Assessment Day: Questions About the Communication Development of Your Young Child with an Autism Spectrum Disorder
Contributed by Beverly Vicker, M.S., CCC-SLP
It is normal for parents to be worried about any assessment or evaluation of their young child. Parents will be worried about the results or outcome of the assessment but they might also be anxious about what questions will be asked. It is always difficult to deal with something that is unknown or unfamiliar.
What questions are asked may depend on who is doing the assessment or evaluation and the purpose of the assessment. For example, one examiner may be concerned whether: (1) There is a delay or difference in your child's development compared to his or her age; and (2) If the delay or difference is significant enough to qualify him or her for services under state guidelines. In Indiana, for example, a child must have a 20% delay in the communication area to qualify for the state's First Steps or birth to three intervention program. Various other questions might be asked by an examiner if he or she is trying to make a differential diagnosis, i.e., he or she is considering autism spectrum disorder and/or some other diagnosis. More detailed questions might be asked if the examiner is gathering information to determine a starting point or baseline for your child's intervention program.
The purpose of this article is to identify some of the questions that you might be asked during a language/communication assessment for program eligibility or for a diagnosis. Although the article was written to help parents, speech language pathologists may also wish to use some of the questions to supplement the information they have gathered through any formal published communication inventory.
There is a reason that you as the parent may be asked lots of questions about your child and his or her communication skills. Sometimes it is difficult to directly assess or evaluate the child suspected of or diagnosed with an autism spectrum disorder. The assessment or evaluation may need to consist of an observation and many interview questions rather than extensive direct testing of the child. How much you as the parent will be asked, will depend on your child's skill level. Frequently, the more able the child, in terms of communication skills, the more direct assessment of the child that may take place. Generally it is the child with fewer skills that necessitates a high dependence by the examiner on using interview questions.
Areas or topics that might be probed include the following: developmental history and patterns of development, language development in terms of comprehension and expression, means/interest/effectiveness of communication, and play behavior. The following sections will give you some clues about the questions that might be asked. This advance information will give you time to think about the questions before the assessment or evaluation occurs. You might want to review family video to help you remember what was happening at a specific age. You might want to jot down some notes so you don't forget information or examples. Remember the purpose of this list is to make you less anxious rather than more anxious. The list may also trigger some other observations that you wish to share or questions that you wish to ask of the examiner. It is OK to tell the examiner that you don't remember exact details or to acknowledge that you need to guess about skills or an age level.
The History of Development and Pattern of Development
At what ages did your child coo, babble, use jargon speech and use his or her first words (cooing = vowel like sounds; babbling= consonant+vowel play such as "bababa"; jargon= vocal production that sounds like speech but is really nonsense)?
- Was he or she as vocal and responsive to your communication efforts as other children when they were that age (e.g., brothers and sisters, cousins, neighborhood children)? Did he or she look at you, smile, and vocalize? Did he or she often turn away or ignore you when you talked to him or her?
- Was there anything different about your child's pattern of development? Did he or she make steady progress with communication milestones? Did he or she ever lose skills?
- Did he or she have frequent ear infections or any other significant illness?
- Did he or she have feeding or eating problems?
Comprehension of Language
- At what age did your child turn toward whomever said his or her name?
- Does he or she stop an activity, even briefly, if told “No”?
- Does he or she seem to recognize common words such as names of family members, animals, food, and familiar places when someone is talking directly to him or her? Recognition may be signaled by excitement, smiling, running to go get a jacket or some other such behavior.
- Does he recognize pictures of common items and will he or she point to them in a book when asked? ("Where's the ball? Find the ball.")
- Does he recognize key words or phrases in overheard conversation and have expectations built upon having heard those messages? Mom might say to Dad that she didn't feel like cooking. Maybe he should go to McDonalds.
- Does he or she follow familiar directions such as "Go get a diaper."
