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Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference

July 28, 2006

Identifying, Screening, & Assessing Acknowledgement


Autism at School
Adapted from
Stephen E. Brock, Ph.D., NCSP Brock, S. E., Jimerson, S. R., & Hansen,
California State University Sacramento R. L. (2006). Identifying, assessing,
and treating autism at school. New
NASP & AHI Summer Conference York: Springer.
Chicago, IL - July 28, 2006

Presentation Outline Introduction: Reasons for Increased Vigilance

z Introduction: Reasons for Increased Vigilance z Autistic spectrum disorders are much more
z Diagnostic Classifications and Special common than previously suggested.
Education Eligibility 60 (vs. 4 to 6) per 10,000 in the general population
(Chakrabarit & Fombonne, 2001).
z School Psychologist Roles, Responsibilities,
600% increase in the numbers served under the
and Limitations
autism IDEA eligibility classification (U.S. Department of Education,
z Case Finding 2003).

z Screening and Referral 95% of school psychologists report an increase in the


number of students with ASD being referred for
z Assessment: Diagnostic and Psycho-educational assessment (Kohrt, 2004).
Evaluation

Explanations for Changing ASD Increased Prevalence in Special


Rates in the General Population Education (U.S. Department of Education, 2003)

z Changes in diagnostic criteria. Total Number of Student Classified as Autistic and Eligible for
Special Education Under IDEA by Age Group
z Heightened public awareness of autism.
100,000
z Increased willingness and ability to diagnose
80,000
autism.
60,000
z Availability of resources for children with 40,000
autism. 20,000
z Yet to be identified environmental factors. 0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

6 11 years 12 17 years 18 21 years

Stephen E. Brock, Ph.D., NCSP 1


Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
July 28, 2006

Explanations for Changing ASD Increased Prevalence in Special


Rates in Special Education Education (U.S. Department of Education, 2005)

School Population Rates of Mental Retardation and Autism


z Classification substitution Special Education Eligibility Classifications: 1991 to 2004
IEP teams have become better able to identify 12

Rate per 1,000 Students


students with autism. 10 4
3 9.9 5 2 6
9 9.4 9.5 9.4 9.4 9.3
8 7 1
9.3 9.1 9.2
Autism is more acceptable in todays schools than is 8
9.1 9.0 8.8
1
8.6
7
8.4
3

the diagnosis of mental retardation. 6


The intensive early intervention services often made 4
available to students with autism are not always

2.51
2.13
1.79
2

1.49
1.21
offered to the child whose primary eligibility

1.01
0.84
0.67
0.55
0.48
0.38
0.32
0.25
0.09
0
classification is mental retardation.

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004
Year

Mental Retardation Autism

Reasons for Increased Vigilance Reasons for Increased Vigilance

z Autism can be identified early in development, z Not all cases of autism will be identified before
and school entry.
Average Age of Autistic Disorder identification is 5 1/2
z Early intervention is an important determinant years of age.
of the course of autism. Average Age of Aspergers Disorder identification is
11 years of age Howlin and Asgharian (1999).

Reasons for Increased Vigilance Presentation Outline

z Most children with autism are identified by school z Introduction: Reasons for Increased Vigilance
resources. z Diagnostic Classifications and Special
Only three percent of children with ASD are identified Education Eligibility
solely by non-school resources.
z School Psychologist Roles, Responsibilities,
All other children are identified by a combination of
school and non-school resources (57 %), or by school
and Limitations
resources alone (40 %) Yeargin-Allsopp et al. (2003). z Case Finding
z Screening and Referral
z Assessment: Diagnostic and Psycho-educational
Evaluation

Stephen E. Brock, Ph.D., NCSP 2


Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
July 28, 2006

Evolution of the Term Autism Evolution of the Term Autism

z First used by Swiss psychiatrist Eugen Bleuler in 1911. z In 1980, infantile autism was first included in the third
Derived from the Greek autos (self) and ismos (condition), Bleuler edition of the Diagnostic and Statistical Manual
used the term to describe the concept of turning inward on ones
self and applied it to adults with schizophrenia. (DSM), within the category of Pervasive
z In 1943 Leo Kanner first used the term infantile autism to Developmental Disorders.
describe a group of children who were socially isolated, were z Also occurring at about this time was a growing
behaviorally inflexible, and who had impaired communication. awareness that Kranners autism (also referred to a
z Initially viewed as a consequence of poor parenting, it was not classic autism) is the most extreme form of a
until the 1960s, and recognition of the fact that many of these spectrum of autistic disorders.
children had epilepsy, that the disorder began to be viewed as
having a neurological basis. z Autistic Disorder is the contemporary classification
used since the revision of DSMs third edition (APA,
1987).

Special Education Eligibility:


Diagnostic Classifications Proposed IDEIA Regulations

Pervasive Developmental Disorders z IDEIA 2004 Autism Classification


P.L. 108-446, Individuals with Disabilities Education
Autistic Disorder In this workshop the Improvement Act (IDEIA), 2004
Proposed USDOE Regulations for IDEA 2004 [ 300.8(c)(1)]
terms Autism, or
z Autism means a developmental disability significantly affecting
Asperger's Disorder Autistic Spectrum verbal and nonverbal communication and social interaction,
generally evident before age three, that adversely affects a childs
Disorders (ASD) will be education performance. Other characteristics often associated with
PDD-NOS used to indicate these autism are engagement in repetitive activities and stereotypical
PDDs. movements, resistance to environmental change or change in daily
routines, and unusual responses to sensory experiences. (i)
Rett's Disorder Autism does not apply if a childs educational performance is
adversely affected primarily because the child has an emotional
disturbance, as defined in paragraph (c)(4) of this section. (ii) A
Childhood Disintegrative child who manifest the characteristics of autism after age three
Disorder could be identified as having autism if the criteria in paragraph
(c)(1)(i) of this section are satisfied.

Special Education Eligibility Special Education Eligibility

z For special education eligibility purposes distinctions z However, it is less clear if students with milder forms
among PDDs may not be relevant. of ASD are always eligible for special education.
z While the diagnosis of Autistic Disorder requires z Adjudicative decision makers almost never use the
differentiating its symptoms from other PDDs, DSM IV-TR criteria exclusively or primarily for
determining whether the child is eligible as autistic
Shriver et al. (1999) suggest that for special (Fogt et al.,2003).
education eligibility purposes the federal definition
z While DSM IV-TR criteria are often considered in
of autism was written sufficiently broad to hearing/court decisions, IDEA is typically
encompass children who exhibit a range of acknowledged as the controlling authority.
characteristics (p. 539) including other PDDs. z When it comes to special education, it is state and
federal education codes and regulations (not DSM
IV-TR) that drive eligibility decisions.

