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Assessment of Children with Autistic
 Spectrum Disorders: Best Practices
          for Educators
    Kristine Strong, Ph.D.,LEP #2314

            Copyright 2012
Goals of the Workshop
 Increase  knowledge and awareness of
  effective assessment tools and methods for
  ASD
 Develop understanding about
  multidisciplinary assessment teams
 Develop understanding about the importance
  of the parent - school relationship and
  working effectively with parents
 Learn about current evidence based practices
 Develop skills in IEP development
ASD Is A “Spectrum” Disorder
   “Spectrum” ranges from mild (more able) to
    severe (less able).
      Mild = High-functioning Autism (HFA),
       Asperger’s Syndrome, PDD, PDD-NOS
      Moderate = Classic Autism (As described by
       Kanner)
      Severe = Autism with other collateral
       conditions such as MR and seizures, Retts
       Disorder(females only), Childhood
       Disintegrative Disorder (rare), Landau-Kleffner
       Syndrome.
                                         3
Statistics
   Autism is increasing at an
    alarming rate.
     Department of Developmental
      Services study: rates of
      autism have risen 210% in the
      past 10 years.
     Increase of over 600% for
      Special Education eligibility
      under the autism category
      from 1994 to 2003 (US Dept
      of Ed).

                                      4
Why the Increase?
   1975 Education of the Handicapped Act identified
    “autism” and “pervasive developmental delay” as
    disabling categories. Prior to that change persons were
    labeled as MR.
   DSM IV broadened the disability to include PDD-NOS,
    Autism and Asperger’s Syndrome.
   1990 IDEA made autism a qualifying disability category.
   Many studies being conducted, with a causation model
    including both genetic predisposition and environmental
    variables -- no one cause likely


                                              5
The Anatomy of Autism


Neuro-imaging (fMRI
and PET scans)
indicate location of
pathology
Multiple brain
systems and brain
functions are
impacted by this
disorder
Three Types of Autism?
 Center  for             Autism is considered to
  Excellence in            have a strong genetic
  Developmental            component.
  Disabilities UC         Pattern of onset may be
                           related to specific type
  Davis MIND               of autism:
  research:                 Predominant language
 Interactive models         regression
                            Predominant social
  of ASD include             regression
  multiple                  Early onset in both social
  environmental              and language
  variables and gene         development
  interactions.
Deviation In:
 Hippocampus  and amygdala (emotional
 regulation and memory)

 Cerebellum  (motor coordination, shifting
 attention, concept formation, sequencing,
 working memory, complex problem solving,
 sensory discrimination)
Deviations In:
   Brain stem (brain/body communication, basic
    functions)
   Brain size, growth pattern, and white matter (axons
    -cables connecting brain cells)
   Brain microstructures, minicolumns are narrower and
    made up of smaller cells vs. normal brain
   Neocortex
     Particularly frontal lobe (higher level thinking and executive
      functions, early speech acquisition, and integration of
      information)
     temporal lobes (auditory processing)
Understanding Autism Spectrum
Disorders
   Neurobiological differences lead to deficits in social
    perception, theory of mind and social relatedness,
    that in turn lead to problem situations for group
    learning, peer interactions, and student-teacher
    interactions in school.

   Problem behaviors are a result of known
    neurobiological differences and environmental
    influences but can be addressed through active,
    direct teaching of adaptive social skills and problem
    solving skills.
Social-Emotional Implications of
autism spectrum disorders
 Few   or no close friends--limited social
  interests
 Avoidance of socially demanding situations
 Difficulty sensing or interpreting emotions in
  self and others
 Greater likelihood of also having anxiety
  and/or depression
Social and Emotional
Implications
 Impaired non-verbal communication,
 including limited facial expressions

 Impaired pragmatic language, including
 lack of cohesion to conversation
Impaired Executive Functioning
        An inability to engage
in goal-directed, future-
oriented behaviors including:
planning, flexibility, organized
search, self-monitoring, and
use of working memory.
“Behavior Problems” Associated With
Executive Dysfunction
Noncompliance
Off Task Behaviors/Distractibility
Inflexibility or Rigidity
Procrastination
Prompt Dependence
Disorganization
Socially Inappropriate Behaviors
Understanding HFA & AD cont.
 Deficits  in working memory, attention, and
  executive functioning, such as organization
  and planning, can lead to increased stressors
  in school, difficulty completing work, and
  escape and avoidance behaviors.
 Remember, behaviors happen for a reason
  and are likely in large part a symptom of
  these underlying deficits and lack of adaptive
  skills to respond to these deficits.
Model of Problem Behaviors

       Core Neuro -              Lack
       Development               Adequate
       al Deficits               supports


                      Problem
                      Behavior
                                      Poor
       Poor Social                    Coping
       Skills                         Skills
California Code of
Regulations 3030 g:
A pupil exhibits any combination of the
 following autistic like behaviors, to include but
 not limited to:
    An inability to use oral language for appropriate
     communication.
     A history of extreme withdrawal or relating to
     people inappropriately and continued impairment
     in social interaction from infancy through early
     childhood.
California Code cont.:
 Anobsession to maintain sameness.
 Extreme preoccupation with objects or
 inappropriate use of objects or both.

 Extreme resistance to controls
 Displays peculiar motoric mannerisms
 and motility patterns.
 Self stimulating- ritualistic behavior.
DSM IV Diagnosis of Autism Spectrum
Disorders
A. 1.  Social Interactions (Must have at least 2 of the following)
        Impaired use of nonverbal behaviors
        Impaired peer relations
        Limited sharing of enjoyment
        limited social or emotional reciprocity
   2. Communication (Must have at least 1 of the following)
        Delay of development of spoken language
        Impairment in conversation
        Repetitive use of language or idiosyncratic language and
          prosody
        Lack of varied make believe play
   3. Restrictive and Repetitive/Stereotyped Patterns of Behavior
       (Must have at least 1 of the following)
        Restricted interests
        Adherence to nonfunctional routines
        Stereotyped motor mannerisms
        Preoccupation with parts of objects     19
DSM IV Diagnosis for Autism Cont.

B.    Delays or abnormal functioning in at least one of
     the following areas:
     1. Social Interaction
     2. Language as used in social interactions
     3. Symbolic or imaginative play
     The disturbance is not accounted for by Rett’s or
     Childhood Disintegrative Disorder.
    To be diagnosed with Autism, at least six symptoms from A (at
     least two from A1 and one each from A2 and A3), one from B,
     and C must be present.
    To be diagnosed with PDD-NOS, disorders will be apparent in all
     areas (A-C), but some will be atypical or sub-threshold. This
     disorder is often recognized later than autism.
                                                    20
DSM IV Diagnosis of Asperger’s
Syndrome (AS)
  A. Social Interactions (Must have at least two of the
     following)
          Impaired use of nonverbal behaviors
          Impaired peer relations
          Limited sharing of enjoyment
          Limited social or emotional reciprocity
  B. Activities and Interests (Must have at least one
     of the following)
          Restricted interests
          Adherence to nonfunctional routines
          Stereotyped motor mannerisms
          Preoccupation with parts of objects
                                            21
DSM IV Criteria for Asperger’s Cont...
 C. The disturbance causes clinically significant impairment in
    social, occupational, or other important functioning.
 D. There is no clinically significant general delay in language
    (e.g. single words used by age 2, communicative phrases
    by age 3).
 E. There is no clinically significant delay in cognitive
    development or in the development of age appropriate self
    help skills, adaptive behavior (other than social
    interaction), and curiosity about the environment in
    childhood.
 F. The criterion are not met for other specific Pervasive
    Developmental Disorders or Schizophrenia.



