Diagnostic Autism Spectrum Interview

DASI

English

Diagnostic Autism Spectrum Interview

www.psychology-services.uk.com

Professor Susan Young

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I started working with young people with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) over 25 years ago. In those days these two conditions were considered to be independent of each other, in other words they were ‘differential diagnoses’. Since then, advances in science have led to our understanding that the two disorders may co-exist and when they do, they represent a condition of greater severity and complexity. In real terms this means that the person with both disorders is suffering and has suffered greatly, often without the support they require. Neurodevelopmental disorders, such as ASD and ADHD, require a comprehensive assessment spanning the life of the individual. For ASD, one needs to assess and consider early developmental problems. Over time, robust methods of assessment of ADHD have been developed and there are several rating scales and clinical diagnostic assessments available that can be accessed free of charge. However for ASD, this is not the case. As a Clinical and Forensic Psychologist, I found myself increasingly frustrated at having to purchase assessment materials that did not easily map across to the criteria set within formal diagnostic classifications. What I wanted was a ‘gold standard’ tool that would facilitate the clinical diagnostic process and I set myself the task. How did I do this? Well, I had already developed the ADHD Child Evaluation (ACE) and the ACE+ for adults, both of which are free to download in multiple languages from the resources section of my website (www.psychology-services.uk.com). They are also available to purchase in electronic format (https://bgaze.com/en/ace) in English and Spanish. So, adopting the same methodology as before, I commenced the journey to do the same for ASD; the one exception being the inclusion of a structured observational record which aims to supplement the interview with objective information using a task-based structured approach. Hence, the Diagnostic Autism Spectrum Interview (fondly referred to as DASI) was born and, like ACE and ACE+, it is free to download from my website. I strongly advise practitioners to access the introductory online training to use these tools (ACE, ACE+ and DASI) on my website (www.psychology-services.uk.com). Accredited reliability training is also available by request. I thank all of my colleagues for their optimism, encouragement and practical feedback on drafts of DASI, in particular Anna Backman, Tobias Banaschewski, David Coghill, David Daley, Stephan Eliez, Gisli Gudjonsson, Isabel Hernández Otero, Jack Hollingdale, Peter Mason, Denise McCartan, J. Antoni Ramos-Quiroga, Bengi Semerci, Joseph Sergeant and Emma Woodhouse. Thanks also to the talented Benjamin Wild (www.iBenWild.com) for producing the OR4 illustration. Special thanks go to Hannah Mullens for her consistent motivation, support and skills in transforming my ideas into the practical steps required to make them a reality. It is such a pleasure to collaborate with Hannah who has great patience and an excellent eye for detail, especially when working with colleagues from other countries who have kindly translated the tools into so many languages.

Professor Susan Young London, 1st January 2020

Preface

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Page

Introduction to DASI 3 Diagnostic Criteria 3 Co-existing Problems and Disorders 4

DASI Administration 5 Assessor Qualifications 5 Interviewee and Sources of Information 5 Prior to the Appointment 5 Introducing the DASI Interview 6 Background Interview 6 Symptom Ratings 6 Chronological and Developmental Age 9 Non-Verbal Clients 9 Cultural Considerations 9 Accommodations and Camouflaging 10 Co-existing Problems and Disorders 10 Observational Record 10 Observational Record Summary 16 Scoring 17

Interview 18 Background 18 Symptom Ratings 26 Co-existing Problems and Disorders 67

Observational Record 74

Observational Record Summary 83

Scoring 84

Assessor Notes 87

Appendix 88

About the Author 94

Contents

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DASI is a semi-structured clinical interview designed to support healthcare practitioners in assessing ASD in children (age >2 years), young people and adults. DASI leads the assessor through the diagnostic process by assessing the symptoms of ASD across the lifespan and the extent to which they impair functioning. DASI sets out a series of questions and prompts to guide clinical judgement about the presence of the core domains of (1) difficulties in social-communication and social interaction, and (2) restricted, repetitive patterns of behaviour, interests or activities. DASI includes an observational assessment, which aims to supplement the clinical interview with objective information using a structured approach. The assessor is guided to consider the onset of difficulties, their persistence over time, and pervasiveness across settings. The impact of symptoms on daily life is considered in terms of functional impairments, together with any accommodations made by the family and/or others in order to minimise disruption to family life or everyday activities. The assessor is also guided to be mindful that the client may mask symptoms by applying learned strategies and consider whether they are helpful and successful. If the diagnosis is supported, the assessor is guided to consider the severity of the presentation and the resultant level of support that may be required, and any known or possible comorbid conditions.

Diagnostic Criteria

There are two diagnostic criteria in common use, the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5: American Psychiatric Association, 2013) and the International Statistical Classification of Diseases and Related Health Problems 11th Revision (ICD-11: World Health Organisation, 2016). ICD-11 is currently being processed and it is anticipated it will align with DSM-5’s diagnostic criteria being organised under the two categories described above. Other revisions include Asperger’s Syndrome and other generalised developmental disorders falling within the broader classification of the autism spectrum and the acceptance that ASD can co-occur with ADHD. According to DSM-5, there are three core symptoms associated with the domain of social-communication and social interaction (Criterion 1). These relate to (1) persistent deficits in social-emotional reciprocity; (2) non-verbal communicative behaviours used for social interaction; and (3) the ability to develop, maintain and understand relationships. The criterion is met if all three of these symptoms are endorsed. There are four core symptoms associated with the domain of restricted, repetitive patterns of behaviour, interests or activities (Criterion 2). These relate to (1) persistent stereotyped or repetitive motor movements, use of objects, or speech; (2) insistence of sameness, inflexible adherence to routines or ritualized patterns of verbal or non-verbal behaviour; (3) highly restricted, fixated interests that are abnormal in intensity or focus; and (4) hyper-reactivity or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment. The criterion is met if at least two of the four symptoms are endorsed. Individuals with ASD exhibit a range of intellectual and language functioning. Broadly, symptoms typically present in early childhood (by 2-3 years of age) with or without language delay and may be associated with early developmental delays and/or loss of social or language skills. However, many people may not receive a diagnosis of ASD until adulthood. Symptoms must not be accounted for by general developmental delays. Symptoms must be associated with clinically significant impairment in

Introduction to DASI

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personal, family, social, educational, occupational, or other important areas of functioning. They are relatively stable across the life span, although there may be some developmental gains in adolescence and adulthood due to increased interest in social interaction, behavioural improvement associated with interventions and/or compensations applied, and/or the environmental supports provided.

Co-existing Problems and Disorders

For a diagnosis of ASD, symptoms must not be better explained by general developmental delays (i.e. intellectual disability) or another mental disorder (e.g. substance use, anxiety, depression), which involves an assessment for differential diagnoses. However, individuals with ASD often present with co-existing problems and disorders. Indeed, 70% of children with ASD will have at least one co-occurring psychiatric condition and 41% will have two or more, the most common being social anxiety, ADHD and oppositional defiant disorder (Simonoff et al., 2008). Adults also experience high rates of comorbidity, the most common being mood disorders, anxiety disorder and ADHD (Hofvander et al., 2009). Hence, the presentation of people with ASD may be complex from both a clinical and behavioural perspective and the assessor must distinguish between primary (i.e. differential) and secondary (i.e. co-existing) conditions. DASI includes a section that prompts the assessor to consider the presence of co-existing problems and disorders, which will support them to make these decisions.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Association. Hofvander, B., Delorme, R., Chaste, P., Nydén, A., Wentz, E., Ståhlberg, O., et al. (2009). Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry, 9(1), 35. Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. J Am Acad Child Adolesc Psychiatry, 47(8), 921-929.

World Health Organization. (2016). International classification of diseases 11th ed (ICD-11). http://www.who.int/classifications/icd/en/. Accessed 21/04/2019.

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Assessor Qualifications

DASI should only be administered by healthcare practitioners who are very familiar with autism spectrum disorder and the range of difficulties and impairments that are associated with the condition. It is highly recommended that practitioners access the introductory online training to use DASI (available at www.psychology-services.uk.com). Accredited reliability training is also available by request.

Interviewee and Sources of Information

DASI is administered directly to the client and/or their family. When assessing children, the interview is typically administered to parents/carers but it is essential for the assessor to meet and, if possible, interview and conduct the observational assessment with the child. A wealth of useful information may also be obtained from observing a child in school and speaking directly with teachers, if this can be arranged. When assessing adolescents and adults, a similar procedure is recommended (i.e. interviewing parents/carers as well as interviewing and observing the client themselves) due to the need to obtain reliable information about the client’s childhood functioning across settings. In some cases, a parent/carer may not be available (especially when assessing adults), in which case collateral information should be obtained from someone who is familiar with the client’s functioning in different settings (e.g. a close family member or friend of the family). If a suitable informant cannot be identified who knew (and can recall) the client well during their early childhood, it may be helpful to obtain information from an informant who currently knows the client well (e.g. a close friend or partner) in order to supplement self-reported information with an objective perspective. For both child and adult clients, it is good practice to obtain corroborative information, whenever possible, from appropriate informants and/or to obtain contemporaneous information about their functioning across settings and across the lifespan. This may include completion of rating scales and perusal of current and/or past reports (for example, educational, occupational appraisals/performance reviews, social care, clinical reports). In the event that reliable and accurate clinical information about the client’s functioning in childhood is unavailable, the assessor needs to make their best judgement as to whether trait-like symptoms were present in childhood. This may present a difficulty for ‘borderline’ cases, i.e. clients presenting with symptoms of lower severity and requiring a lower level of support.

Prior to the Appointment

In advance of the appointment it is helpful to provide those attending with information about the assessment process (duration, breaks etc.). It may also be helpful to send out parts of the background interview (which includes information about developmental milestones) for completion ahead of the appointment.