Stephen E. Brock, Ph.D., NCSP 3


Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
July 28, 2006

School Psychologist Roles,


Presentation Outline Responsibilities, and Limitations

z Introduction: Reasons for Increased Vigilance 1. School psychologists need to be more


z Diagnostic Classifications and Special vigilant for symptoms of autism among the
Education Eligibility students that they serve, and better
prepared to assist in the process of
z School Psychologist Roles, Responsibilities,
identifying these disorders.
and Limitations
z Case Finding
z Screening and Referral
z Assessment: Diagnostic and Psycho-educational
Evaluation

School Psychologist Roles, School Psychologist Roles,


Responsibilities, and Limitations Responsibilities, and Limitations

2. Case Finding 3. Screening


All school psychologists should be expected to All school psychologists should be prepared to participate
in the behavioral screening of the student who has risk
participate in case finding (i.e., routine factors and/or displays warning signs of autism (i.e., able to
developmental surveillance of children in the general conduct screenings to determine the need for diagnostic assessments).
population to recognize risk factors and identify All school psychologists should be able to distinguish
warning signs of autism). between screening and diagnosis.
z This would include training general educators to identify the 4. Diagnosis
risk factors and warning signs of autism. Only those school psychologists with appropriate training and
supervision should diagnose a specific autism spectrum
disorder.

School Psychologist Roles,


Responsibilities, and Limitations Presentation Outline

5. Special Education Eligibility z Introduction: Reasons for Increased Vigilance


All school psychologists should be expected to
conduct the psycho-educational evaluation that is a z Diagnostic Classifications and Special
part of the diagnostic process and that determines Education Eligibility
educational needs.
NOTE: z School Psychologist Roles, Responsibilities,
z The ability to conduct such assessments will require school and Limitations
psychologists to be knowledgeable of the accommodations
necessary to obtain valid test results when working with the z Case Finding
child who has an ASD.
z Screening and Referral
z Assessment: Diagnostic and Psycho-educational
Evaluation

Stephen E. Brock, Ph.D., NCSP 4


Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
July 28, 2006

Case Finding Case Finding

z Known Risk Factors z Currently there is no substantive evidence


High Risk supporting any one non-genetic risk factor for
z Having an older sibling with autism. ASD.
Moderate Risk z However, given that there are likely different
z The diagnosis of tuberous sclerosis, fragile X, or epilepsy. causes of ASD, it is possible that yet to be
z A family history of autism or autistic-like behaviors.
identified non-heritable risk factors may prove
to be important in certain subgroups of
individuals with this disorder.

Case Finding Case Finding

z Infant & Preschooler Warning Signs z Infant & Preschooler Warning Signs
Absolute indications for an autism screening Absolute indications for an autism screening
No big smiles or other joyful expressions by 6 months.b No 2-word spontaneous (nonecholalic) phrases by 24
months.a, b
No back-and-forth sharing of sounds, smiles, or facial
Failure to attend to human voice by 24 months.c
expressions by 9 months.b
Failure to look at face and eyes of others by 24 months.c
No back-and-forth gestures, such as pointing, showing,
Failure to orient to name by 24 months.c
reaching or waving bye-bye by 12 months.a,b
Failure to demonstrate interest in other children by 24
No babbling at 12 months.a, b months.c
No single words at 16 months.a, b Failure to imitate by 24 months.c
Any loss of any language or social skill at any age.a, b
Sources: aFilipek et al., 1999; bGreenspan, 1999; and cOzonoff, 2003. Sources: aFilipek et al., 1999; bGreenspan, 1999; and cOzonoff, 2003.

Case Finding Case Finding


z School-Age Children Warning Signs z School-Age Children Warning Signs
Social/Emotional Concerns Communication Concerns
z Poor at initiating and/or sustaining activities and friendships with
z Unusual tone of voice or speech (seems to have an accent or
peers
monotone, speech is overly formal)
z Play/free-time is more isolated, rigid and/or repetitive, less interactive
z Overly literal interpretation of comments (confused by
z Atypical interests and behaviors compared to peers
sarcasm or phrases such as pull up your socks or looks can
z Unaware of social conventions or codes of conduct (e.g., seems
kill)
unaware of how comments or actions could offend others)
z Excessive anxiety, fears or depression z Atypical conversations (one-sided, on their focus of interest or
on repetitive/unusual topics)
z Atypical emotional expression (emotion, such as distress or
affection, is significantly more or less than appears appropriate for z Poor nonverbal communication skills (eye contact, gestures,
the situation) etc.)
Sources: Adapted from Aspergers Syndrome A Guide for Parents and Professionals (Attwood, 1998), Sources: Adapted from Aspergers Syndrome A Guide for Parents and Professionals (Attwood, 1998), Diagnostic
Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (APA, 1994), and The Apserger Syndrome and Statistical Manual of Mental Disorders, 4th ed. (APA, 1994), and The Apserger Syndrome Diagnostic Scale
Diagnostic Scale (Myles, Bock and Simpson, 2000) (Myles, Bock and Simpson, 2000)

Stephen E. Brock, Ph.D., NCSP 5


Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
July 28, 2006

Case Finding Presentation Outline

z School-Age Children Warning Signs


z Introduction: Reasons for Increased Vigilance
Behavioral Concerns
z Excessive fascination/perseveration with a particular topic, z Diagnostic Classifications and Special
interest or object Education Eligibility
z Unduly upset by changes in routines or expectations
z School Psychologist Roles, Responsibilities,
z Tendency to flap or rock when excited or distressed
z Unusual sensory responses (reactions to sound, touch,
and Limitations
textures, pain tolerance, etc.) z Case Finding
z History of behavioral concerns (inattention, hyperactivity,
aggression, anxiety, selective mute) z Screening and Referral
z Poor fine and/or gross motor skills or coordination z Assessment: Diagnostic and Psycho-educational
Sources: Adapted from Aspergers Syndrome A Guide for Parents and Professionals (Attwood, 1998), Diagnostic
and Statistical Manual of Mental Disorders, 4th ed. (APA, 1994), and The Apserger Syndrome Diagnostic Scale Evaluation
(Myles, Bock and Simpson, 2000)

Adaptation of Filipek et al.s (1999) Algorithm


for the Process of Diagnosing Autism Screening and Referral
Case
Finding z Screening is designed to help determine the
YES Screening Indicated NO Continue to monitor development
need for additional diagnostic assessments.
z In addition to the behavioral screening (which
Autism
Screening at school should typically be provided by the
school psychologist), screening should
Autism Inicated Refer for assessment as indicted
YES NO
include medical testing (lead screening) and
Diagnostic
a complete audiological evaluation.
Assessment

Psych-educational
Assessment

Behavioral Screening of Infants


Behavioral Screening for ASD and Preschoolers

z School psychologists are exceptionally well qualified z CHecklist for Autism in Toddlers (CHAT)
to conduct the behavioral screening of students Designed to identify risk of autism among 18-month-olds
suspected to have an ASD. Takes 5 to 10 minutes to administer,
z Several screening tools are available Consists of 9 questions asked of the parent and 5 items
z Initially, most of these tools focused on the that are completed by the screeners direct observation of
identification of ASD among infants and the child.
preschoolers. 5 items are considered to be key items. These key items,
z Recently screening tools useful for the identification assess joint attention and pretend play.
of school aged children who have high functioning If a child fails all five of these items they are considered to
autism or Aspergers Disorder have been developed. be at high risk for developing autism.

