Autism Basics

Autism Information

Autworks strives to provide information that creates autism awareness. Prevalence rates and other facts stress the importance of understanding autism, and the need for more research and more collaboration.

Leo Kanner published his novel study on 11 children in 1943 and labeled them with what he called 'infantile autism'. Children who were autistic had a term coined just for them, and could be diagnosed correctly, instead of being clustered with mental retardation, schizophrenia, or other neurological diseases. It would still be decades before Kanner's insight into the diagnosis of autistic children became wholly recognized.

The Autism Society of America was established in 1965 as an advocacy group, however, autism was still being classified under schizophrenia. In 1971, the 'refrigerator mother' theory of autism emerged. This theory claimed that autistic children were withdrawn from others because their mothers were 'cold as refrigerators' and did not show the affection needed to raise appropriately communicating children. Fortunately, after 9 years, and in time for the publication of the Diagnostic and Statistical Manual (DSM) - III, autism seceded from its previous classification and was was recognized as a developmental disorder.

The DSM-IV, published in 1994, further honed the specifications required to classify someone as autistic. Additionally, autism was realized to be a spectrum disorder, with the phenotype manifesting in many combinations of behavior. The formation of groups, such as the National Alliance for Autism Research and Cure Autism Now, were catalysts for the growth of awareness that more autism research was needed. The National Institutes of Health (NIH) estimated in 2000 that 1 in 500 children were being born with an Autism Spectrum Disorder. The Centers for Disease Control, (CDC) now puts the number at 1 in 110.

One of the most widely used diagnostic instruments is the Autism Diagnostic Interview - Revised (ADI-R). It can be used to diagnose children or adults, and contains 93 questions which focus on three main areas of developmental delay: reciprocal social interaction, communication and language, and restricted and repetitive, stereotyped interests and behaviors. There are many diagnostic instruments, which help pinpoint the characteristic phenotypes of each child or adult for guidance in providing targeted therapies.

Diagnostic instruments are not only used to obtain a diagnosis, but to gain information that provides a parent, teacher, caregiver, or doctor with full insight into a particular individual's phenotype. Many of the instruments ask for much more information than is needed to make a diagnosis for this reason. The more information, the better, and more tailored, the treatment plan. There is not a single set of symtoms to define ASDs, but rather the three areas of impaired development as discussed above. The three most common labels of ASDs are Autistic Disorder (classic autism), Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS or atypical autism), and Asperger's disorder.

Having a community network of autism-affected familes and friends can be the best way to share knowledge and find other autistics with very similar phenotypes. This opens the door for communication, whether it is for support, making friends, or suggesting therapies that have worked for them.

The DSM-V is set to be published in 2013 with revised 'must meet' requirements for Autism Spectrum Disorder.

