Play Based Autism Assessment aka The Autism Diagnostic Observation Schedule (ADOS)

I’ve talked about Autism in play previously but for this post I’d like to talk about how a play based assessment can be used to test for signs of Autism Spectrum Disorder:

The way people think about autism has changed in recent years. It is best described as a group of disorders with a similar pattern of behaviour in three key areas – communication, social interaction and imaginative thought.

The currently favoured term is Autism Spectrum Disorder, with the word ‘spectrum’ used because no two people with an Autism Spectrum Disorder are exactly alike.

Today Heidi and I visited the Child Development Unit (CDU) at LaTrobe University, this is not our first visit to the CDU, although I think it will be the first Heidi has memory of. 4 years ago it was through the CDU that we received Heidi’s provisional diagnosis of Autism Spectrum Disorder (ASD), as part of this study.  2 years later we returned to the CDU for a follow up visit and I was thrilled to see how much Heidi had progressed since her initial diagnosis.

Today we were back again, this time it was for some trainees develop their expertise in working with individuals with ASD.

At each of our visits Heidi was assessed using the Autism Diagnostic Observation Schedule (ADOS). For children, the assessment is like a play session with the adults who were giving the test.

I thought it might be helpful to other parents who are the beginning of their assessment journey to talk about our experience with the ADOS test.

When I hear the word test I think of people jammed into a big hall sitting at rows of desks, scribbling busily and quietly onto pieces of paper, I remember my own stress and anxiety during similar exams. The ADOS test is nothing at all like that.

Firstly and most importantly, I have found each time Heidi had fun during the ADOS test, she would occasionally get frustrated, most especially if something she enjoyed was finished and she wanted to continue playing with it, but the testers were able to divert her attention to the next task.

In fact the frustration levels decreased at each assessment. During our first assessment Heidi was obsessed with the bubbles (have I mentioned Bubbles was her first word :grin:), Heidi frequently asked for the bubbles to reappear during the testing and cried several times. At our second assessment Heidi took control of the bubble blower and ran around the room in circles blowing bubbles, after a slightly extended play she agreed to ‘finish bubbles’. During our third visit today Heidi was happy to let the tester blow the bubbles while Heidi spun in circles trying to pop them.

It is really important to me that the test was not distressing for Heidi and I can say that on each of the three occasions we have done the ADOS test it has been a pleasant experience. The frustrations were overcome with patience and understanding from the testers.

During each of our three assessments a parent has been allowed to stay in the room and observe the test – although Heidi is now at the age where she would usually go in alone. Parents are encouraged to restrict interaction with their child, this so that the child’s social interactions, communications and other autistic behaviours can be observed in the context of the structured activities and language the testers use.

I did note that during her first test Heidi would frequently approach Ralph for a hug and reassurance, during the second test she would glance at me for reassurance and approach for the occasional hug, today there was a couple of looks in my direction but in the main her attention was focused on the tester.

What does the play based ADOS assessment involve? Remembering this is strictly from a parental point of view, if you are concerned about your childs development please do seek professional help and assessment.

It starts off with some puzzle playing using an abstract puzzle and some discussions about what shape the puzzle has made.

From Blog Posts

Next up is a family of dolls house dolls, a few bits of dolls house furniture an empty box and non dolls house objects. It fascinates me Heidi’s development in this area. At our first visit I recall Heidi having very little interest in the dolls, during our second visit Heidi would pick up the objects but only copied the testers lead to play with the dolls. At todays visit the baby doll spent lots of time falling and being rescued by fire truck and had a little nap in her box bed. This of particular interest to me because we did a semester long social skills group shortly after the second ADOS test that was all about learning pretend play, in particular they rehearsed rescue scenarios with a fire truck and object substitution using boxes. Heidi’s pretend play now frequently includes on these scenarios when she is not replaying scripts from various movies and books she is interested in.

2 years ago not really sure what to do –

From Blog Posts

Today the fire engine is rescuing the baby –

From February 2011

There was a story book to read, using the pictures to tell the story Heidi and the tester would take turns reading. Very similar to how I’ve experienced the girls Kinder teachers and Prep teachers talking to children about books using the pictures to help the children ‘read’ the story.

Occasionally the various testers would call out Heidi’s name to see if she would respond and look towards them. Also items would occasionally be withheld to see if Heidi would request them to use in her play.

As mentioned earlier bubbles are blown and Heidi on each occasion found them highly motivational. From a parents view point running around the room chasing the bubbles also gave Heidi a great break from sitting at the table. Each of the three tests were conducted with Heidi sitting in a child size chair at a child size table, however if she decided to move and play in another part of the room the tester would follow her and continue the activity in that location. They did encourage Heidi to move back to the table at the start of each new play scenario.

Heidi was asked to demonstrate how to brush your teeth and how to wash your hands. Once again fascinating to go back and watch the old DVDs of her tests and see how much her verbal skills have improved from mostly acting out the activity in question (with lots of shy giggles and covering of her face) to talking through and acting out the activity.

There is some more pretend play with a dolly who is having a birthday, I’m pleased to report that today Heidi did not try to eat the playdough cake :grin: The tester on each occasion has pretended to burn their fingers while lighting the candles on the cake, and each time Heidi has been oblivious to their pain.

From February 2011

During the test a snack is given, using two different foods (today it was sultanas and rice crackers). The tester gives Heidi one of each, and then asks which she would like. It is interesting seeing Heidi’s progress in requesting items, from the non verbal pointing and grabbing to the verbal request “Dat one..” and points to the one she wants.

We finished up today with one of Heidi’s favourites – balloon play, the tester blows up a balloon and lets it go. I will leave Heidi to explain what happens:

‘the air runs out and makes balloon fart’
‘I love it farting it’s just like a whoopy cushion’

Lots of jumping in circles and giggles of delight resulting from balloon play.

This is our experience of the ADOS test, it was mostly fun, occasionally a little frustrating for Heidi as her abilities were challenged and an incredibly useful tool to provide information about my childs development and which areas we need to focus on to help her.

After Heidi is always a little tired and today was the same, we came home and had a very quiet afternoon relaxing together.

Some early signs of ASD – usually seen in the first two years – are listed here.

If you are concerned about your childs development then I encourage you to seek assistance from a professional, in Australia your Maternal and Child Health Nurse or GP is often the best place to start.

For those that are interested, this is a step by step list of what we did to get our oldest daughter assessed for ASD.


We Play

Leave a Reply

Your email address will not be published.Required fields are marked *