Stephen E. Brock, Ph.D., NCSP 6


Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
July 28, 2006

CHecklist for Autism in Toddlers CHecklist for Autism in Toddlers

CHAT Section B: general practitioner or health visitor observation


CHAT SECTION A: History: Ask parent
i. During the appointment, has the child made eye contact with your? YES NO
1. Does your child enjoy being swung, bounced on your knee, etc.? YES NO
ii. Get childs attention, then point across the room at an interesting object YES NO*
2. Does your child take an interest in other children? YES NO and say Oh look! Theres a [name of toy]. Watch childs face. Does the
child look across to see what you are point at?
3. Does your child like climbing on things, such as up stairs? YES NO iii. Get the childs attention, then give child a miniature toy cup and teapot YES NO
and say Can you make a cup of tea? Does the child pretend to pour out
4. Does your child enjoy playing peek-a-boo/hide-and-seak? YES NO tea, drink it, etc.?
iv. Say to the child Where is the light?, or Show me the light. Does the YES NO
child POINT with his/her index finger at the light?
5. Does your child ever PRETEND, for example to make a cup of tea using YES NO
v. Can the child build a tower of bricks? (if so how many?) (No. of YES NO
a toy cup and teapot, or pretend other things?
bricks:)
6. Does your child ever use his/her index finger to point to ASK for something? YES NO * To record Yes on this item, ensure the child has not simply looked at your hand, but has
actually looked at the object you are point at.
7. Does your child ever use his/her index finger to point to indicate YES NO
If you can elicit an example of pretending in some other game, score a Yes on this item.

INTEREST in something? Repeat this with Wheres the teddy? or some other unreachable object, if child does not
8. Can your child play properly with small toys (e.g., cars or bricks) without YES NO understand the word light. To record Yes on this item, the child must have looked up at your
just mouthing, fiddling or dropping them? face around the time of pointing.
9. Does your child ever bring objects over to you (parent) to SHOW your YES NO
something? Scoring: High risk for Autism: Fails A5, A7, Bii, Biii, and Biv
Medium risk for autism group: Fails A7, Biv (but not in maximum risk group)
Low risk for autism group (not in other two risk groups)
From Baron-Cohen et al (1996, p. 159).

Behavioral Screening of Infants


CHecklist for Autism in Toddlers and Preschoolers

z Modified Checklist for Autism in Toddlers (M-


http://www.autisticsociety.org/article136.html CHAT)
Designed to screen for autism at 24 months of age.
More sensitive to the broader autism spectrum.
Uses the 9 items from the original CHAT as its basis.
Adds 14 additional items (23-item total).
Unlike the CHAT, however, the M-CHAT does not require
the screener to directly observe the child.
Makes use of a Yes/No format questionnaire.
Yes/No answers are converted to pass/fail responses by
the screener.
A child fails the checklist when 2 or more of 6 critical
items are failed or when any three items are failed.

Behavioral Screening of Infants Modified Checklist for Autism in


and Preschoolers Toddlers
Modified Checklist for Autism in Toddlers (M-CHAT)
z Modified Checklist for Autism in Toddlers (M-CHAT) Please fill out the following about how your child usually is. Please try to answer every question. If the
behavior is rare (e.g., youve seen it once or twice), please answer as if the child does not do it.

The M-CHAT was used to screen 1,293 18- to 30- 1. Does your child enjoy being swung, bounced on your knee, etc.? Yes No

2. Does your child take an interest in other children? Yes No


month-old children. 58 were referred for a
3. Does your child like climbing on things, such as up stairs? Yes No
diagnostic/developmental evaluation. 39 were 4. Does your child enjoy playing peek-a-boo/hide-and-seek? Yes No
diagnosed with an autism spectrum disorder (Robins 5. Does your child ever pretend, for example, to talk on the phone or No
take care of
et al., 2001). 6. Does your child ever use his/her index finger to point, to ask for No
something?
Does your child ever use his/her index finger to point, to indicate
Will result in false positives. 7.
interest in
No

8. Can your child play properly with small toys (e.g. cars or bricks) No
without just
Data regarding false negative is not currently 9. Does your child ever b ring objects over to you (parent) to show No
you something?
available, but follow-up research to obtain such is 10. Does your child look you in the eye for more than a second or two? Yes No
currently underway. 11. Does your child ever seem oversensitive to noise? (e.g., plugging ears) Yes No

Robins et al. (2001, p. 142)

Stephen E. Brock, Ph.D., NCSP 7


Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
July 28, 2006

Modified Checklist for Autism in Modified Checklist for Autism in


Toddlers Toddlers
Modified Checklist for Autism in Toddlers (M-CHAT)
Please fill out the following about how your child usually is. Please try to answer every question. If the M-CHAT Scoring Instructions
behavior is rare (e.g., youve seen it once or twice), please answer as if the child does not do it.
13. Does your child imitate you? (e.g., you make a face-will your child No A child fails the checklist when 2 or more critical items are failed OR when any three items are
imitate it?)
failed. Yes/no answers convert to pass/fail responses. Below are listed the failed responses for each
14 Does your child respond to his/her name when you call? Yes No
item on the M-CHAT. Bold capitalized items are CRITICAL items.
15. If you point at a toy across the room, does your child look at it? Yes No
Not all children who fail the checklist will meet criteria for a diagnosis on the autism spectrum.
16. Does your child walk? Yes No
Howev er, children who fail the checklist should be evaluated in more depth by the physician or
17. Does your child look at things you are looking at? Yes No referred for a developmental evaluation with a specialist.
18. Does your child make unusual finger movements near his/her face? Yes No
1. No 6. No 11. Yes 16. No 21. No
19. Does your child try to attract your attention to his/her own activity? Yes No 2. NO 7. NO 12. No 17. No 22. Yes
3. No 8. No 13. NO 18. Yes 23. No
20. Have you ever wondered if your child is deaf? Yes No
4. No 9. NO 14. NO 19. No
21. Does your child understand what people say? Yes No 5. No 10. No 15. NO 20. Yes
22. Does your child sometimes stare at nothing or wander with no No
purpose?
23. Does your child look at your face to check your reaction when faced No
with
Robins et al. (2001, p. 142) Robins et al. (2001)

Modified Checklist for Autism in Behavioral Screening of School


Toddlers Age Children

z Autism Spectrum Screening Questionnaire (ASSQ)


The 27 items rated on a 3-point scale.
http://www.firstsigns.org/downloads/m-chat.PDF Total score range from 0 to 54.
Items address social interaction, communication,
restricted/repetitive behavior, and motor clumsiness and other
associated symptoms.
The initial ASSQ study included 1,401 7- to 16-year-olds.
z Sample mean was 0.7 (SD 2.6).
z Asperger mean was 26.2 (SD 10.3).
A validation study with a clinical group (n = 110) suggests the
ASSQ to be a reliable and valid parent and teacher screening
instrument of high-functioning autism spectrum disorders in a
clinical setting (Ehlers, Gillber, & Wing, 1999, p. 139).

