DISCO
Diagnostic Interview for Social and Communication Disorders framework
What is DISCO?
The Diagnostic Interview for Social and Communication Disorders (DISCO) was developed for use at The Centre for Social and Communication Disorders, by Dr Lorna Wing and Dr Judith Gould, as both a clinical and a research instrument for use with children and adults of any age.
Its special value is that it collects information concerning all aspects of each individual’s skills, deficits and untypical behaviour, not just the features of autism spectrum disorder.
Dr Lorna Wing at the Autism Professionals Conference
How is DISCO different?
The DISCO was developed for use at The Centre for Social and Communication Disorders, by Dr Lorna Wing and Dr Judith Gould, as both a clinical and a research instrument for use with children and adults of any age.
No specific tests
There are no specific physical or psychological tests for autism spectrum disorders. In order to recognise and identify the impairments of social interaction, social communication and social imagination together with the associated repetitive behaviours, and all the other features that can be found in autism, information must be collected in a systematic way.
Context and history
Where possible, information concerning the person's history in infancy and childhood should be collected from an informant who has known the person from birth. However when, for an adult, there is no informant available to give an early history, the items of the schedule can be completed for current skills, deficits and untypical behaviour.
Working diagnosis
If no developmental history is available, this does not allow for a diagnosis using the ICD or DSM classification systems, but the information gathered from the DISCO does allow the experienced clinician to use their clinical judgement to make a working diagnosis in order to plan a management programme.
Why use the DISCO?
Since the DISCO was designed a small number of other schedules for the diagnosis of autism spectrum disorders have become available.The DISCO has certain important advantages as follows:
The DISCO is designed to elicit a picture of the whole person through the story of their development and behaviour. In clinical work, the primary purpose is to facilitate understanding of the pattern over time of the specific skills and impairments that underlie the overt behaviour. As mentioned above sometimes no informant is available. When this is the case the clinician has to obtain as much information as possible concerning the details of current skills and pattern of behaviour of the person. This type of dimensional approach to clinical description is far more useful for prescribing how to help each person than is assigning a diagnostic category. The dimensional approach is fundamental to the DISCO in contrast to other diagnostic schedules.
The findings from the DISCO are relevant and helpful for children and adults of any age; for any level of ability from profound learning disability to the superior range, for any manifestation of the autism spectrum from the most obvious to the most subtle. It can also assist in identifying conditions often associated with the spectrum, such as ADHD, tics, dyspraxia and catatonia-like disorders.
For research, it has been adapted so that different diagnostic systems can be applied and compared. It is also useful for examining the patterns of clinical features and their significance for present behaviour and future prognosis.
It is also important to note that DISCO training courses are designed not only to teach how to use the schedule but also to increase understanding of the nature of autism spectrum disorders and the wide variation in the ways they can be manifested.
As emphasised in the section on its history, the DISCO should be used in conjunction with psychological assessment, observation and any other sources of reliable information.
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On the basis of some years of clinical work and personal experience of being a parent of a young daughter with Kanner's syndrome, Lorna Wing designed the Handicaps Behaviour and Skills schedule (HBS) which was the precursor of the DISCO.
From the results of this epidemiological study, Wing and Gould developed the concept of a spectrum of autistic conditions. This was much wider that the syndrome originally named by Leo Kanner in 1943. It included the pattern of behaviour described by Hans Asperger in 1944 and a range of other clinical pictures that did not fit either of these named syndromes. What held all these clinical pictures together was a triad of impairments affecting social interaction, social communication and social imagination, which was associated with a stereotyped repetitive pattern of behaviour.
In 1991 Wing and Gould, together with Carole Murray, set up the Centre for Social and Communication Disorders. It soon became clear that the HBS, which was designed for research with children, was not detailed enough for the clinical diagnostic work of the centre that was concerned with diagnosis of people of all ages. The team expanded the areas covered by the HBS to include sections on infancy, developmental domains, the triad of impairments, repetitive routines, emotional difficulties and challenging behaviour. The HBS schedule was renamed the Diagnostic Interview for Social and Communication Disorders (DISCO). It was adapted to cover all ages, all levels of ability and conditions on the borderlines of autism. Thanks to the fundraising efforts of Lady Astor of Hever, author of Loving Olivia, the first DISCO manual was able to be printed.
From the experience of training professionals to use the DISCO, it became clear that a separate section for recording clinical judgement was necessary. This had to be based on all the information obtained from the rest of the schedule, psychological assessment, observation and any other sources of reliable information. This DISCO section asks the interviewer to make a judgement concerning the quality of the social interaction, social communication, social imagination and pattern of activities. To do this it is essential for the interviewer to have adequate clinical experience in the field.
Use of the DISCO in research
The precursor of the Diagnostic Interview for Social and Communication Disorders (DISCO), the Handicaps, Behaviour and Skills (HBS) Schedule designed by Wing and Gould, was used in research and featured in many academic publications.
The DISCO was designed primarily for clinical work but has also featured in research and has appeared in many leading academic publications. To find out more about these, or any other, autism-related research articles, please go to Autism Data. This gives abstracts to journal articles and a mechanism for requesting photocopies of articles for your research.
