When Should My Child Be Re-Assessed?
Ted Wormeli, Ed. D., POPARD Psychologist/Consultant
Since 2004 in BC the protocol in the Standards and Guidelines for the Assessment and Diagnosis of Young Children with Autism Spectrum Disorder in British Columbia1 for diagnostic assessment of children under six includes:
- detailed history covering development and presenting concerns;
- review of all community referral materials and previous assessments;
- consultation with other professionals and disciplines involved;
- use of a standardized, structured, caregiver ASD interview;
- use of a standardized, structured ASD observation instrument.
If the clinical diagnostic assessment finds a diagnosis of ASD is probable, the child requires a comprehensive multi-disciplinary assessment which must include:
- psychological assessment;
- speech-language-communication assessment;
- medical evaluation.
A diagnosis of ASD may also require one or more of the following:
- occupational therapy assessment;
- comprehensive family assessment;
- psychiatric assessment;
- additional specialty assessments (p. 6).
The Ministry of Education in Special Education Services: A Manual of Policies, Procedures, and Guidelines2 subscribes to the Standards.
For designation as a student with ASD (which qualifies a student for supplementary funding during the K-12 years), it requires, for children over age six:
- mental health review (including history and mental status examination);
- evaluation of developmental level;
- review of community records and prior assessments;
- history guided by use of a standardized ASD diagnostic interview with the primary caregivers (ADI-R);
- documentation of use of appropriate tool as well as details of data that the tool generated;
- administration of a standardized ASD diagnostic observation of the patient (ADOS);
- documentation of use of appropriate tool as well as details of data that the tool generated (p. 87).
The protocol for assessment described in the Standards is a comprehensive diagnostic assessment, a “gold standard.” Current Ministry of Education core requirements for designation do not explicitly require all of the components for diagnosis that are described in the Standards, but text is supportive of a comprehensive assessment.
Because the provision of special education services is expensive and time-consuming for both the recipient and the provider(s), it behooves us to try to insure that it is useful and sufficient. We cannot know easily if services are sufficient unless assessment is reasonably comprehensive. Re-assessment should be considered if:
- for any reason an initial diagnostic assessment, especially for older children, did not include the elements of assessment listed in the Standards, or
- it is believed that some portions of a comprehensive assessment are no longer valid or applicable with regard to development, learning, or behaviour
It is reasonable to consider either assessment of those portions that were not examined or a re-assessment of those portions that are in need of revision. In regard to the latter, it is not uncommon for some portions of an assessment performed in preschool years, especially those relating to intellectual ability or learning difficulties, to have limited applicability to programming for children enrolled in intermediate grades.
Another reason for redoing portions of an assessment is to address potential needs that may emerge after transitions, such as elementary → secondary school or school-age → adulthood. Writing sufficient and responsive Individual Education Plans relies on comprehensive assessments that include those elements that ought to be addressed in planning the most appropriate educational experiences for a child. As well, for the transition to adulthood, some students with ASD may be eligible for support from Community Living BC. The determination of eligibility for CLBC services may require an up-dated psychoeducational assessment of intellectual ability and/or adaptive functioning.
Because assessments are in themselves expensive and time-consuming for all who are involved, it is helpful for parents and school staff to consult with a psychologist before deciding to have an assessment or re-assessment performed.
What to Do Before the Psychologist Comes?
The first thing to do, after deciding to have your child assessed or re-assessed by a psychologist, might be to gather as many documents as you can that will help the examiner to understand your child. These could include:
- diagnostic reports
- individual education plans
- report cards
- medical records (including hearing and vision reports)
If your child attends school, the school will have some of these but not necessarily all, depending on what you have shared. The school may only have report cards, IEPs, and documentation required for designation as a student with ASD. The last may not include a diagnostic report.
Second, if your child has not been to an optometrist in the last two years, make an appointment. Vision assessment for children by an optometrist is paid for by our government and does not require a physician’s referral. It is very important to do if your child is experiencing any learning difficulties in school, but it is also a good idea to monitor vision every year or two. Ask for a printed result that you can keep at home and/or place in your child’s school file. If the results of this examination result in the provision of a first pair of glasses, it would be best to postpone the psychologist’s assessment for a few weeks, especially if the glasses are intended to worn for near-point work (e. g., reading) allow your child to accommodate to the glasses.
Third, if your child has not had an assessment of hearing by an audiologist, or if s/he has had a previous hearing assessment with abnormal results, make an appointment with either a public health audiologist or with a private audiologist. Hearing is critical for learning, as well as for language and social development. Ask for a report that you can keep. If your child had a hearing assessment by an audiologist that was completely normal a few years ago, that will likely do. Note that generally the most comprehensive and valid assessments of hearing are those that are conducted in a sound-proof booth by a registered audiologist. As with vision, if a problem does emerge from evaluation of hearing, a psychological or psychoeducational assessment is best postponed until the hearing issue is resolved or completely understood.
Fourth, insure that the provider who is performing the assessment is qualified to do the assessment and to make additional diagnoses that might be helpful to your child. In BC, this means that the examiner must be a registered psychologist, registered school psychologist, or certified school psychologist. Schools, school districts, and CLBC will not accept psychoeducational reports that are written by anyone else.
Fifth, prepare for your initial interview with the examiner. Make a list of questions that you might have. Note that if you decide at the time of that first interview that you do not want to proceed with the assessment, you can terminate the process. It is your right to do so. If you wish to proceed with the assessment, be sure to discuss with the examiner how to support the assessment. For example, if the assessment will be performed outside of your child’s school, you might discuss with the examiner the possibility of taking a picture of the examination office to show your child, or you might schedule a drive-by or brief visit for your child to say “hello.” Consider what incentives might encourage your child to do his/her best during the assessment and discuss what might make the assessment more difficult. Discuss both the length and timing of assessment sessions.
Finally, help your child to be as rested as possible, to have eaten, and to be as calm as possible during the assessment. That means that it is important, that as your child’s parent(s), you be calm as well!