International Journal of Psychiatry

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Volume 8 | Issue 4 | 51

Int J Psychiatry, 2023

Improving Intervention Strategies for Autism Spectrum Disorders by Altering the

Design of the Diagnostic Procedure

Short Communication

International Journal of Psychiatry

*Corresponding author

Rosalie E Seymour, ABC Learning Options SOUTH AFRICA

Submitted: 2022, Oct 10; Accepted: 2022, Nov 02; Published: 2023, July 03

ISSN: 2475-5435

Abstract

Since the identification of the childhood disorder Autism by Dr Leo Kanner in 1943 and Dr Hans Asperger in 1944, our

understanding of this condition has evolved. At first it was described as an attachment disorder, then it was described as a

psycho-social-educational disorder, which is largely where our thinking on the topic has remained. This thinking determines

the interventions applied. There is little expectation by physicians, parents or educators of significant emergence from ASD. It

is common for parents to report that they receive no real advice as to what to do after the diagnosis other than placement of the

child in a special school and to start Speech Therapy. The increasing incidence of ASD (1 in 44 births: CDC) means the mounting

pressure on service providers is unmanageable. However there have been changes in thinking that brought some promise of

brighter outcomes. For example since the 1990’s there has been increasing appreciation of the role of the biome, with reports of

positive outcomes following metabolic interventions. Approaches have arisen that offer positive outcomes and have brought a

greater understanding of the nature of ASD. This presentation proposes a change to the way the diagnostic protocol is executed

in keeping with a more pervasive view of ASD. A new approach is needed in line with research and new developments, so that

at the time of diagnosis parents get pointers for actions to follow that can greatly benefit the child, since all agree that early

intervention brings better outcomes.

Rosalie E Seymour*

ABC Learning Options SOUTH AFRICA

Citation: Seymour, R. E. (2023). Improving Intervention Strategies For Autism Spectrum Disorders By Altering The Design Of The

Diagnostic Procedure. Int J Psychiatry, 8(4), 51-58.

“While diagnosis has traditionally been viewed as an essential

concept in medicine, particularly when selecting treatments, we

suggest that the use of diagnosis alone may be limited, particular-

ly within mental health.” Macneil, Hasty et al. [1].

When we assign a label such as Autism to a condition, we tend to

be directed by that label when planning interventions. In this we

do not adequately recognise the differences within each present-

ing individual profile, and thereby fail to meet the requirements of

Best-Practice. It is of vital importance that suitably trained pro-

fessionals be knowlegeable of all the factors that affect each child

within the diagnostic category of Autism. This is a demanding task

given the very prevasive nature of the disorder, and since profiles

within the diagnosis of‘Autism’ or ‘Autism Spectrum Disorder’

can vary considerably.

It is logical that the information to which we respond when deal-

ing with a pervasive disorder as in the case of Autism, should nat-

urally be as varied and pervasive. This assists us to best serve the

needs of the individual.

1. The Influence of Early History

When the condition of Autism was first noted by Dr Leo Kanner

in 1948, he described children displaying “inborn autistic distur-

bances of affective contact” Rosen, N.E., Lord, C. & Volkmar,

F.R.

The emphasis in diagnostic interviews and research since Kanner

has tended to focus on the factor of disordered ‘affective content’.

The fundamental disorder of Autism has been viewed as that of

attachment.

Dr Kanner described autism as a developmental condition, while

Dr Hans Asperger described behaviours that more closely resem-

bled a personality disorder. This view was developed more fully

by Dr Bruno Bettelheim ( The Empty Fortress, 197....) in which

parents – particularly the mothers, were described as creating the

child’s withdrawal from the ‘cold, hostile’ emotional environment.

The intervention directed by this view was the removal of the chil-

dren from these supposed toxic situations (parent-ectomies) and

placement in supposedly ‘good-enough’ nurturing settings (spe-

cial ‘orthogenic’ centres).

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Int J Psychiatry, 2023

This concept has remained active despite having been discredited,

as understanding of Autism as a pervasive developmental disorder

has grown. In 1964 the book “Infantile Autism,” by Dr Bernard

Rimland described Autism as a neuro-developmental disorder of

brain function (1964) [2]. In 1974 Dr Carl Delacato published

‘The Ultimate Stranger – the Autistic Child’ in which he connected

these childrens’ unusual behaviours with the behaviours of chil-

dren with sensory differences related to neurological and physical

conditions e.g. blindness [3].

