Neuropsychological Assessment Contributions
in Autism Diagnosis
Amanda Lima Rubim, Ana Flávia Lima Teles da Hora* and Alexia Lima Laboratory
Assessment, Research and Intervention on Autism Spectrum Disorder Laboratory, CEUMA University, Brazil
Submission: February 29, 2020; Published: March 11, 2020
*Corresponding author: Ana Flávia Lima Teles da Hora, Assessment, Research and Intervention on Autism Spectrum Disorder Laboratory, CEUMA University, São Luís - Maranhão, Brazil
How to cite this article: Amanda Lima Rubim, Ana Flávia Lima Teles da Hora, Alexia Lima Lobato. Neuropsychological Assessment Contributions in
Autism Diagnosis. Open Access J Neurol Neurosurg. 2020; 13(2): 555857.DOI: 10.19080/OAJNN.2020.13.555857.
The Autism Spectrum Disorder is characterized by deficits on social interaction and communication and by the presence of restrict repertoire of behaviors, activities and interests. The comprehension about this neurodevelopment disorder remains complex nowadays, owing to its unknown etiology. Neuropsychological Assessment provides a deep analysis of cognitive functioning in people with such diagnosis, by being an auxiliary tool in the process of investigation, confirming or not the ASD diagnosis with higher precision. This branch of neuropsychological science contributes a lot to assertive interventions and therapeutic indications, by studying the interaction of brain functioning and human behavior. This study will contribute by presenting Brazilian publications that demonstrate the neuropsychological assessment for the differential diagnosis of ASD. It will be discussed and summarized some of this tool contributions at the national level, indicating the most used tests in Brazilian scenario. It is emphasized that neuropsychological evaluation contributes significatively due to identification of impairments on cognitive functions that are very important for human development.
Abbreviations: ASD: Autism Spectrum Disorder; BDTD: Brazilian Digital Library of Theses and Dissertations; CARS: Childhood Autism Rating Scale; DSM: Diagnostic and Statistical Manual of Mental Disorders; RCPM: Raven’s Colored Progressive Matrices; WHO: World Health Organization; WISC: Wechsler Intelligence Scale for Children
According to the World Health Organization (WHO) report, a global average of 1 in 160 people is diagnosed with Autistic Spectrum Disorder (ASD) . The understanding about ASD remains complex today, justified by the absence of etiology or defined causes . It is known, however, that this neurodevelopment disorder encompasses and involves conditions related to a group of quantitative and qualitative commitment of developmental specific skills, among which are communicative, behavioral and social skills . Autism Spectrum Disorder is a term now used by the fifth edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-V), which presents a single condition with different subdivisions regarding the level of severity related to interaction, social aspects of communication (verbal or non-verbal) and in the patterns of restricted and repetitive behaviors . In the spectrum, the level of severity varies according to the support demand demanded by the individual. Behaviorally,
losses in social communication can be evidenced by deficits in socioemotional reciprocity, qualitative losses in social interaction,
difficulties in adapting to other contexts, making friends, starting a dialogue or maintaining a conversation sharing interests; difficulty in spontaneous nonverbal communicative behaviors, in understanding other people’s interests and feelings, as well as in responding to other people’s emotions and atypical attachment [5,6].
