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Assessing Autism: Conducting a Medical or NeuroSomatic Evaluation?


A consistent hoop that many parents of children with neurodevelopmental disabilities need to jump through in having a child with neurodevelopmental challenges is that of performing a formal medical, psychological or psychiatric assessment for autism.


Conducting a baseline evaluation for autism is often an imperative step for children and their families in the process of living with autism. Before the diagnosis of autism is confirmed, or even suspected, a child with neurodevelopmental symptoms associated with autism, may demonstrate particular neurodevelopmental symptoms, such as developmental delay, lack of eye contact, repetitive behaviors, non-responsiveness to calling his/her name. Receiving a confirmation of the diagnosis of autism connects all of these disparate symptoms together under a single label – ASD. While it may be a shock for parents to receive the diagnosis of autism in their child, there are obvious benefits in terms of providing access to state subsidized therapeutic and clinical services, such as occupational therapy, physiotherapy and direct autism therapeutic interventions; as well as in providing a gateway to a clinical community of parents and children with the similar autism diagnosis.


There are a range of formal assessments for autism, which can be conducted by a qualified psychologist, psychiatrist or health professional. Probably, the most validated and well-known screening instrument is the Autism Diagnostic Observation Schedule (ADOS), which can be applied from 18 months of age when the diagnosis of autism can reliably be confirmed. The ADOS screening instrument consists of a series of structured and semistructured presses for interaction, accompanied by coding of specific target behaviors associated with particular tasks and by general ratings of the quality of behaviors. It attempts to emphasize the nature of social and communicative behavior in autism as well as evaluate the qualities of autistic interactions and communication in terms of specific behaviors. [1]


It is recognized today that it is possible to assess infants for behavioral symptoms associated with the later development of autism, the so-called prodrome of autism, from 12 months of age, and even earlier in severe instances. In Israel, for example, the ESPASSI© screening assessment developed by the Mifne Center is applied from the age 5-months in a number of medical centers. Behavioral variables in the ESPASSI© include: excessive-passivity, excessive-activity, lack of eye-contact, lack of reaction to voices, refusal to eat, reaction to touch, motor development, and head circumference. [2] Early assessment for autism is especially beneficial in terms of highlighting any neuro-developmental delay, which will be amenable for early therapeutic intervention from the age of 6-months onward, for example in terms of Feldenkrais and Play provided at SomaticWell. In my mind the main importance of early assessment of autism is to provide clinical evidence for referral for therapeutic intervention at an age where the infant is undergoing its most rapid development. Early effective therapeutic intervention may significantly reduce behavioral symptoms associated with autism.


Screening instruments, in particular the ADOS, has been of immense importance in stabilizing autism as a medical entity. Indeed, the medical history of autism from the time of child psychiatrist Leo Kanner till the present, culminating in the development and fixing of the ADOS, has been in terms of the identification and stabilization of traits associated with autism in the midst of vast individual variation. This has benefits in terms of standardization; but may come with the cost of personalized attention to each individual child with autism. Formal medical evaluations for autism are aimed at diagnosing a child based on behaviors fixed at a particular moment of time. They do not capture any neurodevelopmental flow, nor do they help provide a roadmap on which to base individualized therapeutic intervention.


The Neuro-Somatic Assessment provided by SomaticWell provides an alternative form of evaluation, rooted in somatic understanding of neurodevelopment as observed in each individual infant and child. The components of the SomaticWell Neuro-Somatic assessment include: in-depth anamnesis regarding developmental milestones and neurodevelopmental delays, clinical evaluation of retained primitive reflexes, in-depth observation of movement and play based on Laban-Bartenieff movement fundamentals [3] – including for example, elements of body, effort, shape, space, balance and relationships – as well as principles of Authentic Movement.


The SomaticWell Neuro-Somatic assessment is not at all a formal medical assessment of autism to which it bears no relation. Rather, it emphasizes the neuro-developmental patterns of each individual child and focuses on capabilities instead of deficits. Additionally, each component of the Neuro-Somatic assessment may be built upon to provide a personalized therapeutic roadmap. This therapeutic roadmap is especially important in terms of considering the early manifestation of autism in infancy as primarily a disorder of sensory-motor development (see https://www.somaticwell.com/post/autism-the-movement-perspective). As opposed to formalized medical assessments for autism, which are temporally static, the SomaticWell Neuro-Somatic assessment is temporally dynamic. In this sense, it can theoretically be repeated innumerable times. Each assessment will enrich the findings of the previous assessment. There is a strong clinical intuitive component to conducting and evaluating this assessment, speaking to the somatic connection of two nervous systems – that of the participant and the therapist observer. Reflecting on what feelings arise in the therapist through observation of movement and play behavior is also an essential component of the ongoing therapeutic evaluation. Perhaps, most importantly, in terms of differentiating the NeuroSomatic assessment from a formal medical evaluation of autism – the outlines of the Neuro-Somatic assessment may be taught to parents, thereby including them in the art of observation and principles of somatic therapeutic intervention.


References:

1. Lord, C., Rutter, M. and Goode, S., Heemsbergen, J. and Jordan, H., Mawhood, L., Schopler, E. (1989). “Autism Diagnostic Observation Schedule: A Standardized Observation of Communicative and Social Behavior,” Journal of Autism and Developmental Disorders, Vol 19, No. 2, 185-212.

2. Alonim, A. H. (2011). “Red Lights: Early Signs of Autism in Infants.” Israeli Journal of Pediatrics, 76.

3. Hackney, P. (2002). Making Connections: Total Body Integration Through Bartenieff Fundamentals. Routledge: London and New York.

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