Diagnostic Instruments

Instrument Name Description Citation PDF
Aberrant Behavior Checklist (ABC) (Aman, Singh, Stewart, & Field, 1985) The ABC consists of five subscales and takes about 10-15 minutes to complete. It is meant for people aged six to 54 years of age and checks symptoms of irritability and agitation, lethargy and social withdrawal, stereotypic behavior, hyperactivity and non-compliance, and inappropriate speech. The test can be completed by anyone with direct knowledge of the person being assessed. Aberrant Behavior Checklist (ABC) PDF
ADI-R (Rutter, LeCouteur, & Lord, 2003) The Autism Diagnostic Interview - Revised is a structured, interview-based instrument administered to the parent or caregiver of the referred child by a trained professional. The most recent version was published in 2003 and contains 93 questions, which takes about on and a half to two and a half hours to complete. These questions measure social interaction, communication, and patterns of behavior in order to make an evaluation of autism in a child, or to differentiate this disorder from other developmental disorders. ADI-R PDF
ADOS-G (Lord, Rutter, DiLavore, & Risi, 1999) The Autism Diagnostic Observation Schedule - Generic contains four modules. Which test is taken by the affected is determined by age and level of speech and development. A trained professional administers the test and answers questions related to the diagnosis of pervasive developmental disorders and based on his or her observations of the test taker performing various tasks. The activity time takes about 30-45 minutes to complete. The child should be at least at a non-verbal developmental level of 12 months and able to walk independently for a valid interpretation of the scoring algorithm. ADOS-G PDF
ADOS Module 1 Pre-verbal children and young children with no consistent phrase speech take this module. They take part in activities that test name recognition and interests such as free play and imitation. ADOS PDF
ADOS Module 2 Given to children who have phrase speech but are not fluent talkers, this module includes many of the same activities as Module 1. ADOS PDF
ADOS Module 4 Module 4 is administered to adolescents and adults who are verbally fluent. The activities are the same as Module 3, although some are considered optional. ADOS-4 PDF
Behavior Rating Inventory of Executive Function (BRIEF) (Gioia, Isquith, Guy, & Kenworthy, 2005) This instrument is meant to evaluate developmental and acquired neurological conditions including learning disabilities, ADHD, traumatic brain injury, low birth weight, Tourette's Disorder, and autism. The age range is from five to 18 years, and there are 86 items on the exam, which only requires about 10-15 minutes to take. The eight clinical scales and two validity scales in BRIEF form two broader indexes: behavioral regulation and metacognition. BRIEF PDF
Broad Autism Phenotype Questionnaire (BAPQ)(Hurley, Losh, Parlier, Reznick, & Piven, 2007) Intended for relatives of autistics, the BAPQ measures language and personality characteristics of the broad autism phenotype. There are 36 items on the test, which take about 10-15 minutes to complete. The three subscales (each with 12 questions) quantitatively measure characteristics that correspond to the diagnosis of autism in the DSM - IV: social deficits, stereotyped-repetitive behaviors, and social language deficits. BAPQ PDF
Child Behavior Checklist (CBCL) OR Adult Behavior Checklist (ABCL) (Achenbach, 2001) The format is a parent-report questionnaire where the subjects are between one and a half and five years for one version and between six and 18 for another version, which has 140 questions. The test can take anywhere from 15 minutes to just under an hour and addresses social and emotional problems, as well as involvement in social activities and hobbies. It is meant to provide a diagnostic (mainly for ADD or ADHD) or evaluative assessment.
The ABCL is for those ages 18 to 59 years and is to be filled out by someone who knows the adult very well. It contains scales for adaptive functioning, empirically based syndromes, substance use, internalizing, externalizing, and total problems.
CBCL/ABCL PDF
Children's Communication Checklist - 2 (CCC-2) (Bishop, 2006) Meant for children ages four to 16 years and 11 months, this 70-item questionnaire can be filled out by parents, caregivers, teachers, etc. It only takes about 5-10 minutes to complete and is used to rate aspects of communication such as speech, vocabulary, sentence structure, and social language skills. It is also used to screen for general language impairments or for the possibility of further testing for an autism spectrum disorder, and it is used to identify children with pragmatic language impairment. CCC-2
Clinical Evaluation of Language Fundamentals - Fourth Edition (CELF - 4) (Semel, Wiig, & Secord, 2003) This instrument is made up of core and supplementary subtests (depending on age, not all subtests taken by each student), which give a comprehensive evaluation of a student's language performance. Total testing time ranges from about 30-60 minutes. CELF - 4 helps to appropriately develop solutions to language problems in the classroom. CELF-4 PDF
