Understanding Your Veritas Autism Diagnostic Assessment Report
Veritas autism assessment reports are written in 2 main sections. The first section comprises of the assessment outcome letter and ‘Summary of Assessment’, the second section contains the detail of the assessment. This is because you may wish to share the diagnostic outcome with a range of people and may not always want them to see the detail; if this is the case, you can just share the outcome and summary of assessment.
Assessment Outcome Letter
This letter gives you the outcome of the assessment in bold. If you a diagnosis has been confirmed, the letter also provides a brief summary of autism.Summary of Assessment
This is a high-level summary of the assessment.Background and Current Concerns
In this section we have highlighted who commissioned the assessment and what the main concerns are.
Assessment information
This section outlines all the information that was taken into account when considering the assessment conclusion. It will include any screening / additional information questionnaires completed and by who, the assessments completed and if applicable information provided by a child’s education setting. This section also includes the DSM 5 diagnostic criteria and which criteria have been met. The DSM 5 (Diagnostic and Statistical Manual of Mental Disorders) is the handbook used by health care professionals across much of the world as the authoritative guide to the diagnosis of mental health issues and neurodevelopmental conditions. The DSM contains descriptions, symptoms, and other criteria for diagnosing these conditions, ensuring a standardised approach to diagnosis. In order to confirm a diagnosis of autism spectrum disorder, the 3 criteria from section A must be met, along with at least 2 from section B; C, D and E must also be met. You will note a YES / NO next to each criteria to indicate whether we have seen evidence that the criteria has been met.Outcome of the Assessment
This is the overall outcome of the assessment which confirms whether a diagnosis has been given or not.Appendix 1 – Detailed Assessment Findings
This is the second section of your report which contains the detailed assessment information.Background
This section contains the information that we gathered prior to completing the assessment, and detail of any additional information we sought.Questionnaires
The questionnaires used during the assessment will depend on various factors, including age, other information gathered and presentation during the session. Questionnaires can be useful in identifying the varying characteristics of autism but are not diagnostic tools. As self-report tools, the rationale or ‘evidence’ for the responses is not collected; but they do help us build a picture of the individual being assessed and the pattern of their differences.The adult autism quotient is a questionnaire designed to measure autistic traits in adults with average or above average intelligence. Scores range from 0 – 50, with higher scores indicating more autistic traits. Scores above 26 indicate the possibility of autism. The Adolescent AQ50 and Child AQ50 are other versions of the AQ50 for different age groups, again the higher the score, the more autism traits are reported.
The Childhood Autism Spectrum Test is a questionnaire designed to measure autistic traits in childhood. Also known as the Relatives Questionnaire, the CAST scores positively for autism traits, therefore the higher the score the more traits are reported, the maximum score is 31, and scores of 15 or higher are viewed as indicative of autism.
These sections contain the historical information that we gathered during the assessment. We gather this information because we want to identify factors that are associated with autism such as being born prematurely, being late developing language or having someone who has a neurodevelopmental condition in the family. We also need to ensure that the characteristics / symptoms reported could not be explained by another reason or issue such as trauma, attachment difficulties or cognitive damage.
In this section we report the information given about early years education, school and / or college and university. We consider this information to understand whether there are also learning difficulties, whether there were difficulties separating from parents and either how the child is coping socially and academically, or in the case of an adult how they coped when in school. If the assessment report is for a child who is in education this section also contains information reported by the setting or school. We consider this information to understand whether the child has difficulties at school as well as at home. We sometimes see that there are no issues in school due to masking or being able to manage in a more structured environment.
Autism Diagnostic Interview-Revised (ADI-R)
If the ADI-r has been completed during the assessment, this section will outline this here. The ADI-r is a structured interview, usually conducted with a parent. For children under 5, the ADI-r looks at current behaviours whereas for an older child or adult the interview focusses on both current behaviours and behaviours during the 4 – 5 year period. The ADI-r has a scoring algorithm with ‘threshold’ scores that indicate autism. The ADI-r can also be used with a partner, in which case the interview focusses on current behaviour only; there are no ‘threshold’ scores in this case, and the information gathered is used on a qualitative basis.The ADI-r scores are separated into 4 domains, social interaction, communication, patterns of behaviours and development.
