Diagnosing Autism Spectrum Disorders: A Lifespan Perspective PDF
Preview Diagnosing Autism Spectrum Disorders: A Lifespan Perspective
P1:OTE/OTE/SPH P2:OTE JWBK386-FM JWBK386-Gallo January8,2010 21:33 PrinterName:YettoCome Diagnosing Autism Spectrum Disorders Diagnosing Autism Spectrum Disorders: A Lifespan Perspective Donald P. Gallo © 2010 Donald P. Gallo. ISBN: 978-0-470-74924-1 P1:OTE/OTE/SPH P2:OTE JWBK386-FM JWBK386-Gallo January8,2010 21:33 PrinterName:YettoCome Donald P. Gallo Diagnosing Autism Spectrum Disorders A Lifespan Perspective AJohnWiley&Sons,Ltd,Publication P1:OTE/OTE/SPH P2:OTE JWBK386-FM JWBK386-Gallo January8,2010 21:33 PrinterName:YettoCome Thiseditionfirstpublished2010 (cid:2)C 2010DonaldP.Gallo Wiley-BlackwellisanimprintofJohnWiley&Sons,formedbythemergerofWiley’sglobalScientific, Technical,andMedicalbusinesswithBlackwellPublishing. RegisteredOffice JohnWiley&SonsLtd,TheAtrium,SouthernGate,Chichester,WestSussex,PO198SQ,UK EditorialOffices TheAtrium,SouthernGate,Chichester,WestSussex,PO198SQ,UK 9600GarsingtonRoad,Oxford,OX42DQ,UK 350MainStreet,Malden,MA02148-5020,USA Fordetailsofourglobaleditorialoffices,forcustomerservices,andforinformationabouthowtoapplyfor permissiontoreusethecopyrightmaterialinthisbookpleaseseeourwebsiteat www.wiley.com/wiley-blackwell. Therightoftheauthortobeidentifiedastheauthoroftheeditorialmaterialinthisworkhasbeenasserted inaccordancewiththeCopyright,DesignsandPatentsAct1988. Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,or transmitted,inanyformorbyanymeans,electronic,mechanical,photocopying,recordingorotherwise, exceptaspermittedbytheUKCopyright,DesignsandPatentsAct1988,withoutthepriorpermissionofthe publisher. Wileyalsopublishesitsbooksinavarietyofelectronicformats.Somecontentthatappearsinprintmaynot beavailableinelectronicbooks. Designationsusedbycompaniestodistinguishtheirproductsareoftenclaimedastrademarks.Allbrand namesandproductnamesusedinthisbookaretradenames,servicemarks,trademarksorregistered trademarksoftheirrespectiveowners.Thepublisherisnotassociatedwithanyproductorvendor mentionedinthisbook.Thispublicationisdesignedtoprovideaccurateandauthoritativeinformationin regardtothesubjectmattercovered.Itissoldontheunderstandingthatthepublisherisnotengagedin renderingprofessionalservices.Ifprofessionaladviceorotherexpertassistanceisrequired,theservicesofa competentprofessionalshouldbesought. LibraryofCongressCataloging-in-PublicationData Gallo,DonaldP. Diagnosingautism:alifespanperspective/byDonaldP.Gallo. p.cm. Includesbibliographicalreferencesandindex. ISBN978-0-470-74924-1(cloth)–ISBN978-0-470-74923-4(pbk.) 1.Autism–Diagnosis. I.Title. [DNLM:1.AutisticDisorder–diagnosis.WM203.5G172d2009] RC553.A88.G352009 616.85(cid:3)882075–dc22 2009035846 AcataloguerecordforthisbookisavailablefromtheBritishLibrary. Typesetin11/13ptMinionbyAptaraInc.,NewDelhi,India. PrintedinSingaporebyMarkonoPrintMediaPteLtd 1 2010 P1:OTE/OTE/SPH P2:OTE JWBK386-FM JWBK386-Gallo January8,2010 21:33 PrinterName:YettoCome Formylovingfamily.ToEmilyandJosh—Iwishthatallparents wouldbeasblessedasIhavebeenwithsuchwonderfulchildren. ToDebbie—youaremyeverything. P1:OTE/OTE/SPH P2:OTE JWBK386-FM JWBK386-Gallo January8,2010 21:33 PrinterName:YettoCome Contents Preface ix Acknowledgments xiii AbouttheAuthor xv 1. ABriefLookattheHistoryofAutism 1 2. TheImportanceoftheAutismReferral 5 3. HowtoConducttheEvaluation 17 4. InformationtoGatherattheOutsetoftheEvaluation 33 5. DiagnosticCriteriafortheAutismSpectrumDisorders 39 6. TheMainProblemAreasofAutism:SocialImpairment 45 7. TheMainProblemAreasofAutism:LanguageImpairment 61 8. TheMainProblemAreasofAutism:BehavioralConcerns 79 