It is helpful to ask the client and/or parents/carers to peruse and send, ahead of the appointment, copies of relevant childhood documents (e.g. developmental health records, school reports) and/or to

DASI Administration

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look through any photographs they have of when the client was a young child (i.e. special occasions, with family, with peers, holidays). This might jog their memory about the presentation and specific characteristics of the client across situations and settings. It is often very helpful to ask the interviewee to bring these photographs with them to the assessment. Prompting the client and/or parents/carers to think about key transitions in the client’s life (such as moving home, change of school) can also help to jog their memory ahead of the appointment.

Introducing the DASI Interview

Prior to administering the interview, the assessor should try to establish rapport with the interviewee(s) in order to make them feel comfortable, settled and at ease. This may be challenging when conducting the interview directly with a client with autism as their preference may be to embark directly on the semi-structured interview rather than engage in social ‘chit chat’. To some extent, this may be circumvented by reiterating practical information about the assessment process (i.e. its anticipated duration, to take breaks when needed, where to go when taking breaks, arrangements about refreshments). When interviewing an informant, it is helpful to tell them that they will be asked about the client’s functioning across their lifespan (including their young childhood/toddler years) and that you are interested in the client’s interests, play/hobbies, engagement, communication and interpersonal style with others. A helpful ‘ice breaker’ is to look through the photographs they bring with them.

Background Interview

Commence the interview by completing the 'Background' section. If this has been sent out and completed in advance of the appointment, the assessor should check through the responses for omissions, clarifications and/or further details that may be required. In addition to demographic information, the background section enquires about the presentation and early development of the client, their educational and occupational history, medical history, family and relationships.

Symptom Ratings

Before embarking on the symptom ratings, it may be helpful for the assessor to briefly revise the symptom ratings guidance. This guidance is located at the beginning of the Symptom Ratings section, and provides a one-page reminder of the important diagnostic factors that the assessor should be bearing in mind throughout the assessment. For each item, it is important to enquire whether symptoms were present at a very young age (e.g. as a toddler) and if any developmental differences were observed/reported. It is also important to enquire about frequency, severity, impairment and mediating factors, in addition to considering each symptom across the entire lifespan of the client. The assessor needs to be mindful of the need for symptoms to be consistent and pervasive over time and across settings; difficulties should not be better explained by a situation-specific event that required them to adapt to substantial change in their life (such as moving home or school). The assessor should also consider whether difficulties are being masked by compensatory strategies and/or ‘accommodations’ (i.e. adjustments) made by others. Contextual influences need to be kept in mind. For example, the purpose of verbal and/or behavioural rituals may be to provide comfort (ego-syntonic) or to neutralise feelings of distress (ego-dystonic).

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The symptom ratings section assesses social-communication and social interaction (three items) and restricted, repetitive patterns of behaviour, interests or activities (four items). The three items relating to social-communication and social-interaction (Criterion 1) are organised under nine core symptoms as follows: 1a. Abnormal social approach 1b. Initiation of social interactions and response to those of others 1c. Engagement in two-way conversations (NB. Not applicable for non-verbal clients) 1d. Sharing of interests, emotions and/or affect 2a. Integration of verbal and non-verbal communication 2b. Facial expressions and body language 3a. Forming and maintaining friendships 3b. Sharing in imaginative play 3c. Adjusting behaviour according to social context The four items relating to restricted, repetitive patterns of behaviour, interests or activities (Criterion 2) are organised under eleven core symptoms as follows: 4a. Stereotyped or repetitive motor movements 4b. Stereotyped or repetitive use of objects 4c. Stereotyped or repetitive speech 5a. Insistence on sameness and inflexible adherence to routines 5b. Ritualized patterns of verbal or non-verbal behaviour 6a. Preoccupations or attachments to unusual objects 6b. Restricted or perseverative interests 7a. Unusual response to pain or changes in temperature 7b. Unusual response to specific sounds 7c. Unusual response to specific textures, tastes and/or smells 7d. Unusual response to lights or movement Each symptom consists of a series of questions. It may not be necessary to put every question to the interviewee; they are there solely to assist the assessor in determining the appropriate rating and the assessor should continue to administer the prompts until they are satisfied they have sufficient information to reach a decision. Each symptom has four text boxes that prompt the assessor to record notes as follows:

As a toddler/child does/did the client differ from other children of the same age? As a child, do/did other people (e.g. teachers, peers, fellow parents) make comments about the client?

How do/did these characteristics impact on daily activities? Are/were accommodations made to reduce disruption to family life? Does/did the client use camouflaging or strategies to mask their symptoms?

How do/did these characteristics manifest at home and outside of the home (i.e. school, occupation, leisure activities)?

How do these characteristics currently cause concern or impairment?

It is recommended that these notes are written in sufficient depth to guide and support the assessor’s

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decision about the symptom. The assessor should prompt the interviewee to describe specific situations and/or to give specific examples about when, how and where the difficulty presents across settings and whether it has changed over time (and if so why). Given the high estimates of heritability of neurodevelopmental conditions in families, it is important to be mindful that informants may have an (undiagnosed) condition, which in turn may impact on their judgment of ‘typical’ behaviour. It is therefore important for the assessor to obtain very specific examples of behaviour from the informant and use these examples to make clinically informed judgments, rather than relying upon the informants’ perception of what is ‘typical’ or ‘atypical’. From this in-depth exploration of each symptom, the assessor will judge and record at the bottom of the page whether each symptom is (1) absent, (2) partially present without impairment, (3) partially present with impairment, and (4) present. Impairment is defined as a diminishment or loss of function or ability, either physical or mental. It refers to a severe limitation that people experience in carrying out functions in their daily lives at home, in school or at work, and in the community, that falls outside a range of considered ‘normal’. To assist in differentiating between the ratings, the following guidance is provided: Absent: This is endorsed when a symptom is determined not to be present. Partially present: Partially present is applicable if a symptom is present across settings and situations, but not consistently (i.e. it is only sometimes present). One reason for this may be when the client is able to moderate their presentation in some situations due to camouflaging and/or applying compensatory strategies. These methods enable the client to maintain their presentation for a brief period and/or in some contextual situations, but it cannot be sustained across all situations or for extended periods of time. Sometimes it is others who make the modifications or provide ‘scaffolding’ to support the client. We have subdivided this category based on associated impairment as follows:

Partially present without impairment: Partially present without impairment refers to a symptom which does not cause impairment to the client’s personal, social, or educational/occupational functioning. An example relating to symptom 1c (engagement in two-way conversations) is a client who appears to communicate relatively well with their immediate family but struggles with others who know him/her less well. This may be because the client’s family is used to the client’s interpersonal style, can understand and anticipate their needs, is well acquainted with their specific interests and is skilled at facilitating conversation. When interacting with people they know less well however, the client is able to engage in two-way conversation but communication is more stilted and difficult to maintain. In this case, a partially present symptom may be rated because the client is able to successfully use a conversation strategy that allows them to engage in minimal, scripted small talk that is sufficient for small social encounters, and/or they avoid any scenarios where extended conversations would be required (i.e. happily chooses to play alone at school or successfully pursues a career with minimal social contact). This would not be associated with impairment if the client does not report any distress or frustration at their limited conversational abilities and is happy and able to successfully participate in limited social engagement (outside of the immediate family).

Partially present with impairment: In the example above, a partially present symptom may be rated to be with impairment if the client is able to communicate relatively well with their immediate family but is unable to successfully adopt strategies that they can consistently apply

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across a variety of social encounters and social settings and/or their communication difficulties cause him/her to feel frustration and/or distress. As a result, the client suffers impaired personal and social functioning because they are unable to successfully socialise beyond their immediate family.

Present: This is selected when a symptom is determined to be consistently present (with impairment) across settings and situations. The qualifiers that determine this decision, especially with regards to the level of impairment and any accommodations made, should be included when writing a clinical assessment report based on DASI.

Chronological and Developmental Age

It is important to consider the extent to which the client’s functioning is both age and developmentally appropriate. A child’s chronological age relates to their date of birth, which may differ substantially from their developmental age. Their developmental age is the age at which they function emotionally, physically, cognitively and socially. For example, a child may be 12 years of age but developmentally they display emotions or behaviours that make them seem much younger. Hence, it is important not to focus solely on a child’s intellectual limitations or chronological age but to be mindful of a child’s developmental limitations more broadly. For example, a child of 12 years may have an IQ that falls within normal limits, but their emotional and social functioning may be highly discrepant with other areas of functioning and therefore developmentally inappropriate. Hence, one has to consider the broader developmental functioning of the child.

Non-Verbal Clients

Some items and questions are not relevant when conducting an assessment about a client who is non-verbal. For consistency across interviews, DASI has adopted the definition of ‘verbal’ applied in the Autism Diagnostic Interview – Revised (ADI-R; Rutter, Le Couteur & Lord, 2003, p81) “the functional use of spontaneous, echoed, or stereotyped language that, on a daily basis, involves phrases of three words or more that at least sometimes include a verb and are comprehensible to other people”. Hence item (1c) ‘Engagement in two-way conversations’ is not applicable for clients who do not meet this definition of verbal ability. In item (2a) ‘Integration of verbal and non-verbal communication’ a prompt has been added to indicate that for non-verbal clients this item might involve integrating one or more of the following: eye contact, gestures, facial expressions and/or sounds/vocalisations (rather than verbalisations). With respect to the Observational Record, only OR5: General Presentation can be completed for non-verbal clients.

Cultural Considerations

Cultural issues may impact on the assessment; for example, expectations regarding the use of eye contact vary in different parts of the world. Style of interaction may also differ; for example, language

1 Rutter, M., Le Couteur, A., & Lord, C. (2003). ADI-R. Autism Diagnostic Interview Revised. Manual. Los Angeles: Western Psychological Services.