                                                22
Autism - utube videos

Samples of autistic like behaviors
What is Different about the Assessment
of ASD vs. other Educational
Categories?
 More  comprehensive because of the
  pervasive nature of the disorder
 Requires more specialists and service
  providers, requiring increases in
  communication and collaboration--
  systemic challenges
 An ASD requires more specialized
  services and increasingly more
  demands on educators to develop
  expertise in autism specific strategies
Educators Responsible for Ed.
Code Eligibility
 Although  the DSM-IV criteria are
  important to know and use as a
  reference for determining “autistic like”
  behaviors, educators do not diagnose
  using the DSM-IV.
 Autism specific measures use the DSM-
  IV diagnostic criteria as a part of their
  content validity - so need to be
  knowledgeable about DSM-IV criteria
What is Different cont.:
 Adaptations    for standardized tests, including
  use of structured reinforcement
 Increased use of non-standardized
  assessment methods, including both natural
  and structured observations
 Critical to differentiate between ASD and
  other disorders, such as ADHD, Emotional
  Disturbance, and Language Disorders--
  course of educational planning is different
Team Activity
 What  are the core deficits in children
  with ASD?
 What do you already know about how to
  evaluate those areas?
 What parts or aspects of ASD
  assessments do you believe are the
  most challenging?
Case Study: Bobby V.
 Transitioning from Early Start
 2 years - 10 months
 Recent dx of ASD
 Highly verbal
 Bright
 Concurring assessment by NPA
 Advocate already involved
Case Study cont.
 Priority on parent-district relationship
 Home visits, natural environment was
  primary assessment setting
 Critical to respond to parent concerns
 Language evaluation utilized a range of
  tools - on the surface he looked fine
 Teaming was critical - the team was
  able to identify core deficits and needs-
  got agreement on our assessment
Goals of Assessment: Why do we
assess?
 Establish  eligibility
  under Ed. Code.
 Identify student
  unique needs that
  will lead to specific
  goals and objectives
 Understanding
  unique needs
  directs team when
  determining FAPE
Good Data = Good Planning
                Team   who is
                 knowledgeable
                 about the child
                 develops trust and
                 credibility with
                 agencies and
                 families
                Develop appropriate
                 intervention plans
The Autism
Assessment/Intervention Team
 TeamMembers should include a
 Behavior Analyst, Behavior Specialist,
 Speech Therapist, Occupational
 Therapist, Classroom teacher, Special
 Education Teacher, Nurse, School
 Psychologist and Administrator.
The Assessment Process: Developmental
Areas and the Trans-Disciplinary Model
 Specialists collaborate to provide a multi-
  method assessment across developmental
  areas
 Trans-disciplinary teams design assessment
  tasks and activities together for mutual
  benefit
 The TDT generates rich information about the
  child leading to meaningful goals, integrated
  services, and a meaningful report to parents
Assessment Areas
 Health  and Medical    Social - emotional
 Behavioral             Cognitive
  assessment-             functioning
  baseline of
  behaviors that         Adaptive Behaviors
  interfere with         Communication
  learning               Pre-academic and
 Fine and Gross
                          academic areas
  Motor
 Sensori-Integration
Assessment Methods
 Developmental     Standardized
  health history     Assessments
 Natural           Parent Interview
  Observations      Review of
 Structured         records/reports
  Observations
Developmental and Medical
History
 Initialeligibility assessment requires
  extensive parent interview about the
  child’s early development and medical
  history.
 Important to gather data on early signs
  of ASD, including, lack of gestures, little
  or no babbling, delayed language, lack
  of pointing, lack of interest in children,
  limited shared attention, lack of eye
  contact during feeding and games.
Developmental History cont.:
 Feeding  or sleeping problems
 Unusual sensory reactions, ie., noise or touch
 Unusual focus or attention toward limited
  areas of interest
 Range of affect, flat vs. full range
 Verbal and nonverbal forms of
  communication--intent to communicate needs
 Unusual motoric movements
 Fine and gross motor development
Natural Observations
 Occur  in several settings such as home,
  preschool/school or child care
 Take place with no structured activities other
  than those that occur naturally within the
  setting
 Important to observe on more than one
  occasion and by multiple observers
 When possible, chose one or two “controls” to
  observe in relation to student, ie., Tommy
  completed the task at the same pace as his
  peers, but needed twice as many prompts
Structured Observations-Play
Based
 Structured
  observations
  provide specific
  tasks to be
  performed, such as
  putting puzzles
  together, imitation
  tasks, and pretend
  play activities
 Activities are play
  based - interactive
 Specific    behaviors are elicited, including
     Reciprocal turn taking
     Pretend play
     Social reciprocity
     Imitation of novel acts
     Ability to be directed by examiners
     Use of toys and objects
     Use of spontaneous language
     Quality of spontaneous and prompted verbal and nonverbal
      communication
     Play imitation
     Joint referencing
     Eye gaze, following a point
     Eye contact, seeking eye contact to gain attention of others
Play-based assessment
 Toys  and materials       Develop   a play
  of interest to child’s     based assessment
  age or mental age          box or “tool kit”
 Variety of toys to        Include toys that are
  engage and illicit         sensory based,
  interest                   symbolic play, cause
 Include books,             and effect, can be
  musical toys, balls,       used to prompt
  cars, pretend play         imitation
Standardized Assessments: Uses
and Limitations
 Standardized    assessments provide
  objective data about broad functioning
  and abilities in specific developmental
  areas.
 Important to cross reference
  standardized results with observation
  data and interview data to make
  relevant, as well as to point out where
  there are discrepancies.
Limitations to
Standardized Tests
 ASD   children often do not perform well on
  these types of measures, and therefore they
  can underestimate their ability
 Reliability is also an issue due to highly
  variable performance of skills
 Note in your report the specific limitations of
  the results.
Parent Interview for Initial
Eligibility
 Can  be structured or informal -- strongly
  recommend including a home visit.
 Use of structured interviews such as
  The Autism Diagnostic Interview, R
  (ADI-R) (can be used for children
  through adults) is critical for establishing
  clear developmental clusters consistent
  with ASD.
Family Centered
                     Family centered
                      format--this is often the
                      first impression the
                      family gets of
                      educators.
                     Highly sensitive time for
                      parents, make sure you
                      provide ample time to
                      answer their questions.
The Faces of Autism

Parent perspectives reflect the
wide range of needs of children
  with ASD and highlight the
  individual nature of autism.
Areas to Assess: Core Deficits
 Reflect - what are      What  will most
  the core deficits?       assessment plans
 Comprehensive            need to consider?
  evaluations need to     Develop
  include all areas        assessment plans
  related to a             with parent input.
  suspected disability
Team Assessments
                  Set up stations such as,
                   fine motor, pretend
                   play, academic, sensory
                  Tag team - take turns
                   observing and
                   evaluating
                  Tag team - one team
                   member with parent,
                   two with child and then
                   rotate.
Cognitive Assessment
 Use  good                 Note  the type of
  comprehensive              support needed to
  tools: DAS-2,              learn a new task --
  WPPSI-2, KABC-2,           how many trials
 Consider using             does the child need
  processing tests, ie.,     to learn new
  WRAML-II for older         information?
  children,and NEPSY        Note processing
  - can use with 2 1/2       profiles, visual
  year olds, DAS-2           memory vs. verbal
Cognitive cont.
 With young children      Focus   on the
 between 2 and 5,          cognitive functioning
 important to explain      and how areas of
 validity of results -     deficit may impact
 IQ or cognitive           learning, ie., verbal
 functioning is not yet    processing deficits
 stable and can            likely to impact
 change especially         ability to take
 following intensive       teacher instruction
 program                   in a large group
Cognitive cont.

