Most people have an idea of what a person with Autism might be like. This will depend on their previous experience or what they've watched for instance when Rain Man with Dustin Hoffman was shown, people assumed all children with ASD were like that with extra abilities in one area. Many teachers tell me they've worked with children with autism before when I'm discussing a potential new one, as if that makes them experts. The real truth is that the spectrum is so wide and each individual so different, that its very hard to be an expert in all aspects of ASD: 'when you've met one person with autism, you've met one person with autism' is by far the best quote I've come across. We must be aware of the aspects of ASD and potential strategies to help but each will require their own individual programme.
Diagnosing ASD can be very straight forwards with some children because the red flags are so numerous while others can be very difficult because they have become skilled at coping and the right questions must be asked in the right situations. Dr Ravi from 'Born Naughty' says that for some children, its like appraising fine art' so just like some of us may look at a Picasso and think that's definitely NOT art, others would be able to admire the subtle messages portrayed within.
When you first met Thomas, you don't see any red flags initially: non verbal communication, language skills and even pragmatic skills can look to be within normal limits to the un-trained eye. I saw him in a clinic situation at first, we chatted, played a little and did some formal and informal language assessments. He coped well with the filming and having to do things again for the camera angle. We'd dedicated the entire afternoon to the initial part of the assessment so we had a tea-break in the middle.
At this point, I hadn't spoken to his mother very much as my plan was to see her after Thomas so he could get something to eat and so we weren't talking in front of him. While we were in the kitchen area, she showed me her phone with a video of Thomas having a temper tantrum. It wasn't a major one, in fact as a mother of a child the same age, I would say it was 5/10, BUT my son would be absolutely mortified if he thought I'd told anyone let alone, videoed and shown it. Was Thomas bothered? No way, he didn't see that I would think anything.... he has impaired perspective taking, he couldn't put himself in others shoes (no theory of mind) and I needed to explore that route.
I saw him at his special sports club with his instructors: he didn't follow any instructions yet told everyone else what to do. The other children all attended special, schools but he didn't notice their differences.
I spent some time at home before doing the first session of social thinking (Garcia-Winner) which is about being a social detective. I introduce the session and then lie on the floor while I'm still talking...... did he look shocked, look to see where I'd gone, say anything about an adult lying on a classroom floor? NO, he carried on talking!! I got out the ASD assessment!
Sure enough he scored a profile which together with the parental interviews and Ravi's observations, would suggest mild to moderate ASD.
With the programme, you get a snapshot of the assessment, which actually took several days over a month. Thomas was seen at home, in a school setting, sports group setting and in a clinic by me and at home by the Paediatrician. I interviewed parents on three separate occasions too. ASD diagnosis needs to be thorough to be sure.
Perspective taking and high level ASD is fascinating and we'll look at that more another time.