9. AdditionalQuestionstobeAskedwhenInterviewingTeens 87 10. AdditionalQuestionstobeAskedwhenInterviewingAdults 97 11. OtherImportantFactorstoTakeintoConsideration 105 P1:OTE/OTE/SPH P2:OTE JWBK386-FM JWBK386-Gallo January8,2010 21:33 PrinterName:YettoCome viii Contents 12. DifferentialDiagnosisthroughtheLifespan 117 13. FeedbackforthePatientandFamily/Parents 143 AppendixA: SampleCopyofMyQuestionnaire 151 AppendixB: SampleCopiesofReports 157 References 179 Index 181 P1:OTE/OTE/SPH P2:OTE JWBK386-FM JWBK386-Gallo January8,2010 21:33 PrinterName:YettoCome Preface In late 2000, I was hired by Kaiser-Permanente to be the psychologist for their AutismSpectrumDisorderDiagnosticServiceintheSanFernandoValleyofLos Angeles.ThispositioncameaboutbecauseCalifornia’sAssemblyBill88requires insurance plans to provide coverage for the diagnosis and medically necessary treatmentofnineseverementalillnesses,includingautismandpervasivedevel- opmentaldisorder. Between my position there and my private practice, I have conducted ap- proximately 1,500 evaluations on a wide variety of individuals ranging in age from12monthsto65years.Itypicallyconductfivetosixevaluationsaweek.In the beginning, I was seeing mostly young children for autism evaluations after receivingreferralsfromtheirpediatricians.Afterawhile,Ibeganseeingpatients inallageranges,from16monthsto55yearsold. Atfirst,Ireliedratherheavilyontheuseofformalscreeningdevices,suchas theChildhoodAutismRatingScale(CARS)andtheGilliamAutismRatingScale (GARS), in addition to the wisdom of a senior psychologist who had worked with Dr. Ivar Lovaas at University of California at Los Angeles decades earlier. Dr. Lovaas is one of the early pioneers of applied behavioral analysis, a way of modifyingthebehaviorofchildrenwithautism. AstimeprogressedandIconductedmoreevaluations,attendedmoreconfer- ences,andreadmorebooksaboutautism,Iincreasedmyunderstandingofthe vastnessoftheautismspectrumandtheneedtobroadenmyapproachtomore fullycomprehendandappropriatelydiagnosetheseindividuals.Inaddition,the early childhood rating scales did not translate easily for adults. As you could imagine,itwouldbemoredifficultforthemotherofa40-year-oldmantorecall earlydevelopmentalmilestonesthanthemotherofafour-year-old. In2001,Icreatedmyownscreeningquestionnaire,whichisreproducedinAp- pendixA.Thisquestionnaireisnotanytypeofempiricallyvalidatedinstrument P1:OTE/OTE/SPH P2:OTE JWBK386-FM JWBK386-Gallo January8,2010 21:33 PrinterName:YettoCome x Preface butmoreofthequestionsthatencompassallaspectsofthespectrumthatIfeel arenecessarytomakeanappropriatediagnosis.BythetimeIfeltcomfortablein myabilitytoappropriatelyidentifychildrenonthespectrum,Iwasbeginningto seeabroaderarrayofagesandwasreadingotherprofessionals’reportsinwhich theyandIappearedtohavevastlydifferentpicturesofthesameindividual. I was diagnosing children and teens as “being on the spectrum” after their parents reported a history consistent with the disorder, and my observations of the individual in my office were consistent with what the parents had told me. However, other professionals were coming up with alternative diagnoses. ChildrenIdiagnosedwithautismwerebeingdiagnosedwithADHD,obsessive- compulsivedisorder,andanxietydisorders,withoutautismbeingconsideredas thereasonforthechild’sproblems. In an effort to better understand the reasons for these various diagnoses, I placedafewphonecallstootherexperiencedautismprofessionalsthroughout theLosAngelesarea,whoseopinionIrespected.WhenIspokewithDr.Laurie Stephens, the former director of the Help Group Center for Autism Spectrum DisordersandnowtheDirectorofClinicalServicesforEducationSpectrumin