Recently, someone posted about the lovely way that they administer the construction task. They asked about how I do it. I said, “I don’t do anything particularly interesting.”
That is not a criticism of myself, it’s a truism but it does not mean that young people fall asleep if they do this task with me – not yet anyway. It got me thinking. What do I do? This blog is an attempt to answer that question!
Well, first of all, I don’t always start the ADOS in exactly the same way. It depends on the young person and the situation. I try to avoid having a big conversation, although I never say never as that might just be what happens. My primary aim is always to get to know the person I am assessing and to find out as much as I can about them in the short time we have together. A personal rule is to always be authentic, respectful and compassionate. Most people know they are being assessed, but I do not want them to feel judged. Many have very low self-esteem, very critical inner voices, and often view themselves as not good enough. I do not want to add to this. I want to see strengths, and I need to see differences to understand what can be difficult in certain situations, but I try to do this discreetly without exacerbating the negative thoughts and feelings many already have about themselves. Anyone who has trained with me will know this can make it hard to code my videos.
As the assessment progresses, hypotheses and questions build up in my mind. I test and try to answer some of them on the spot, and others I ask about after the ADOS. I have two lists in my head.
One is a list of observations that I am curious about, but which are not related to coding. For example, things that suggest the person might have difficulties with interoception and/or alexithymia. I am very interested in this, and it is important for recommendations and support. I am assessing, but that is not the only hat I am wearing during assessments, I am thinking about support too. I notice things that, as I said, don’t code but help me understand the person and I want to learn more to think about support.
The other list is questions that are related to coding, questions that often lead to hypotheses and that affect my administration during the ADOS. For example, if the person wants to make a pattern with the colours in the construction task, if they move the pieces once to try to make a pattern- so there is a hint of a preference for order, pattern and symmetry but not enough to code, questions start to form in my mind. For example, how strong is this preference for pattern? Is it a characteristic that I am going to see in other tasks? Can they tolerate things not being ordered or in a pattern? Can they move on when things are not right, or is it too uncomfortable? Does this affect attention, listening, interactions? I also think about how I can answer these questions without making the person I am assessing feel uncomfortable.
I hope to answer the questions on my list related to coding during the ADOS. The other list is different. I spend about an hour with people I assess after the assessment discussing support, recommendations for the report and I ask the questions on my list. It’s really helpful on many levels. The ADOS gives me so much information and tells me much more than I code. My aim is to get to know the person I am assessing and the ADOS helps me do that – I am not just focussed on coding.
An example of trying to answer questions I had related to coding: Recently, at the end of the construction task, the young person I was working with, started turning the paper with the shape on it, over to do the other side. I was thinking “How will they react if they can’t do the other side? Will they have to do it? Will they get upset?”
To find out, I adapted my administration in the following way, very casually, in the context of a chat. Before they could turn the paper over to do the other side, I said, “Let me show you what someone said the shape looked like recently!” And I moved the paper to show them how another person saw the shape. They listened, and said that they couldn’t see that and told me what they thought it looked like, but when I started to put the paper away, they said, “It’s got two sides can I do the other side?” I said, “Yes you’re right, but we’re going to do something else now” and I put the shape in its bag and started to put away the pieces. I noted this next to D5.
Particular items I look out for in the Construction task:
Some of the things I think about throughout the ADOS, not necessarily for coding purposes:
- Attention control, particularly being able to shift attention from one thing to another.
- Thinking style, e.g., a focus on details, reduced awareness of context, needing time to integrate information, linking past and present to make sense of situations.
- Feeling self-conscious, and possible impact on body language and gesture.
- Putting ideas into words, using language to express what they want to say. This is not to do with speech and language difficulties; it is a difference in integrating the two that I am very interested in.
If the person does not spontaneously suggest what the shape looks like in the Construction task, I prompt but I do not code this. I do this to close the activity in a nice way. Then, I start to put the small shapes back in the bag very slowly. Sometimes people help me, sometimes they don’t. I note what they do and if it is the same the next time I put away resources as I am thinking about awareness of me and what I am doing and wanting to help me. I code doing things for my benefit in reciprocity.
I like this task, it is usually a nice, gentle start to the ADOS that does not put too much pressure on the person and gives us a chance to get used to each other.
