As parents or 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 does the testing
process really look like?
Hi, I'm Dr. Mary Barbera, autism mom, board certified behavior analyst, online course
creator and bestselling author of The Verbal Behavior Approach.
Each week I provide you with some of my ideas about turning autism around so if you haven't
subscribed to my YouTube channel, you can do that now.
Today I'm sharing a small excerpt from a recent podcast episode with developmental pediatrician,
Dr. James Coplan where he gives us insight on how autism is diagnosed and what treatment
he usually recommends.
I’m sure you in your vast experience, you've had many parents where they really want to
pinpoint where the child's at and that's a very slippery slope, right?
And in fact, what I've said to people is I can give you a map of the territory or it's
like a chart of the harbor maybe, but there's fog out there.
I know there's an island here.
Pardon me?
There's, there's a rip tide over here and rocks over here, but because it's foggy out
there, I can't tell you exactly where your child's boat is at the moment.
There is this territory, there are these hazards, there is this ship’s channel, but it would
be unfair to your child for me on the basis of an hour in the room with him to give you
a prediction with that degree of precision.
Now let me back up for a second.
Excuse me.
One of the differences between psychological testing that Jerilyn Radcliffe did and the
way I arrive at a diagnosis and I respect this and it's like there are different ways
to get somewhere, psychologists put a lot of value and correctly so on what they can
test in the room and demonstrate in the room.
Whereas as a physician, what I'm taught is a lot of the times you make the diagnosis
based on the history.
So parents come in and they say to me, my child doesn't do this.
He does do this, he doesn't do this.
He does do that.
I attach a huge amount of weight to that and I'll try to do some testing at the table,
but basically, or predominantly, well maybe not basically or predominantly, but to a larger
degree, my diagnosis is my diagnostic impression is going to be formed in at least equal parts
by what I see and what I hear.
Unless there's a disconnect between those 2 things.
If the parents say, oh, he doesn't do X, but he does, or he does X, Y,Z , but I can't get
him to.
But when they align, it's like 2 legs of a stool.
Um, but I'm going to put a lot more weight on the history where psychologists, by, by
the nature of their training, by design, they're going to give a skills development or they're
going to give an ADOS, or they're going to give whatever, and they're going to go much
more by the numbers on that piece of paper.
And those may be discrepant and it doesn't mean 1 person is right and 1 person is wrong.
What it means is we came to our diagnostic impressions using different subsets of the
universe of data.
Now and again, but let me come back to your larger point on that first day when the kid
doesn't even understand that he's being tested and that his job is to do his best for this
strange adult, that he's never met before.
It's not fair.
It's not professional on my part to conclude that he couldn't do X, all I can say is he
didn't do X. I can't say, and this is another mistake that teachers make, it's another mistake
school psychologists make, I don't think behavioral psychologists make it but school psychologists
and teachers will say he refused to do X in class when what you need to say is, he didn't
do X in class.
Or put it on yourself and say, I was unable to get him to do X in class rather than impute
willful task refusal to the child.
So on day 1, if the kid doesn't understand what's the game that's being played here and
my job is to jump through Dr. Coplan’s hoops, I can't make a conclusion from that.
On the flip side of that, if by sheer luck that day, he puts the pretzel on the plate
and gets points, good, good for him.
I'm not going to take it away from him.
So there were discrepant answers, but I think, um, the professional answers are to say what
we need to give you today is knowledge of what you need to do tonight and tomorrow.
And anybody who claims that they can predict 5 years from now is really blowing smoke because
that technology or those skills really aren't there to hold onto your wallet when somebody
tries to take that line with you.
Yeah.
So I remember, you know, when you gave the diagnosis, like I said, you, you recommended
ABA, Applied Behavior Analysis program.
Um, and I know many years have gone by, 2 decades since you diagnosed Lucas, but, and
you've, and so I, and I know you retired from clinical practice 5 years ago, but you know,
within the past when you were practicing the past 15 years, did you continue to recommend
intensive ABA programs or did that depend on the child?
And what level of ABA programming did you usually recommend for a child with moderate
to severe autism?
Okay, so you, you put in the qualifier, moderate to severe autism kind of at the end of your
discussion.
But, um, I would see kids at 16.
I had a child referred to me at 16 for quote a reading disability because couldn't understand
the social content of stories.
It was not a reading problem at all.
It was a theory of mind problem and I don't think that kid would've needed ABA.
He needed social stories and insight based intervention.
But for somebody who, um, you need, there's an old Kentucky recipe for rabbit stew.
And I used to say this in the office also.
Okay.
Maybe I never said it to you.
There's an old Kentucky Kentucky recipe for rabbit stew with a first line on the recipe
says first, catch a rabbit.
And at the very beginning the object is to get the child to come sit, attend, reciprocate
and um, that's like catching the rabbit.
And then once you have that basic skill set imparted, then you can use that skill set
to impart more complex skills, reciprocity, self care, communication.
The fact that when I say milk, that person out there is going to give me the milk, which
they might not learn through incidental learning.
Um, kids without spectrum disorder are graded incidental learning.
They do something once by accident and they catch on right away.
You never have to teach them again.
So wow, where did he learn that?
Kids on the spectrum often need explicit, you know that they need explicit learning
but until the kid is sitting at the table and attending and he knows now what the game
is that’s being played and it's not a game.
Although you make it game-like to engage the kid.
The object of this is for me to acquire a new skill set and that the child may not say
that to themselves.
They don't internally verbalize it.
But definitely ABA is a really proven time tested, proven way of imparting new skills
to somebody who may not be available to social learning or trying to appeal to verbal inducement
of some of the clients.
So I continue to endorse ABA in that kind of situation.
Absolutely.
I hope you enjoyed this short snippet from the podcast.
If you want more content, check out the podcast at marybarbera.com/podcast.
Wherever you're watching this, I'd love it if you would leave me a comment, give me a
thumbs up, share this video with others who may benefit, and for more information, you
can attend a free online workshop at marybarbera.com/workshop and I'll see you right here next week.