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use is typically more formal in Russian and ex-soviet cultures and in Mediterranean cultures people often speak more loudly and with greater gesticulation. Play activities may also be culturally sensitive. For this reason, the assessor should place greater emphasis on the interpersonal style children adopt in their play (e.g. whether they follow or impose strict rules, whether they dominate and delegate as opposed to engage in reciprocal activities) rather than the type of play activities in which they engage.

Accommodations and Camouflaging

There may be diagnostic challenges when diagnosing client’s with subtle or ’mild’ presentations. This may be due to difficulties being ‘masked’ by comorbid conditions and/or environmental accommodations being applied at home such as avoiding family outings, social events and school trips. The individual may also ‘camouflage’ their difficulties by acquiring compensatory strategies or ‘surface skills’ that they are able to sustain for a limited time, which make them appear more socially able than they really are.


In this section the assessor is steered to consider the issue of differential or co-occurring presentations by referring to a list of alternative and/or common co-existing problems. These include neurodevelopmental/cognitive, behavioural, emotional, physical and medical disorders, and each includes a brief description that aims to prompt the assessor to consider the presentation of the client from a different perspective. The section is not intended to be presented sequentially to the client; the items serve only as a prompt from which the assessor selects co-existing conditions that may have been indicated during the interview. It is not recommended that the problems and disorders are disclosed (as labelled) to the interviewee. Preferably, the assessor should lead with general questions that relate to the condition before focusing on specific symptoms. A space is provided to make notes and classify whether the condition has been previously diagnosed or whether further investigation is required. This section is not intended to make a diagnosis; rather it aims to identify symptoms that should be considered as potential differential or co-existing conditions that require further investigation. Any known co-existing and suspected inherited or acquired conditions are also recorded here (i.e. medical, psychiatric and genetic). If in the course of this assessment a client has disclosed that they have had a condition diagnosed in the past that is no longer a problem, this should also be recorded (including the duration of the episode).

Observational Record

The aim of this section is simply to provide a structure to observe and record the client in order to obtain objective information that might supplement the clinical interview. It is not a ‘test’ and it should not be presented in that way to the client. The section consists of five items, OR1-OR5, as follows: OR1: Communication Task OR2: Emotions Task OR3: Picture Task OR4: Story Task OR5: General Presentation Only the OR5: General Presentation can be completed for non-verbal clients.

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The materials required for OR3 and OR4 can be found in the Appendix. OR3 should be printed in colour. Although presented as an independent section, the items can be split up and administered at any point during the assessment. This means that the assessor can take advantage of an opportunity that may naturally present in the flow of the assessment rather than commencing the section independently, which may cause anxiety. The recording process requires that, for each item, the assessor rates a qualitative description of any observed difficulty and/or the client’s response in the sections provided. Based on their clinical judgement and bearing in mind the age, developmental level and/or expressive language level of the client, the assessor is invited to consider and rate the level of difficulty, insight or understanding. These ratings aim to guide the assessor to reflect on the client’s response and to categorise it from a subjective clinical perspective (as opposed to any objectively imposed criteria that has been obtained from empirical research). Guidance for each observational record item and its corresponding rating can be found below. If a discrepancy arises between information given during the interview and the observed behaviour, priority should be given to observed difficulties (even if these are not reported or played down by informants). However, in the reverse situation (if difficulties are reported by informants but not observed), the assessor should prioritise the informant account if they are able to provide supporting examples. OR1: Communication Task OR1 aims to assess social communication and conversation style, noting reciprocity and use of gesture, based on objective observation by the assessor. The record is based on what is directly observed (i.e. not based on the report of others). The assessor is guided to record a qualitative description of any observed difficulty in the following categories:

General level and style of language (intonation, volume, rhythm, rate, hyper-formality)

Conversation flow (spontaneity, reciprocal social interchange, domination)

General direction of conversation (initiation of topics, building on topic, switching topic, excessive interest in a topic, flexibility within conversation)

Unusual use of language (stereotyped/idiosyncratic use of words, echolalia, neologisms)

Non-verbal communication (spontaneous emphasis, gesture, eye contact, smiling, gesture/speech integration)

OR1 may be administered at any point during the assessment if an unstructured interaction has occurred that has extended beyond a general social greeting or overture. The conversation should not be limited to a general (and often rehearsed) social interchange (i.e. ‘how are you today?’, discussion about the weather, how they got to the appointment and questions about the journey). This may be a good ‘icebreaker’ when first meeting but a simple ‘question and answer’ format is not going to provide the opportunity to meaningfully observe social communication difficulties. Indeed, many people with ASD are able to engage in a brief and/or superficial social interchange of this nature. Difficulties may not be observed until a conversation advances in duration and complexity. This may be achieved by introducing various age-appropriate topics (e.g. talking about pets, plans to move house, academic subjects the client liked/didn’t like at school, public speaking, holiday plans), intentionally

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interrupting the client, offering an alternative opinion, as well as deliberately switching topics in the course of the conversation. The aim is to assess the extent to which the client can be flexible and adaptive in their response. If there is no opportunity to integrate OR1 into the interview and it is administered independently (e.g. at a separate meeting with the client), the assessor should introduce and structure a conversation as described above, taking care that this does not seem unnatural and stilted. It might be helpful to go back to the OR1 task after OR5 has been completed (and when the assessor has had the opportunity to further observe and discern difficulties). In this case, the assessor may wish to review the OR1 qualitative notes and ratings awarded. It may also be helpful for the assessor to note their observations as a passive observer of the client’s interaction with others, should an appropriate opportunity arise.

The assessor should note in the record whether OR1 has been completed from observations made from (1) an unstructured interaction/conversation that arose in the course of the appointment/interview (but drawing on the guidance provided); (2) a more structured ‘stand alone’ interaction/conversation; and/or (3) an observation of the client’s interaction/conversation with others. In the latter case, the assessor is not a participant in the conversation and the assessor should record the context of the observation by noting the situation and persons present. The duration of the interaction/conversation should also be recorded. Aside from making qualitative notes, based on their clinical judgement and bearing in mind the age, developmental level and/or expressive language level of the client, the assessor is invited to consider and circle the overall level of difficulty from four options (no difficulty, some/limited difficulty, difficulty, marked difficulty). To assist in differentiating between the ratings the following guidance is provided:

No Difficulty – at least typical and consistent for developmental age (functioning that is advanced for developmental age should also be included in this rating).

Some/Limited Difficulty – despite some difficulties being present, the client is able to apply and communicate the element adequately.

Difficulty – some difficulties are present but the client struggles to apply and communicate the element adequately.

Marked Difficulty – atypical and not consistent for developmental age. OR2: Emotions Task OR2 aims to define and establish insight into how emotions may relate to social behaviour and/or consequences. The client is asked to describe a time they felt happy, sad, angry, sorry, excited, worried, guilty and surprised. The client should be allowed sufficient time to respond but if they do not respond and/or they appear to struggle with the task, the assessor can give an example prompt (selecting the prompt for the respective emotion) as follows:

I felt happy on Saturday because I went skating with my friend

I felt sad when my sister fell off her bike and broke her leg

I felt angry when a teacher told me off at school

I felt sorry after I said nasty things to a friend

I felt excited when I saw all of my Birthday presents

I felt worried when I thought I lost my mum in the store

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I felt guilty when I sat on my friend’s glasses and they broke

I was surprised when my dad came home early from work

The assessor records whether an example prompt was given, or not. If it is, the client should be guided to give a response of their own, rather than repeating or making a minor adaptation to the example prompt given by the assessor. It is important the assessor enquires why the client associated the emotion with the event or situation in order to ensure their understanding of the concept. The assessor makes a verbatim note of the response for each emotion together with any observations of non-verbal communication (intonation, facial expression). If the client appears to be making an effort but is unable to attempt the task, or if there is a clear refusal and/or disengagement from the task, this should be recorded. Aside from making qualitative notes, based on their clinical judgement and bearing in mind the age, developmental level and/or expressive language level of the client, the assessor is invited to consider and circle the overall level of insight displayed from four options (good insight, some/limited insight, poor insight, inability/refusal to attempt task). To assist in differentiating between the ratings the following guidance is provided:

Good Insight – no prompt required, an appropriate response is given, and a clear rationale is provided for why the client experienced the target emotion.

Some/Limited Insight – required prompting (i.e. an example given), following which an appropriate response is given which markedly differs from the prompt and with a clear rationale for why the client experienced the target emotion.

Poor Insight – client provided an inappropriate response and/or an unclear rationale for why the client experienced the target emotion, regardless of whether a prompt was provided.

Inability/Refusal to Attempt Task – the client is unable to produce a response at all (despite prompting) or refuses to attempt task.