Behavioral Screening of School Autism Spectrum Screening


Age Children Questionnaire
Different parent and teacher ASSQ cutoff scores with true positive rate (% of children with an ASD
z Autism Spectrum Screening Questionnaire (ASSQ) who were rated at a given score), false positive rate (% of children without an ASD who we re rated
at a given score), and the likelihood ratio a given score predicting and ASD.
Two separate sets of cutoff scores are suggested.
z Parents, 13; Teachers, 11: = socially impaired children Cutoff Score True Positive Rate (%) False Positive Rate (%) Likelihood Ratio
Low risk of false negatives (especially for milder cases of ASD). Parent
7 95 44 2.2
High rate of false positives (23% for parents and 42% for teachers). 13 91 23 3.8
Not unusual for children with other disorders (e.g., disruptive behavior 15 76 19 3.9
disorders) to obtain ASSQ scores at this level. 16 71 16 4.5
Used to suggest that a referral for an ASD diagnostic assessment, 17 67 13 5.3
while not immediately indicated, should not be ruled out. 19 62 10 5.5
20 48 8 6.1
z Parents, 19; Teachers, 22: = immediate ASD diagnostic referral. 22 42 3 12.6
False positive rate for parents and teachers of 10% and 9 % Teacher
respectively. 9 95 45 2.1
The chances are low that the student who attains this level of ASSQ 11 90 42 2.2
cutoff scores will not have an ASD. 12 85 37 2.3
15 75 27 2.8
Increases the risk of false negatives. 22 70 9 7.5
24 65 7 9.3

Stephen E. Brock, Ph.D., NCSP 8


Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
July 28, 2006

Behavioral Screening of School Childhood Asperger Syndrome


Age Children Test
Childhood Asperger Sy ndrome Test (CAST)

z Childhood Asperger Syndrome Test (CAST) 1. Does s/he join in playing g ames with other children easily? YES NO

Scott, F. A., Baron-Cohen, S., Bolton, P., & Brayne, C. (2002). 2. Does s/he co me up to you spontaneou sly for a chat? YES NO

The CAST (Childhood Asperger Syndrome Test). Autism, 6, 9- 3. Was s/he speaking by 2 yea rs old? YES NO

4. Does s/he en joy sports? YES NO


31.
5. Is it important to him/her to fit in with the peer group? YES NO
z A screening for mainstream primary grade (ages 4 through 11 6. Does s/he app ear to notice unusual details that others miss? YES NO
years) children. 7. Does s/he tend to take things literally? YES NO

z Has 37 items, with 31 key items contributing to the childs total 8. When s/he was 3 yea rs old, did s/her spend a lot of time pretending (e.g. p lay-
acting begin a superhero, or holding a teddys tea parties)?
YES NO

score. 9. Does s/he like to do things over and over aga in, in the same way all the time? YES NO

z The 6 control items assess general development. 10. Does s/he find it easy to interact with other children? YES NO

11. Can s/he keep a two-way conve rsation go ing? YES NO


z With a total possible score of 31, a cut off score of 15 NO
12. Can s/he read approp riately for his/her age? YES NO
responses was found to correctly identify 87.5 (7 out of 8) of the
13. Does s/he mostly have the same interest as his/her peers? YES NO
cases of autistic spectrum disorders. 14. Does s/he hav e an interest, which takes up so much time that s/he does little
YES NO
else?
z Rate of false positives is 36.4%. 15. Does s/he hav e friends, rather than just acquaintances? YES NO

z Rate of false negatives is not available 16. Does s/he often bring you things s/he is interested in to show you? YES NO
From Scott et al. (2002, p. 27)

Childhood Asperger Syndrome Childhood Asperger Syndrome


Test Test
17. Does s/he en joy joking around? YES NO

18. Does s/he have difficulty understanding the rules for polite behavior? YES NO

19. Does s/he appear to have an unusual memory for details? YES NO
http://www.autismresearchcentre.com/tests/cast_test.asp
20. Is his/her voice unusual (e.g., ove rly adult, flat, or very monotonous)? YES NO

21. Are people important to him/her? YES NO

22. Can s/he dress him/herself? YES NO

23. Is s/he good a t turn-taking in conve rsation? YES NO

24. Does s/he play imaginatively with other children, and engage in role-play? YES NO

25. Does s/he often do or say things that are tactless or so cially inappropriate? YES NO

26. Can s/he coun t to 50 without leaving out any numbers? YES NO

27. Doe s s/he make normal eye -contact? YES NO

28. Doe s s/he have any unusu al and rep etitive move ments? YES NO

29. Is his/her social behaviour very one -sided and always on his/her own terms? YES NO

30. Doe s s/he sometimes say youor s/hewhen s/he means I? YES NO
31. Doe s s/he prefer imaginative activities such as play-acting or story-telling,
YES NO
rather than numbers or lists of facts?
32. Doe s s/he sometimes lose the listener bec ause of no t explaining what s/he is
YES NO
talking about?
33. Can s/he ride a bicycle (even if with stabilizers)? YES NO
34. Doe s s/he try to impose routines on h im/herself, or on others, in such a way
YES NO
that is causes problems?
35. Doe s s/he care how s/he is perceived by the rest of the group? YES NO
36. Doe s s/he often turn the conversations to his/her favo rite subject rather than
YES NO
following wha t the other person wants to talk about?
37. Doe s s/he have odd or unusua l phrases? YES NO
From Scott et al. (2002, pp. 27-28)

Behavioral Screening of School Behavioral Screening of School


Age Children Age Children
z Social Communication Questionnaire (SCQ) z Social Communication Questionnaire (SCQ)
Two forms of the SCQ: a Lifetime and a Current form.
z Current ask questions about the childs behavior in the past 3-
months, and is suggested to provide data helpful in
understanding a childs everyday living experiences and
evaluating treatment and educational plans
z Lifetime ask questions about the childs entire developmental
history and provides data useful in determining if there is need
for a diagnostic assessment.
Consists of 40 Yes/No questions asked of the parent.
The first item of this questionnaire documents the childs
ability to speak and is used to determine which items will be
used in calculating the total score.

Rutter, M., LeCouteur, A., & Lord, C. (2003). Social Communication Questionnaire. Los Angeles, CA:
Western Psychological Services.

