Differential Diagnosis of Autism and other Developmental Disabilities in International Adoption Cases: The Implications of Language Abilities

Abstract

An accurate differential diagnosis of children adopted from foreign language situations that include challenging conditions (e.g., neglect) often rests upon accurate measurement of cognitive abilities in the context of low English proficiency, specifically, and may also include generally poor linguistic skills in the native language. In addition, because the goal of any adoption program is ultimately to generate effective intervention supports when needed and measurable progress in function as the child assimilates into his/her new home, it is essential that these programs be designed within the context of valid measurement. Given the particular confluence of low language ability and entrée into a culture that may have differing social interactive norms than the previous culture, one can imagine that identifying disabilities generally, but social-interactive based disabilities such as autism spectrum disorders specifically, could be problematic. Thus, assessment and treatment in these children is difficult and fraught with potential pitfalls. Moreover, recent advances in the measurement of cognitive abilities have out-paced changes in diagnostic classification and treatment methods, and it appears that applications to international adoption cases have lagged even further. This suggests that diagnosis should not be guided solely by available subtests on an intelligence battery or on clinical ascertainment instruments, because these could be confounded by language ability and cultural background. The purpose of this paper is to review measurement of cognitive abilities and diagnosis in international adoption situations and discuss methods for ensuring that diagnosis and treatment include consideration of potential pitfalls. In addition, potential confounds on clinical instruments are discussed.