OR3: Picture Task OR3 aims to (1) assess items of interest to the client and (2) assess the client’s ability to understand and interpret social situations. The OR3 task sheet can be found in the appendix and should be printed in colour in advance of the interview. This is a picture of a ‘fancy dress’ birthday party. Seven children are present. One is dressed as an astronaut; this is the birthday girl and she is wearing a birthday badge indicating she is 7 years old. The other children are dressed as a wizard, a pirate, a karate kid, a woodland character, and a clown. One child is not wearing fancy dress and one female adult is present. The clown is wearing the wrong hat; he is wearing a king’s crown. The people in the picture are standing in groups. Three children are talking together; they are playing a game ‘pin the tail on the donkey’ with the karate kid, who is blindfolded. He is pinning the tail in the wrong place. In the middle of the room a child is sitting on a rug playing alone with a train. He is not wearing fancy dress. He is sitting with his hands over his ears. In the corner of the room an adult is looking angrily at two children (the woodland character and the clown) who are fighting. One of them has chocolate on his hand (and there is a chocolate handprint on the wall next to him). There is a chocolate birthday cake on a table with a piece missing. There are only six candles on the cake (the

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birthday girl is 7 years old) and one of them isn’t alight. There are birthday presents in gift wrapping in the room. A fish and several animals feature in the picture. There is a fish swimming in a fishbowl on the table. There is also a cat on the table who is watching the fish. The fish seems aware of the cat’s interest. A giraffe and squirrel are outside looking in through the window at the party. There is a spider near the ceiling in the corner, by a crack in the wall. There are five decorative ducks in the picture, two to the left of the window and three to the right. There is a picture of a donkey on an easel for the ‘pin the tail on the donkey’ game. The décor in the room includes things that are ‘odd’, misaligned or lopsided and/or that can be counted. This includes a picture on the wall of an elderly man; the picture is not hanging straight. The wallpaper has countable patterns but with irregularities. The curtains hanging around the window are different lengths on each side. The flowers on the table are all the same (yellow with four petals) with the exception of one, which is red and has eight petals. The wall clock is lopsided and shows the time to be 3.22pm and 50 seconds. The digital clock that is diagonally opposite, on the table, is faster; the time is 15:25 (i.e. 3.25pm). It is ‘odd’ to have a giraffe in the garden looking through the window. Some earphones are dangling from the ceiling. There are three balloons in the picture, each differing in their colour, size and/or pattern. The assessor places the picture in front of the client. The assessor directs the client to look at the picture and asks the client to tell them what they notice about it. The assessor should not direct the client’s attention towards specific parts of the picture (either verbally or by pointing). A space is provided for the assessor to qualitatively record the client’s response. If the client does not respond verbally, the assessor may give general prompts (What are you looking at? What are you thinking? What are you doing? What do you find interesting? Is there anything that bothers you?). In some cases the assessor may notice that the client is engaged in some kind of activity (e.g. counting items, staring at a particular part of the picture), in which case the assessor should prompt the client to tell them what it is they are doing or what has taken their interest. Supplementary information from non-verbal responses and observations should also be recorded. Following this, the assessor is guided to give specific prompts to assess the client’s understanding of the social groupings, context, activities, and their ability to take the perspective of others. The assessor may use both specific verbal and visual prompts (such as pointing) for these sections. If the client does not spontaneously attempt to identify the thoughts and feelings of others (including the animals), the assessor should give prompts by pointing to specific people/animals in the picture and asking how they feel and why. For each category, the assessor records a qualitative description of any observed difficulties in the client’s comprehension of the setting, the social groupings, and their ability to take the perspective of others (e.g. their thoughts and feelings). If the client appears to be making an effort but is unable to attempt the task, or if there is a clear refusal and/or disengagement from the task, this should be recorded. Aside from making qualitative notes, based on their clinical judgement and bearing in mind the age, developmental level and/or expressive language level of the client, the assessor is invited to consider and circle the level of social understanding displayed from four options (good understanding, some/limited understanding, poor understanding, inability/refusal to attempt task). To assist in differentiating between the ratings the following guidance is provided:

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Good Understanding – at least typical and consistent for developmental age (functioning that is advanced for developmental age should also be included in this rating).

Some/Limited Understanding – an incomplete understanding of the item, even with prompting (e.g. an understanding of some, but not all, aspects of the item).

Poor Understanding – despite being given multiple prompts, the client displays only a basic and/or superficial understanding of the item.

Inability/Refusal to Attempt Task – the client is unable to produce responses at all (despite prompting) or refuses to attempt task.

OR4: Story Task OR4 aims to assess the client’s ability to spontaneously engage in an activity that requires imagination and creativity. The OR4 task sheet contains images of an apple, a question mark, a cat, a tree and a triangle. The OR4 task sheet can be found in the appendix and should be printed in advance of the interview. The assessor should place the task sheet in front of the client and ask them to make up a story that incorporates each of the five items and tell the assessor when they are finished. If the client seems unsure how to proceed, the assessor may give the client some encouragement to get started by discussing the items with them (e.g. what is this, what is it used for, where might you see it?) before repeating the instructions. However the assessor should not guide or lead the client by selecting the first or any other items in the task to generate a sequential imaginative story. Furthermore, the assessor should not model the procedure by providing an example story.

If the client completes the task having omitted one or more of the items the assessor may remind the client to include all five items in the story, but this prompt should only be given once. The assessor makes a verbatim note of the client’s story. For example (not to be read out to the client): “a cat runs up a tree and an apple falls from the tree into a hole shaped like a triangle in the ground. The cat is curious (the question mark) and wonders where the apple’s gone”. The items can be incorporated into the story in any order and the items do not have to be specifically named but it must be clear when they are including each item. The client may choose to point out items instead of naming them, for example, the client might state the apple fell into a hole in the ground and indicate the triangle is the hole by pointing at it. Aside from the story content, the assessor notes whether a prompt had to be given to include all five items and records the number of items included in the story before and after the prompt (if this is given). If the client appears to be making an effort but is unable to attempt the task, or if there is a clear refusal and/or disengagement from the task, this should be recorded. Aside from making qualitative notes, based on their clinical judgement and bearing in mind the age, developmental level and/or expressive language level of the client, the assessor is invited to consider and circle the overall level of imaginative effort from four options (spontaneous creativity/imagination, good creativity/imagination, some/limited creativity/imagination, or inability/refusal to attempt task). To do this, there are three aspects to be considered:

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A. The number of items used to create the story. B. The client’s use of abstraction from the ‘triangle’ and ‘question mark’ items (if used). Have these

been applied to the story in a literal or a non-literal manner? Examples of abstract application are the ‘triangle’ being used to represent a mountain, rocket, hat, person, piece of cheese. For the ‘question mark’ these might be a snake, river, necklace, earring, coat hanger. The question mark might also be used abstractly to represent a cognitive or emotional state (e.g. thinking, pondering, curious, confused). An example of literal use of these items might be the inclusion of a picture or card with a ‘triangle’ or ‘question mark’ in the story. In the previous example this might be ‘the apple fell onto a card on the ground that had the shape of a triangle on it’.

C. The narrative generated by the client. To what extent has the client provided a ‘rich’ story that links some or all of the items together? Even if the client has not incorporated all of the items and those that have been used have been incorporated in a literal way, the client may have generated a creative story that involves a level of complexity and imaginative material.

To assist in differentiating between the ratings the following guidance is provided:

Spontaneous Creativity/Imagination – credit for each of the following three aspects (A, B and C): A. Number of items: without prompting, the client generated a story incorporating all of the items B. Abstraction: abstract use of at least one of the ‘triangle’ and ‘question mark’ items C. Narrative: an imaginative and creative story was generated

Good Creativity/Imagination – credit for two of the three aspects (A, B or C): A. Number of items: with prompting, the client generated a story incorporating all of the items B. Abstraction: abstract use of at least one of the ‘triangle’ and ‘question mark’ items C. Narrative: an imaginative and creative story was generated

Some/Limited Creativity/Imagination – credit for one of the three aspects (A, B or C): A. Number of items: the client is able to produce a story using some, but not all of the items (even

with prompting) B. Abstraction: no abstract use the ‘triangle’ and ‘question mark’ items but the client used one or

both of the two items literally (if used) C. Narrative: an imaginative and creative story was generated

Inability/Refusal to Attempt Task - the client is unable to produce a story at all (despite prompting) or refuses to attempt task

OR5: General Presentation OR5 is a qualitative record of behaviours that the assessor has observed in the course of the DASI assessment. OR5 can be completed for both verbal and non-verbal clients, noting observations relating to complex mannerisms (hand/finger movements, flapping); intense interest, dislike or reference to sensory stimuli; compulsions and/or ritualised behaviours; excessive interest or preoccupation with unusual or highly specific topics, objects or repetitive behaviours; and self-injurious behaviour. There is a category called ‘other’ where the assessor might capture atypical and/or other difficulties that were noted during the assessment (such as rigid thinking patterns, hyperactivity, oppositional behaviours). OR5 is a qualitative record only, and no ratings are made for these observations.

Observational Record Summary

The Observational Record Summary is a section where the assessor copies across the ratings awarded for OR1, OR2, OR3 and OR4 of the observational record. A notes box is provided at the end where the

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assessor can summarise pertinent observations from OR5 (which has no ratings). The Observational Record Summary will support the assessor to reflect upon the pattern of difficulties across the domains that have been objectively assessed.

Scoring

The scoring section is organised under Criterion 1, Criterion 2, Diagnosis and Notes. For ease of scoring, the assessor should transfer the rating for each symptom to the corresponding boxes on the scoring sheets. The assessor then records whether the required number of symptoms have been endorsed (Yes) or not endorsed (No). Endorsement (Yes) is achieved if at least 1 item per category has been rated as ‘present’ or ‘partially present with impairment’. For Criterion 1, the assessor records (a) if all three categories of Criterion 1 have been endorsed, (b) if they present across multiple settings and contexts and (c) are not better accounted for by general developmental delays. For Criterion 2, the assessor records (a) if at least two out of the four categories of Criterion 2 have been endorsed, (b) if they are present across multiple settings and contexts and (c) are not better accounted for by general developmental delays. Assessors are guided to consider whether the client has a diagnosis of ASD by completing the Diagnosis section. This asks them to record in a Yes/No format:

A. Whether all three categories of Criterion 1 have been endorsed (Yes) across multiple settings and

not better accounted for by general developmental delay (as shown on the Criterion 1 scoring sheet)

B. Whether at least two of the four categories of Criterion 2 have been endorsed (Yes) across multiple settings and not better accounted for by general developmental delay (as shown on the Criterion 2 scoring sheet)

C. Whether symptoms have been present since early childhood. D. Whether symptoms cause clinically significant impairment in social, occupational or other

important areas of functioning. A diagnosis of ASD is present if each of the above (i.e. A, B, C and D) are all endorsed (Yes). A diagnosis of Social Communication Disorder is present if A, C and D are endorsed (Yes) but not B (No). The Notes section collates further information and context for the diagnosis. The assessor is guided to consider the presence of intellectual impairment in addition to any current language impairment. If intellectual impairment or an uneven cognitive profile is suspected (but not known), the assessor should consider obtaining a comprehensive intellectual assessment. The assessor is then invited to rate the severity of the client’s presentation, determined by circling the one level of support option that best reflects the client’s requirements (mild to moderate, substantial, or very substantial). DSM-5 provides guidance on making this decision. Finally, a space is provided for additional notes including the presence of possible or known comorbid conditions.