Kanner’s suggestion that autism is not associated with other med-

ical conditions was proven incorrect [4-6]. Autism has come to be

seen as a brain-based disorder given its frequent association with

epilepsy, often of adolescent onset [7]. Autism is also found to be

strongly genetic. The shift in diagnostic emphasis to regard autism

as a developmental disorder led to the DSM-lll (1980 ) listing Au-

tism separately from Childhood Schizophrenia for the first time,

and indicated that mental handicap could be an associated feature.

Rutter and Bartak demonstrated that an educational approach, that

is applying structured and consistent teaching within educational

settings, was far more effective than a psychotherapeutic approach

[8].

Many schools were started for children with Autism, employ-

ing a specially-adapted educational curriculum, that featured a

much-reduced and simplified content, repetitive experiences, and

heightened individual support. Originally derived from existing

programmes for children with mental handicap, these programmes

include (where possible) access to a variety of therapies such as

speech therapy, occupational therapy, behavioural therapy and oth-

ers. However, the psychotherapeutic approach is still adhered to in

a few countries, most notably in parts of southern Europe. Smith

[9].

New theories about the nature and causes of Autism continued to

arise. In 1993 Dr Simon Baron-Cohen proposed a psychological

theory of Autism known as ‘Theory of Mind’ [10]. He suggested

that cognitive impairments are responsible for the occurrence of

autistic disorder . This theory is based on the idea that the child

with Autism fails to understand that other people have different

ideas and mental states. Because of this, the children seem to have

difficulty in understanding that other people have different percep-

tions, experience and emotions. This is held to be the fundamental

problem which leads to relational problems. Tager - Flusberg pro-

poses a problem with language learning as the basis for Autism

communication and relationship breakdown [11].

These theories have influenced the development of intervention strategies, classified roughly in this table:

VIEW or THEORY OF ASD

ACTIVITIES / INTERVENTIONS

EMOTIONAL / SOCIO-EMOTIONAL

‘GOOD-ENOUGH’ ENVIRONMENT, PSYCHOLOGICAL

EDUCATIONALLY /MENTALLY RESTRICTED

ADAPTED CURRICULUM – SIMPLIFIED, RELATIONAL /

PSYCHO-EDUCATIONAL

THEORY OF MIND / LANGUAGE

ADAPTED CURRICULUM, RELATIONAL/ PSYCHO-ED-

UCATIONAL

1.1 Some Considertions on the Matter of Diagnosis

“It is important to distinguish between validity and utility in con-

sidering psychiatric diagnoses.” Kendell, Jablensky (....).

1. It is agreed that there is a need for a valid and accurate diagnosis

of Autism, or Autism Spectrum Disorder(ASD). The main reason

is that without a diagnosis, parents and their children are barred

from access to such services as might exist, e.g. admission to a

school or support or funding for children with ASD.

2. The Mayo Clinic initiative, ‘Operation autism’, has contributed

much to the development of diagnostic services to families in the

USA, and state that ‘Studies show that the earlier the child is di-

agnosed, the sooner a treatment program can be started, and the

better the results for the child’

3. There is no definitive laboratory test to diagnose ASD. As a de-

velopmental disorder it relies on the skill of an experience doctor

to evaluate a child’s developmental history and behaviour. At this

time ASD can be diagnosed in a child by the age of 20 months

[12].

4. The emotional impact of diagnosis on the parents is intense, but

most parents report that there was relief due to finding an explana-

tion for the child’s behaviours [13].

5. Despite many excellent checklists and assessments, no one as-

sessment serves all presenting clients. But then, given the perva-

sive nature of the condition, no one assessment tool is likely to

do so. ‘Researchers are increasingly assuming that variation in

symptoms is continuous’ (Kendall and Jablensky).The very nature

of Autism Spectrum Disorders is such that the presenting features

in different individuals are infinitely varied and unique.

This term equally includes the young non-verbal child who w-sits

in the sandpit rocking and flapping his hands, but also the ado-

lescent who has obsessive and repetitive speech with poor social

skills who enjoys doing pages of arithmetic, and also a child with

echolalic speech who seems not to comprehend what is said, and

has painful hearing but slams doors in the house obsessively and

screams randomly through nights.

6. Parents surveyed by Makino et al report that the journey to

diagnosis is fraught with delays, between 12 months and 55

months [13]. They were equally accepting of online or face to face

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feedback, and accepted the ADOS and ADI used, but expressed

concern at the lack of knowlegeable professionals. Parents are

reported to be largely disappointed by how little useful action is

recommended.

