Excerpted from chapter 1 of Interdisciplinary Clinical Assessment of Young Children with Developmental Disabilities, by Michael J. Guralnick, Ph.D.

Copyright © 2000 by Paul H. Brookes Publishing Co. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

The overarching purpose of the interdisciplinary team assessment of young children is to develop plans and recommendations, including locating community resources to meet the identified needs of the child and family. To accomplish this, the interdisciplinary team assessment process should yield at least five outcomes. First, it is essential to establish the child's developmental and health patterns and to profile family functioning in a community context. This outcome is achieved through assessments by representatives of disciplines considered relevant to the presenting concerns. In essence, this process begins by ensuring that team members from each discipline are able to gather information and to understand thoroughly, in relation to their domains of expertise, child and family functioning. These discipline assessments that establish patterns of strength and concern form the core of a more complex process that integrates and reconciles this material.

A second outcome is to determine areas in which additional information is needed. This is an important feature of the clinical assessment because, as described previously, the process is time limited. Even with reasonably good records or history taking, the nature of the information that can be gathered is nevertheless limited by the assessments that occur during a restricted time period. Moreover, additional issues may arise during the course of the assessment that require information to be obtained at a later time. This point highlights that the team's conclusions and recommendations will vary considerably in terms of their degree of certainty. Accurately estimating this degree of certainty, communicating it effectively to the family, and formulating a strategy for obtaining additional information to increase the degree of certainty are all expected outcomes of the interdisciplinary team assessment.

Third, if necessary, the interdisciplinary team assessment will need to help establish a diagnosis or at least provide the probable source or sources of the child's difficulties. This diagnostic process can occur at many levels. At minimum, the team can provide a classification diagnosis in which a category is assigned that best fits the child's developmental profile. Terms such as developmental delay, autism spectrum disorder, or cerebral palsy constitute such categorical diagnoses. Standard classification systems, such as the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (American Psychiatric Association, 1994), are often used for this purpose. When no clear biological markers are available to assist in determining a categorical diagnosis, as is often the case, the team must engage in the generally difficult task of integrating the diverse disciplinary information to achieve a reasonable level of agreement. It is essential, however, that the child's individual developmental profile and the variability inherent in any classification system be communicated adequately to parents. Oversimplifying the diagnostic findings, especially regarding young children, can be misleading and can redirect the family's focus from the rich and diverse patterns of their child's behavior.

At another level, the team tries to determine an etiology as part of the diagnostic process. With the development of more sophisticated genetic testing, the source of a developmental delay, for example, such as that associated with fragile X syndrome, can be confidently established. Other nongenetic, biologically based etiologies are often more tenuous, but a team can reasonably identify the likely source or sources of the child's major problems. In the same way, environmental etiologies or influences are examined by the team. The nature of the parent-child relationship, possible abuse or neglect, related chronic health conditions, or the mental health status of the parents are all important contributors to identifying either a specific etiology or gaining insight into the source or sources of the problem.

Despite the often uncertain nature of the diagnostic outcome, it is a critical feature of the interdisciplinary team process. Establishing a diagnosis may help link families to specific parent support groups, determine eligibility for services, provide a focus for the team's recommendations, facilitate anticipatory guidance for families, and supply parents with some deeper understanding of the nature of their child's problem despite frequent difficulties in working through a diagnosis. It also may have family planning implications.

Fourth, the interdisciplinary team assessment is expected to provide recommendations and suggestions for intervention. From both a disciplinary and an interdisciplinary perspective, perhaps the most valuable feature of the process is the recommendations that result. In some instances, recommendations will be quite specific, focusing on interventions such as prescribing a diet for a child with PKU, recommending a specific program to facilitate a child's language development, or encouraging the family to seek a particular community service. In other instances, the recommendations will be quite general, such as suggesting that the child be enrolled in therapeutic child care or an intensive early intervention program or explaining how to locate a qualified physical therapist in the community. The advice should, of course, respond to the concerns that originally prompted the assessment but may well go beyond those issues as the situation dictates.

The interdisciplinary team assessment recommendations in many ways are the starting point for a new intervention program. The interventions themselves generally are not carried out by team members, although some team members or groups within teams do elect to provide longer-term management, at least for some issues. Discussions with the family and community providers are essential to determine whether the team wishes to take a management role.

Finally, an outcome of the interdisciplinary team assessment is often to establish a framework for more detailed, intervention-oriented assessments. The global nature of many of the assessments comprising the interdisciplinary team approach, although valuable for addressing the issues that brought families to the team, is typically only the first stage in an extended undertaking of disciplinary- and interdisciplinary-based assessments and early interventions. For example, for children newly identified as exhibiting developmental delays that require intervention services, additional steps designed to gather information uniquely suited for intervention often occur in the context of the community early intervention service system. Community teams providing assessments that assist in the creation of IFSPs and IEPs are also interdisciplinary in their composition. Information from the initial interdisciplinary assessment team can focus and refine these community team intervention-oriented assessments. This final expected result of the interdisciplinary team emphasizes its role in the continuum of early intervention services and supports.