Child with Autism Spectrum Disorder
Unique Challenges associated with the Psychiatric Interview of a Child with Autism Spectrum Disorder
The United States grapples with a number of health conditions and issues that affect individuals, families, and the society as a whole. Among these conditions is Autism Spectrum, ASD, a neurodevelopmental disorder that is relatively common in children. Hyman, Levy and Myers (2020), approximately 1.7% of children in the US suffer from ASD. Although this seems quite a small number, it is an issue of great concern given the impact of the condition on children together with their families. Children suffering from ASD usually require extensive medical, educational, and behavioral services (Hyman et al., 2020). More specifically, children with the condition typically have very complex needs that require long-term treatment. Taking care of such children is a very costly undertaking, with estimates indicating that it costs the government US $268 annually (Stadnick et al., 2017). Apart from this, it has been established that more than 70% of kids diagnosed with ASD exhibit symptoms of a comorbid psychiatric syndrome when they are assessed by use of structured interviews (Stadnick et al., 2017). Considering that these comorbid disorders persist even into adolescence, there is necessary to conduct timely psychiatric interviews so that appropriate evidence-based interventions are implemented.
Just as ASD is a complex condition, its diagnosis is equally complex. Hus and Segal (2021) attribute this complexity in diagnosing ASD to the fact that the symptoms and severity of the disorder vary with age. More importantly, identifying psychiatric comorbidities is generally difficult in children due to unique challenges that are specific to this population. Children suffering from ASD typically have social communication difficulties, which make traditional assessment methods such as clinical interviews difficult, at times even impossible (Matson, 2015). Some of the core features of ASD are that individuals generally tend to score low on the areas of social-emotional reciprocity, social interaction, and social communication (Caplan & Bursch, 2012). This may be taken to mean that children with ASD are generally disinterested in conversations or developing relationships with other people apart from their caregivers. Without doubt, this can be a huge challenge for psychiatrists or clinicians as they try to interview the child.
Psychiatric interviews involving children with ASD are also hampered by deficits in critical functions such as executive functioning, theory of mind, and central coherence (Matson, 2015). For example, ASD affects the ability of some individuals to determine other people’s intentions and understand how others are affected by their behaviors (Caplan & Bursch, 2012). Consequently, some people suffering from ASD may expect that other people will think, behave, and perceive things exactly the same way they do. In the event that a psychiatrist or clinician is interviewing a child with such deficits and the psychiatrist holds a different perception or thought, the child may easily develop a suspicious, defensive attitude (Caplan & Bursch, 2015). This will clearly hinder the effectiveness and success of the interview.
Also related to the theory of mind is the issue of ASD and its association to pragmatic language deficits. Defined as the practical capacity of an individual to utilize language within social settings, pragmatic language proficiency enables people to choose appropriate words and say them in an appropriate manner (Caplan & Bursch, 2012). As such, a child who has ASD may miss meanings of questions and statements posed by a psychiatric during interview. When this happens, the psychiatrist’s attempts to initiate longer, productive conversations are rendered somewhat futile. In the same way, the psychiatrist may make benign comments that could turn out to be terrifying to the child. In such a scenario, it will be hard for the psychiatrist to engage in a meaningful interview with the child, thus failing to accomplish the objectives and purpose of the exercise altogether.
Inability to properly describe their symptoms is another challenge that is commonly encountered during psychiatric interviews of children with ASD. In most cases, children suffering from ASD tend to have sensory abnormalities. Because of this, some children may not be able to describe how they feel. Due to what Caplan and Bursch (2012, p.144) refer to as “confused internal senses”, children with ADD may describe their symptoms using atypical words such as feeling weak or pain. In such situations, it may be difficult for the clinician to know exactly how the patient is feeling and to make an accurate diagnosis.
Serious mood swings and episodes of intense anxiety are also another unique challenge associated with psychiatric interview of children with autism spectrum disorder. In children, this condition is particularly linked to a higher risk of developing mood and anxiety disorders as well as other emotional disturbances (Caplan & Bursch, 2012). This is why persons with ASD commonly exhibit temper tantrums and aggressiveness. Such instability of emotional reactions may make it difficult for psychiatrists to engage children suffering from ASD in productive talks and interviews aimed at assessing the severity of their problem.
