INDIAN SCALE FOR ASSESSMENT OF AUTISM (ISAA)

Aim: The aim of the Indian Scale for Assessment of Autism (ISAA) is to assess and quantify
the severity of autism spectrum disorder in children and adolescents.
Introduction:

Autism Spectrum Disorder is defined by the DSM-5 as a neurodevelopmental disorder

characterized by persistent deficits in social communication and social interaction across
multiple contexts, accompanied by restricted, repetitive patterns of behaviour, interests, or
activities. According to ICD-11, autism spectrum disorder includes impairments in the ability
to initiate or sustain reciprocal social interaction and communication, combined with
restricted, repetitive behaviours.
Clinical Features
1. Social Communication Deficits
 Difficulty with back-and-forth conversation, reduced sharing of interests, or failure to
initiate or respond to social interactions.
 Challenges in nonverbal communication, such as eye contact, facial expressions, and
body language.
 Difficulty in developing, maintaining, and understanding relationships. This may include
a lack of interest in peers or difficulty adjusting behavior to suit various social contexts.
2. Repetitive Behaviors and Restricted Interests
 Stereotyped or repetitive motor movements, use of objects, or speech (e.g., repetitive
hand-flapping, lining up toys, echolalia).
 Insistence on sameness, inflexible adherence to routines, or ritualized behavior patterns
(e.g., distress at small changes, rigid thinking patterns).
 Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., intense
focus on numbers, specific objects).
 Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the
environment (e.g., indifference to pain/temperature, adverse response to specific sounds,
or fascination with lights or spinning objects).
3. Developmental Delays and Comorbidities
 Delayed language or motor development.
 Co-occurring intellectual disability or attention-deficit/hyperactivity disorder (ADHD) is
common.
 Potential for comorbid psychiatric conditions like anxiety and mood disorders.
In the ICD-11, Autism Spectrum Disorder (ASD) is classified under 6A02 in the chapter on
neurodevelopmental disorders. ICD-11 no longer separates autism into distinct subtypes
(such as Asperger’s syndrome or pervasive developmental disorder not otherwise specified).
Instead, it recognizes autism as a single, continuous spectrum with varying levels of support
needs based on the severity of social communication and behavioral challenges.
Causes
1. Genetic Factors
 ASD is known to have a strong genetic component, with multiple genes
involved in neurodevelopment implicated.
 Studies have shown that ASD can run in families, though the specific genetic
mechanisms are complex and involve many gene variants.
2. Environmental Factors
 Prenatal and perinatal factors such as advanced parental age, low birth weight,
and exposure to certain environmental toxins or infections may increase the
risk of autism.
 There is ongoing research into how environmental factors might interact with
genetic predispositions.
3. Neurobiological Factors
 Differences in brain structure and function, such as abnormal connectivity
between brain regions involved in social communication, are often seen in
people with ASD.
 Neurochemical imbalances, involving neurotransmitters like serotonin and
dopamine, are also being studied.
Management
1. Behavioral Interventions
 Applied Behavior Analysis (ABA): A widely used intervention focusing on
improving specific behaviors such as social skills, communication, reading,
and academics, as well as adaptive learning skills.
 Early Intensive Behavioral Intervention (EIBI): Targeted at younger
children, EIBI aims to improve communication, play, and social skills.
 Pivotal Response Treatment (PRT): A play-based intervention focused on
developing motivation and the ability to respond to multiple cues.
2. Speech and Language Therapy
 Supports children in improving language, communication, and understanding
social norms.
  Can help nonverbal individuals or those with delayed language development
learn alternative communication methods, such as picture exchange or
assistive technology.
3. Occupational Therapy (OT)
 Helps individuals develop daily living skills and improve fine motor skills,
such as handwriting or self-care routines.
 Sensory integration therapy within OT helps individuals manage
hypersensitivity or hyposensitivity to sensory stimuli.
4. Educational and School-Based Interventions
 Individualized Education Programs (IEPs) provide accommodations tailored
to each child’s learning needs, focusing on academic and social success.
 Special education services provide support in inclusive or specialized
classrooms.
5. Pharmacological Treatment
 No medication directly treats ASD, but medications like selective serotonin
reuptake inhibitors (SSRIs), antipsychotics (e.g., risperidone), or stimulants
(for ADHD symptoms) can help manage certain symptoms, such as irritability,
hyperactivity, or anxiety.
6. Family Support and Parent Training
 Families play a crucial role in supporting children with autism, and many
programs focus on helping parents develop effective skills and strategies to
enhance communication, reduce challenging behaviors, and promote social
skills.
 Support groups and resources also help families manage stress and navigate
services.
7. Alternative and Complementary Treatments
 Some families explore alternative treatments like dietary changes or
supplements, though these should be approached with caution and discussed
with healthcare providers.
8. Community and Social Support
 Social skills groups and recreational programs help individuals with autism
develop relationships and social skills.
 Vocational training and employment support can aid adolescents and adults in
building independence and contributing to society.
Methodology:
 Participant Details:
Name- ABC
Age- 9 years
Sex- Male
Occupation- School student
 Materials Required: ISSA Manual, ISSA Questionnaire, Stationary, etc.