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Client’s name: Date of birth: Gender: Male Female Other - please specify:

Date of interview: Name of assessor: Informant's name(s): Relationship to client:

Initial Presentation How would you describe the client when they were a toddler/child? Did you feel the client was different from other children in any way?

___ /___ /___

___ /___ /___

INTERVIEW - Background

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At what age did you first become concerned about the presentation of the client? What specifically caused you to be concerned? Has anyone else raised a concern about the presentation of the client? Yes* No

Early Development

Were there any complications during the pregnancy or birth of the client?

Problems during pregnancy* Problems during the birth* Premature birth* Low birth weight (<2.5kgs or 5.5lbs)*

Was the client able to walk by 18 months? Yes No*

Was the client able to say single words by 18 months? Yes No*

*Please provide further details of all those selected:

____ yrs ____mths

* If ‘Yes’:

Who raised the concern? At what age? What was their concern?

*If ‘No’: At what age was this achieved?


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Was the client able to form short sentences by 24 months? (i.e. put at least 2 different words together, not simply repeating other people)

Please provide any further information about the client’s developmental milestones, including whether any concerns were raised about these and by whom: For children who were not meeting language milestones, how did they make their needs known? Were any of these skills achieved but subsequently lost/declined? Yes* No

As a child, has/did the client receive speech and language therapy support? Yes* No

*If ‘Yes’: Please detail -

Yes No*


* If ‘Yes’:

Who referred the client? At what age? How often and over what time frame was the support provided?

What was the aim of the intervention?

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As a child, has/did the client ever have contact with external agencies e.g. social and/or health services?

As a child, has/did the client have their cognitive ability assessed? Yes* No

Education and Occupation Please provide the following information regarding the client’s education:

Yes* No



Dates of attendance

Age of client

Name of school

Type of school

Reason for moving on (e.g. expelled, family relocation, end of schooling)

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If in mainstream education, does/did the client receive extra support or help at school?

Has the client left school? Yes* No For those who have left school, please detail any further education the client has undertaken (i.e. homeschooling, college, university, vocational study, apprenticeships, other training): Please list all qualifications and grades achieved by the client: For those who have left school, please detail the client’s occupational history including paid/unpaid work, number of jobs, duration of employment, reasons for a change in occupation and periods of unemployment:


*If ‘Yes’:

At what age did they leave school?

Why did the client leave school? (i.e. reached end of compulsory education; expelled; to be

homeschooled)

Yes* No

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Medical History Has the client been previously clinically diagnosed with ASD (including Asperger’s Syndrome)?

Does the client have a history of any medical/psychiatric conditions? Yes* No

Is the client currently taking any medication? Yes* No

Does/has the client used alcohol or non-prescription drugs? Yes* No

Yes* No

*If ‘Yes’: Please detail –

At what age?

Who provided the diagnosis?



*If ‘Yes’:

What substances have they used in the past?

With what frequency did they use these?

What substances do they use currently?

With what frequency do they use these?

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Family and Relationships For young people and adults, does the client currently have an intimate partner? Describe the number and quality of the client’s intimate relationships (including duration and reasons for ending of relationships). Note whether there is a substantial age difference: Does the client have any children? Yes* No

Do any family members (e.g. parents, children) have diagnosed or suspected neurodevelopmental conditions such as ASD, ADHD and/or intellectual disability? Yes – diagnosed* Yes – suspected* No

Do any family members (e.g. parents, children) have a specific learning difficulty (e.g. dyslexia, dyscalculia, dysgraphia, processing deficits)? Yes* No

Yes* No

*If ‘Yes’: For how long have they been with this intimate partner?




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Do any family members (e.g. parents, children) have a diagnosed or suspected psychiatric condition such as anxiety disorder, depression, bipolar disorder or psychosis? Yes – diagnosed* Yes – suspected* No

Notes Please use the space below to expand upon any of the background information included here, or to record further information you feel may be relevant:


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Items 1-3 relate to CRITERION 1: Persistent deficits in social-communication and social interaction Items 4-7 relate to CRITERION 2: Restricted, repetitive patterns of behaviour, interests, or activities

Each symptom item consists of a series of questions and prompts. It may not be necessary to put every question to the interviewee, the prompts are there solely to assist the assessor to determine whether a symptom item is (1) absent, (2) partially present without impairment, (3) partially present with impairment, or (4) present. It is important to enquire whether symptoms were present at a very young age, e.g. as a toddler. Please refer to the DASI Administration section for further details. When conducting the interview bear in mind and/or note the following points:

Onset: When did this symptom first appear? Symptoms are typically recognised by 24 months,

but may be earlier if developmental delays are severe or later if symptom presentation is more subtle. In some cases there may be a loss of skills (typically between 12 and 24 months) which may be a gradual or rapid deterioration in social behaviours and/or language skills. In some cases loss of skills may be transient.

Persistence: Has the symptom persisted over time? Does/did it occur more frequently than

that typically expected for the child’s age and development level? Note, the symptom may persist but change in nature or character.

Pervasiveness: Does/did the symptom present in more than one context (e.g.

school/occupation, home and leisure activities)?

Developmental Difference: Does/did the client differ from other children of the same

age? In what way? Do/did other people make comments about this?

Impairment: To what extent (1) does this symptom impair the client’s current functioning and

(2) did it impair the client’s functioning and development as a toddler/child? Note that initially, symptoms may not appear to cause impairment. For example a young child may play alone for long periods of time which, although not typical behaviour, may not have been perceived as problematic or impairing at that time.

Masking: In childhood, to what extent are/have symptoms been masked by accommodations

made by the family and/or others in order to minimise disruption to family life or everyday activities? In later years, to what extent are symptoms masked by learned strategies (sometimes symptoms may be camouflaged for a limited duration in certain settings or situations)?

Severity: Consider the level of support required to accommodate impairments associated with

Criterion 1 and Criterion 2 symptoms (i.e. requiring support, substantial support or very substantial support).

Symptom Ratings Symptom Ratings

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Does the client’s approach to others differ from that of their peers?

What is the purpose or quality of the client’s approach to others? Is it solely motivated to meet a specific need (to get something or find out something) or is it motivated to initiate a social interaction?

As a toddler/child, how does/did the client behave if you are/were in a waiting room at the doctor or dentist? What if other children are/were there?

Does the client respect the personal boundaries of others (e.g. barging into bedrooms unannounced, taking/using items that belong to others, invading personal space)?

Would you describe the client as being socially naïve?

Would you describe the client as being socially disinhibited (in the way they approach others socially)?

As a toddler/child does/did the client differ from other children of the same age? As a child, do/did other people (e.g. teachers, peers, fellow parents) make comments about the client? How do/did these characteristics impact on daily activities? Are/were accommodations made to reduce disruption to family life? Does/did the client use camouflaging or strategies to mask their symptoms?

1a. Abnormal social approach

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How do/did these characteristics manifest at home and outside of the home (i.e. school, occupation, leisure activities)? How do these characteristics currently cause concern or impairment?

1a. Absent Partially present

without impairment

Partially present

with impairment Present

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Does the client initiate social interactions of any kind (i.e. not just verbal) with adults, children, friends, family, acquaintances, strangers?

Does the client respond to social interactions of any kind (i.e. not just verbal) with adults, children, friends, family, acquaintances, strangers?

Does the client repeatedly make inappropriate ‘embarrassing’ statements or ask inappropriate questions? Is the client ever cheeky or rude to people?

Does the client realise the social impact of his/her comments or behaviour?

For non-verbal clients this item might involve attempts to initiate/respond to social contact through use of eye gaze, facial expressions, gestures and sounds/vocalisations


1b. Initiation of social interactions and response to those of others

[30]


1b. Absent Partially present

without impairment

Partially present


[31]

What is the purpose of the client’s speech? What proportion of their speech is to make a request or get their needs met? What proportion is to be social/chatty?

If you said nothing to the client, would he/she make conversation?

Can the client maintain a conversation by taking turns in speaking? Does the client wait for a person to respond?

Can the client sustain a conversation by building on other people’s comments?

When making conversation, is it one-sided? Does the client dominate the conversation?

Does the client respond to social cues (indicating someone is busy or trying to close down a conversation)?

Can the client have a conversation about topics you or others have introduced (unrelated to special interests of their own)?

How do people outside of the family experience conversations with the client? Do they report a sense of unease or that they do not fully understand what is being communicated?


1c. Engagement in two-way conversations (N.B. not applicable for non-verbal clients)

[32]


1c. Absent Partially present

without impairment

Partially present


[33]

How does the client express their feelings and emotions?

If the client is watching something wondrous (magician, fireworks) will the client turn to you to share this wonder/excitement?

Does the client spontaneously draw attention to things of interest (e.g. when on a journey, YouTube clips, TV shows)?

Does the client keep things to him/herself unless explicitly asked about something?

Does the client show favourite objects (e.g. toys, hobby items) without being prompted to do so?

How does the client respond to another person’s distress or discomfort?

Would the client ask why they are distressed (e.g. crying, angry)? Would the client understand the emotion being expressed and what might have caused this?

Does the client spontaneously give comfort to others (verbal expression of concern, and/or touch/gesture)?


Failure to engage and/or limited ability to engage in two-way conversations

1d. Sharing of interests, emotions and/or affect

[34]


1d. Absent Partially present

without impairment

Partially present


[35]

Does the client integrate both verbal and non-verbal methods to gain your attention and/or to communicate their needs?