  Important   to let parents know the
   possibilities, such as mental
   retardation,processing challenges, while
   at the same time recognizing that
   cognition is difficult to determine at a
   young age, and need to see how child
   will respond to intervention.
Case Study: Mark
 Six year old still in preschool NPA program
 Transition to school
 Standardized evaluation difficult
 Standardized results indicate moderate MR,
  however, adaptive skills and academic skills
  indicate much higher functioning.
 Following transition, child is now reading and
  able to access general education setting.
Adaptive Behavior
   Parent and teacher interview are integral to a
    comprehensive assessment and often lead to specific
    needs to generate goals and objectives.
   Cross reference adaptive behavior with other areas of
    functioning -- are there discrepancies?
   How much support does the student need to perform
    these tasks?
   Use standardized questionnaires, such as Vineland,
    to establish baseline and to provide objective data on
    the student’s development.
Fine and Gross Motor
 Fine and gross motor deficits are often deficit
  areas in children with ASD, often requiring
  direct assessment and intervention.
 Occupational Therapists are best equipped to
  provide a comprehensive assessment of
  these two areas, in addition to sensory
  issues.
 Observe child’s grasp, use of writing and
  drawing tools, visual-perceptual issues, motor
  planning, and ability to keep up with written
  motor tasks - pace of instruction.
Behavior & ASD Specific
Measures:
 Use   of standardized measures:
     BASC-2
     Achenbach Child Behavior Checklist
     Childhood Autism Rating Scale - 2 (CARS-2)--very
      strong validity
     Gilliam ARS (moderate validity)
     Social Responsiveness Scale -ages 4 and up
     Autism Diagnostic Observation Schedule (ADOS)
     The Autism Diagnostic Interview-R (ADI-R)--
      highest validity
Determine Interfering Behaviors
 Observation   and data collection:
   Target  behaviors, or interfering behaviors,
    level of intensity, frequency, impact on
    learning
   Critical to gather baseline data on target
    behaviors, determine if a BSP is needed or
    FAA
Tools Looking at
“Autistic Like Behaviors”
Solid Psychometric Support    Adequate Support
    The Autism Diagnostic        Autism Diagnostic
    Interview-R (ADI-R)          Observation Schedule (ADOS)
    Social Communication         Child Behavior Checklist
                                 (CBC)
    Questionnaire (SCQ)
                                 Psycho-educational Profile -R
Sufficient Support
                                 (PEP-R)
    Childhood Autism Rating   Modest Support
    Scales (CARS)                Autism Behavior Checklist
    Social Responsiveness        Gilliam Autism Rating Scales
    Scales (SRS)                 (GARS)
                                 Asperger’s Syndrome
                                 Diagnostic Interview (ASDI)
A Closer Look at the CARS 2
                CARS     2 has high
                 reliability and validity
                Utilizes three data
                 points: observation
                 in multiple
                 environments,
                 parent
                 survey/interview/
                 and teacher survey
                 and interview
Group Think
 Sample    Reports:
     Jigsaw in groups of 3
     How are ASD
      specific issues
      addressed?
     What would you
      add/change?
     Your concerns
      questions about
      addressing ASD
      specific behaviors
Assessment Environment
 “When    clinically indicated, observations of a child in
  various settings and at different times increases the
  validity of information obtained and assists in
  diagnosis, case management and intervention.”
 Looking at the child in multiple environments is
  beneficial and necessary
 Home, preschool, playground, backyard, daycare,
  school/clinic
 Collaborative assessment with other team members
  allows for better observation/data collection
                                                   Autism Spectrum Disorders:
            Best Practice Guidelines for Screening, Diagnosis and Assessment
                              California Dept. of Developmental Services 2002
ASSESSMENT TOOLS:
 Direct/Standardized

1. Preschool   Language   5. Comprehensive Assessment
   Scale-4                   of Spoken Language (CASL)
2. Peabody Picture        6. Reynell Developmental
   Vocabulary Test           Language Scales
3. Receptive and          7. Goldman Fristoe Test of
   Expressive One Word       Articulation-2/KLPA-2
   Picture Vocabulary     8. Clinical Assessment of
   Tests                     Articulation and Phonology
4. Sequenced Inventory of    (CAAP)
   Communicative          9. Language Sample
   Development-
   Revised(SICD-R)
Parent Interview and Observation Tools




  1.Rossetti Infant Toddler Language Scale
  (Linguisystems)
  2.Pragmatics Profile of Everyday Communication Skills
  in Preschool Children (Hazel Dewart and Susie
  Summers )
  3.Pragmatic Communication Skills Protocol (Academic
  Communication Associates)
  4.Functional communication Profile Revised
  (Linguisystems)
DIRECT ASSESSMENT MEASURES-
 LANGUAGE/COMMUNICATION
 SKILLS
                     ROWPVT/EOW
PLS-4   -measures
 Auditory             PVT-measures
 Comprehension        receptive
 and Expressive       single
 Communication        word/expressiv
 for Birth-6-11       e single word
                      vocabulary(2-
PPVT-measures
                      18)
 receptive single     SICD-R
 word vocabulary      Receptive and
                      Expressive
                      portions(4mos-
                      48 mos)
Direct Assessment cont

CASL-Research-based, theory-driven oral language
assessment battery for ages 3-21. Fifteen tests
measure language processing skills,comprehension,
expression, and retrieval—in four language structure
categories:Lexical/Semantic, Syntactic,
Supralinguistic, and Pragmatic. Subtests can “stand-
alone”.
PRAGMATICS PROFILE OF EVERYDAY
  COMMUNICATION SKILLS/PRESCHOOL

   Interview questions               Information   gathered
   Typically done in home             can be helpful for
    with parent/caregiver              parents to understand
   4 domain areas:                    all aspects involved in
                                       communication
    Communicative
                                      Information also helpful
    Function, Response to
    Communication,                     in identifying specific
    Interaction and                    areas of need, writing
    Conversation,                      goals and planning
    Contextual Variation               intervention


Website to download profile:
http://wwwedit.wmin.ac.uk/psychology/pp/documents/Pragmatics
%20Profile%20Children.pdf
Language Goals