Autism spectrum disorder affects an individual’s motor functions, which have significant impact on key developmental areas such as self-confidence and speech clarity. It therefore follows that a child with ASD suffers motor dysfunctions that affect his/her confidence levels (Caplan & Bursch, 2012). Without enough confidence, the child who is being interviewed by a psychiatrist may not be of much help because he/she lacks confidence to answer questions, however simple they may be.
All the above factors point out to the conclusion that psychiatrists who are attempting to interview children with ASD may encounter difficulties developing rapport with the child. Rapport development is identified as a very crucial factor in the assessment of children with ASD (Caplan & Bursch, 2012). This is because although children with this condition may exhibit some common traits, effective interventions are those that are based on a proper understanding of the manner in which each individual engages the world around him or her (Caplan & Bursch, 2012). With challenges such as low self-confidence, problems with social interaction, and communication difficulties, building this much-needed rapport may become a real challenge for the psychiatrist.
Interviewing a child with autism spectrum disorder may prove to be a challenging exercise due to significant memory deficits. In a study conducted among 68 children, 30 of whom had ASD, it was found that the autobiographical memory of kids with ASD was significantly poorer compared to those children that did not suffer from the disorder (Kohen & Olness, 2012). The study results indicated that for children with the condition, memory was specifically poor for events that took place earlier in their lives. This is a major challenge for psychiatrists when interviewing children with ASD, as it means that they may not be able to accurately answer some questions simply because they cannot remember events that provide useful hints in answering questions.
Still on the issue of memory recollection challenges, children with autism spectrum disorder may be a difficult group to interview because of inability to address multiple topics. The National Children’s Advocacy Center (2019) identifies a challenge known as perseveration among this particular group. Perseveration refers to a situation where an individual has “sizeable amounts of facts related to a singular topic of interest” (National Children’s Advocacy Center, 2019 p.1). Where this is the case, the psychiatrist or clinician may be unable to obtain all the information he/she needs as only a single topic dominates the conversation.
In conclusion, autism spectrum disorder presents significant challenges to clinicians and psychiatrists as they attempt to interview patients with a view to understanding the severity of their problem. These challenges essentially emanate from the features and traits exhibited by individuals with the disorder. The major traits, as identified in this paper, are sensory abnormalities, social reciprocity difficulties, communication deficits, and motor dysfunction. Due to this, autism spectrum disorder affects important functions and abilities such as social interaction, language ability, memory recollection, communication, and rapport development. These effects in turn pose unique to psychiatrists and clinicians as they assess and interview children suffering from autism spectrum disorder. Specific examples of such challenges include impaired memory, perseveration, failure to understand instructions or questions, failure to answer questions correctly, and inability to interact effectively with the psychiatrist. In other cases, psychiatrists may be dealing with children who are defensive and suspicious and from whom obtaining information may prove quite an arduous task. In view of these challenges, it is recommended that clinicians and psychiatrists try as much as possible to establish rapport, giving the child enough time to acquaint himself/herself with unfamiliar words or people. Additionally, longer pauses should be allowed throughout the interview so that the child can process questions and formulate answers.
References
Caplan, R. & Bursch, B. (2012). How many more questions?: Techniques for clinical interviews of young medically ill children. OUP USA.
Hus, Y. & Segal, O. (2021). Challenges surrounding the diagnosis of autism in children. Neuropsychiatric Disease and Treatment, 17, 3509-3529.
Hyman, S. L., Levy, S. E., Myers, S. M., Kuo, D., Apkon, S., Brei, T., … & Bridgemohan, C. (2020). Executive summary: Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1).
Kohen, D. & Olness, K. (2012). Hypnosis and hypnotherapy with children. Routledge.
Matson, J. (2015). Comorbid conditions among children with autism spectrum disorders. Springer.
National Children’s Advocacy Center. (2019). Interviewing children on the spectrum. https://calio.org/wp-content/uploads/2019/07/Interviewing-Children-on-the-Spectrum-Fact-Sheet.pdf
Stadnick, N., Chlebowski, C., Baker-Ericzén, M., Dyson, M., Garland, A., & Brookman-Frazee, L. (2017). Psychiatric comorbidity in autism spectrum disorder: Correspondence between mental health clinician report and structured parent interview. Autism, 21(7), 841-851.