When speaking, does the client use hand movements, gestures and/or facial expressions to communicate?

How would you describe the client’s use of eye-contact? Does the client look at you when talking to you? Does the client lack eye-contact, even when you are trying to catch their eye?

Does the client seem to rest his/her eyes on the bridge of your nose or on your mouth, instead of making eye contact?

Does the client ever turn away from the person they are speaking to or who is speaking to them?

If the client needs help, does the client point to something and/or come and get you as well as communicating the need verbally?

For non-verbal clients this item might involve integrating one or more of the following: eye contact, gestures, facial expressions, sounds/vocalisations (rather than verbalisations)


Failure to engage and/or limited ability to engage in two-way conversations

2a. Integration of verbal and non-verbal communication

[36]



without impairment

Partially present


[37]

Does the client show a range of feelings through facial expressions (including subtle expressions such as curiosity)?

What makes the client excited or happy? How do you know? How does the client show feelings? If given a present, how does the client respond?

Does the client spontaneously use gestures when communicating, such as pointing, waving, nodding, shaking head? Is it always a functional gesture (e.g. rub tummy to show hungry)?

Does the client use hand or arm movements to convey emotional signals (e.g. hand over face to convey embarrassment or shock, shrinking with fear)?

Does the client shake his finger to indicate ‘bad’ or ‘naughty’, clapping hands to applaud or praise, blow a kiss, finger to mouth for ‘shushhh’?


2b. Facial expressions and body language

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without impairment

Partially present


[39]

Does/did the client initiate friendships or does/did the client lack interest in peers? Does/did the client want to have friends? Does/did the client prefer to be alone?

As a toddler/child, if the client saw a group of same-age children he/she didn’t know at a park/beach/swimming pool, what would the client do? Would the client go over and approach them? How? What would the client do if one of them approached him/her?

As a toddler/child did the client engage in parallel play (playing next to a child but not playing with the child)?

Does/did the client actively avoid interacting with peers and/or social situations? Does/did this happen even if the client is familiar with the person and setting?

Does/did the client have friends in school? Outside of school? How does/did the client spend break time at school? How old are/were the client’s friends compared to the client?

Does/did the client meet up with friends outside of school? How often? Who initiates/initiated this? What do/did they do together?

If the client has left school, how many friends does the client have that he/she makes an effort to speak to or meet up with (i.e. not organised by someone else)?

Are/were the client’s friendships circumstantial (neighbours, children of family friends, friends of partner/housemate)?

Are/were the client’s friendships mutual and equal in terms of reciprocity?

Does/did the client have online friends? How many? What percentage of time does the client interact with online friends?


3a. Forming and maintaining friendships

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without impairment

Partially present


[41]

As a child, did the client organise play on his/her own without the help or direction of others?

Does/did the client spontaneously engage in imaginative ‘pretend play’ or games as a child (e.g. playing doctors, soldiers, teachers, dolls tea parties, space adventures, shopping)?

Does/did the client talk to toys/dolls/stuffed animals or make them talk or make noises?

Does/did the client play co-operatively with peers? How flexible is/was the client’s play?

Does/did the client engage in group games and social activities such as charades or hide and seek?

Does/did the client make up or create stories? Does/did the client do this with others and incorporate their ideas? If so, was this spontaneous?

Does/did the client copy the things people do but using a pretend object or toy (e.g. making tea, mowing lawn) as part of their play? Is/was this spontaneous (i.e. not initiated or prompted by others)?

Does/did the client imitate other people (e.g. how they sit or walk - NOTE: not as a joke). Is/was this spontaneous (i.e. not initiated or prompted by others)?

Does/did the client make the effort to keep the interaction/play going?

Does/did the client take an authoritarian role (e.g. not actually engaging in the game but creating order and rule by bossing others around)?


3b. Sharing in imaginative play

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without impairment

Partially present


[43]

Is the client’s behaviour appropriate to that expected in the setting/environment (church, restaurant, shopping)?

Does the client’s behaviour vary according to who is present?

Does the client display inappropriate facial expressions?

How does the client respond to strangers, teachers, adults, children (reserved, shy, disinhibited, cheeky)?

Is the client able to moderate their behaviour according to context or setting? As a toddler/child does/did the client differ from other children of the same age? As a child, do/did other people (e.g. teachers, peers, fellow parents) make comments about the client? How do/did these characteristics impact on daily activities? Are/were accommodations made to reduce disruption to family life? Does/did the client use camouflaging or strategies to mask their symptoms?

3c. Adjusting behaviour according to social context

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without impairment

Partially present


[45]

Does the client have any stereotyped behaviours, repetitive mannerisms or odd hand movements (flapping, finger flicking, twisting)? [NOTE: not nail biting, twisting hair, sucking thumb, clapping for applause]

Does the client engage in repetitive complex body movements (swaying, spinning, walking on toes, bouncing, head rolling, rocking)?

Does this happen at particular times (anxiety, distress, anger, frustration)?

Do these movements interfere with the client’s functioning (i.e. their ability to do things)? How? What happens if you ask the client to stop?


4a. Stereotyped or repetitive motor movements

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without impairment

Partially present


[47]

Does the client repeatedly interact with objects in a manner that is excessive and/or unnecessary (e.g. opening/shutting a door, flipping objects, switching lights on/off)?

Does the client ever change or adapt these activities or are they always the same?

As a toddler/child, did the client play with a whole toy or just a part of it (e.g. spinning the wheels of a car rather than its intended use)?

Does/did the client do the same thing over and over again with toys/items (e.g. by lining them up rather than playing with them, dropping them from a distance)?


4b. Stereotyped or repetitive use of objects

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without impairment

Partially present


[49]

Does the client engage in a repetitive speech pattern (repeating words, sentences or questions; talking to him/herself, giving a running commentary of what he/she is doing or thinking and repeating the commentary)?

Does the client ever use odd phrases or say something over and over again in exactly the same way (other than when asking for something they want)?

Does the client have routine phrases that he/she repeats out of context (e.g. must not pull eyelashes)?

Does the client repeatedly use phrases from a TV programme or from songs?

Does the client ever use words he/she’s invented or made up (neologisms)?

Does the client use idiosyncratic language, e.g. real words/combined phrases in an odd way to convey specific meanings such as ‘raw toast’ for bread? [NOTE: Not as part of a game or joke and not conventional metaphors, such as rhyming slang]

Would someone outside the family understand what the client is communicating?

Does the client speak in a high-pitched, sing-song, flat or robotic-like manner?

If stereotyped speech is used, is this functional (i.e. a child saying “by gosh, I don’t even know your name” in order to find out someone’s name)?


4c. Stereotyped or repetitive speech

[50]



without impairment

Partially present


[51]

How does the client react to change? [NOTE: marked negative reaction to minor change required; not associated with major transitions such as moving house, changing school]

Do routines need to be consistently specific and rigidly followed (e.g. same route taken for familiar journeys, same time each day)?

Is the client bothered by minor changes to personal routines and arrangements (switching mittens to gloves, long sleeves to short sleeves, bathing 15 minutes earlier/later than usual, dressing after breakfast instead of before, where food is placed on a plate)?

How does the client react to change in someone else’s routine (e.g. if a family member/teacher is away or late) or to changes in another person’s appearance (e.g. if a family member has a haircut)?

How does the client react to items being moved (e.g. how furniture is arranged, position of ornaments, place settings at mealtime)?


5a. Insistence on sameness and inflexible adherence to routines

[52]



without impairment

Partially present


[53]

Does the client engage in any compulsive behaviours they are compelled to repeatedly perform, such as needing to clap hands 5 times before entering a room, checking things, hand washing?

Must the client do things in a fixed sequence or specific order (e.g. a ritual of touching or putting things in a specific place before leaving home or going to bed, placing cutlery and folding napkins in a specific way before eating)?

What happens if the client can’t complete the whole sequence and/or the client is disrupted before it is completed? Does the client have to re-start the sequence?

Does the client have rigid thinking patterns (e.g. can’t understand humour, irony, sarcasm)?

Does the client engage in verbal rituals (e.g. they repeat fixed word or number sequences that must be said in a particular order. This can also involve insistence that another person responds in a highly specific way)? [NOTE: excludes bedtime routines to say goodnight unless they are markedly unusual]

What happens if the client is interrupted or you refuse to comply? Does the disruption of routine lead to distress? How is this expressed (pacing, motor movements, flapping, tantrums)?


5b. Ritualized patterns of verbal or non-verbal behaviour

[54]



without impairment

Partially present


[55]

Does the client have any unusual, narrow and/or peculiar interests in objects that intensely preoccupy him/her that might seem odd to others (e.g. barcodes, street lamps, metal pegs, pipes, colours, numbers)? [For each interest record age and duration of phase. NOTE: Interest should be present for at least 3 months]

Does the client become fixated on unusual objects (e.g. vegetables, batteries, a piece of string)?

Does the client carry these objects around with him/her until a new object attachment is formed?

What percentage of time does/did the client spend on these objects/interests, including talking about them (0-100%)?


6a. Preoccupations or attachments to unusual objects

[56]



without impairment

Partially present


[57]

Has the client gone through phases when he/she had a special interest or hobby that was unusual in intensity? [NOTE: Not solely a collection – it must involve a strong interest or preoccupation that is present for at least 3 months. For each interest, record age, duration of phase and level of intensity (0–100%)]

How did the client show that they were interested in this topic/hobby?

What percentage of time does/did the client spend on these interests, including talking about them (0 – 100%)?

Does/did the client collect items associated with the interest? What does/did the client do with these items? Were they kept in boxes? Does/did the client catalogue items and/or associated information?

Does/did the client undertake research about the special interest (e.g. internet searches on the history/associated facts, making detailed notes, logging information/timetables)?