•Important  to meet as a team to discuss who
will write which goals
•Behavior specialists/analysts have expertise
in writing ABA type goals
•Language goals should not be addressed
solely in pull-out therapy –Language
opportunities happen all day!!
•Important for classroom teachers/aides to be
familiar with goals and how to implement them
within the classroom.
Pre-Academics and Academic
Assessment:
 Consider   using          Note the necessary
  criterion referenced       accommodations
                             needed for learning
  measures in
  addition to
                            Does the child need
                             frequent breaks?
  standardized, ie.,        Note level of frustration
  Brigance, AEPS,            tolerance.
  Hawaii                    Observe how well the
 Obtain work                child generalizes
  samples using age          academic information,
  level / adjusted age       can they respond to a
  level curriculum           question in circle time?
Executive Function
 Executive   function is becoming a prominent
  area for assessment and intervention for a
  range of neuro-developmental disorders, in
  particular, ASD. Difficult to evaluate in
  children younger than 5.
 Areas to assess: planning and organization,
  anticipating an event and preparing for it,
  ie.,forming goals, and strategies to reach
  them, attention, memory processing,
  cognitive flexibility, cognitive planning.
Assessment of Executive
Function
   Behavioral Rating          Cognitive
    Inventory of Executive
    Function (BRIEF), 5 and     Assessment System
    up                          (CAS)-ages 5 and
   Conner’s-for Attention      up-Attention Scale
    issues, ages 3-5           Tower Tasks
   DAS-2 working memory
    ages 5 and up              Wisconsin Card
   NEPSY Developmental         Sorting Test
    Neuropsychological         Reference (Ozonoff
    Assessment-
    Attention/Concentration     and Schetter)
    Scale
Sensori-Integration
 SI is an important area to assess due to the
  high probability of SI problems--about 70% or
  > in ASD population.
 SI is related to ability to attend, adapt to new
  environments, fatigue, and emotional
  regulation.
 Occupational Therapists are the most
  qualified to assess in this area.
 include observing response to various
  sensory activities, checklists (Sensori-
  Integration and Praxis Test, Ayers clinic),
  parent interview, and natural observation.
HFA vs. AS: How do we tell the
difference?
   High functioning autism      Asperger’s   is
    requires the same
    DSMIV conditions as           typically not
    autism, however, high         identified until age 7
    functioning autism is         or 8, and there is no
    characterized by higher
    cognitive skills, some in     discernable delay in
    the normal or above           language
    average range, often          acquisition, and
    with wide scatter across      typically there is
    cognitive domains.
   Definitive delay in           average or above
    language acquisition.         average intelligence.
Assessment Tips
   Find out best time of           Use preferred activities
    day to test (try to              throughout
    eliminate fatigue)              Include caregiver or
   Use approved                     individual who is very
    motivators or
    reinforcers, ie., favorite       familiar with the child to
    food or activity                 participate with you
   Give clear directions           Assess in teams of two
    using abbreviated                to three
    instructions when               Plan on two to three
    possible                         assessment sessions
Case Study: Conner
2   years 10 months       Team strategies and
 Parent referral           approach
                           Four sessions, parent
 Ambivalent about          present throughout
  delays                   Talked with parent prior
 Conflicted about          to IEP
  getting a dx             Presented possibilities
 Very young parents,       and concerns for parent
                            to consider
  first child
Translating Assessment
Information into FAPE
    Assessment data needs to be translated
     into:
1.   Identifying Unique needs
2.   Goals that address all areas of need
3.   Accommodations/supports for educational
     benefit
4.   Recommendations for
     programming/placement, ie., ABA/EIBT
     instruction
Unique Needs
 What   does the assessment data
  indicate are unique needs of the child?
 Deficit areas/weaknesses
 Areas directly related to educational
  benefit, ie., those skills needed to
  benefit from education
 Needs related to learning, accessing
  curriculum and instruction, accessing
  their environment
Goals - The Hallmark of a Good
IEP
 Good  goals indicate a quality
  assessment and knowledgeable team
 Goals are the driving force behind
  rationale for services, accommodations
  and supports
 ASD goals need to be comprehensive,
  intensive, and designed with a
  developmentally sequenced curriculum
 Refer to Curriculum Assessment Sheet
  developed by Patty Schetter, ABTA
Goal activity
   Refer to Sample Goals
   Look at a set of unique
    needs and determine
    what type of goals will
    effectively address the
    needs
   Goals set a trajectory
    for progress
   How can we make
    goals meaningful?
Rationale for Services/Supports

    General education opportunities
    Specialized Academic Instruction
    Individual Instruction, IA support
    Need for intensity, ratio of adult to child
    Need for ABA approach or other
    DIS services - is the model collaborative,
     individual, both?
Rationale and LRE
 Criticalto know what empirically based
  practices (EPBs) are and provide clear
  direction for how these can be delivered, and
  in what setting they can most be effective in.
 Does the child’s needs require a degree of
  intensity such as one to one and small group
  with highly controlled environment?
 Or is the child able to observe and attend to
  small and large group instruction and
  generalize skills in group settings?
Accommodations and Supports

    Small group
    Instructional Assitant
    Verbal cues
    Visual supports
    Sensory breaks
    BSP/BIP?
    Visual schedule
    Clear routine
    Alternative communication-PECS
FAPE Considerations:
 Data  needs to back up
  recommendations and provide rationale
  for placement considerations
 Need to consider a full range of
  continuum of options
 Tie goals to services - ie., functional
  communication needs/goals require …
FAPE considerations cont.
 Tie unique needs to program
  components-what is a good fit or match
  to these needs?
 Have clear descriptions of
  supports/accommodations program can
  provide, ie., good ratios, 1:1,
  developmentally sequenced curriculum,
  systematic instruction,etc.
National Autism Center
  Resources: Educator’s Manual
Evidenced Based Practices, National
        Standards Project
Established Treatments from National Standards
Project:
◖◖ Antecedent Package
◖◖ Behavioral Package
◖◖ Comprehensive Behavioral Treatment for Young
Children
◖◖ Joint Attention Intervention
◖◖ Modeling
◖◖ Naturalistic Teaching Strategies
◖◖ Peer Training Package
◖◖ Pivotal Response Treatment
◖◖ Schedules
◖◖ Self-management
◖◖ Story-based Intervention Package
National Professional
Development Center On Autism
Spectrum Disorders
 What  are Evidence-Based
 Practices (EBP)?While many
 interventions for autism exist, only some
 have been shown to be effective
 through scientific research.
 Interventions that researchers have
 shown to be effective are called
 evidence-based practices. The NPDC
 has identified 24 evidence-based
 practices.
View NPDC Website

http://autismpdc.fpg.unc.edu
The Report
                Consider team report-
                 pros & cons
                Reports need to provide
                 specificity, be
                 comprehensive yet
                 readable for parent
                Clear headings,
                 meaningful sequence
                Clear summary and
                 conclusions
                Clear recommendations
                 for IEP team to use in
                 determining FAPE
Journey of Hope:
         Parent Interview
Listen to the core message of this parent
 and reflect on your practice of working
               with parents.
Parent Collaboration
 Establish   a positive rapport at the
  earliest point possible in the referral
  process
 Explain the roles of each examiner, and
  explain what the assessment process
  will look like and the IEP process
 Find out what the parent’s interests are
Parent Input
 Find  out their long term goals are
 Establish shared interests based on the
  child’s needs
 Establish common goals
 Refrain from making assumptions
 Provide frequent follow-up and an
  established routine of communication
Parent Collaboration cont.:
 Provide  regularly scheduled
  communications, such as quarterly
  review dates, monthly phone call,
  weekly note home.
 When things get diverted, bracket knee
  jerk reactions, and redirect the
  discussion to the child’s needs and
  goals.
Parent Input cont.
 Acknowledge  parent concerns and
  needs -- communicate that you want to
  understand their perspective so that
  you can work jointly on behalf of their
  child.
 Emphasize areas in which there is
  agreement and areas of common
  interest.
Parent Perspective
 Important  to convey to a parent that their
  input is valued-How do we do this?
 This is their child for the rest of their lives -
  the issues for them are truly intense
 Parents feel an urgency - they are in a crisis
 For a parent, trust is the most critical aspect,
  with trust you can move forward
 Building relationships is critical to any
  successful team - even when there is
  disagreement
When there is
disagreement
 Remember,   there is no “winner” in an
  argument
 Goal is to maintain a positive relationship
 Shift from a framework that is argumentative
  to one that is trying to gain common
  understanding of the child
 Look for opportunities to build agreement
 Recognize when there is not agreement and
  provide an environment where this is okay
 Recognize when mediation will be helpful
Parent shoes
 Put yourself in the parent’s shoes -
 relate to having a child with an ASD like
 you would having a child or spouse with
 a life threatening disease or illness --
 what are your likely emotions, actions,
 and needs?
Teaming: What does it mean?
 Define  “team”
 Reflect on positive
  team experiences:
  what were the core
  elements of that
  experience? What
  are effective “team”
  behaviors?
 What are the key
  characteristics of a
  strong team?
Your Team: Next Steps
 Identify   three goals in the next three
  weeks
 What are potential barriers or road
  blocks?
 What strengths do you bring to your
  team? -- dyad exercise
It’s the Journey not the
Destination
                   The  assessment
                    process is like a
                    journey, discovering
                    unique needs,
                    learning about
                    families, and
                    continuous new
                    challenges as well
                    as successes.

