About Diagnosis

Diagnosis for Children


Make an appointment to speak with your GP and bring with you a list of behaviours and characteristics that make you think your child may be on the autism spectrum. For some guidance on these behaviours and characteristics see the Physicians Handbook here (link to PDF) Once you meet with your GP they may advise that your child should be referred for a formal assessment (diagnosis).

It is recommended that your child have a multi-disciplinary assessment “ that is, an assessment by a team of registered professionals. The team may include; a paediatrician, a speech language pathologist and a psychologist found at the Janeway Hospital in St. John’s, Gander Central Health, Corner Brook Western Health or the Rainbow Clinic in St. Anthony/ Labrador.

Diagnosis for Adults


Make an appointment to speak with your GP and bring with you a list of behaviours and characteristics that make you think you may be on the autism spectrum. Your GP may refer you to a registered practitioner who will be able to formally assess you for an autism diagnosis. For a list of registered Psychologists in the province, click here

Private assessments


Private diagnosis is an option, and can reduce the waiting time. The costs of private assessments can vary and the ADOS is available from some private practitioners. Health authorities and education authorities may not accept the results of all private diagnoses. They might insist upon a diagnosis from the ADOS team before they will provide services to you and your child. For this reason, we suggest that you stay on the waiting list for an assessment through your regional health authority regardless of whether you receive a private assessment or not.

What is ADOS?


This is the Autism Diagnostic Observation Schedule and is a semi-structured assessment of communication, social interaction and play (or imaginative use of materials). The ADOS consists of four modules, each of which is appropriate for children and adults of differing developmental and language levels, ranging from nonverbal to verbally-fluent. The ADOS consists of standardized activities that allow the examiner to observe the occurrence or non-occurrence of behaviors that have been identified as important to the diagnosis of autism and other pervasive developmental disorders across developmental levels and chronological ages. To learn more about ADOS click here

Development Team Contacts

Eastern Region

Referrals can be faxed to (709) 777-4955
Child Development Nurse Coordinator Janeway(709) 777-4003
Child Development Intake (709) 777-4957

Central Region

Speech & Audiology Department (709) 256-5458.

Western Region

Child Development Team
Western Memorial Regional Hospital
Corner Brook
(709) 637-5000, ext. 6655

Labrador

Rainbow Clinic
Curtis Memorial Hospital
St. Anthony, NL
A0K 4S0
Phone #: (709) 454-3333  Ext. 7275
Fax #: (709) 454-3417

How do professionals determine if someone is on the autism spectrum?


In North America, medical professionals use the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (revised May 2013) to evaluate autism spectrum disorder (ASD). 

Autism Spectrum Disorder 299.00 (F84.0)

  1. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):
  2. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
  3. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
  4. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative paly or in making friends; to absence of interest in peers.

Specify current severity:
Severity is based on social communication impairments and restricted repetitive patterns of behavior (see Table 2).

  1. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
  2. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
  3. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
  4. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
  5. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Specify current severity:
Severity is based on social communication impairments and restricted, repetitive patterns of behavior (see Table 2).

  1. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
  2. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
  3. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

TABLE 2   Severity Levels for Autism Spectrum Disorder 

Level 3: Requiring very substantial support
Social Communication
Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches.
Restricted, Repetitive Behaviours
Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.

Level 2: Requiring Substantial Support
Social Communication
Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or  abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited  to narrow special interests, and how has markedly odd nonverbal communication.
Restricted, Repetitive Behaviours
Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in  a variety of contexts. Distress and/or difficulty changing focus or action.

Level 1: Requiring Support
Social Communication:
Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to- and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.
Restricted, Repetitive Behaviours
Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.