7. It is reported by parents that the diagnostic process as it exists

does not readily point to effective interventions or actions that are

indicated for each individual. This is the most problematic discon-

nect between the diagnostic process and the needs of the child and

family.

It is not unusual to see a family still in search of useful interven-

tions three years after diagnosis, presenting a folder 10 cm thick

with numerous assessment reports representing time and financial

resources, but no practical intervention strategy evident. The IEP

(Individual Evaluation Profile) fails to effectively become the IIP

(Individual Intervention Profile).

8. There is little inherent in the diagnostic process that charts a

course of individualised action for the child with ASD. Whichever

tools were used at diagnosis, once the diagnosis is received, the

way forward presented to parents is , for the most part, a simplified

and repetitive educational program followed by sheltered employ-

ment in adulthood (for the fortunate.)

If one considers the subcategories of two commonly used assess-

ment tools , the ADOS with the ADI, one can understand that the

intervention pathways are not readily evident post-diagnosis.

The areas assessed are: The ADOS categories are pointing / ges-

tures/ eye contact/ facial expression/ /shared enjoyments/ showing/

spontaneous initiation of joint attention/ response to joint attention

/ quality of social overtures / stereotyped , idiosyncratic words or

phrases/ unusual sensory behaviours / mannerisms / repetitive in-

terests and behaviours. The ADI-R has three categories: language

and communication / reciprocal social interaction / restricted, re-

petitive and stereotyped behaviours and interests.

Much is now known about the factors associated with Autism.

Thus, mapping the pathway to effective intervention is potentially

more attainable than it was in the early days. Even though the ex-

act cause of autism is still a medical mystery, it is generally accept-

ed that it is caused by abnormalities in brain structure or function

and has a genetic origin. Dr Mary Megson referred to ’ a cascade

of biochemical (immunogenetic) responses [14]. That can be iden-

tified. It is known that a wide variety of factors can be involved

leading to a wide range of symptomatology.

1.3. Notes on the Biome And Environmental Triggers

Research has demonstrated that biological factors play a role in

alleviating or intensifying some of the features of Autism.

Just as there is a genetic basis to Autism, there is a genetic basis

to inborn errors of metabolism, allergies and food intolerances. It

is conceivable that these genetic factors could be linked. In the

1970’s Dr Benjamin Feingold (...) published papers linking behav-

ioral disturbances to the ingestion of food additives. He claimed

that children could react to any of the thousands of food additives,

as well as certain foods, but also that not all children reacted to the

same substances. Dr Doris Rapp included the effect of dust, molds

and chemicals on behaviour [15]. Dr W. Crook published work on

the role of intestinal candida in disturbing cognitive, socio-emo-

tional, and physical functioning [16]. There are almost 2000 meta-

bolic processes known that if weakened (singly or in combination)

can lead to developmental difficulties. Great amounts of support

for this view have issued from the works of Drs Kalle Reichelt, Dr

[17]. The current understanding is that Autism can be regarded as

‘A neurological disorder of biological origin’. It is believed that

autism is a disorder caused by a combination of a lowered immune

response, toxinic loading from various external sources, and prob-

lems triggered by ingesting certain substances to which the person

is sensitive.

The mere existance of neuro-biodiversity does not invalidate this

concept. It does however complicate the search for each individu-

al’s ‘trigger’ substances. Each person has a unique metabolic func-

tioning, making it a challenge to map the route to optimal wellness

in sensitive children. The ideal investigation must act on the widest

platform, drawing on the broadest, most informed knowlege base.

It is furthermore necessary to differentiate between those historical

precipitating ‘triggers’ that are no longer active, and those which

are very much active and continue to exacerbate the problem, and

those that are (according to our current knowlege) insignificant.

What is indisputable is that reports are increasing of children

having made significant improvements and the lessening of the

severity of Autistic symptoms to the point of becoming ‘indistin-

guishable from their peers’, once the correct combination of neu-

ro-biological cause-and-intervention is found. (autism turnaround

stories) .

1.4. The Biopsychosocial Model And Case Formulation [18]

While diagnosis has traditionally been viewed as an essential

concept in medicine, particularly when selecting treatments, we

suggest that the usefulness of diagnosis alone may be limited, par-

ticularly within mental health. The concept of clinical case for-

mulation advocates for collaboratively working with patients to

identify idiosyncratic aspects of their presentation and select in-

terventions on this basis [19].

The current 2-tier diagnostic process comprises:

1. A screening assessment by a physician, to eliminate co-morbid-

ities.