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Best practices in ASD Assessment 1

  • 1. Assessment of Children with Autistic Spectrum Disorders: Best Practices for Educators Kristine Strong, Ph.D.,LEP #2314 Copyright 2012
  • 2. Goals of the Workshop  Increase knowledge and awareness of effective assessment tools and methods for ASD  Develop understanding about multidisciplinary assessment teams  Develop understanding about the importance of the parent - school relationship and working effectively with parents  Learn about current evidence based practices  Develop skills in IEP development
  • 3. ASD Is A “Spectrum” Disorder  “Spectrum” ranges from mild (more able) to severe (less able).  Mild = High-functioning Autism (HFA), Asperger’s Syndrome, PDD, PDD-NOS  Moderate = Classic Autism (As described by Kanner)  Severe = Autism with other collateral conditions such as MR and seizures, Retts Disorder(females only), Childhood Disintegrative Disorder (rare), Landau-Kleffner Syndrome. 3
  • 4. Statistics  Autism is increasing at an alarming rate.  Department of Developmental Services study: rates of autism have risen 210% in the past 10 years.  Increase of over 600% for Special Education eligibility under the autism category from 1994 to 2003 (US Dept of Ed). 4
  • 5. Why the Increase?  1975 Education of the Handicapped Act identified “autism” and “pervasive developmental delay” as disabling categories. Prior to that change persons were labeled as MR.  DSM IV broadened the disability to include PDD-NOS, Autism and Asperger’s Syndrome.  1990 IDEA made autism a qualifying disability category.  Many studies being conducted, with a causation model including both genetic predisposition and environmental variables -- no one cause likely 5
  • 6. The Anatomy of Autism Neuro-imaging (fMRI and PET scans) indicate location of pathology Multiple brain systems and brain functions are impacted by this disorder
  • 7. Three Types of Autism?  Center for  Autism is considered to Excellence in have a strong genetic Developmental component. Disabilities UC  Pattern of onset may be related to specific type Davis MIND of autism: research:  Predominant language  Interactive models regression  Predominant social of ASD include regression multiple  Early onset in both social environmental and language variables and gene development interactions.
  • 8. Deviation In:  Hippocampus and amygdala (emotional regulation and memory)  Cerebellum (motor coordination, shifting attention, concept formation, sequencing, working memory, complex problem solving, sensory discrimination)
  • 9. Deviations In:  Brain stem (brain/body communication, basic functions)  Brain size, growth pattern, and white matter (axons -cables connecting brain cells)  Brain microstructures, minicolumns are narrower and made up of smaller cells vs. normal brain  Neocortex  Particularly frontal lobe (higher level thinking and executive functions, early speech acquisition, and integration of information)  temporal lobes (auditory processing)
  • 10. Understanding Autism Spectrum Disorders  Neurobiological differences lead to deficits in social perception, theory of mind and social relatedness, that in turn lead to problem situations for group learning, peer interactions, and student-teacher interactions in school.  Problem behaviors are a result of known neurobiological differences and environmental influences but can be addressed through active, direct teaching of adaptive social skills and problem solving skills.
  • 11. Social-Emotional Implications of autism spectrum disorders  Few or no close friends--limited social interests  Avoidance of socially demanding situations  Difficulty sensing or interpreting emotions in self and others  Greater likelihood of also having anxiety and/or depression
  • 12. Social and Emotional Implications  Impaired non-verbal communication, including limited facial expressions  Impaired pragmatic language, including lack of cohesion to conversation
  • 13. Impaired Executive Functioning An inability to engage in goal-directed, future- oriented behaviors including: planning, flexibility, organized search, self-monitoring, and use of working memory.
  • 14. “Behavior Problems” Associated With Executive Dysfunction Noncompliance Off Task Behaviors/Distractibility Inflexibility or Rigidity Procrastination Prompt Dependence Disorganization Socially Inappropriate Behaviors
  • 15. Understanding HFA & AD cont.  Deficits in working memory, attention, and executive functioning, such as organization and planning, can lead to increased stressors in school, difficulty completing work, and escape and avoidance behaviors.  Remember, behaviors happen for a reason and are likely in large part a symptom of these underlying deficits and lack of adaptive skills to respond to these deficits.
  • 16. Model of Problem Behaviors Core Neuro - Lack Development Adequate al Deficits supports Problem Behavior Poor Poor Social Coping Skills Skills
  • 17. California Code of Regulations 3030 g: A pupil exhibits any combination of the following autistic like behaviors, to include but not limited to:  An inability to use oral language for appropriate communication. A history of extreme withdrawal or relating to people inappropriately and continued impairment in social interaction from infancy through early childhood.
  • 18. California Code cont.:  Anobsession to maintain sameness. Extreme preoccupation with objects or inappropriate use of objects or both.  Extreme resistance to controls Displays peculiar motoric mannerisms and motility patterns. Self stimulating- ritualistic behavior.
  • 19. DSM IV Diagnosis of Autism Spectrum Disorders A. 1. Social Interactions (Must have at least 2 of the following)  Impaired use of nonverbal behaviors  Impaired peer relations  Limited sharing of enjoyment  limited social or emotional reciprocity 2. Communication (Must have at least 1 of the following)  Delay of development of spoken language  Impairment in conversation  Repetitive use of language or idiosyncratic language and prosody  Lack of varied make believe play 3. Restrictive and Repetitive/Stereotyped Patterns of Behavior (Must have at least 1 of the following)  Restricted interests  Adherence to nonfunctional routines  Stereotyped motor mannerisms  Preoccupation with parts of objects 19
  • 20. DSM IV Diagnosis for Autism Cont. B. Delays or abnormal functioning in at least one of the following areas: 1. Social Interaction 2. Language as used in social interactions 3. Symbolic or imaginative play The disturbance is not accounted for by Rett’s or Childhood Disintegrative Disorder.  To be diagnosed with Autism, at least six symptoms from A (at least two from A1 and one each from A2 and A3), one from B, and C must be present.  To be diagnosed with PDD-NOS, disorders will be apparent in all areas (A-C), but some will be atypical or sub-threshold. This disorder is often recognized later than autism. 20
  • 21. DSM IV Diagnosis of Asperger’s Syndrome (AS) A. Social Interactions (Must have at least two of the following)  Impaired use of nonverbal behaviors  Impaired peer relations  Limited sharing of enjoyment  Limited social or emotional reciprocity B. Activities and Interests (Must have at least one of the following)  Restricted interests  Adherence to nonfunctional routines  Stereotyped motor mannerisms  Preoccupation with parts of objects 21
  • 22. DSM IV Criteria for Asperger’s Cont... C. The disturbance causes clinically significant impairment in social, occupational, or other important functioning. D. There is no clinically significant general delay in language (e.g. single words used by age 2, communicative phrases by age 3). E. There is no clinically significant delay in cognitive development or in the development of age appropriate self help skills, adaptive behavior (other than social interaction), and curiosity about the environment in childhood. F. The criterion are not met for other specific Pervasive Developmental Disorders or Schizophrenia. 22
  • 23. Autism - utube videos Samples of autistic like behaviors