AltaDena,California,shereportedthatshetoowasfacingthesamedifficulties that I was, namely, that the combination of the broadness of the autism spec- trum, the high number of children and teens being evaluated, and the lack of a commensurate number of professionals trained to diagnose autism created a greatdealofmissedorincorrectdiagnoses. This was the main reason why I felt the need to write this book. I consider myself quite lucky to have been able to learn how to identify symptoms of the autismspectruminanenvironmentincludingothertrainedprofessionalswho have had significant experience in that area and were trained by leaders in the field.Whatabouttheotherprofessionalswhodonothavethatopportunityor whoarenotexposedtoindividualsonthespectruminthenumbersthatIhave seenbecauseofworkingforsuchalargeorganization?Conductingevaluations with children and teens who may have autism on an occasional, monthly, or fortnightly basis is incredibly different than seeing a half-dozen children and teensforevaluationseveryweekforthepast10years. This book is formatted to follow the chronology of an autism evaluation fromstarttofinish.InChapter1,averybriefsynopsisofthehistoryofautism is presented. While that topic could fill an entire book on its own, only the informationthatprovidesthereaderwithbackgroundinformationaboutautism and helps them to answer the main question posed by this book is included; namely,doesthepersonyouareevaluatinghaveanautismspectrumdisorder? In Chapters 2 and 3, information that is necessary for the professional to considerbeforeevenseeingthechildispresented.Chapter4focusesonadditional questionsthatneedtobeaskedbeforeautismisevenconsidered.Chapter5lists the diagnostic criteria of the autism spectrum disorders, while Chapters 6–8 P1:OTE/OTE/SPH P2:OTE JWBK386-FM JWBK386-Gallo January8,2010 21:33 PrinterName:YettoCome Preface xi delveintothespecificareasofimpairmentthatarenecessaryforadiagnosisof autism.Withineachofthosethreechapters,informationwillbepresentedabout several different ranges and the type of information that needs to be obtained beforeadiagnosiscanbemadeorruledout. Chapter9consistsofadditionalquestionstoaskwheninterviewingteensand their families, while Chapter 10 covers interviewing adults and the particular challenges inherent in doing so. Chapter 11 is a compilation of supplemental informationthatIhavefoundtobeextremelyhelpfulinmakingadiagnosisbut arenotfactorsincludedintheDSM-IV-TR.Chapter12includesthenumerous “rule-out diagnoses” that need to be considered before a diagnosis is finalized. The final chapter, Chapter 13, deals with the conclusion of the evaluation and waystoimpartyourfindingstothepatientandtheirparentsorfamily.Copiesof thequestionnaireIcreated,aswellassamplereports,arealsoincluded.Examples ofevaluationsIhaveconductedwillalsobepresentedthroughoutthebook. While this book is obviously not all that a professional would need to be qualifiedtoconductautismevaluations,itprovidesthereaderwith“real-world” experiencesandexamplesthattheywouldnotreceive,orpotentiallyeventhink about,fromlearningaboutthisdisorderinaclassroom. P1:OTE/OTE/SPH P2:OTE JWBK386-FM JWBK386-Gallo January8,2010 21:33 PrinterName:YettoCome Acknowledgments I owe a great debt of gratitude to Kaiser-Permanente in general and Dr. Len Sushinsky in particular for having faith that a newly licensed psychologist can notonlyhandlebutalsoexcelinthepositionthatIwasgiven.Iwouldalsolike tothankSusanBassettforherconstantsupportandforbeingsuchawonderful coworker.AspecialthankstoDr.JerroldParrishforallofhiseditingassistance andbrainstorming,nottomentionallthewonderfulcoffee.
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