- Does he or she have special, intense, or unusual interests? Does he or she respond to requests to point to the specific high interest items by name in books, videos, or the environment? This may include letters of the alphabet, numbers, shapes, colors, types of dinosaurs, car models, types of plumbing fixtures, and so forth.
- Does he or she have an interest in books and songs? How does he or she show an interest? What are some of his or her favorites books and songs?
- When talking to your child, do your sentences need to be kept short and simple in order to aid his or her comprehension? Can you give examples?
- Is comprehension more difficult if there is background noise or if the content is unfamiliar to your child?
- Can his or her attention be directed through words and a pointing gesture? For example, can you say, “Jacob, look at the sky” and he will follow your point to the intended object in the sky?
Expression of Language
- Does the child use spoken language such as words or word attempts that familiar people can recognize?
- Describe his expressive vocabulary - estimate of size, types of words in his or her vocabulary (e.g., names of objects or every model of car but no names of people or action words). Does he or she keep increasing the vocabulary base or do some words drop out and are never heard again or are heard infrequently?
- Does your child speak in unique sentences of two or more words? Are they sentences that he or she has created for the situation? This means he or she is not echoing what others have said.
- Does he or she use word endings to indicate plurality or verb tense such as "-s," "-ing," and "-ed."?
- How much of what is expressed is memorized (e.g., immediate or delayed echoed speech) rather than messages that are created in the moment to fit each new situation?
- How understandable is the spoken language to adults and children who see your child quite often versus to strangers or family members who rarely see him or her?
Means/Interest/Effectiveness of Communication
- How interested is your child in communicating or interacting with others?
- Who are his or her typical communication partners?
- How often during the course of the day does he or she communicate with someone?
- Is there a difference between what he or she can express and what he or she appears to understand?
- Is your child able to make requests, refuse, ask questions, comment, share information, and/or engage in simple conversations?
- Does your child primarily communicate using speech, gestures, sign language, picture exchange, or communication displays/ devices?
- Does he or she initiate interaction, or does he or she need cues or prompts?
- Regardless of what method is used, how effective is he or she at getting his or her messages understood?
- Are there situations where behavior challenges occur because of your child's limitation in communication skills? What situations are most difficult?
Depending on the team composition, the questions about play behavior may be asked by team member other than the speech pathologist.
- Name some of your child's favorite toys, his or her favorite solitary play activities, and his or her favorite play activities with you.
- Describe how your child currently plays and how he or she had played in the past. Consider the following:
- Does he or she play with the toy the way you expected?
- Does or did your child ever perform the same action pattern with a particular toy day after day with almost no variation? For example, he may have pushed a specific car along the same route across the floor on a daily basis.
- Does or has your child spent considerable time spinning objects, lining them up in rows, sorting them into piles, or waving them in front of his or her eyes?
- Does your child have any unusual objects that he or she prefers for playtime?
- Does any pretend play occur? What does your child pretend to do and is it something that has been taught by someone or learned from a video?
- Does your child like physical play such as wrestling, chasing, or being tickled?
- Describe the way your child currently spends playtime. Consider the following:
- How much of play time is spent wandering the house or a particular room and not knowing how to get involved with some toys?
- How much time is spent quietly sitting somewhere or laying on the floor without getting involved in some play?
- How much of playtime is spent climbing, jumping or spinning him or herself?
- How much of playtime is spent looking at books by him or herself?
- How much of playtime is spent watching videos or TV?
- How much of playtime is spent playing with the computer?
- How much of playtime is spent being alone versus interacting with adults, peers, or siblings?
- How often does he or she seek out someone else to play with him or her?
When a child is assessed or evaluated for communication skills, the types of questions asked may vary by the purpose and the circumstances associated with the assessment/evaluation. The purpose of this article is to give parents some advance knowledge about questions that might be asked. This will allow parents to reflect and scan their memories for information that might otherwise be difficult to retrieve in the moment during an interview.
Vicker, B. (2003). Assessment day: Questions about the communiction development of your young child with an Autism Spectrum Disorder. The Reporter, 8(2), 18-21.