2. The Diagnostic Assessment by knowledgeable specialists, often

using the ADOS and ADI.

This 2-tier process may afford the label of Autism to be given to

the child.

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Barker writes of Case Formulation in psychiatry which is a way

of understanding a patient as more than a diagnostic label. It struc-

tures the way one can consider the origins and causes of a patient's

symptoms. This is done through the biopsychosocial approach,

first described in 1980 by George Engel [20].

Biopsychosocial formulation combines biological, psychological,

and social factors to understand a patient, and uses this to guide

treatment. Case formulation is a core clinical skill that links as-

sessment information and treatment planning. It is a hypothesis

about the mechanisms that cause and maintain the problem. Im-

portantly, formulations should incorporate new information as it

emerges [21].

McNeill et al 2012 listed 5 P’s of case formulation [1]. These are

referred to as the standandard:-

1. Presenting Problem

2. Predisposing factors

3. Precipitants – what triggered/ is exacerbating the problem

4. Perpetuating – what maintains / is worsening the problem

5. Positive – what strengths can be drawn on?

Where used, this approach would offer the parents of the newly-di-

agnosed child with Autism some structured and well-reasoned

guidelines for the selection of indicated interventions. This in turn

may provide a more positive outcome than is currently available.

One such useful framework is presented below.

1.5. Stages In Development 0f Neurological Self-Mastery

In the introductory chapters of their book, M.O.R.E: Integrating

the Mouth With Sensory and Postural Functions – March 1, 1999,

Oetter, Richter and Frick describe three stages of brain develop-

ment required for effective self-regulation [22]. These three stages

are seen as a hierarchy, in which each level must be well-estab-

lished in order for the subsequent level to develop efficiently. As

the infant progresses through these stages successfully, the pinna-

cle of development is reached in which the individual achieves ef-

fective neurological integration which supports self-mastery. This

self-mastery is required to become a well-integrated sensory-mo-

tor-cognitive and socio-emotionally competent person.

In this paradigm, the acquisition of new skills requires cycling

through earlier-achieved levels. A hiatus or interference in any of

the stages will negatively impact on subsequent levels of develop-

ment which could have lasting consequences on the individual’s

competence. If neurological integration is not achieved effective-

ly, there are likely to be cognitive, socio-emotional and physical

consequences.

*In the first order the lower brain centres are organized, such as

thalamus, hypothalamus, lower brainstem, medulla and cerebel-

lum. These areas regulate activities for survival, such as ingestion,

digestion and elimination, heart rate and cortical tone, tempera-

ture, respiration, blood pressure and the sleep-wake cycle. Here

too are integrated the functions of the endocrine, immune and ner-

vous systems.

*In the second order, the higher brain centres become organized,

notably those of the brain stem, reticular activation centre, and

cerebellum. These areas organize and integrate the sensory-motor

loops such as the suck-swallow-breathe synchrony, selective at-

tention, the righting response, reflexive babbling, and importantly

the ability to achieve, maintain and change situation-appropriate

states.

*In the final, or third order in the development of self-regulation,

the main areas of processing are of the cortex including the frontal

lobes, regulating the higher cortical functions of intention, volun-

tary goal-directed behaviour, sustained attention, communication

and organization of spaces, tasks, time and environments, such as

speech and language, scholastic skills, and socialisation.

1.6. Application of This Construct During Case Formulation

During the Diagnostic Process – The Neuro-Cognitive Mobili-

zation Project (Seymour 1993)

This conceptualisation devised by Oetter, Richter and Frick can

readily be applied for use in the case of Autism and related con-

ditions. It provides a useful framework to create a diagnostic case

formulation that can readily inform intervention and establish pri-

orities in planning.

One such project that applies this is named Neuro-Cognitive Mo-

bilisation. Firstly, the child’s early development, symptoms and

presenting problems are noted and categorized in this framework.

Next the appropriate intervention to specifically deal with the

most critical of these features is selected from the available in-

terventions, as demonstrated in the tables below. The information

required to develop this formulation is usually available from the

parent interview, appropriately-designed questionnaires, observa-

tion and reports from teachers or carers involved. Where indicated

one may call for further investigations if appropriate.