Does/did the client actively seek out these interests, even when they are absent (e.g. internet search) or is the client just interested in them when he/she sees them?

When the client has moved onto a new interest, what did he/she do with items and paraphernalia relating to these interests?


6b. Restricted or perseverative interests

[58]



without impairment

Partially present


[59]

Does the client show an unusual response to pain (e.g. a high or very low tolerance to pain)?

Is the client unaware if he/she has cut themself (e.g. when falling over)?

Does the client engage in self-injurious behaviour (head banging, eye poking, scratching, biting)?

Does the client show an unusual response to changes in temperature (e.g. a high or very low tolerance for heat/cold, wearing multiple layers of clothing on a hot day)?

How does the client respond (e.g. crying, tantrums, indifference)?

Does the client seek out comfort?


7a. Unusual response to pain or changes in temperature

[60]



without impairment

Partially present


[61]

Does the client show an intense aversion or fascination for certain ordinary sounds (e.g. ringtones, household appliances, traffic noise)? [NOTE: excludes reaction to sudden, harsh unexpected noise, startle or fearful reaction].

How does the client respond (e.g. screaming, covering their ears, tantrums)?

Is the response predictable?


7b. Unusual response to specific sounds

[62]



without impairment

Partially present


[63]

Does the client show an intense aversion or fascination for the texture of some items (e.g. stroking velvet, wood, bristles rubber, silk, sand, earth, chalk)?

Does the client touch things with their lips to see how they feel or taste?

Does the client inspect some items closely by licking or smelling them inappropriately?

How does the client respond, e.g. does he/she refuse foods due to their smell or texture?


7c. Unusual response to specific textures, tastes and/or smells

[64]



without impairment

Partially present


[65]

Does the client seem to look at or stare at some things for a long time?

Have you noticed the client watching things out of the corner of his/her eye, or by squinting?

Does the client show an intense aversion or fascination for visual stimuli such as lights (street lights, car headlights, chandeliers)?

Does the client show an intense aversion or fascination for moving objects (e.g. appears transfixed by spinning fans, wheels on toys)?

Does the client appear to have an intense aversion or fascination for opening and closing doors, switching lights on/off or watching dust particles?

How does the client respond?


7d. Unusual response to lights or movement

[66]


7d. Absent Partially present

without impairment

Partially present


[67]

Notes: Previously Further investigation diagnosed: required:

Yes Yes No No

Common differential and co-existing conditions are presented below. The assessor should consider each in turn and decide whether it is a primary (i.e. differential diagnosis) or secondary (i.e. co-existing) condition. It is important to establish whether the presenting problem is chronic or whether it has a recent onset. When applying ICD-10 criteria, note that this classification system does not recognise comorbid conditions. It is recommended that the assessor DOES NOT disclose (as labelled) the disorder being discussed. Preferably, the assessor should lead with general questions that relate to the condition before focusing on specific symptoms. In the scoring section, known or suspected inherited or acquired conditions should be noted.

Cognitive and Learning Impairments Is there evidence of generalised intellectual disability or specific learning difficulties such as reading, writing or arithmetic difficulties?

Speech and Language Impairments Is there evidence of specific expressive and receptive language delay?


Yes Yes No No


[68]


Yes Yes No No


Yes Yes No No

Attention Deficit Hyperactivity Disorder Is there evidence of problems with sustaining attention, poor impulse control and hyperactive behaviour (in adults hyperactive behaviour may present more as inner restlessness)?

Tics Disorder (Including Tourette’s) Is there evidence of motor and/or vocal tics?

Other Developmental Disorders Is there evidence of gross motor or fine motor developmental difficulties?


Yes Yes No No

[69]


Yes Yes No No


Yes Yes No No


Yes Yes No No

Oppositional Defiant Disorder or Conduct Disorder In childhood, is there evidence of oppositional behaviour and refusal to comply with authority, or more serious antisocial behaviours?

Excessive Irritability (Including Disruptive Mood Dysregulation Disorder) In childhood, is there evidence of excessive irritability and/or anger, either in intensity, frequency, and/or ease of provocation?

Emotional Instability/Dysregulation In adulthood, is there evidence of changeable and volatile mood including anger, frustration and irritability?

[70]


Yes Yes No No


Yes Yes No No

Substance Misuse Is there evidence of the client using or misusing substances including alcohol, cigarettes, prescription medication and/or illicit drugs? (Note also the severity of and the reasons for using drugs).

Traumatic Brain Injury Is there evidence of a history of severe head trauma or recurrent head injuries (e.g. falls, sport accidents, motor vehicle related injuries)? Note any loss of consciousness.

Anxiety Disorders Is there evidence of phobia, panic, social and/or generalised anxiety?


Yes Yes No No

[71]


Yes Yes No No


Yes Yes No No


Yes Yes No No

Obsessive Compulsive Disorder Is there evidence of obsessions, compulsions or other ritualistic or stereotyped behaviour?

Post-Traumatic Stress Disorder Has the client experienced any significant physical, sexual or emotional trauma?

Depression Is there evidence of low mood, negative thinking, low self-esteem, fluctuating mood, and irritability? (Note if there has ever been suicidal ideation or behaviour).

[72]


Yes Yes No No


Yes YesNo No


Yes Yes No No

Bipolar Disorder Is there evidence of an episodic disorder, including mania or hypomania?

Psychosis Is there evidence of thought disorder, delusions or hallucinations?

Personality Disorders Is there evidence of social and behavioural problems that may indicate a personality disorder (such as antisocial or borderline disorders)?

[73]


Yes Yes No No


Yes Yes No No

Other Mental Health Problems Does the client have any other mental health problems (e.g. eating disorder, sleep-wake disorders)?

Other Medical Conditions Does the client have any other diagnoses or suspected inherited or acquired conditions (e.g. Rett syndrome, Fragile X syndrome, Downs syndrome, epilepsy, fetal valproate syndrome, fetal alcohol syndrome)?

[74]

Detailed guidance on the administration of the Observational Record is provided in the DASI Administration section. The materials to administer the OR3: Picture Task and the OR4: Story Task can be located in the Appendix of this document. It is essential that the OR3: Picture Task is printed in colour. Only the OR5: General Presentation can be completed for non-verbal clients. The assessor records a qualitative description of any observed difficulty in the sections provided. Based on their clinical judgement and bearing in mind the age, developmental level and/or expressive language level of the client, the assessor is invited to consider and rate the client’s functioning from one of four options. OR5 is a qualitative record only, and no ratings are made for these observations.

Observational Record

[75]

Interaction/Conversational style observed from (tick the method applied and note duration):

Unstructured interaction/conversation with the assessor during appointment/interview

Duration: Structured ‘stand alone’ interaction/conversation with the assessor

Duration: Observation of interaction/conversation with other(s)

Duration: Details of situation and person(s) present:

___ hours ___ minutes



Marked Difficulty

General level and style of language (intonation, volume, rhythm, rate, hyper-formality)

If any difficulty is present, please detail:

Conversation flow (spontaneity, reciprocal social interchange, domination)


Some/ Limited

Difficulty

No Difficulty

Circle the client’s difficulty for each communication element below and provide details/examples (see DASI Administration for guidance):

OR1 Communication Task

Marked Difficulty

Some/ Limited

Difficulty

No Difficulty

Difficulty

Difficulty

[76]


Unusual use of language (stereotyped/idiosyncratic use of words, echolalia, neologisms)


General direction of conversation (initiation of topics, building on topic, switching topic, excessive interest in a topic, flexibility within conversation)

Non-verbal communication (spontaneous emphasis, gesture, eye contact, smiling, gesture/speech integration)


Marked Difficulty

Some/ Limited

Difficulty

No Difficulty

Marked Difficulty

Some/ Limited

Difficulty

No Difficulty

Marked Difficulty

Some/ Limited

Difficulty

No Difficulty

Circle the client’s difficulty for each communication element below and provide details/examples (see DASI Administration for guidance):

Difficulty

Difficulty

Difficulty

[77]

Happy

Tell me about a time when you felt ….. ? Record verbatim response and circle the client’s level of insight for each emotion (see DASI Administration for guidance):

OR2 Emotions Task

Poor Insight Some/

Limited Insight Good Insight

Inability/Refusal to Attempt Task

Sad Poor Insight Some/



Angry Poor Insight Some/



Sorry Poor Insight Some/



Detail response:

Why?

Unable to attempt? Prompt given? Refusal to attempt?

No Yes

No Yes

No Yes

Detail response:

Why?


No Yes

No Yes

No Yes

Detail response:

Why?


No Yes

No Yes

No Yes

Detail response:

Why?


No Yes

No Yes

No Yes

[78]

Tell me about a time when you felt ….. ? Record verbatim response and circle the client’s level of insight for each emotion (see DASI Administration for guidance):

Excited Poor Insight Some/



Worried Poor Insight Some/



Guilty Poor Insight Some/



Surprised Poor Insight Some/



No Yes

No Yes No Yes

Detail response:

Why?


No Yes

No Yes

No Yes

Detail response:

Why?


No Yes

No Yes

No Yes

Detail response:

Why?


No Yes

No Yes

No Yes

Detail response:

Why?


No Yes

No Yes

No Yes

[79]

Look at the picture. Tell me what you notice about it? (Do not draw attention towards specific parts of the

picture, either verbally or by pointing. If the client does not verbally respond, general prompts may be given, as guided in the DASI Administration). Record their description of the picture and specify areas of particular interest or dislike.

What do you think is happening here? (Prompt: Specifically ask about the social groupings, the context, and

the activities occurring in the picture. Assessor may use verbal and visual prompts, such as pointing). Record their response.

If the client has not spontaneously attempted to identify the thoughts and feelings of others, prompt:

How do you think this person feels? Why? What might this person be thinking? What about the animals? (Assessor may use verbal and visual prompts, such as pointing). Record their response.