  • 24. What is Different about the Assessment of ASD vs. other Educational Categories?  More comprehensive because of the pervasive nature of the disorder  Requires more specialists and service providers, requiring increases in communication and collaboration-- systemic challenges  An ASD requires more specialized services and increasingly more demands on educators to develop expertise in autism specific strategies
  • 25. Educators Responsible for Ed. Code Eligibility  Although the DSM-IV criteria are important to know and use as a reference for determining “autistic like” behaviors, educators do not diagnose using the DSM-IV.  Autism specific measures use the DSM- IV diagnostic criteria as a part of their content validity - so need to be knowledgeable about DSM-IV criteria
  • 26. What is Different cont.:  Adaptations for standardized tests, including use of structured reinforcement  Increased use of non-standardized assessment methods, including both natural and structured observations  Critical to differentiate between ASD and other disorders, such as ADHD, Emotional Disturbance, and Language Disorders-- course of educational planning is different
  • 27. Team Activity  What are the core deficits in children with ASD?  What do you already know about how to evaluate those areas?  What parts or aspects of ASD assessments do you believe are the most challenging?
  • 28. Case Study: Bobby V.  Transitioning from Early Start  2 years - 10 months  Recent dx of ASD  Highly verbal  Bright  Concurring assessment by NPA  Advocate already involved
  • 29. Case Study cont.  Priority on parent-district relationship  Home visits, natural environment was primary assessment setting  Critical to respond to parent concerns  Language evaluation utilized a range of tools - on the surface he looked fine  Teaming was critical - the team was able to identify core deficits and needs- got agreement on our assessment
  • 30. Goals of Assessment: Why do we assess?  Establish eligibility under Ed. Code.  Identify student unique needs that will lead to specific goals and objectives  Understanding unique needs directs team when determining FAPE
  • 31. Good Data = Good Planning  Team who is knowledgeable about the child develops trust and credibility with agencies and families  Develop appropriate intervention plans
  • 32. The Autism Assessment/Intervention Team  TeamMembers should include a Behavior Analyst, Behavior Specialist, Speech Therapist, Occupational Therapist, Classroom teacher, Special Education Teacher, Nurse, School Psychologist and Administrator.
  • 33. The Assessment Process: Developmental Areas and the Trans-Disciplinary Model  Specialists collaborate to provide a multi- method assessment across developmental areas  Trans-disciplinary teams design assessment tasks and activities together for mutual benefit  The TDT generates rich information about the child leading to meaningful goals, integrated services, and a meaningful report to parents
  • 34. Assessment Areas  Health and Medical  Social - emotional  Behavioral  Cognitive assessment- functioning baseline of behaviors that  Adaptive Behaviors interfere with  Communication learning  Pre-academic and  Fine and Gross academic areas Motor  Sensori-Integration
  • 35. Assessment Methods  Developmental  Standardized health history Assessments  Natural  Parent Interview Observations  Review of  Structured records/reports Observations
  • 36. Developmental and Medical History  Initialeligibility assessment requires extensive parent interview about the child’s early development and medical history.  Important to gather data on early signs of ASD, including, lack of gestures, little or no babbling, delayed language, lack of pointing, lack of interest in children, limited shared attention, lack of eye contact during feeding and games.
  • 37. Developmental History cont.:  Feeding or sleeping problems  Unusual sensory reactions, ie., noise or touch  Unusual focus or attention toward limited areas of interest  Range of affect, flat vs. full range  Verbal and nonverbal forms of communication--intent to communicate needs  Unusual motoric movements  Fine and gross motor development
  • 38. Natural Observations  Occur in several settings such as home, preschool/school or child care  Take place with no structured activities other than those that occur naturally within the setting  Important to observe on more than one occasion and by multiple observers  When possible, chose one or two “controls” to observe in relation to student, ie., Tommy completed the task at the same pace as his peers, but needed twice as many prompts
  • 39. Structured Observations-Play Based  Structured observations provide specific tasks to be performed, such as putting puzzles together, imitation tasks, and pretend play activities  Activities are play based - interactive
  • 40.  Specific behaviors are elicited, including  Reciprocal turn taking  Pretend play  Social reciprocity  Imitation of novel acts  Ability to be directed by examiners  Use of toys and objects  Use of spontaneous language  Quality of spontaneous and prompted verbal and nonverbal communication  Play imitation  Joint referencing  Eye gaze, following a point  Eye contact, seeking eye contact to gain attention of others
  • 41. Play-based assessment  Toys and materials  Develop a play of interest to child’s based assessment age or mental age box or “tool kit”  Variety of toys to  Include toys that are engage and illicit sensory based, interest symbolic play, cause  Include books, and effect, can be musical toys, balls, used to prompt cars, pretend play imitation
  • 42. Standardized Assessments: Uses and Limitations  Standardized assessments provide objective data about broad functioning and abilities in specific developmental areas.  Important to cross reference standardized results with observation data and interview data to make relevant, as well as to point out where there are discrepancies.
  • 43. Limitations to Standardized Tests  ASD children often do not perform well on these types of measures, and therefore they can underestimate their ability  Reliability is also an issue due to highly variable performance of skills  Note in your report the specific limitations of the results.
  • 44. Parent Interview for Initial Eligibility  Can be structured or informal -- strongly recommend including a home visit.  Use of structured interviews such as The Autism Diagnostic Interview, R (ADI-R) (can be used for children through adults) is critical for establishing clear developmental clusters consistent with ASD.
  • 45. Family Centered  Family centered format--this is often the first impression the family gets of educators.  Highly sensitive time for parents, make sure you provide ample time to answer their questions.
  • 46. The Faces of Autism Parent perspectives reflect the wide range of needs of children with ASD and highlight the individual nature of autism.
  • 47. Areas to Assess: Core Deficits  Reflect - what are  What will most the core deficits? assessment plans  Comprehensive need to consider? evaluations need to  Develop include all areas assessment plans related to a with parent input. suspected disability
  • 48. Team Assessments  Set up stations such as, fine motor, pretend play, academic, sensory  Tag team - take turns observing and evaluating  Tag team - one team member with parent, two with child and then rotate.
  • 49. Cognitive Assessment  Use good  Note the type of comprehensive support needed to tools: DAS-2, learn a new task -- WPPSI-2, KABC-2, how many trials  Consider using does the child need processing tests, ie., to learn new WRAML-II for older information? children,and NEPSY  Note processing - can use with 2 1/2 profiles, visual year olds, DAS-2 memory vs. verbal
  • 50. Cognitive cont.  With young children  Focus on the between 2 and 5, cognitive functioning important to explain and how areas of validity of results - deficit may impact IQ or cognitive learning, ie., verbal functioning is not yet processing deficits stable and can likely to impact change especially ability to take following intensive teacher instruction program in a large group
  • 51. Cognitive cont.  Important to let parents know the possibilities, such as mental retardation,processing challenges, while at the same time recognizing that cognition is difficult to determine at a young age, and need to see how child will respond to intervention.