Comprehensive Test of Phonological Processing (CTOPP) (Wagner, Torgesen, & Rashotte, 1999) The CTOPP is a non-word repetition task that assesses phonological awareness, phonological memory, and rapid naming. It is meant for ages five to 24 years and 11 months. The instrument contains eight subtests (ages 5 to 6) or 12 subtests (ages seven through 24), takes about 30 minutes to complete, and is administered individually by a professional. Its uses are to identify individuals who are significantly below their peers in important phonological abilities, determine strengths and weaknesses among developed phonological processes, document an individual's progress, and serve as a measurement device in research studies. CTOPP PDF
Delis-Kaplan Executive Function System (D-KEFS)
(Delis, Kaplan, & Kramer, 2001)
Developed for ages eight to 89, the D-KEFS is a set of standardized tests used to evaluate higher-level cognitive functions in both children and adults. More specifically, it assesses the integrity of the frontal system of the brain, determines how deficits in abstract, creative thinking may impact daily life, and allows for the planning of coping strategies and rehabilitation programs tailored to each patient's profile of executive-function strengths and weaknesses. If all nine tests are administered, the total time to take it is about 90 minutes. D-KEFS™ PDF
Developmental Coordination Disorder Questionnaire (DCDQ)
(Wilson, Kaplan, Crawford, & Roberts, 2007)
Used to evaluate the deficiencies in children with motor problems, this test is meant for developing children aged five to 15 years, and is used to screen for coordination disorders. The instrument contains 15 items and takes about 10-15 minutes to complete. DCDQ PDF
Leiter International Performance Scale - Revised (Leiter - R)
(Roid & Miller, 2002)
The Leiter - R is a completely non-verbal test, which requires no reading or writing and is appropriate for ages two to 20 years and 11 months. It takes about 25-40 minutes to complete depending on what subtests are taken. This is an IQ instrument, which focuses on a child's abilities, rather than deficits by testing fluid intelligence (the ability to reason quickly and think abstractly). It can also distinguish children with ADHD or other neuropsychological impairments from typical children. Leiter - R PDF
Mullen Scales (Mullen, 1995) This instrument consists of five scales: gross motor, visual reception, fine motor, expressive language, and receptive language. The purpose of the exam is to provide an overall picture of the subject's cognitive and motor ability in order to point out the strengths and weaknesses that will aid in successful interventions. The test is appropriate for children from birth to five years and eight months, and takes anywhere from 15 to 60 minutes depending on the child's age. The test is administered through motor, visual, and language tasks, which gives age-equivalence, percentiles, and t-scores for each scale. Mullen Scales PDF
Peabody Picture Vocabulary Test, Fourth Edition (PPVT-4)
(Dunn, L, & Dunn, D, 2007)
The PPVT measures receptive vocabulary and is used to screening test of verbal ability. There is no reading or writing involved in the exam and it only takes about 10-15 minutes for completion. The examiner says a word, and the test taker points to one out of an array of pictures that correspond to that word. The exam can be taken from ages two years and six months to 90+ years, and scoring is based on the performance of the test taker compared to other children (or adults) in his or her age group. PPVT-4 PDF
Pediatric Quality of Life Inventory Version 4.0 (PedsQL 4.0)
(Varni, 1998)
This instrument measures the health-related quality of life in healthy children and adolescents as well as those with chronic and acute health conditions between the ages of two and 18 years. There is a self-report form for ages five to 18 years, and a parent-proxy report available for any age. The Generic Core Scales has 23 items, which only takes about five minutes to complete. The 23 items are broken up into four scales of functioning: physical, emotional, social, and school. Additional to the Generic Core Scales are condition-specific complementary tests for asthma, rheumatology, cancer, cardiac conditions, and diabetes and more. PedsQL 4.0 PDF
Purdue Pegboard Test (Triffin, 1948) This instrument is a dexterity test originally designed to determine the ability of potential workers who needed to have good fine motor skills. It measures gross movements of hands, fingers and arms, and fingertip dexterity as necessary in assembly tasks. Today, it is also used by physical and occupational therapists for injury rehabilitation, and it is used to assess and track the progress of a patient. The test only takes about 10 minutes to complete and is non-verbal. Simply, the individual places as many pins into a board with holes for 30 seconds. The test measures the ability of the right hand, left hand, and both hands together. Purdue Pegboard PDF
Raven Colored Progressive Matrices
(Raven, 1998)
Given to children five to 11 years, the elderly, and persons who are mentally and physically impaired, this test measures clear-thinking ability. It is divided into three sets of 12 items, and takes about 15-30 minutes. During each test, the child (or adult) is asked to find the missing pattern in a series. Raven Colored Progressive Matrices PDF
Repetitive Behavior Scales - Revised (RBS-R)
(Aman & Lam, 2006)
This instrument contains 43 items organized into six subscales: compulsion, ritualistic, sameness, self-injurious, stereotyped, and repetitive behaviors. RBS-R PDF
