Main Body
17 Autism in children with multiple, severe disabilities
Learning Objectives
- Understand special considerations in considering a diagnosis of autism in this population of children.
Autism (Contributing Author: Dr. Armansa Glodjo)
Autism has a higher prevalence in individuals with CP (about 7%) compared to the general population[1]. It is likely that both under and over diagnosis of autism is common in children with severe disabilities. Evaluating the question of autism in children with multiple, severe disabilities takes special consideration. Evaluation by someone with expertise in developmental expectations of children with severe disabilities is essential. Children in British Columbia with a question of an autism spectrum disorder can be referred for assessment to the British Columbia Autism Assessment Network.
Standardized tools used in autism assessments were not developed for children with sensory impairments, severe intellectual disabilities, or multiple disabilities. Thus, these tests must be used with caution. Questionnaires may include many items which are inappropriate for the child (e.g., asking about eye contact or use of gestures in a child with a visual impairment). Furthermore, the “youngest” module from the Autism Diagnostic Observation Schedule (ADOS) is designed for children with a “nonverbal mental age” of at least 12 months. For children with developmental skills under 12 months, ADOS results may be misleading. Clinical impressions are thus much more important in guiding diagnosis than test scores.
For children with severe disabilities, whose cognitive functioning is well below their age level, repetitive behaviours may be present and be consistent with the child’s developmental level. Therefore, when considering a diagnosis of Autism, less emphasis should be placed on the presence of these behaviours. Rather, more emphasis should be placed on social communication skills. When children have motor and/or sensory impairments, one way to do this is to look for evidence of capacity of a skill, but not using that skill for social communication, for example:
- Able to use a point to activate a button, but not pointing to draw a person’s attention.
- Auditory attention to a musical toy, but not to one’s own name being called.
- Visual attention to an object, but not to faces.
- Self-directed but not other-directed play.
Key Takeaways
- There are special considerations in considering a diagnosis of autism in children with low developmental level, sensory impairments, or motor impairments.
- Evidence of reduced social communication despite the physical capacity to engage in social communication is an important factor.
- Childhood vision impairment, hearing loss and co-occurring autism spectrum disorder
- Autism Spectrum Disorders (ASD) in Blind Children: Very High Prevalence, Potentially Better Outlook
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Szarkowski, A., Flynn, S., & Clark, T. (2014). Dually diagnosed: A retrospective study of the process of diagnosing autism spectrum disorders in children who are deaf and hard of hearing. In Seminars in Speech and Language 35(4), 301-308.
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Szymanski, C. A., Brice, P. J., Lam, K. H., & Hotto, S. A. (2012). Deaf children with autism spectrum disorders. Journal of autism and developmental disorders, 42(10), 2027-2037.
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Mood, D., & Shield, A.M. (2014). Clinical use of the autism diagnostic observation schedule-second edition with children who are deaf. Seminars in speech and language, 35 (4), 288-300.
- Christensen, D., Van Naarden Braun, K., Doernberg, N. S., et. al. (2014). Prevalence of cerebral palsy, co-occurring autism spectrum disorders, and motor functioning – Autism and Developmental Disabilities Monitoring Network, USA, 2008. Developmental Medicine and Child Neurology, 56(1), 59–65. ↵