  • 52. Case Study: Mark  Six year old still in preschool NPA program  Transition to school  Standardized evaluation difficult  Standardized results indicate moderate MR, however, adaptive skills and academic skills indicate much higher functioning.  Following transition, child is now reading and able to access general education setting.
  • 53. Adaptive Behavior  Parent and teacher interview are integral to a comprehensive assessment and often lead to specific needs to generate goals and objectives.  Cross reference adaptive behavior with other areas of functioning -- are there discrepancies?  How much support does the student need to perform these tasks?  Use standardized questionnaires, such as Vineland, to establish baseline and to provide objective data on the student’s development.
  • 54. Fine and Gross Motor  Fine and gross motor deficits are often deficit areas in children with ASD, often requiring direct assessment and intervention.  Occupational Therapists are best equipped to provide a comprehensive assessment of these two areas, in addition to sensory issues.  Observe child’s grasp, use of writing and drawing tools, visual-perceptual issues, motor planning, and ability to keep up with written motor tasks - pace of instruction.
  • 55. Behavior & ASD Specific Measures:  Use of standardized measures:  BASC-2  Achenbach Child Behavior Checklist  Childhood Autism Rating Scale - 2 (CARS-2)--very strong validity  Gilliam ARS (moderate validity)  Social Responsiveness Scale -ages 4 and up  Autism Diagnostic Observation Schedule (ADOS)  The Autism Diagnostic Interview-R (ADI-R)-- highest validity
  • 56. Determine Interfering Behaviors  Observation and data collection:  Target behaviors, or interfering behaviors, level of intensity, frequency, impact on learning  Critical to gather baseline data on target behaviors, determine if a BSP is needed or FAA
  • 57. Tools Looking at “Autistic Like Behaviors” Solid Psychometric Support Adequate Support The Autism Diagnostic Autism Diagnostic Interview-R (ADI-R) Observation Schedule (ADOS) Social Communication Child Behavior Checklist (CBC) Questionnaire (SCQ) Psycho-educational Profile -R Sufficient Support (PEP-R) Childhood Autism Rating Modest Support Scales (CARS) Autism Behavior Checklist Social Responsiveness Gilliam Autism Rating Scales Scales (SRS) (GARS) Asperger’s Syndrome Diagnostic Interview (ASDI)
  • 58. A Closer Look at the CARS 2  CARS 2 has high reliability and validity  Utilizes three data points: observation in multiple environments, parent survey/interview/ and teacher survey and interview
  • 59. Group Think  Sample Reports:  Jigsaw in groups of 3  How are ASD specific issues addressed?  What would you add/change?  Your concerns questions about addressing ASD specific behaviors
  • 60. Assessment Environment  “When clinically indicated, observations of a child in various settings and at different times increases the validity of information obtained and assists in diagnosis, case management and intervention.”  Looking at the child in multiple environments is beneficial and necessary  Home, preschool, playground, backyard, daycare, school/clinic  Collaborative assessment with other team members allows for better observation/data collection Autism Spectrum Disorders: Best Practice Guidelines for Screening, Diagnosis and Assessment California Dept. of Developmental Services 2002
  • 61. ASSESSMENT TOOLS: Direct/Standardized 1. Preschool Language 5. Comprehensive Assessment Scale-4 of Spoken Language (CASL) 2. Peabody Picture 6. Reynell Developmental Vocabulary Test Language Scales 3. Receptive and 7. Goldman Fristoe Test of Expressive One Word Articulation-2/KLPA-2 Picture Vocabulary 8. Clinical Assessment of Tests Articulation and Phonology 4. Sequenced Inventory of (CAAP) Communicative 9. Language Sample Development- Revised(SICD-R)
  • 62. Parent Interview and Observation Tools 1.Rossetti Infant Toddler Language Scale (Linguisystems) 2.Pragmatics Profile of Everyday Communication Skills in Preschool Children (Hazel Dewart and Susie Summers ) 3.Pragmatic Communication Skills Protocol (Academic Communication Associates) 4.Functional communication Profile Revised (Linguisystems)
  • 63. DIRECT ASSESSMENT MEASURES- LANGUAGE/COMMUNICATION SKILLS ROWPVT/EOW PLS-4 -measures Auditory PVT-measures Comprehension receptive and Expressive single Communication word/expressiv for Birth-6-11 e single word vocabulary(2- PPVT-measures 18) receptive single  SICD-R word vocabulary Receptive and Expressive portions(4mos- 48 mos)
  • 64. Direct Assessment cont CASL-Research-based, theory-driven oral language assessment battery for ages 3-21. Fifteen tests measure language processing skills,comprehension, expression, and retrieval—in four language structure categories:Lexical/Semantic, Syntactic, Supralinguistic, and Pragmatic. Subtests can “stand- alone”.
  • 65. PRAGMATICS PROFILE OF EVERYDAY COMMUNICATION SKILLS/PRESCHOOL  Interview questions  Information gathered  Typically done in home can be helpful for with parent/caregiver parents to understand  4 domain areas: all aspects involved in communication Communicative  Information also helpful Function, Response to Communication, in identifying specific Interaction and areas of need, writing Conversation, goals and planning Contextual Variation intervention Website to download profile: http://wwwedit.wmin.ac.uk/psychology/pp/documents/Pragmatics %20Profile%20Children.pdf
  • 66. Language Goals •Important to meet as a team to discuss who will write which goals •Behavior specialists/analysts have expertise in writing ABA type goals •Language goals should not be addressed solely in pull-out therapy –Language opportunities happen all day!! •Important for classroom teachers/aides to be familiar with goals and how to implement them within the classroom.
  • 67. Pre-Academics and Academic Assessment:  Consider using  Note the necessary criterion referenced accommodations needed for learning measures in addition to  Does the child need frequent breaks? standardized, ie.,  Note level of frustration Brigance, AEPS, tolerance. Hawaii  Observe how well the  Obtain work child generalizes samples using age academic information, level / adjusted age can they respond to a level curriculum question in circle time?
  • 68. Executive Function  Executive function is becoming a prominent area for assessment and intervention for a range of neuro-developmental disorders, in particular, ASD. Difficult to evaluate in children younger than 5.  Areas to assess: planning and organization, anticipating an event and preparing for it, ie.,forming goals, and strategies to reach them, attention, memory processing, cognitive flexibility, cognitive planning.
  • 69. Assessment of Executive Function  Behavioral Rating  Cognitive Inventory of Executive Function (BRIEF), 5 and Assessment System up (CAS)-ages 5 and  Conner’s-for Attention up-Attention Scale issues, ages 3-5  Tower Tasks  DAS-2 working memory ages 5 and up  Wisconsin Card  NEPSY Developmental Sorting Test Neuropsychological  Reference (Ozonoff Assessment- Attention/Concentration and Schetter) Scale
  • 70. Sensori-Integration  SI is an important area to assess due to the high probability of SI problems--about 70% or > in ASD population.  SI is related to ability to attend, adapt to new environments, fatigue, and emotional regulation.  Occupational Therapists are the most qualified to assess in this area.  include observing response to various sensory activities, checklists (Sensori- Integration and Praxis Test, Ayers clinic), parent interview, and natural observation.
  • 71. HFA vs. AS: How do we tell the difference?  High functioning autism  Asperger’s is requires the same DSMIV conditions as typically not autism, however, high identified until age 7 functioning autism is or 8, and there is no characterized by higher cognitive skills, some in discernable delay in the normal or above language average range, often acquisition, and with wide scatter across typically there is cognitive domains.  Definitive delay in average or above language acquisition. average intelligence.