Regarding to restricted and repetitive behavior patterns, the child may present echolalia, motor stereotypes, mannerisms, absence of spontaneous imitative, symbolic or exploratory play, repetition of routines with resistance to changes, very limited interests, hyper or hyposensitivity to sensory stimuli, as, for example, they may be insensitive to pain and hypersensitive to sound [7,8]. Affected children often express an idiosyncratic interest in a range of restricted activities, resistance to change, unusual gestures, avoidance of social interaction and do not react
to the actions of their peers . Due to this multiplicity and variety
of characteristics, a more accurate psychological assessment
is extremely necessary to determine the ASD diagnosis and
its level of severity, as well as to elaborate and to plan efficient
interventions effectively. In this sense, the neuropsychological
evaluation is configured as an auxiliary tool in the investigation,
being a valuable instrument to confirm the diagnosis of ASD with
greater precision , contributing to more assertive therapeutic
indications. Coming from neuropsychological science, it is a branch
dedicated to the study of the interaction of brain functioning and
human behavior, based on the functional analysis of cognitive
processes and multidimensional understanding of possible
losses . The present contribution will illustrate Brazilian
publications that demonstrate the neuropsychological assessment
for the differential diagnosis of ASD, by summarizing some of their
contributions at the national level. Based on a systematic literature
review, this study presents a national panorama of publications
that shows the contributions of Neuropsychological Assessment
for the diagnosis of ASD. The methodological procedure adopted
consisted on a survey of bibliographic references. As it integrates
complete scientific publications from 107 graduate programs
and provides greater visibility of national productions , the
Brazilian Digital Library of Theses and Dissertations (BDTD) was
determined as a search source. The survey of the studies was
carried out in February 2020, in Portuguese and English, in view
of the availability of some theses and dissertations in the English
It was considered the descriptors Neuropsychological
Assessment, Diagnosis, Autistic Spectrum Disorder, and the time
frame 2013 - 2019, in view of the fifth edition of the Diagnostic
and Statistical Manual of Mental Disorders. Productions available
in their entirety, published in the field of Psychology and that
presented in the abstract the Neuropsychological Assessment in ASD
diagnosis were selected, analyzed in full, providing data that were
tabulated and organized into the categories: year of publication;
author; and characterization of Neuropsychological Assessment
in ASD diagnosis. After some researches and estimations, we
found out the most used tests from neuropsychological science to
autism diagnosis. It is seen a deep relationship between executive
functions and neurodevelopment of the person with ASD. Among
the most used tests in Brazil between the years 2013 - 2019, it
can be seen: Wechsler Intelligence Scale for Children IV (WISC),
Childhood Autism Rating Scale (CARS) and Raven’s Colored
Progressive Matrices (RCPM).
The Wechsler Intelligence Scale for Children IV (WISC IV) is
one of the most commonly used tests for measuring intelligence
in ASD individuals, and there is a wealth of literature on this
tool. It is a clinical instrument, of individual application, used to
assess intellectual capacity, subdivided into verbal and execution
subtests . It is the most used instrument according to the
Brazilian scientific literature. This fact suggests that it is a useful
and essential evidence in the process of neuropsychological
assessment. WISC-IV contributes by guiding the hypotheses
about areas of cognitive dysfunction and for the choice of
complementary tests, in order to achieve a differential diagnosis
. The cognitive functions that are assessed that contributes
to the comprehension of ASD are: Intelligence, Operational
Memory, Verbal Understanding, Processing Speed and Perceptual
Reasoning . Cognitive profiles in ASD, such as those
documented, can serve as informative key for future investigations
and also have clinical implications. The Childhood Autism Rating
Scale (CARS) contains 15 items for complementary assessment of
the diagnosis of autism and severity (mild, moderate and severe)
. It contributes to ASD diagnosis because it distinguishes
children with ASD from typical children, making it possible to
differentiate children with ASD from children with impaired
development, however, without having ASD . In addition to
a general category of impression of autism, 14 domains that are
usually affected in ASD are analyzed by CARS, and some of which
are: interpersonal relationship, imitation, emotional response,
body use, use of objects, use of the look, hearing, taste, smell,
touch, response to changes, activity level, verbal and non-verbal
communication, fear or nervousness, level and consistency of the
intellectual response .
