syndrome, additional observations may address aspects of topic management and conversational ability, ability to deal with nonliteral language, and language flexibility. As with other aspects of assessment, an evaluator should be flexible and knowledgeable about the particular concerns related to assessment of children with autism.

Motor abilities in autism may, at least in the first years of life, represent an area of relative strength for a child, but as time goes on, the development of motor skills in both the gross and fine motor areas may be compromised, and motor problems are frequently seen in young children with autism. Evaluations by occupational and physical therapists are often needed to document areas of need and in the development of an intervention program (Jones and Prior, 1985; Hughes, 1996). Standardized tests of fine and gross motor development and a qualitative assessment of other aspects of sensory and motor development, performed by a professional in motor development, may be helpful in educational planning.

MEDICAL CONSIDERATIONS

For very young children, there may be concerns about the child recognized or first expressed in the context of well-child care. The education of physicians, nurses, and others regarding warning signs for autistic spectrum disorders is very important. After initial referral for assessment and diagnosis, consultations with other medical professionals may be indicated, depending on the context (Filipek et al., 1999; Volkmar et al., 1999), for example, to developmental and behavioral pediatricians, child psychiatrists, geneticists, and pediatric neurologists. When this consultation is relevant to the educational program, reimbursement may appropriately be made by the local education authority.

The available literature has clearly documented that children with autism are at risk for developing seizure disorders throughout the developmental period (Deykin and MacMahon, 1979; Volkmar and Nelson, 1990). Seizure disorders in autism are of various types and may sometimes present in unusual ways. Although not routinely indicated, an electroencephalogram (EEG) and/or neurological consultation is indicated if any symptoms suggestive of seizures, such as staring spells, are present. The presence of a family history of developmental delay or unusual aspects of a child’s history or examination may suggest the need for genetic or other consultation. In some cases, autism may be associated with other conditions—notably fragile X syndrome and tuberous sclerosis (Dykens and Volkmar, 1997).

A child’s hearing should be tested, but behavioral problems may sometimes complicate assessment. Definitive documentation of adequate



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement