Autism Testing & Autism Treatment Recommendations with Dr. James Coplan

As parents or professionals, most of us have been involved in the autism diagnosis process at least once, but do we really know how autism is actually diagnosed and what does the testing process really look like?

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Today I’m talking with developmental pediatrician, Dr. James Coplan who gives us insight on how autism is diagnosed and what treatment he usually recommends.

Mary Barbera: I’m sure in your vast experience, you’ve had many parents where they really want to pinpoint where the child’s at and that’s a very slippery slope, right?

Dr. James Coplan: What I’ve said to people is I can give you a map of the territory or it’s like a chart of the harbor maybe, but there’s fog out there. I know there’s an island here. There’s a riptide over here and rocks over here, but because it’s foggy out there, I can’t tell you exactly where your child’s boat is at the moment. There is this territory, there are these hazards, there is this ship’s channel, but it would be unfair to your child for me on the basis of an hour in the room with him to give you a prediction with that degree of precision. Now let me back up for a second. One of the differences between psychological testing that Jerilyn Radcliffe did and the way I arrive at a diagnosis and I respect this and it’s like there are different ways to get somewhere, psychologists put a lot of value and correctly so on what they can test in the room and demonstrate in the room.

Whereas as a physician, what I’m taught is a lot of the times you make the diagnosis based on history. So parents come in and they say to me, my child doesn’t do this. He does do this, he doesn’t do this. He does do that. I attach a huge amount of weight to that and I’ll try to do some testing at the table, but to a larger degree, my diagnostic impression is going to be formed in at least equal parts by what I see and what I hear. Unless there’s a disconnect between those 2 things like if the parents say, oh, he doesn’t do X, but he does, or he does X, Y, Z, but I can’t get him to. But when they align, it’s like 2 legs of a stool. But I’m going to put a lot more weight on the history where psychologists, by the nature of their training, by design, they’re going to give a skills development test or they’re going to give an ADOS, or they’re going to give whatever, and they’re going to go much more by the numbers on that piece of paper.

And those may be discrepant and it doesn’t mean one person is right and one person is wrong. What it means is we came to our diagnostic impressions using different subsets of the universe of data. But let me come back to your larger point. On that first day when the kid doesn’t even understand that he’s being tested and that his job is to do his best for this strange adult that he’s never met before, it’s not fair. It’s not professional on my part to conclude that he couldn’t do X, all I can say is he didn’t do X. I can’t say, and this is another mistake that teachers make, it’s another mistake school psychologists make, I don’t think behavioral psychologists make it but school psychologists and teachers will say he refused to do X in class when what you need to say his, he didn’t do X in class.

Or put it on yourself and say, I was unable to get him to do X in class rather than impute willful task refusal to the child.  So on day one, if the kid doesn’t understand the game that’s being played here and my job is to jump through Dr. Coplan’s hoops, I can’t make a conclusion from that. On the flip side of that, if by sheer luck that day, he puts the pretzel on the plate and gets points, good for him. I’m not going to take it away from him. So there were discrepant answers, but I think the professional answers are to say what we need to give you today is knowledge of what you need to do tonight and tomorrow. And anybody who claims that they can predict 5 years from now is really blowing smoke because that technology or those skills really aren’t there and to hold onto your wallet when somebody tries to take that line with you.

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Mary Barbera: I remember, when you gave the diagnosis, you recommended an ABA, Applied Behavior Analysis program. I know many years have gone by, 2 decades since you diagnosed Lucas. I also know you retired from clinical practice 5 years ago, but within the past 15 years when you were practicing, did you continue to recommend intensive ABA programs or did that depend on the child? And what level of ABA programming did you usually recommend for a child with moderate to severe autism?

Dr. James Coplan: Okay, so you, you put in the qualifier, moderate to severe autism kind of at the end of your discussion. But, I would see kids at 16. I had a child referred to me at 16 for a “reading disability” because he couldn’t understand the social context of stories. It was not a reading problem at all. It was a theory of mind problem and I don’t think that kid would’ve needed ABA. He needed social stories and insight based intervention. But there’s an old Kentucky recipe for rabbit stew with a first-line on the recipe that says first, catch a rabbit. And at the very beginning, the object is to get the child to come to sit, attend, reciprocate and that’s like catching the rabbit.

And then once you have that basic skill set imparted, then you can use that skill set to impart more complex skills, reciprocity, self-care, communication. The fact that when I say milk, that person out there is going to give me the milk, which they might not learn through incidental learning. Kids without spectrum disorder are graded incidental learning. They do something once by accident and they catch on right away. You never have to teach them again. So wow, where did he learn that? Kids on the spectrum often need explicit learning but until the kid is sitting at the table and attending and he knows now what the game is that’s being played and it’s not a game. Although you make it game-like to engage the kid. The object of this is for me to acquire a new skill set and that the child may not say that to themselves. They don’t internally verbalize it. But definitely ABA is a really proven, time tested, way of imparting new skills to somebody who may not be available to social learning or trying to appeal to the verbal inducement of some of the clients. So I continue to endorse ABA in that kind of situation. Absolutely.

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