Also, research has shown that CARS has a high degree of
consistency and test-retest reliability, as well as high validity
values, making it easier to recognize and classify ASD by providing
information about children’s behavior and the severity of
symptoms . The use of this instrument is encouraged in Brazil
in order to improve diagnostic accuracy and agreement with other
diagnostic instruments. The Raven’s Colored Progressive Matrices
(RCPM) test is a non-verbal instrument that contributes to ASD
differential diagnosis because it is used to assess intelligence,
specifically the g factor (general intellectual capacity) and its two
components: education and reproduction . Education is the
ability to extract meaning from an unclear situation and to develop
new understandings of what is given. Reproduction includes
the recall and reproduction of materials that are part of prior
knowledge . The RCPM is performed from the presentation
to the subjects, individually, of geometric figures reproduced on
paper, with a missing part. The task consists of indicating, pointing
out, which part of the figure would complete the main drawing,
with the suggested parts of figures being available as alternatives
. This very important test of general and fluid intelligence
contributes a lot in order to more fairly assess the potential of
autistic children. As we could notice through this study about
the contributions of the Neuropsychological Assessment for
ASD diagnosis, there is a deep relationship between executive
functions and the neurodevelopment of people with ASD. The
neuropsychological assessment precisely identifies with the
mentioned psychological instrumentals, impairments from the
analysis of important cognitive functions for human development.
Therefore, the contributions of neuropsychological assessment to ASD are notorious in the national Brazilian scenario, where
their relevance is highlighted for being an effective instrument for
differential diagnosis, due to the lack of biological markers for this
disorder. This is an important step forward, given its contribution
to an earlier diagnosis, and consequently, early well-planned and
Knowledge about the intellectual and cognitive functioning
of each patient that has ASD diagnosis is essential for the design
of appropriate and effective individual interventions. In this
way, we can assure that paths are opened for a safe and precise
intervention, with a view to the development of the atypical
person in social environment.
World Health Organization- WHO (2013) Autism Spectrum Disorders & other developmental disorders: from raising awareness to building capacity. World Health Organization: meeting report. Geneva, Switzerland. pp. 1-36.
Whitbourne S, Halgin R (2015) Psicopatologia: perspectivas clínicas dos transtornos psicoló Porto Alegre: AMGH.
Borges J (2008) Avaliação neuropsicológica dos transtornos psicológicos na infância: um estudo de revisã Psico-USF 13 (1): 125-133.
Ramos A, Hamdan A (2016) O crescimento da avaliação neuropsicológica no Brasil: uma revisão sistemá Psicologia: Ciência e Profissão 36(2).
Instituto Brasileiro de Informação em Ciência e Tecnologia (IBICT) (2019) Biblioteca Digital Brasileira de Teses e Dissertações (BDTD).
Fernandes C, Fichman H, Barros P (2018) Evidências de diagnóstico diferencial entre Transtorno do Espectro Autista (TEA) e Transtorno do desenvolvimento intelectual (TDI): análise de casos. Neuropsicologia latino-americana, Brazil 10(2): 29-41.
Pereira A, Maia L (2015) Avaliação Neuropsicológica: Perturbação do Espectro Autista, Brazil.
Neumann D, Tariga A, Gomes P, Silveira J, Azambuja L (2016) Avaliação Neuropsicológica do Transtorno do Espectro Autista. Portal dos Psicólogos Brazil.
Paris T, Blakleitz J, Souza B (2017) A avaliação neuropsicológica no diagnóstico do autismo: uma revisão de literatura, 15 Minas Gerais, Brazil.
Mariano M, Pelles P, Terra W, Frontzek L, Silva E (2016) Avaliação Psicológica de crianças com transtorno do espectro autista. Revista Universo, Belo Horizonte, Minas Gerais, Brazil.
Reis F, Borges R (2019) Avaliação Neuropsicológica do autista. Centro Universitário de Anápolis, UniEvangélica, Goiás, Brasil.
Maranhão S (2018) Transtorno do Espectro do Autismo: Da avaliação à intervenção neuropsicológica histórico-cultural. Universidade Federal, Rio Grande do Norte, Brasil.
Savali A, Dias M (2018) Transtorno do Espectro Autista: do conceito ao processo terapê FCEE, (20th ed) São José, Santa Catarina, Brasil.
Figueiredo L, Light L, Corrêa G (2018) O transtorno do espectro autista em inter-relação com a neuropsicologia. Práticas Disciplinares e Intersetoriais, Santa Maria, Rio Grande do Sul, Brasil.