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Int J Psychiatry, 2023

CAUSES

PRIMARY

FIRST ORDER

SECOND ORDER

THIRD ORDER *

→

CO-ORDINAT-

ED INPUTS

SENSORY

“GATE”

→

GENETIC

DIGESTIVE

DIFFICULTIES

EXCESS OPIOIDS

IN THE SYSTEM

MONITORING

FOR SURVIVAL

AUTONOMIC

FUNCTIONS

VISUAL

Spatial / colour / depth

VOLUNTARY,

GOAL-

DIRECTED BE-

HAVIOUR

PERCEPTION

CONCEPT

KNOWLEDGE

GENETIC

INBORN

ERRORS OF

METABO-

LISM

TOXIC

EXPOSURE

HEAVY

METALS

CANDIDA

ALBICANS

VIRAL

AUTO-IM-

MUNE

ANOMALIES

INFLAMMATION

INFECTIONS

RESPIRATION

AUDITORY

Hearing / processing speed

Transmission time

ANTICIPATORY

PLANNING,

INTENTION

WIDENING

RANGE OF

INTERESTS

AND ACTIV-

ITIES

ALLERGIES

IGE, IGA

HEART RATE

TACTILE

RECOGNITION OF

STATE CHANGE

INSIGHT

SENSITIVITIES GLUTEN, CASEI-

EN,

GLIADIN

MSG / ASPAR-

TAME

BLOOD PRES-

SURE

BALANCE

TASTE

ORGANISATION

OF SPACES,

TASKS, ENVIRON-

MENTS,

AND

TIME

SPEECH &

GESTURES

ARTICULA-

TION PROS-

ODY SYTAX

SEMANTICS

BODY

LAGUAGE

POSTURE

DISCOURSE

NARRATIVE

DETOX

PROBLEMS

PST / SULPHA-

TION

FEINGOLD ISUES:

FLAVOURANTS

COLOURANTS

PRESERVATIVES

SUGAR

CORTICAL TONE PROPRIOCEPTION

SMELL

WELL-BEING

NEUROLO-

GI-CAL

UNUSUAL DE-

VELOPMENT OF

MIDBRAIN, CER-

EBELLUM, LEFT

TEMPORAL

MUSCLE TONE

SLEEP-WAKE

CYCLES

CO-ORDINATED OUTPUTS

MOTOR CO-ORDINATIONS

inhibit reflexes defeat gravity,

Isolating and combining

FORMULATION

OF STRATEGIES

INGESTION

SUCK-SWALLOW BREATHE

SYNCHRONY

FORMULATION

OF STRATEGIES

EXPOSURE TO

TOXINS,

EVEN IN

UTERO

DIGESTION

ADAPTIVE MOVEMENTS

SELF-MONITOR-

ING

USING LAN-

GUAGE FOR

ORGANISA-

TION

INTERFERANCE

IN NEURO

-TRANSMITTERS

ELIMINATION

VOCALISING IN PATTERNS-

TICS

EXECUTION OF

STRATEGIES

CO-ORDINATION

OF ENDOCRINE-

IMMUNO- AND

NERVOUS SYS-

TEMS

REFLEX INHIBITION IM-

PULSE INHIBITION

EVALUATION OF

STRATEGIES

ACADEMIC

SKILLS

LIMBIC SYSTEM

/ emotions

WELL-BEING

SELECTIVE ATTENTION

SELF-CONTROL

LIFE-SKILLS

TEMPERATURE

REGULATION

STATE MAINTE-

NANCE

ABILITY TO ACHIEVE,

MAINTAIN, AND CHANGE

SITUATION-APPROPRIATE

STATES PERCEPTUAL

CONSTANCY VACCINATION

SWITCHING

SUSTAINED AT-

TENTION ABILITY

TO SWITCH

SOCIAL

SKILLS

RESPONSI-

BILITY

One enters the information derived from observation and assess-

ment, parent reports and professional reports onto this framework

according to the neurological hierarchical ‘order’ as shown. For

example, in the table below, a sample formulation for Child A is

summarized.

An early sampling framework is presented below:

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Int J Psychiatry, 2023

A sampling for Child B could look different:

First Order

Second Order

Third Order

Sleep disturbance

Hyper-arousal, Cries easily, cannot be comforted

Problem making friends

Low muscle tone in upper body

Sensory defensive - touch

language disorder

Abnormal EEG (cortical tome)

Sound -sensitive

Poor self-help skills

Newborn Colic

Moro-reflex still present – check others

Poor following of instructions

Night sweats

Delayed motor milestones, clumsy

Handwriting poor, refuses to write or colour

Frequent diarrhoeia

Distractible, poor regulation of attention

Dyslexia

Repeated ear infections

Easily frightened, anxious

First Order

Second Order

Third Order

Low muscle tone throughout the body

Hyper-active, restless, climbs furniture, the roof

Non-verbal, non-communicative vocalisations

Constantly hungry

Repetitive rocking

Does not imitate

Constipation, very smelly gas and stools Destructive

Does not draw or write

Doesn’t seem to feel the cold

Seeks pressure, rough play

Poor self- care skills

Some seizures reported

Poor attention except for TV

Does not seem to comprehend what is said.