Stephen E. Brock, Ph.D., NCSP 9


Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
July 28, 2006

Behavioral Screening of School Behavioral Screening of School


Age Children Age Children

z Social Communication Questionnaire (SCQ) z Social Communication Questionnaire (SCQ)


An AutoScore protocol converts the parents While it is not particularly effective at distinguishing among
Yes/No responses to scores of 1 or 0. the various ASDs, it has been found to have good
discriminative validity between autism and other disorders
The mean SCQ score of children with autism including non-autistic mild or moderate mental retardation.
was 24.2, whereas the general population mean The SCQ authors acknowledge that more data is needed to
was 5.2. determine the frequency of false negatives (Rutter et al.,
The threshold reflecting the need for diagnostic 2003).
assessment is 15. This SCQ is available from Western Psychological Services.
A slightly lower threshold might be appropriate if
other risk factors (e.g., the child being screened
is the sibling of a person with ASD) are present.

Presentation Outline Autistic Disorder Diagnostic Criteria

z Introduction: Reasons for Increased Vigilance A. A total of six (or more) items for (1), (2), and (3), with
at least two from (1), and one each for (2) and (3):
z Diagnostic Classifications and Special (1) qualitative impairment in social interaction, as manifested
Education Eligibility by at least two of the following:
a) marked impairment in the use of multiple nonverbal
z School Psychologist Roles, Responsibilities, behaviors such as eye-to-eye gaze, facial expression, body
postures, and gestures to regulate social interaction
and Limitations b) failure to develop peer relationships appropriate to
developmental level
z Case Finding c) a lack of spontaneous seeking to share enjoyment,
interests, or achievements with other people (e.g., by lack
z Screening and Referral of showing, bringing, or pointing out objects of interest)
z Assessment: Diagnostic and Psycho-educational d) lack of social or emotional reciprocity

Evaluation

Autistic Disorder Diagnostic Criteria Autistic Disorder Diagnostic Criteria

A. A total of six (or more) items for (1), (2), and (3), with A. A total of six (or more) items for (1), (2), and (3), with at
at least two from (1), and one each for (2) and (3): least two from (1), and one each for (2) and (3):
(2) qualitative impairments in communication as manifested (3) restricted repetitive and stereotyped patterns of behavior,
by at least one of the following: interests, and activities, as manifested by at least one of
a) delay in, or total lack of, the development of spoken the following:
language (not accompanied by an attempt top compensate a) encompassing preoccupation with one or more stereotyped
through alternative modes of communication such as and restricted patterns of interest that is abnormal either in
gesture or mime) intensity or focus
b) in individuals with adequate speech, marked impairment in b) apparently inflexible adherence to specific, nonfunctional
the ability to initiate or sustain a conversation with others routines or rituals
c) stereotyped and repetitive use of language or idiosyncratic c) stereotyped and repetitive motor mannerisms (e.g., hand or
language finger flapping or twisting, or complex whole-body
d) lack of varied, spontaneous make-believe play or social movements)
imitative play appropriate to developmental level d) persistent preoccupation with parts of objects

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Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
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Autistic Disorder Diagnostic Criteria Other ASDs

B. Delays or abnormal functioning in at least one of the z Aspergers Disorder


following areas, with onset prior to age 3 years: (1) social The criteria for Aspergers Disorder are essentially
interaction, (2) language as used in social communication, the same as Autistic Disorder with the exception that
or (3) symbolic or imaginative play. there are no criteria for a qualitative impairment in
communication.
C. The disturbance is not better accounted for by Retts In fact Aspergers criteria require no clinically
Disorder or Childhood Disintegrative Disorder. significant general delay in language (e.g., single
words used by 2 years, communicative phrases used
by 3 years).

Other ASDs Other ASDs

z Childhood Disintegrative Disorder (CDD) z Retts Disorder


Criteria are essentially the same as Autistic Disorder. z Both Autistic Disorder and Retts Disorder criteria include
Difference include that in CDD there has been delays in language development and social engagement
(a) Apparently normal development for at least the first 2 years after (although social difficulties many not be as pervasive).
birth as manifested by the presence of age-appropriate verbal z Unlike Autistic Disorder, Retts also includes
and nonverbal communication, social relationships, play, and (a) head growth deceleration,
adaptive behavior; and that there is (b) loss of fine motor skill,
(b) Clinically significant loss of previously acquired skills (before age (c) poorly coordinated gross motor skill, and
10 years) in at least two of the following areas: (d) severe psychomotor retardation.
1. expressive or receptive language;
2. social skills or adaptive behavior;
3. bowel or bladder control;
4. play;
5. motor-skills.

Symptom Onset Developmental Course

z Autistic Disorder is before the age of three years. z Autistic Disorder:


Before three years, their must be delays or abnormal Parents may report having been worried about the
functioning in at least one of the following areas: (a) social childs lack of interest in social interaction since or
interaction, (b) social communicative language, and/or (c) shortly after birth.
symbolic or imaginative play.
In a few cases the child initially developed normally
z Aspergers Disorder may be somewhat later. before symptom onset. However, such periods of
z Childhood Disintegrative Disorder is before the age of 10 normal development must not extend past age three.
years. Duration of Autistic Disorder is typically life long, with
Preceded by at least two years of normal development. only a small percentage being able to live and work
z Retts Disorder is before the age of 4 years. independently and about 1/3 being able to achieve a
Although symptoms are usually seen by the second year of partial degree of independence. Even among the
life. highest functioning adults symptoms typically continue
to cause challenges.

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Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
July 28, 2006

Developmental Course Associated Features

z Aspergers Disorder:
Motor delays or clumsiness may be some of the first symptoms z Aspergers Disorder is the only ASD not typically associated
noted during the preschool years. with some degree of mental retardation.
Difficulties in social interactions, and symptoms associated with z Autistic Disorder is associated with moderate mental
unique and unusually circumscribed interests, become apparent retardation. Other associated features include:
at school entry. unusual sensory sensitivities
Duration is typically lifelong with difficulties empathizing and abnormal eating or sleeping habits
modulating social interactions displayed in adulthood.
unusual fearfulness of harmless object or lack of fear for real
z Retts and Childhood Disintegrative Disorders: dangers
Lifelong conditions. self-injurious behaviors
Retts pattern of developmental regression is generally z Childhood Disintegrative Disorder is associated with severe
persistent and progressive. Some interest in social interaction mental retardation.
may be noted during later childhood and adolescence.
The loss of skills associated with Childhood Disintegrative
z Retts Disorder is associated with severe to profound mental
Disorder plateau after which some limited improvement may retardation.
occur.

Age Specific Features Gender Related Features

z Chronological age and developmental level


influence the expression of Autistic Disorder.
z With the exception of Retts Disorder,
Thus, assessment must be developmentally sensitive. which occurs only among females, all other
For example, infants may fail to cuddle; show indifference or ASDs appear to be more common among
aversion to affection or physical contact; demonstrate a lack
of eye contact, facial responsiveness, or socially directed males than females.
smiles; and a failure to respond to their parents voices.
On the other hand, among young children, adults may be
The rate is four to five times higher in males
treated as interchangeable or alternatively the child may than in females.
cling to a specific person.