  • 72. Assessment Tips  Find out best time of  Use preferred activities day to test (try to throughout eliminate fatigue)  Include caregiver or  Use approved individual who is very motivators or reinforcers, ie., favorite familiar with the child to food or activity participate with you  Give clear directions  Assess in teams of two using abbreviated to three instructions when  Plan on two to three possible assessment sessions
  • 73. Case Study: Conner 2 years 10 months  Team strategies and  Parent referral approach  Four sessions, parent  Ambivalent about present throughout delays  Talked with parent prior  Conflicted about to IEP getting a dx  Presented possibilities  Very young parents, and concerns for parent to consider first child
  • 74. Translating Assessment Information into FAPE  Assessment data needs to be translated into: 1. Identifying Unique needs 2. Goals that address all areas of need 3. Accommodations/supports for educational benefit 4. Recommendations for programming/placement, ie., ABA/EIBT instruction
  • 75. Unique Needs  What does the assessment data indicate are unique needs of the child?  Deficit areas/weaknesses  Areas directly related to educational benefit, ie., those skills needed to benefit from education  Needs related to learning, accessing curriculum and instruction, accessing their environment
  • 76. Goals - The Hallmark of a Good IEP  Good goals indicate a quality assessment and knowledgeable team  Goals are the driving force behind rationale for services, accommodations and supports  ASD goals need to be comprehensive, intensive, and designed with a developmentally sequenced curriculum  Refer to Curriculum Assessment Sheet developed by Patty Schetter, ABTA
  • 77. Goal activity  Refer to Sample Goals  Look at a set of unique needs and determine what type of goals will effectively address the needs  Goals set a trajectory for progress  How can we make goals meaningful?
  • 78. Rationale for Services/Supports  General education opportunities  Specialized Academic Instruction  Individual Instruction, IA support  Need for intensity, ratio of adult to child  Need for ABA approach or other  DIS services - is the model collaborative, individual, both?
  • 79. Rationale and LRE  Criticalto know what empirically based practices (EPBs) are and provide clear direction for how these can be delivered, and in what setting they can most be effective in.  Does the child’s needs require a degree of intensity such as one to one and small group with highly controlled environment?  Or is the child able to observe and attend to small and large group instruction and generalize skills in group settings?
  • 80. Accommodations and Supports  Small group  Instructional Assitant  Verbal cues  Visual supports  Sensory breaks  BSP/BIP?  Visual schedule  Clear routine  Alternative communication-PECS
  • 81. FAPE Considerations:  Data needs to back up recommendations and provide rationale for placement considerations  Need to consider a full range of continuum of options  Tie goals to services - ie., functional communication needs/goals require …
  • 82. FAPE considerations cont.  Tie unique needs to program components-what is a good fit or match to these needs?  Have clear descriptions of supports/accommodations program can provide, ie., good ratios, 1:1, developmentally sequenced curriculum, systematic instruction,etc.
  • 83. National Autism Center Resources: Educator’s Manual Evidenced Based Practices, National Standards Project
  • 84. Established Treatments from National Standards Project: ◖◖ Antecedent Package ◖◖ Behavioral Package ◖◖ Comprehensive Behavioral Treatment for Young Children ◖◖ Joint Attention Intervention ◖◖ Modeling ◖◖ Naturalistic Teaching Strategies ◖◖ Peer Training Package ◖◖ Pivotal Response Treatment ◖◖ Schedules ◖◖ Self-management ◖◖ Story-based Intervention Package
  • 85. National Professional Development Center On Autism Spectrum Disorders  What are Evidence-Based Practices (EBP)?While many interventions for autism exist, only some have been shown to be effective through scientific research. Interventions that researchers have shown to be effective are called evidence-based practices. The NPDC has identified 24 evidence-based practices.
  • 87. The Report  Consider team report- pros & cons  Reports need to provide specificity, be comprehensive yet readable for parent  Clear headings, meaningful sequence  Clear summary and conclusions  Clear recommendations for IEP team to use in determining FAPE
  • 88. Journey of Hope: Parent Interview Listen to the core message of this parent and reflect on your practice of working with parents.
  • 89. Parent Collaboration  Establish a positive rapport at the earliest point possible in the referral process  Explain the roles of each examiner, and explain what the assessment process will look like and the IEP process  Find out what the parent’s interests are
  • 90. Parent Input  Find out their long term goals are  Establish shared interests based on the child’s needs  Establish common goals  Refrain from making assumptions  Provide frequent follow-up and an established routine of communication
  • 91. Parent Collaboration cont.:  Provide regularly scheduled communications, such as quarterly review dates, monthly phone call, weekly note home.  When things get diverted, bracket knee jerk reactions, and redirect the discussion to the child’s needs and goals.
  • 92. Parent Input cont.  Acknowledge parent concerns and needs -- communicate that you want to understand their perspective so that you can work jointly on behalf of their child.  Emphasize areas in which there is agreement and areas of common interest.
  • 93. Parent Perspective  Important to convey to a parent that their input is valued-How do we do this?  This is their child for the rest of their lives - the issues for them are truly intense  Parents feel an urgency - they are in a crisis  For a parent, trust is the most critical aspect, with trust you can move forward  Building relationships is critical to any successful team - even when there is disagreement
  • 94. When there is disagreement  Remember, there is no “winner” in an argument  Goal is to maintain a positive relationship  Shift from a framework that is argumentative to one that is trying to gain common understanding of the child  Look for opportunities to build agreement  Recognize when there is not agreement and provide an environment where this is okay  Recognize when mediation will be helpful
  • 95. Parent shoes  Put yourself in the parent’s shoes - relate to having a child with an ASD like you would having a child or spouse with a life threatening disease or illness -- what are your likely emotions, actions, and needs?
  • 96. Teaming: What does it mean?  Define “team”  Reflect on positive team experiences: what were the core elements of that experience? What are effective “team” behaviors?  What are the key characteristics of a strong team?
  • 97. Your Team: Next Steps  Identify three goals in the next three weeks  What are potential barriers or road blocks?  What strengths do you bring to your team? -- dyad exercise
  • 98. It’s the Journey not the Destination  The assessment process is like a journey, discovering unique needs, learning about families, and continuous new challenges as well as successes.

Editor's Notes

  1. Who is in the audience -- who have started teams?
  2. Autism is a very heterogenous disorder -- Three types of autism - R. Hansen, there seems to be three distinct subtypes or endophenotypes and several mechanisms of autism, Early Onset, Regression-Both Social and Language, Regression-Either Social or Language
  3. New rates suggest 1 in 150 last year, to now less than 1 in 100
  4. To highlight the wide range of needs and issues for children on the spectrum -- dvd -- the many faces of autism
  5. Leo - make point that resolved without going to due process
  6. Assessment areas depend on referral concerns, ie., not always need OT
  7. Also important to note regression in either or both language/social
  8. LUNCH BREAK
  9. From the National Autism Center, 2007 report
  10. kaden
  11. Autism Faces - DVD
  12. PARENT EDUCATION WORKSHOP-- will be available through mind online next year.
  13. Example of J.M. IEP --