Does not make eye contact

Bites his wrist

First Order

Second Order

Third order

Gluten-free-caseien-free diet

The sensory diet-brushing protocol

Speech Therapy

Cod-liver oil

Motor reflex-inhibition therapy

Remedial reading/ therapy

Melatonin

Sensory-integration training, rocking / swinging /

ball-pool play

Visual schedules (TEACCH)

The GAPS diet

Auditory Integration Training

Floor-Time DIR

The Feingold Diet

Horse Riding

Counseling

Detoxification programme

ABA

AAC/ signing /

Swimming

Such a formulation framework can be useful to highlight areas re-

quiring further investigation that may have been overlooked. e,g,

an EEG, stool analysis, developmental occupational therapy as-

sessment.

Following this analysis of causative factors, one turns to the pri-

oritising of the most appropriate interventions for each individual.

There are a wide variety of available interventions that have been

reported as useful in research and anecdotally (e.g. Seymour, R.E.,

Autism – Options Galore. 1995 ). One can equally categorise these

in the same three orders according to their targeted action and out-

comes, as shown in a small sample below,e.g.

1.7. Neuro-Cognitive Formulation Directs Effective Interventions

All interventions can be categorised in this way, according to

whether they are chiefly designed to act on the first, second or

third order of developmental difficulty. One then matches the inter-

vention to the indicated area of difficulty, e.g. speech therapy for a

language disorder; AAC ( Alternative and Augmentative Commu-

nication) for a non-verbal child; reflex-inhibition when primitive

reflexes remain inappropriately active.

The next step is to assign an order to the introduction of activities,

for example by using the 4 P’s of McNeill, to determine which

interventions to initiate as the most pressing.

This NCM Formulation can be applied by well-informed and suit-

ably trained educators, carers, therapists and professionals. In this

way the waiting period between diagnosis by a specialist and the

commencement of intervention (the IIP mentioned earlier) can be

significantly shortened.

Using such a construct, parents can immediately start to act, and

thereby ensure the most positive outcomes for their child. In a sit-

uation where the parents have to navigate the various services of-

fered on their own, such a formulation could act as a helpful guide

through the maze of contradictory and confusing options available

[23-32].

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Int J Psychiatry, 2023

2. Conclusion

The process of diagnosing Autism in children remains an active

topic of discussion. The assigning of a diagnostic label to a child

does not of itself direct best-practice interventions to ensure the

most positive outcome for each individual. It has become apparent

that a further tier to the diagnostic process is required in order to

be useful to parents, educators and therapists. It is proposed that

the concept of Case Formulation become common practice, to link

assessment results and treatment planning. Besides asking the 5

questions as advised by McNeill, it is presented here that the Neu-

ro-Cognitive Framework (Seymour) based on the three orders of

development of neurological self-regulation (Oretter, Richter and

Frick) can provide a ready and useful framework in this process.

Parent Comments Regarding Diagnosis [13]

Parents want information specifically geared towards their child

rather than generic.

Parents want information on intervention at diagnosis in writing

Parents want post-diagnostic support specifically with service nav-

igation

Towards A Three-Tier Diagnosis For A Brighter Outcome

•

THE SCREENING ASSESSMENT

By a knowlegeable physician, to identify

co-morbidities

•

THE DIAGNOSTIC ASSESSMENT

e.g. Using ADOS, ADI-R as gold-standard

•

THE NEURO-COGNITIVE FORMULA-

TION OF CAUSES AND ACTIONS

Trained teachers, professionals, health workers,

therapists, to plan intervention priorities and se-

quence.

Examples Of Programmes That Implement The Above

• ABC Learning Options, South Africa, R Seymour, ncm4kids

• iMap and iDevelop, South Africa, Dr Beulah van der Westhuizen

• Connect Therapy, Australia, Monique Simpson

• Giant Steps, Canada, Darlene Berrenger

• Alia for Early Intervention, Bahrain, Princess Rania AlKhalifa

• Matahati Autism Clinic, Surabaya, Java, Mingseh Andranusa

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