Differential Diagnosis Differential Diagnosis

Retts Disorder z Affects only girls Schizophrenia z Years of normal/near normal


z Head growth deceleration development
z Loss of fine motor skill z Symptoms of hallucinations/delusions

z Awkward gait and trunk movement z Loss of fine motor skill

z Mutations in the MECP2 gene z Awkward gait and trunk movement

Childhood z Regression following at least two years z Mutations in the MECP2 gene
Disintegrative Disorder of normal development Selective Mutism z Normal language in certain situations or
Aspergers Disorder z Expressive/Receptive language not settings
delayed z No restricted patterns of behavior
z Normal intelligence Language Disorder z No severe impairment of social
z Later symptom onset interactions
z No restricted patterns of behavior

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Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
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Differential Diagnosis Developmental and Health History

ADHD z Distractible inattention related to external


(not internal) stimuli
z Prenatal and perinatal risk factors
z Deterioration in attention and vigilance Greater maternal age
over time Maternal infections
Mental Retardation z Relative to developmental level, social z Measles, Mumps, & Rubella
interactions are not severely impaired z Influenza
z No restricted patterns of behavior z Cytomegalovirus
z Herpes, Syphilis, HIV
OCD z Normal language/communication skills
z Normal social skills Drug exposure
Obstetric suboptimality
Reactive Attachment z History of severe neglect and/or abuse
Disorder z Social deficits dramatically remit in
response to environmental change

Developmental and Health History Developmental and Health History

z Postnatal risk factors z Developmental Milestones


Infection Language development
z Case studies have documented sudden onset of ASD z Concerns about a hearing loss
symptoms in older children after herpes encephalitis.
z Infections that can result in secondary hydrocephalus, such as Social development
meningitis, have also been implicated in the etiology of ASD. z Atypical play
z Common viral illnesses in the first 18 months of life (e.g., z Lack of social interest
mumps, chickenpox, fever of unknown origin, and ear infection)
have been associated with ASD. Regression
Chemical exposure?
MMR?

Developmental and Health History Developmental and Health History

z Medical History z Diagnostic History


Vision and hearing ASD is sometimes observed in association other
Chronic ear infections (and tube placement) neurological or general medical conditions.
Immune dysfunction (e.g., frequent infections) z Mental Retardation (up to 80%)
Autoimmune disorders (e.g., thyroid problems, z Epilepsy (3-30%)
arthritis, rashes) May develop in adolescence
Allergy history (e.g., to foods or environmental EEG abnormalities common even in the absence of seizures
triggers) z Genetic Disorders
10-20% of ASD have a neurodevelopmental genetic syndrome
Gastrointestinal symptoms (e.g., diarrhea,
z Tuberous Sclerosis (found in 2-4% of children with ASD)
constipation, bloating, abdominal pain)
z Fragile X Syndrome (found in 2-8% of children with ASD)

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Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
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Developmental and Health History Diagnostic Assessments

z Family History z Indirect Assessment


Epilepsy Interviews and Questionnaires/Rating Scales
Mental Retardation z Easy to obtain
Genetic Conditions z Reflect behavior across settings
z Subject to interviewee/rater bias
z Tuberous Sclerosis Complex
z Fragile X Syndrome z Direct Assessment
z Schizophrenia Behavioral Observations
z Anxiety z More difficult to obtain
z Depression z Reflect behavior within limited settings
z Bipolar disorder z Not subject to interviewee/rater bias
Other genetic condition or chromosomal
abnormality

Indirect Assessment: Rating Scales Indirect Assessment: Rating Scales

z The Gilliam Autism Rating Scale (GARS) z The Gilliam Autism Rating Scale (GARS)
Normative group, 1092 children, adolescents, and young adults
Gilliam, J. E. (1995). Gilliam autism rating scale. reported by parent or teacher to be a person with autism.
Austin, TX: Pro-Ed. Age range 3 to 22.
Designed for use by parents, teachers, and professionals
56 items, 4 scales.
Social Interaction, Communication, and Stereotyped Behavior
scales assesses current behavior.
Developmental Disturbances scale assesses maladaptive behavior
history.
Behaviors are rated on a 4-point scale (Never Observed to
Frequently Observed).

Indirect Assessment: Rating Scales Indirect Assessment: Rating Scales

z The Gilliam Autism Rating Scale (GARS) z The Gilliam Autism Rating Scale (GARS)
South, M., Williams, B. J., McMahon, W. M. Owlye, T.,
Yields an Autism Quotient (AQ) Filipek, P. A., Shernoff, E., Corsello, C. C., Lainhart, J. E.,
AQs are classified on an ordinal scale ranging Landa, R., & Ozonoff, S. (2002). Utility of the Gilliam autism
rating scale in research and clinical populations. Journal of
from Very Low to Very High probability of Autism and Developmental Disorders, 32, 593-599.
autism. A score of 90 or above specifies that the z Among a sample of 119 children with strict DSM-IV diagnoses
child is probably autistic. of autism, the GARS consistently underestimated the
likelihood that autistic children in this sample would be
classified as having autism.
z The South et al. (2002) sample mean (90.10) was significantly
below the GARS mean (100).

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Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
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Indirect Assessment: Rating Scales Indirect Assessment: Rating Scales

z The Gilliam Autism Rating Scale (GARS) z The Asperger Syndrome Diagnostic Scale
Gilliam, J. E. (2005). Gilliam autism rating scale (ASDS)
(2nd ed.). Austin, TX: Pro-Ed.

Indirect Assessment: Rating Scales Indirect Assessment: Interview

z The Asperger Syndrome Diagnostic Scale (ASDS) z The Autism Diagnostic Interview-Revised (ADI-R)
Age range 5-18. Rutter, M., Le Couteur, A., & Lord, C. (2003). Autism
50 yes/no items. diagnostic interview-revised (ADI-R). Los Angeles, CA:
10 to 15 minutes. Western Psychological Services.
Normed on 227 persons with Asperger Syndrome, autism,
learning disabilities, behavior disorders and ADHD.
ASQs are classified on an ordinal scale ranging from Very
Low to Very High probability of autism. A score of 90 or
above specifies that the child is Likely to Very Likely to have
Aspergers Disorder.

Indirect Assessment: Interview Indirect Assessment: Interview


z The Autism Diagnostic Interview-Revised (ADI-R)
z The Autism Diagnostic Interview-Revised (ADI-R)
The 93 items that comprise this measure takes approximately 90 to
Semi-structured interview 150 minutes to administer.
Designed to elicit the information needed to diagnose Solid psychometric properties.
autism. z Works very well for differentiation of ASD from nonautistic
Primary focus is on the three core domains of autism (i.e., developmental disorders in clinically referred groups, provided that the
language/communication; reciprocal social interactions; and mental age is above 2 years.
restricted, repetitive, and stereotyped behaviors and z False positives very rare,
interests). z Reported to work well for the identification of Aspergers Disorder.
Requires a trained interviewer and caregiver familiar with However, it may not do so as well among children under 4 years
both the developmental history and the current behavior of of age.
the child. According to Klinger and Renner (2000): The diagnostic interview
The individual being assessed must have a developmental that yields the most reliable and valid diagnosis of autism is the
level of at least two years. ADIR (p. 481).

