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How is Autism Diagnosed? Testing & Treatment Recommendations with Dr. James Coplan

Dr. Mary Barbera

As parents and professionals, most of us have been involved in the autism diagnosis process at least once. But do we really know how autism is actually diagnosed and what the testing process really looks like? Today I’m going to answer the question how is autism diagnosed? with the help of developmental pediatrician Dr. James Coplan.
Many parents want to pinpoint exactly where their child’s at, and that’s a very slippery slope. Dr. James Coplan says that diagnosis is like looking at a chart of the harbor and trying to find your child’s boat when it’s really foggy outside. We know there’s an island, and we know where riptides and rocks are based on the map. But because it’s foggy out there, we can’t tell you exactly where your child’s boat is at the moment. In the same way, it would be unfair to your child to give you a prediction of a diagnosis based on an hour in the room with him.

How is Autism Diagnosed?

Psychologists put a lot of value on what they can test in the room and demonstrate in the room. As a physician, Dr. Coplan will make a diagnosis based on history. Parents visit him and say “my child doesn’t do this but he does do this.” He attaches a huge amount of weight to that history. He will try to do some testing at the table, but to a larger degree, his diagnostic impression is going to be formed in at least equal parts by what he sees and what he hears. Unless there’s a disconnect between the history and the tests. Like if the parents say their child can do something, but the child won’t do it at the table.
Psychologists, by the nature of their training, are going to give a skills development test, a developmental screening, or they’re going to give an ADOS, and go much more by the numbers. But this doesn’t mean one person is right and one person is wrong. What it means is psychologists and physicians come to diagnostic impressions using different subsets of the universe of data.

Autism Testing

On the first day of testing, when a child doesn’t understand that he’s being tested and that his job is to do his best for a strange adult that he’s never met before, it’s not professional to conclude that he couldn’t do X. All we can say is he didn’t do X. A mistake that teachers and school psychologists make is to say he refused to do X in class. What needs to be said is he didn’t do X in class. Or we can put it on ourselves and say we were unable to get him to do X in class. 
On the flip side of that, if by sheer luck that day, the child does X the right way and gets the points, good for him. We don’t take that away from him, either.
The professional answers are to give parents knowledge of what they need to do tonight and tomorrow. Anybody who claims that they can predict a child’s development 5 years from now is lying, because that technology or those skills really aren’t there. Hold onto your wallet when somebody tries to take that line with you.

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Autism Treatment

When Dr. Coplan gave Lucas a diagnosis 2 decades ago, he recommended an Applied Behavior Analysis (ABA) program. But he doesn’t always recommend ABA. He once had a child referred to him at 16 for a “reading disability.” He couldn’t understand the social context of stories. But it turns out he didn’t have a reading problem at all. It was a theory of mind problem. He needed social stories, social interaction, and insight based intervention, not ABA.
At the very beginning, the object of testing and treatment is to get the child to come to sit, attend, and reciprocate. Once you have that basic skill set imparted, then you can use that skill set to impart more complex skills like reciprocity, self-care, and communication.
Children without an autism spectrum disorder are graded on incidental learning. They do something once by accident and they catch on right away. You never have to teach them again. Children on the spectrum often need explicit learning until the child is sitting at the table, paying attention, and knowing what the game is that’s being played. It’s not a game, but you make it game-like to engage the child.
The object is to teach a new skill set that the child may not have learned otherwise. ABA is a really proven, time tested way of imparting new skills to somebody who may not be able to learn through social time.

Get the Help You Need

I hope you enjoyed this short video/article and that it answered your question how is autism diagnosed. If you want more content, and to learn the signs of autism, check out the podcast at marybarbera.com/podcast. I’d love it if you would leave me a comment, give me a thumbs up, share this video/article with others who may benefit, and for more information, you can attend a free online workshop at marybarbera.com/workshop.

Free Workshop to Learn to Turn Autism (or Signs of Autism) Around

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