 Test Description: ISAA is an objective assessment tool for persons with autism which uses
observation, clinical evaluation of behavior, testing by interaction with the subject and also
information supplemented by parents or caretakers in order to diagnose autism. ISAA consists of
40 items rated on a 5-point scale ranging from 1 (never) to 5 (always). The 40 items of ISAA are
divided under six domains as given below.
Psychometric Properties

Reliability – The Indian Scale for Assessment of Autism (ISAA) demonstrates strong reliability,
ensuring consistent and accurate assessment outcomes. The test's reliability is evidenced through
rigorous standardization and validation processes conducted by the National Institute for the
Mentally Handicapped (NIMH) in India. Key reliability measures include:

1. Inter-rater Reliability: Ensures consistency in scores when different examiners assess the
same individual, confirming that the test is objective and yields similar results across
evaluators.
2. Test-retest Reliability: Indicates stability over time, showing that the results remain consistent
when the same individual is assessed under similar conditions after a period.

Validity- Validity of ISAA test items was determined by correlating the individual item scores with
the total scores, all the items of the scale were significantly correlated with total scores at 0.001 level,
except one item (A40), namely 'savant ability' which was significant at 0.5 level.

Procedure:
 Pre-Administration- The participant was called in the room, which was pre-arranged with the
required materials and proper sitting arrangement. Rapport was established with the participant.
His demographic details were taken, the instructions were provided to the participant. She was
given the MCMI-III questionnaire.
 Rapport Formation- Rapport was established with the participant by having a friendly
conversation. The participant was told about the test and what this would assess, proper consent
was taken and confidentiality of identity and results were ensured.
 Instructions-
 Actual Administration- The participant was brought to the comfortable and test conducive
settings, proper arrangements were ensured to make the participant feel at ease. After establishing
rapport, a brief introduction about the test along with the instructions and questionnaire was
provided to the participant. After completion, scoring was done and results were interpreted on the
basis of those scores.
 Behavioral Observation- As she entered the room, she seemed calm during the rapport
formation. However, after giving the questionnaire, he seemed confused at start but felt
comfortable and continued to fill out the questionnaire.
 Introspective Report- It felt like an interesting test assessment and the conduction went
smoothly, as the examiner was calm and explained everything nicely."
 Scoring: The Indian Scale for Assessment of Autism (ISAA) uses a 5-point scoring system for each
of its 40 items, based on the frequency and intensity of observed behaviors:
 Rarely (Up to 20%): Behaviour shown up to 20% of the time; considered normal. Score: 1.
 Sometimes (21–40%): Behaviour shown 21–40% of the time; may cause concern but is often
within normal limits. Score: 2.
 Frequently (41–60%): Behaviour shown 41–60% of the time; interferes with daily functioning
and is disabling. Score: 3.
 Mostly (61–80%): Behaviour shown 61–80% of the time; occurs regularly and hampers daily
activities. Score: 4.
 Always (81–100%): Behaviour shown almost all the time, leading to significant impairment and
dependency. Score: 5.
The total score ranges from 40 (minimum) to 200 (maximum), indicating the overall severity of
autism traits.

 Result Table :-

DOMAIN SCORE OBTAINED INTERPRETATION

Social Relationship and 25
Reciprocity
Emotional Responsiveness 24
Speech-Language and 41
Communication
Behaviour Patterns 32
Sensory Aspects 8
Cognitive Component 15
TOTAL 145 Moderate Autism

Interpretation: The aim of the Indian Scale for Assessment of Autism (ISAA) is to assess and quantify
the severity of autism spectrum disorder in children and adolescents.

A total score of 145 places the child within the "Moderate Autism" category, as per the ISAA
scoring interpretation (range for moderate autism: 107 to 153). This indicates that the child shows
significant signs of autism that are noticeable and can impact daily functioning but do not reach the
severity of the highest category.
 Social Relationship and Reciprocity: This score reflects significant challenges in building and
maintaining social relationships, as well as difficulties with social reciprocity. The individual may
struggle to understand social cues, maintain eye contact, or engage in age-appropriate social
interactions. This can impact their ability to connect with peers, respond to social signals, or show
empathy.
 Emotional Responsiveness: This score indicates moderate to high challenges in emotional
responsiveness. The individual may have difficulty interpreting or expressing emotions
appropriately, possibly appearing indifferent or overly reactive in various situations. There may be
challenges in showing emotions that match the context, or in responding to the emotions of
others, such as comforting someone in distress.
 Speech-Language and Communication: A high score in this domain signifies substantial
difficulties with both verbal and non-verbal communication. The individual may have a limited
vocabulary, struggle with conversational skills, or rely on gestures instead of spoken words. They
may also face challenges in understanding the nuances of language, such as metaphors or jokes,
which can hinder effective communication.
 Behaviour Patterns: This score suggests a moderate level of repetitive or restrictive behaviors,
common in autism. The individual may have routines they strongly prefer, resist changes, or
engage in repetitive actions (e.g., hand-flapping, rocking). Such behaviors can be a way to self-
soothe or manage sensory inputs, but they may also limit flexibility in adapting to new situations.
 Sensory Aspects: A lower score in this domain suggests mild sensory sensitivity. This means the
individual may experience fewer issues with sensory stimuli than those with higher scores. They
might be more adaptable to sensory changes in their environment, though occasional sensitivity
could still occur in specific situations.
 Cognitive Component: This score indicates mild cognitive difficulties, suggesting the individual
may face some challenges in attention, memory, or problem-solving, but these may not be as
pronounced as in other areas. This can affect their ability to focus on tasks, retain information, or
solve complex problems.

Conclusion: The total score of 145 falls within the Moderate Autism category on the ISAA scale.
This implies that the individual exhibits moderate autistic traits across different domains, affecting
social interactions, emotional expression, communication, behaviour, and cognitive functions. Support
and intervention would be beneficial in various areas, especially social and communication skills, to
help improve daily functioning and engagement with others.
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