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Direct Assessments: ADOS Direct Assessments: ADOS

z The Autism Diagnostic Observation Schedule z A standardized, semi-structured, interactive play


(ADOS) assessment of social behavior.
Uses planned social occasions to facilitate observation of the
Lord, C., Rutter, M., Di Lavore, P. C., & Risis, S. (). Austims social, communication, and play or imaginative use of material
diagnostic observation schedule. Los Angeles, CA: Western behaviors related to the diagnosis of ASD.
Psychological Services.
z Consists of four modules.
Module 1 for individuals who are preverbal or who speak in
single words.
Module 2 for those who speak in phrases.
Module 3 for children and adolescents with fluent speech.
Module 4 for adolescents and adults with fluent speech.

Direct Assessments: ADOS Direct Assessments: CARS


z Administration requires 30 to 45 minutes. z The Childhood Autism Rating Scale (CARS)
z Because its primary goal is accurate diagnosis, the Schopler, E., Reichler, R., & Rochen-Renner, G.
authors suggest that it may not be a good measure of
(1988). The Childhood Autism Rating Scale
treatment effectiveness or developmental growth
(especially in the later modules). (CARS). Los Angeles, CA: Western Psychological
Services.
z Psychometric data indicates substantial interrater and
test-retest reliability for individual items, and excellent
interrater reliability within domains and internal
consistency.
z Mean test scores were found to consistently
differentiate ASD and non-ASD groups.

Direct Assessments: CARS Direct Assessments: CARS

z 15-item structured observation tool. z Data can also be obtained from parent interviews and student
z Items scored on a 4-point scale ranging from 1 (normal) to 4 record reviews.
(severely abnormal). z When initially developed it attempted to include diagnostic
z In making these ratings the evaluator is asked to compare the criteria from a variety of classification systems and it offers no
child being assessed to others of the same developmental level. weighting of the 15 scales.
Thus, an understanding of developmental expectations for the 15 z This may have created some problems for its current use
CARS items is essential. z Currently includes items that are no longer considered essential
z The sum ratings is used to determine a total score and the for the diagnosis of autism (e.g., taste, smell, and touch
severity of autistic behaviors response) and may imply to some users of this tool that they are
Non-autistic, 15 to 29 essential to diagnosis (when in fact they are not).
Mildly-moderately autistic 30-37 z Psychometrically, the CARS has been described as
Severely autistic, 37 acceptable, good, and as a well-constructed rating scale.

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Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
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Psycho-educational Assessment Testing Accommodations

z Purposes z The core deficits of autism can significantly impact


test performance.
Develop goals and objectives (which are similar Impairments in communication may make it difficult to
to those developed for other children with special respond to verbal test items and/or generate difficulty
needs). understanding the directions that accompany nonverbal
tests.
z To make progress in social and cognitive proficiencies,
verbal and nonverbal communication abilities, and Impairments in social relations may result in difficulty
adaptive skills. establishing the necessary joint attention.
z To minimize behavioral problems. z Examiners must constantly assess the degree to
which tests being used reflect symptoms of autism
To generalize competencies across multiple
and not the specific targeted abilities (e.g.,
environments. intelligence, achievement, psychological processes).

Testing Accommodations Testing Accommodations


z It is important to acknowledge that the autistic z Prepare the student for the testing experience.
population is very heterogeneous. z Place the testing session in the students daily
z There is no one set of accommodations that will schedule.
work for every student with autism.
z It is important to consider each student as an
individual and to select specific accommodations to
meet specific individual student needs.

Pictures from Stephanie Soloman

Testing Accommodations Testing Accommodations

z Minimize distractions. z Make use of powerful external rewards.


z Make use of pre-established physical structures and z Carefully pre-select task difficulty.
work systems. z Modify test administration and allow nonstandard
responses.

One-on-one work area Sample work systems

Pictures from Stephanie Soloman

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Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
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Testing Accommodations Behavioral Observations

z Carefully pre-select task difficulty. z Students with ASD are a very heterogeneous group,
z Modify test administration and allow nonstandard and in addition to the core features of ASD, it is not
responses. unusual for them to display a range of behavioral
symptoms including hyperactivity short attention span
impulsivity, aggressiveness, self-injurious behavior,
and (particularly in young children) temper tantrums.
z Observation of the student with ASD in typical
environments will also facilitate the evaluation of test
taking behavior.
z Observation of test taking behavior may also help to
document the core features of autism.

Choice of Assessment Instruments Cognitive Functioning

z Childs level of verbal abilities. z Assessment of cognitive function is essential given that,
z Ability to respond to complex instructions and social with the exception of Aspergers Disorder, a significant
expectations. percentage (as high as 80 percent) of students with
z Ability to work rapidly. ASD will also be mentally retarded.
z Ability to cope with transitions during test activities. z Severity of mental retardation can also provide some
guidance regarding differential diagnosis among ASDs.
z IQ is associated with adaptive functioning, the ability to
z In general, children with autism will often perform learn and acquire new skills, and long-term prognosis.
best when assessed with tests that require less social Thus, level of cognitive functioning has implications for determining
engagement and verbal mediation. how restrictive the educational environment will need to be.

Cognitive Functioning Cognitive Functioning

z A powerful predictor of ASD symptom severity. z Regardless of the overall level of cognitive functioning,
z However, given that children with ASD are ideally first it is not unusual for the student being tested to display
evaluated when they are very young, it is important to an uneven profile of cognitive abilities.
acknowledge that it is not until age 5 that childhood IQ z Thus, rather that simply providing an overall global
correlates highly with adult IQ. intelligence test score, it is essential to identify these
Thus, it is important to treat the IQ scores of the very young cognitive strengths and weaknesses.
child with caution when offering a prognosis, and when making z At the same time, however, it is important to avoid the
placement and program planning decisions.
temptation to generalize from isolated or splinter skills
However, for school aged children it is clear that the
appropriate IQ test is an excellent predictor of a students when forming an overall impression of cognitive
later adjustment and functioning in real life (Frith, 1989, p. 84). functioning, given that such skills may significantly
overestimate typical abilities.