OR3 Picture Task

[80]

Poor Understanding

Some/Limited Understanding

Good Understanding

For each of the categories below, circle the client’s level of understanding and provide details (see DASI Administration for guidance):

General understanding of setting

Understanding of social groupings

Understanding what others might be thinking and feeling (social-perspective taking)

Poor Understanding


Good Understanding



Poor Understanding


Good Understanding



Unable to attempt?

Refusal to attempt?

No Yes

No Yes


Unable to attempt?

Refusal to attempt?

No Yes

No Yes


Unable to attempt?

Refusal to attempt?

No Yes

No Yes

[81]

How many items did the client include in their story without prompting? Did the client require a prompt to use all five items in their story? No Yes* * Total number of items used after prompting? Did the client seem unable to complete the task? No Yes Did the client refuse to engage in the task? No Yes

Look at these 5 items. There is an apple, a triangle, a tree, a cat face, and a question mark. Make

up a story using all five of these items. (Record their story verbatim)

OR4 Story Task

From the story, circle the client’s level of creativity/imagination (see DASI Administration for guidance):


Some/Limited Creativity/

Imagination

Spontaneous Creativity/

Imagination

Good Creativity/

Imagination

[82]

Please make qualitative notes relating to the following observed behaviours in the course of the interview/assessment (there are no ratings for OR5):

Complex mannerisms: (hand/finger movements, flapping)

Intense interest, dislike, or reference to, sensory stimuli:

Compulsions and/or ritualised behaviours:

Excessive interest or preoccupation with unusual or highly specific topics, objects or repetitive behaviours:

Self-injurious behaviour:

Other: (may include verbal observations, such as rigid thinking patterns)

OR5 General Presentation

[83]

OR2: Emotions Task Good Insight Some/Limited

Insight Poor Insight


Happy

Sad

Angry

Sorry

Excited

Worried

Guilty

Surprised

OR3: Picture Task Good

Understanding Some/Limited Understanding

Poor Understanding


General understanding of setting

Understanding of social groupings

Understanding what other may be thinking and feeling

OR4: Story Task

Spontaneous Creativity/

Imagination

Good Creativity/

Imagination

Some/Limited Creativity/

Imagination


Imaginative effort

OR5: General Presentation

OR1: Communication Task No Difficulty Some/Limited

Difficulty Difficulty Marked Difficulty

General level and style of language

Conversation flow

General direction of conversation

Unusual use of language

Non-verbal communication

Observational Record Summary

Notes: (Summary of observed behaviours)

[84]

CRITERION 1 - Persistent deficits in social-communication and social interaction * not applicable for non-verbal clients

Are all 3 categories of Criterion 1 endorsed? (i.e. ‘Yes’ selected for items 1, 2, and 3)

Are these symptoms present across multiple settings and contexts?

Are these symptoms not better accounted for by general developmental delays?

Partially present

without impairment

Partially present

with impairment

Scoring

1.

Are persistent deficits in social-emotional

reciprocity endorsed by at least 1 item

rated as ‘present’ or ‘partially present with

impairment’?

Yes No

Present Partially present

with impairment

Partially present

without impairment Absent

2.

Are persistent deficits in non-verbal

communicative behaviours used for social

interaction endorsed by at least 1 item


impairment’?

Yes No

2a.

2b.

Present Partially present

with impairment

Partially present

without impairment Absent

3.

Are persistent deficits in the ability to

develop, maintain and understand

relationships endorsed by at least 1 item


impairment’?

Yes No

3a.

3b.

3c.

Present Absent

Yes No

Yes No

Yes No

1a.

1b.

1c.*

1d.

[85]

CRITERION 2 - Restricted, repetitive patterns of behaviour, interests, or activities

Partially present

without impairment

Partially present

with impairment

Partially present

with impairment

Partially present

without impairment

Partially present

with impairment

Partially present

without impairment

Partially present

with impairment

4.

Are persistent stereotyped or repetitive

motor movements, use of objects, or

speech, endorsed by at least 1 item rated as

‘present’ or ‘partially present with

impairment’?

Yes No

4a.

4b.

4c.

Present Absent

5.

Is an insistence on sameness, inflexible

adherence to routines, or ritualized patterns

of verbal or non-verbal behaviour endorsed

by at least 1 item rated as ‘present’ or

‘partially present with impairment’?

Yes No

5a.

5b.

Present Absent

6.

Are highly restricted, fixated interests that

are abnormal in intensity or focus endorsed

by at least 1 item rated as ‘present’ or

‘partially present with impairment’?

Yes No

6a.

6b.

Partially present

without impairment Present Absent

7.

Is hyper-reactivity or hypo-reactivity to

sensory input or unusual interest in sensory

aspects of the environment endorsed by at

least 1 item rated as ‘present’ or ‘partially

present with impairment’?

Present Absent

Are at least 2 categories of Criterion 2 endorsed? (i.e. ‘Yes’ selected for 2 or more of items 4, 5, 6, or 7)

Are these symptoms present across multiple settings and contexts?

Are these symptoms not better accounted for by general developmental delays?

Yes No

Yes No

Yes No

Yes No

7a.

7b.

7c.

7d.

[86]

DIAGNOSIS

A. Are all 3 categories of Criterion 1 endorsed across multiple settings and not better accounted for by general developmental delay?

B. Are at least 2 categories of Criterion 2 endorsed across multiple

settings and not better accounted for by general developmental delay?

C. Have the symptoms been present since early childhood? D. Do the symptoms cause clinically significant impairment in social,

occupational, or other important areas of function?

ASD Diagnosis A, B, C, and D are all endorsed (Yes) Social Communication Disorder Diagnosis A, C, and D are endorsed (Yes) but B is not endorsed (No)

NOTES

Is intellectual impairment present?

Is current language impairment present? (no intelligible speech, single words only, phrase speech)

Level of severity:

Notes (e.g. record possible or known comorbid conditions):

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Based on the evidence gathered and your clinical judgement, please circle the level of support the client requires:

Requires very substantial support

Requires substantial support

Requires mild to moderate support

[87]

Assessor Notes

[88]

APPENDIX

Young, S. (2020). OR3: Picture Task. Diagnostic Autism Spectrum Interview (www.psychology-services.uk.com)

The OR3: Picture Task is part of the Diagnostic Autism Spectrum Interview [DASI] (www.psychology-services.uk.com). It is essential that the OR3: Picture Task is printed in colour for its use as part of the DASI assessment. Instructions for the administration of the OR3: Picture Task are provided in the DASI Administration section.

OR3 Picture Task

http://www.psychology-services.uk.com/

Young, S. (2020). OR4: Story Task. Diagnostic Autism Spectrum Interview (www.psychology-services.uk.com)

The OR4: Story Task is part of the Diagnostic Autism Spectrum Interview [DASI] (www.psychology-services.uk.com). Instructions for the administration of the OR4: Story Task are provided in the DASI Administration section.

OR4 Story Task




Young, S. (2020). OR4: Story Task. Diagnostic Autism Spectrum Interview (www.psychology-services.uk.com)


[94]

Professor Susan Young has a BSc Honours first class degree in Applied Psychology and Sociology from University of Surrey, a Doctorate in Clinical Psychology from University College London and a PhD from King’s College London. She is a Registered Psychologist (clinical and forensic) with the Health and Care Professions Council and registered with the British Psychological Society as a Chartered Clinical Psychologist, Chartered Forensic Psychologist and Chartered Scientist. She is a practitioner member of the Division of Neuropsychology and an Associate Fellow of the British Psychological Society. Susan is the director of Psychology Services Limited (http://psychology-services.uk.com/) providing clinical and forensic psychology services and consultation, including assessment and treatment to children, adolescents and adults with mental health and/or neurodevelopmental problems. She has over 25 years experience working in clinical academia, including prestigious employment at the Maudsley Hospital; Broadmoor Hospital; the Institute of Psychiatry, Psychology and Neuroscience (King’s College London); and Imperial College London. Currently Susan has honorary contracts as a consultant at the Maudsley Hospital and an honorary professorship at Reykjavik University. In the NHS Susan worked at the Maudsley Hospital in their brain injury, neurodevelopmental and clinical services. After gaining experience of working in primary, secondary and tertiary healthcare services, Susan worked in forensic services for many years. She has worked at every level of security (community outreach, open rehabilitation, low, medium and high secure services), in addition to providing specialist advice and consultation at various youth and adult correctional/prison establishments. For 11 years, Susan’s clinical academic post was as an Honorary Consultant Clinical and Forensic Psychologist based at Broadmoor Hospital and for 4 years she was the Director of Forensic Research and Development in the West London Mental Health Trust. Susan has continued to be involved in international research collaborations and has over 150 publications in peer reviewed scientific journals. Susan has also written and published clinical treatment programmes for children, adolescents and adults and these are published in six books. These programmes are delivered in English speaking countries (including North America, Ireland, Canada, Singapore, Australia) and translated for use in Iceland, Sweden, Norway, Denmark, China and Japan. Susan has developed the ADHD Child Evaluation (ACE), which is translated into 20 languages, and ACE+ for use with adults, which has been translated into 12 languages at the present time (see Resources Section for Healthcare Practitioners of her website). ACE and ACE+ have been developed in electronic format and are available in English and Spanish (https://bgaze.com/en/ace). More recently, Susan has launched a comprehensive clinical tool to assess autism in children, young people and adults; the Diagnostic Autism Spectrum Interview (DASI). Susan regularly receives requests for medio-legal assessments. Aside from civil, family and tribunal cases, she has been engaged in over 150 legal cases referred by Defence solicitors, the Crown Prosecution Service, Customs Prosecution Service, the Police, the Criminal Cases Review Commission, the Home Office National Offender Management Service and directly by the Court.

About the Author

www.psychology-services.uk.com

Documents

Diagnostic Autism Spectrum Interview