During the ADI-r interview, the clinician will have asked questions related to specific autism traits, for example eye contact. The responses are scored using a complex scoring system, some of the responses are in the scoring algorithm, in which case they are translated to a score of either a 0, 1 or 2. A 0 score usually indicates that the trait was not reported, 1 means that either the trait is reported to some degree or reported to occur infrequently or have less impact. A score of 2 is used when the trait occurs definitely, frequently or impacts the child / adult. Therefore, higher scores in each domain mean that more traits are reported and / or that the traits occur frequently or significantly impact the child / impacted the adult when a child.
Each domain has a different threshold, but also different maximum scores as outlined below:
| Minimum Score | Maximum Score | Threshold | |
|---|---|---|---|
| Social Interaction | 0 | 30 | 10 |
| Communication | 0 | 26 | 8 (7 if non-verbal) |
| Patterns of Behaviours | 0 | 12 | 3 |
| Development | 0 | 5 | 1 |
The rest of this section of the report contains the detail of each of the responses to the algorithm questions.
Sensory aversions and difficulties with changes in routine are common autism characteristics, but are not part of the ADI-r algorithm. Information reported about these are included at the end of the ADI-r section.
Ritvo Autism Asperger Diagnostic Scale – Revised (RAADS-r)
If you undertook the RAADS-R, you will find this section in your report. The RAADS-r is designed to gather information about current and childhood difficulties where there is no suitable informant from childhood. It is a questionnaire designed to be administered by a clinician.You will have been asked 80 questions during your session, these focus on autistic traits and are worded positively and negatively. You will have been asked to report whether you do not experience the trait, whether you experience the trait now but not in childhood, experienced this in childhood only or experience it now and in childhood. Negatively worded statements are translated, and responses are all scored as a 0,1,2 or 3. Each question is separated into domains which have a threshold score as well as the overall score. Higher scores mean either that more traits are reported or that traits have been present since childhood.
Each domain has a different threshold score which indicates autism, as well as different maximum scores as below:
| Minimum Score | Maximum Score | Threshold | |
|---|---|---|---|
| Language and communication | 0 | 42 | 4 |
| Social relatedness | 0 | 117 | 31 |
| Sensory/motor | 0 | 21 | 16 |
| Circumscribed interests and restrictive behaviour | 0 | 60 | 15 |
| TOTAL SCORE | 0 | 240 | 66 |
The rest of this section of the report contains the detail of each of the responses to the statements.
Autism Diagnostic Observation Schedule – 2
This section of the report provides a summary of the clinician’s observations during the ADOS-2 observation.The ADOS-2 is a semi-structured interview, whereby the clinician administers a set of tasks in a specific way, and for older children and adults will also ask set questions.
There are different ‘modules’ of the ADOS – 2, and the clinician will choose which module to use based on age and language ability.
Whilst administering the ADOS-2, the clinician will be observing for specific behaviours, actions and interactions which they will ‘code’ after the session. These specific behaviours are autistic traits, which for the purpose of the ADOS-2 algorithm the clinician will code as a 0, 1 or 2. The traits that the clinician will be looking for varies between the different modules but include such behaviours as using eye contact to modulate interaction, responding to name or having a reciprocal conversation.
The ADOS-2 has a diagnostic algorithm which provides ‘cut off scores’ for totals from some of the traits observed. The way in which the algorithm is applied is complicated, the section at the end of the ADOS report titled ‘Summary of Observation’ states whether the cut-off scores were met by explaining whether the observation was indicative of autism or not.
The ADOS- 2 section of the report summarises the behaviours that the clinician observed and subsequently scored, for example if the clinician observed issues with eye contact they may report ‘Jonny used poorly modulated eye contact during the session’. This would have scored a 2.