Rey-Osterrieth Complex Figure (ROCF)
Rey & Osterrieth, 1944)
Test takers are shown a complex figure of lines and circles and are asked to first copy it, and then draw it from memory. Two scoring systems are the Boston Qualitative Scoring System™ for the Rey-Osterrieth Complex Figure Test (BQSS™) (Stern, Javorsky, Singer, Singer Harris, Somerville, Duke, Thompson, & Kaplan, 2005) and the Developmental Scoring System for the Rey-Osterrieth Complex Figure (DSS-ROCF) (Bernstein & Waber, 2005). The BQSS™ is a comprehensive scoring system that provides a highly reliable and quantifiable approach to rating the qualitative features of ROCF productions. It takes approximately 45 minutes to administer and is intended for ages 18-94 years. The BQSS™ is also useful in its ability to discriminate between individuals with known traumatic brain injury or ADHD and those without. The DSS-ROCF is for children ages five to 14 years and takes approximately 35 minutes to administer. This scoring allows for the evaluation within a developmental context to determine the age-appropriateness of the child's production. ROCF PDF
Social Communication Questionnaire (SCQ)
(Rutter, Bailey, & Lord, 2003)
This test can be administered to anyone over the age of four years with a mental age of over two years, and it only takes about 10 minutes to complete. There are 40 yes-or-no questions, which help to determine whether the individual should be referred to further testing of autism or an ASD by evaluating social functioning and communication skills. There are two forms of the test: Lifetime and Current. Lifetime addresses the entire developmental period of the child and Current concentrates on the past three months. SCQ PDF
Social Responsiveness Scale (SRS) - Child
(Constantino, 2005)
Meant for children between the ages of four and 18 years, the SRS measures the severity of autism spectrum symptoms that occur in social settings. The questionnaire, filled out by a parent or caretaker, has 65 items and takes about 15 to 20 minutes. It assesses social awareness, social information processing, capacity for reciprocal social communication, social anxiety/avoidance, and autistic preoccupations and traits. SRS PDF
Stanford-Binet Intelligence Scales, Fourth Edition
(Thorndike, Hagen, & Sattler, 1986)
The Stanford Binet assesses cognitive ability and measures fluid reasoning, knowledge, quantitative reasoning, visual-spatial processing, and working memory for those ages two to 85+ years of age. There are 15 subtests, where total testing time amounts to around 45-90 minutes depending on the subject's age and number of subtests given. SB5 PDF
Symptom Checklist-90-Revised (SCL-90-R®)
(Derogatis, 2007)
This 90-item test only takes about 10-15 minutes and is intended for individuals 13 years and older. It helps to evaluate psychological problems and symptoms of psychopathology. A main use of this instrument is to have a quantitative measure of treatment effectiveness. Some of the different scales within the exam measure obsessive compulsiveness, hostility, anxiety, and depression. SCL-90-R PDF
Teacher Report Form (TRF) OR Caregiver-Teacher Report Form (C-TRF)
(Achenbach, 1991)
This form evaluates behavioral problems that a child exhibits in school as well as adaptive function and academic performance. Academic performance is rated on a five-point scale and adaptive functioning is rated on a seven-point scale to compare the child to typical pupils. Adaptive functioning focuses on how hard the child works, how appropriately he/she is behaving, how much he/she is learning, and how happy he/she is. The age range is six through 18 years. Teachers answer 118 items, which takes about 15-20 minutes to complete. TRF/C-TRF PDF
Vineland Adaptive Behavior Scales (VABS)
(Sparrow, Cicchetti, & Balla, 2005)
VABS is a tool used to identify and evaluate the special needs of children; these needs include the ability to demonstrate independence, cope with environmental changes, and learn new skills. Adaptive behavior is a reflection of one's social skills, and thus, the VABS gives pertinent information that can be used to diagnose autism as well as disease like mental retardation, Asperger syndrome, and speech impairment. A caregiver (parent, teacher, etc.) answers a series of questions about the child, which takes about 20 minutes to an hour. This test can be used for any person at any age. If one is looking to create a rehabilitation and treatment plan, there is an expanded form meant for children ages three years to 21 years and 11 months, which takes 60 to 90 minutes to complete and provides a more comprehensive evaluation of the child's needs. VABS PDF
Wechsler Abbreviated Scale of Intelligence™ (WASI™)
(Wechsler, 1999)
This intelligence test only takes 30 minutes to complete and provides verbal, performance, and full IQ scores. There are four subtests: vocabulary, similarities, block design, and matrix reasoning. The test is meant to quickly measure and individual's cognitive functioning, and is not meant to replace more comprehensive tests. It is meant for ages six to 89 years and 11 months. In 2002 the Wechsler Preschool and Primary Scale of Intelligence - Third Edition (WPPSI - III) was introduced for ages two years and six months to seven years and three months, where there is less of an emphasis on acquired knowledge. WASI PDF