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The MIGDAS

What is the MIGDAS?

The MIGDAS is an interview method for evaluating verbal children suspected of having autism spectrum disorders. MIGDAS stands for Monteiro Interview Guidelines for Diagnosing Asperger’s Syndrome: A Team-Based Approach.

Why did you develop it?

The MIGDAS evolved out of my daily work interviewing verbal children suspected of having autism spectrum disorders in schools. I found that the standardized tests and checklists commonly used to diagnose autism spectrum disorders were missing the key process of interacting with children on their unique terms. When I used sensory toys and introduced topics of interest to the child, I found that the children enjoyed the evaluation process and I was able to get to the heart of each child’s pattern of developmental differences in a short period of time.

My colleagues began asking me to teach them how to connect with children in this highly effective way and the MIGDAS is the result of formalizing my method. I have been training professionals to use this approach for the past 15 years.

Why is it called “a team-based approach”?

Because I believe the best practices evaluation of a child involves using a team of professionals: psychologists, speech and language therapists, educational diagnosticians, occupational therapists, and other specialists. Of course, I include the child’s parents in the team as well.

How does the MIGDAS differ from other autism tests?

Unlike other tests for identifying forms of autism, the MIGDAS is an interview process that teaches evaluators to follow the agenda of the child to explore that child’s sensory-driven worldview as the child plays with toys and discusses preferred topics with a group of adults. It is a method that involves dynamic interaction between the evaluators and the child. The sensory toys and topics used will vary depending on the individual child’s particular interests.

With the MIGDAS, the evaluators gather systematic, descriptive information about the child in three key areas: language and communication, social relationships and emotional responses, and sensory use and interests. The descriptive profile of the child’s behavior can be compared to the behaviors typically seen in children who do and who do not have autism spectrum disorders. The MIGDAS interview protocol does not provide a score or a standardized set of numbers.

Most tests require the child to conform to the agenda of the evaluators. Children with high-functioning forms of autism are adept at following adult prompts and may not show enough of their underlying pattern of developmental differences in standardized test situations.

Can I use the MIGDAS as a stand-alone evaluation tool?

The conversational approach can also be used in its own right. The Monteiro Interview Guidelines for Diagnosing Asperger’s Syndrome (MIGDAS) provides detailed guidelines for using a sensory-based diagnostic interview when evaluating verbal children for possible Asperger’s Syndrome, high-functioning Autistic Disorder, or high-functioning Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS).

How does the MIGDAS approach fit with traditional diagnostic categorization systems like the DSM-IV-TR?

Traditional diagnostic categorization systems, such as the DSM-IV-TR, provide sets of criteria for diagnosing psychiatric disorders, such as autism spectrum disorders.

In the visual framework, the distinct behavioral features of autism spectrum disorders described in traditional diagnostic categorization systems are organized into three key areas clinicians look at when evaluating children for suspected autism spectrum disorders: language and communication, social relationships and emotional responses, and sensory use and interests. The three key areas form a behavioral profile, organized around a descriptive triangle, which provides an accessible way to understand the challenges associated with autism spectrum disorders.

Clinicians are better able to recognize the pattern of developmental differences a child presents in an evaluation setting when they use the visual structure and translate the key behaviors into non-technical but specific language, as opposed to using the technical language found in diagnostic categorization systems. They are also better equipped to talk to parents and teachers about the child in terms that are instantly recognizable as qualities the child displays.

When clinicians evaluate children for suspected autism spectrum disorders, they refer to the DSM-IV-TR criteria for Autistic Disorder, Pervasive Developmental Disorder-Not Otherwise Specified, or Asperger’s Syndrome. By using the visual framework, clinicians have an organized and structured way to gather the information needed for these formal diagnoses. If they approach the evaluative process by organizing their understanding of the child’s pattern of developmental differences in this manner, their clinical observations and understanding of the diagnostic process, as well as their ability to communicate a diagnosis to parents and others, will substantially improve.

How does the MIGDAS approach fit in with the use of standardized autism evaluation measures such as the ADOS and the PEP-3?

Standardized autism evaluation measures, such as the ADOS and the PEP-3, provide important information that helps evaluators recognize the pattern of behaviors associated with autism spectrum disorders. However, because the presentation of the presses or tasks is standardized, the examiners set the agenda and the child is required to follow the agenda of the adults. As a result, many times not enough of an individualized profile emerges and it becomes difficult to describe the individual child in an authentic and unique way. The emphasis is placed on the quantitative scoring criteria and subtle details about the child’s responses are lost. Many times, evaluators may feel that they are left with a score but not with a sample of behavior that captures the child’s unique autism-driven agenda and way of organizing information when relating to the world.

The conversational approach is a unique evaluation tool that allows a child to explore sensory toys and to interact with the adults by following his or her own autism-driven agenda. The toys and materials recommended for use during the sensory-based diagnostic interview were selected for their sensory properties, and children with autism spectrum disorders respond in uniquely sensory-driven ways to these materials in comparison to their neuro-typical peers. Using a sensory-based diagnostic interview with young children allows evaluators to experience the child’s natural drive for sensory-driven play. The process helps assess how difficult it is for the child to participate in social communication exchanges in a way that is not as inherently possible when administering standardized autism evaluation measures.

How can I get training in the MIGDAS method?

Many school psychologists and private clinicians are beginning to use the MIGDAS process as part of their autism evaluation toolkit. Training is available through national and state conferences and through workshops provided by Dr. Monteiro. Review the calendar of Dr. Monteiro’s workshops and presentations, or submit a query regarding a training workshop.