Abstract
Autism cannot be identified through concrete physiological or biological determinants. Clinicians must therefore evaluate a person’s communicative functioning, observable behaviours, and developmental level through observations. To receive a diagnosis of autism, the DSM-5-TR stipulates a person must display difficulties in social-emotional reciprocity, including, reduced displayed emotions and affect, a failure of normal back-and-forth conversation, and a failure to initiate or respond to social interactions. Standardised assessments such as the ADOS-2 are therefore used to structure interactions to elicit behaviours revealing autism symptomatology. Yet, the way the behaviours are elicited, i.e., the protocol used, and the facilitating examiner are not taken into consideration when determining the outcome of the interaction within the autism assessment. This PhD project therefore examined interactional tasks and corresponding coding items of the ADOS-2 that are designed to specifically elicit the diagnostic criteria of the DSM-5-TR: the ‘Emotions’ task, the ‘Loneliness' task, the ‘Social Differences and Annoyance’ task and examiner ‘cliffhangers’. To determine the effectiveness of these interactional tasks in eliciting capabilities in social- emotional reciprocity, I utilised Conversation Analysis to sequentially analyse each individual turn at talk to understand how the examiner and examinee make sense of one another within each interaction. Participating within this project were 14 children under assessment for autism, 8 females and 6 males, with an average age of 13.9 (M = 13.9, SD = 2.9) and 20 assessing clinicians (18 females and 2 males). I in turn compared these interactions with the diagnostic reports written by the examiners about the children being assessed to explore how observations of the children’s social-emotional reciprocity were documented in relation to the tasks and the rating criteria within the corresponding coding items of the ADOS-2.
I found that examiners in the data modified assessment protocol to improve opportunities for the child to demonstrate social-emotional reciprocity. Most notable was the examiners attempts to provide contextual information prior to the start of the task, by reformulating the ADOS-2 questions, or after failed answers or instances of difficulty within the interaction. Due to adherence to standardisation, the restrictions placed on the examiner to elicit certain behaviours utilising the design of the ADOS-2 questions often made the interaction unclear. This had implications for both the examinees understanding of what response would satisfy the examiners’ reason for asking, and the examiners’ subsequent turns at talk. When examiners however digressed from institutional progressivity and modified their questions and comments to contain contextual information, the children were able to provide answers that satisfied the examiners reason for asking. Additionally, I found that when the examiners utilised the ADOS- 2 flexibly by using natural conversation in response to the child’s answers, this generated enhanced opportunities for the children to display social-emotional reciprocity. This responsive and dynamic way of implementing the assessment changed it from a deficit approach (to elicit behaviours associated with autism to conclude a diagnosis) to a strengths-based approach. Moreover, the children demonstrated capabilities in social-emotional reciprocity which were comparable to non-autistic people within everyday interaction. Due to the requirement however to match the behaviours elicited from the children to a rating corresponding to the coding items of the ADOS-2, the documented observations in the diagnostic reports often omitted the children’s social-emotional capabilities or were written in a way that supported observations of behaviours associated with autism symptomatology.
Therefore, I show how the examiners communicative actions implicate the observed capabilities displayed by the examinee. By utilising the ADOS-2 flexibly in response to the
communication of the examinee, the examiners created multiple opportunities for the examinee to demonstrate capabilities in social-emotional reciprocity. Due to the limitations of the coding items, documented observations however remain limited to the medical model deficit framework that do not capture the examinees interactional capabilities. Thus, the observations contained in the diagnostic reports can inappropriately document a person’s capabilities and can have negative consequences for a person’s self-representation.
Key words (minimum of 4-5 keywords, listed after the abstract).
Autism, ADOS-2, Social-emotional Reciprocity, Interaction, Assessment, Conversation Analysis
Date of Award | 26 Sept 2024 |
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Original language | English |
Awarding Institution |
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Supervisor | Iris Nomikou (Supervisor), Alessandra Fasulo (Supervisor) & Beatriz Lopez (Supervisor) |