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Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
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Cognitive Functioning Cognitive Functioning

z Selection of specific tests is important to z On the other hand, for students who have more
obtaining a valid assessment of cognitive severe language delays measures that
functioning (and not the challenges that are
minimize verbal demands are recommended
characteristic of ASD).
(e.g., the Leiter International Performance
z The Wechsler and Stanford-Binet scales are
Scale Revised, Raven Coloured Progressive
appropriate for the individual with spoken
language. Matrices)

Functional/Adaptive Behavior Functional/Adaptive Behavior

z Given that diagnosing mental retardation requires examination z Profiles of students with ASD are unique.
of both IQ and adaptive behavior, it is also important to Individuals with only mental retardation typically display flat
administer measures of adaptive behavior when assessing profiles across adaptive behavior domains
students with ASD.
Students with ASD might be expected to display relative
z Other uses of adaptive behavior scales when assessing strengths in daily living skills, relative weaknesses in
students with ASD are: socialization skills, and intermediate scores on measures of
a) Obtain measure of childs typical functioning in familiar communication abilities.
environments, e.g. home and/or school.
b) Target areas for skills acquisition. z To facilitate the use of the Vineland Adaptive
c) Identifying strengths and weaknesses for educational planning Behavior Scales in the assessment of individuals
and intervention with ASD, Carter et al. (1998) have provided special
d) Documenting intervention efficacy norms for groups of individuals with autism
e) Monitoring progress over time.

Functional/Adaptive Behavior Social Functioning


z Tools that provide an overview of social functioning (i.e.,
z Other tools with subtests for assessing social needs and current repertoire)
Vineland Adaptive Behavior Scales.
functional/adaptive behaviors:
Scales of Independent Behavior-Revised.
Brigance Inventory of Early Development. z Typical problem areas/issues:
Early Learning Accomplishment Profiles. Understanding facial expressions and gestures
Scales of Independent Behavior-Revised. Knowing how and when to use turn-taking skills, including
focusing on the interest of others
AAMD Adaptive Behavior Scale. Interpreting non-literal language such as idioms and metaphors
Learning Accomplishments Profile. Recognizing that others intentions do not always match their
verbalizations
Developmental Play Assessment Instrument.
Understanding the hidden curriculum those complex social rules
that often are not directly taught (Myles & Simpson, 2001, p. 6)

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Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
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Language Functioning (AACAP, 1999) Language Functioning

z Measures of single word vocabulary z Specific Tests (Myles & Adreon, 2001)
(receptive and expressive). Clinical Evaluation of Language Fundamentals
z Actual use of language (receptive and Third Edition
expressive). Comprehensive Receptive and Expressive
Vocabulary Test
z Articulation and Oral-Motor skills as indicated
Peabody Picture Vocabulary Test Third Edition
z Pragmatic Skills ( the childs capacities for Test of Language Competence Expanded
use of whatever level of communication skills Edition (Level 2)
he/she has in relation to the social context). Test of Pragmatic Language
Test of Problem Solving - Adolescent

Psychological Processes Academic/Developmental Assessment

z Helps to further identify learning strengths and weakness. z Assessment of academic functioning will often reveal a profile of
strengths and weaknesses.
z Depending upon age and developmental level, traditional
measures of such processes may be appropriate. It is not unusual for students with ASD be hyperverbal/hyperlexic,
while at the same time having poor comprehension and difficulties
z It would not be surprising to find relatively strong rote, mechanical, with abstract language. For others, calculation skills may be well
and visual-spatial processes; and deficient higher-order conceptual developed, while mathematical concepts are delayed.
processes, such as abstract reasoning. z For students functioning at or below the preschool range and with
z While IQ test profiles should never be used for diagnostic a chronological age of 6 months to 7 years, the
purposes, it would not be surprising to find the student with Autistic Psychoeducational Profile Third Edition may be an appropriate
Disorder to perform better on non-verbal (visual/spatial) tasks than choice.
tasks that require verbal comprehension and expression. z For students who are very severely cognitively delayed, the
The student with Aspergers Disorder may display the exact opposite Adolescent and Adult Psychoeducational Profile (AAPEP) may be
profile. an appropriate choice.

Academic/Developmental Assessment Academic/Developmental Assessment

z For older, higher functioning students, the Woodcock-Johnson z Curriculum-based assessment


Tests of Achievement and the Wechsler Individual Achievement Reading decoding (often a strength) should be compared to
Test would be appropriate tools. comprehension (often a weakness).
Comprehension may be related to
z Subject matter
z Instructional setting (large group vs. individual work)
z Stress level
Written language skills to be assessed
z Organization and coherence
z Provision of sufficient background
z Creativity
Computer generated writing samples should be compared to
handwritten samples (fine motor often weak).

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Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
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Emotional Functioning Emotional Functioning

z 65% present with symptoms of an additional z There are occasional reports of schizophrenia developing in
psychiatric disorder such as AD/HD, oppositional adolescence.
defiant disorder, obsessive-compulsive disorder and z Given these possibilities, it will also be important for the school
other anxiety disorders, tics disorders, affective psychologist to evaluate the students emotional/behavioral status.
disorders, and psychotic disorders. z Traditional measures such as the Behavioral Assessment System
z AH/HD is the most common comorbid diagnosis for Children would be appropriate as a general purpose screening
among adolescents and adults. tool, while more specific measures such as The Childrens
Depression Inventory and the Revised Childrens Manifest Anxiety
z Disorders of mood (both depression and mania) are Scale would be appropriate for assessing more specific presenting
the second most common co-existing diagnosis and concerns.
are seen particularly in higher-functioning individuals
among individuals latency age and beyond.
16.9% of CBCL (parent) ratings have elevated depression
subscales.

Emotional Functioning Sensory Assessments

When to consider comorbidity in ASD (Hendren, 2003, p. 39) z Occupational Therapy Assessments
1. When signs of problems outside the autism spectrum Particularly if there is some degree of sensory
are apparent. hyper or hyposensitivity or difficulties in motor
2. When there is an abrupt change in behavior from development.
baseline. z The Sensory Profile (Dunn, 1999)
3. When there is a severe and incapacitating problem z Short Sensory Profile (McIntosh et al., 1999)
behavior. z Sensory Integration Inventory Revised (Reisman &
4. When there is a worsening of symptoms already Hanschu, 1992)
present
5. When student does not respond as expected to
intervention.

Special Education Report


Functional Behavioral Assessment Recommendations

z Identify and describe target behavior z Target specific areas of need and strive to
z Describe establishing operations and immediate build upon learning assets.
antecedents z Sample recommendations
z Collect baseline data/work samples
z Determine the function of the behavior
z Develop a behavior intervention plan
z Assessment tools
z http://www.csus.edu/indiv/b/brocks/Courses/EDS%20240/student_materials.htm

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Identifying, Screening, and Assessing Autism at School NASP & AHD Summer Conference
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Contact Information

z Stephen E. Brock, Ph.D.


Associate Professor
Department of Special Education, Rehabilitation,
and School Psychology
CSU, Sacramento
916-278-5919
brock@csus.edu
http://www.csus.edu/indiv/b/brocks/

Stephen E. Brock, Ph.D., NCSP 22