS is intended to be a direct
observational tool used by a trained clinician. It takes about 20-30 minutes to administer.

The 15 items of the CARS include: Relationships with People, Imitation, Affect, Use of Body, Relation to Non-human
Objects, Adaptation to Environmental Change, Visual Responsiveness, Auditory Responsiveness, Near Receptor
Responsiveness, Anxiety Reaction, Verbal Communication, Nonverbal Communication, Activity Level, Intellectual
Functioning, and the clinician's general impression.

Evidence Ratings: [A] = Strong [B] = Moderate [C] = Limited [D1] = Opinion/No evidence meeting criteria [D2] =
Literature not reviewed

Recommendations

1. The CARS may be useful as part of the assessment of children with possible autism in a variety of settings: early
 intervention programs, preschool developmental programs, and developmental diagnostic centers. [A]

2. Among the autism assessment instruments reviewed, the CARS appears to possess an acceptable combination of
practicality and research support, despite the limited research on its use in children under 3 years of age. [A]

3. Because it gives a symptom severity rating, the CARS may be useful for periodic monitoring of children with autism
and for assessing long-term outcomes. [D1]

4. It is very important that professionals using the CARS have experience in assessing children with autism and have
adequate training in administering and interpreting the CARS. [D1]

5. An autism assessment instrument that is practical, is supported by research, and includes a severity rating (such as
the CARS) may be useful for collecting consistent information to assist with estimating the prevalence of autism and
assess functional outcomes (especially if tied to other information about interventions and service delivery). [D1]

Pre-Linguistic Autism Diagnostic Observation Schedule (PL-ADOS)

The Autism Diagnostic Observation Schedule (ADOS; Lord et al., 1989) consists of eight tasks, four focusing on social
behaviors and four on communicative behaviors. The test was intended primarily for older, higher-functioning, verbal
autistic children. The Pre-Linguistic Autism Diagnostic Observation Schedule (PL-ADOS; DiLavore et al., 1995) is a
version of the ADOS modified to diagnose young children (under the age of 6 years) who are not yet using phrase
speech. It is a semi-structured assessment of play, interaction, and social communication and takes about 30 minutes for
a trained clinician to administer.

Recommendations

1. The PL-ADOS may be useful as part of a multidisciplinary intake assessment in diagnosing young children with
possible autism. [C]

2. Since extensive training is needed to learn how to administer the PL-ADOS, it may not be a practical assessment
method in certain clinical situations. [D1]

Reviews of Other Evidence About Behavior Rating Scales for Autism

Because the BSE may not be readily available to U.S. clinicians, no specific recommendations on the use of this test
were made. However, evidence from scientific studies about the use of various versions of the BSE for identifying young
children with autism is used as the basis for supporting some general recommendations about the use of autism
assessment instruments that provide a symptom severity rating.

The Behavioral Summarized Evaluation (BSE) (Barthelemy et al., 1992) is a rating scale developed in France and
designed to measure changes in behavior in autistic children and adolescents. The BSE is intended to be completed by
someone having daily contact with the child. Its primary use has been as a weekly or biweekly measure of clinical status
of autistic children participating in various intervention studies. However, the original version of the BSE, a revised version
(BSE-R) (Barthelemy et al., 1997) and a downward extension of the BSE known as the Infant Behavioral Summarized
Evaluation (IBSE) (Adrien et al., 1992) have all been analyzed for their ability to identify autism in children.

Evidence Ratings: [A] = Strong [B] = Moderate [C] = Limited [D1] = Opinion/No evidence meeting criteria [D2] =
Literature not reviewed

Recommendations

1. An autism assessment instrument that provides a symptom severity rating may be useful for periodic monitoring of
children with autism and for assessing outcomes. [D1]

2. A behavior rating scale completed by someone familiar with the child (such as a parent, early childhood professional
or teacher), when interpreted by a professional with expertise in assessing children with autism, may provide
information that is useful in helping to identify and diagnose children with autism. [A]
Reviews of Other Evidence about Structured Parent Interviews for Autism

The Parent Interview for Autism (PIA) is an instrument that was used in a research study and might not be readily
available to practicing clinicians. Therefore, the panel chose not to make specific recommendations on using the PIA, but
reviewed evidence from the study to make general recommendations about the use of structured parent interviews for
young children with possible autism.

The Parent Interview for Autism (PIA; Stone and Hogan, 1993) is intended to elicit relevant information about children
functioning at the preschool level and below. The PIA is a respondent-based interview that requires parents to make
judgments about the frequency of occurrence of specific behaviors. PIA items are administered verbally, so that parents'
questions can be clarified. Administration of the PIA takes approximately 30-45 minutes.

Recommendations

1. A structured parent interview may be useful as part of the assessment of children with possible autism, especially if
there is research evidence that the particular assessment instrument has adequate sensitivity and specificity for
identifying children with autism. [A]

2. It is important to supplement the structured parent interview with direct observation of the child. [D1]

"Reprinted from the Clinical Practice Guideline Report of the Recommendations, Autism/Pervasive Developmental Disorders, Assessment and
Intervention for Young Children (Ages 0-3 Years), 1999, with permission of the New York State Department of Health."