School-Based Autism Assessments: Review of Current Practices & Guidelines for a Comprehensive Assessment

Transcription

1 School-Based Autism Assessments: Review of Current Practices & Guidelines for a Comprehensive Assessment Angela Davis, Ph.D. Jeanne Anne Carriere, Ph.D. Kelly Kennedy, Ph.D.

2 Goals for Today s Workshop 1. Introduction to ASD/assessment 2. Review data on a survey completed by California school psychologists 3. Discuss relevant case law for school-based autism assessments 4. Openly discuss planning and conducting of a comprehensive school-based autism evaluation

3 Why conduct research in this area? A meta-analysis examined the content of ASD research in six school psychology research journals (McKenney et al., 2015). Researchers found that only 38 articles over a 10-year span ( ) discussed autismrelated topics. Out of these articles, only five reviewed assessment and identification of ASD.

4 Reasons for Increased Attention & Improved Identification of ASD Early identification and treatment can change the course of the disorder. Given increased rates, educators are more likely to encounter students with ASD. Students under an Autism eligibility have increased four fold between 1999 and 2012 (currently 10% of SWD and 1% of K-12 population) The majority of children with autism are identified through school resources. Average age of ASD identification is about 4 years of age. African American & Latino children often diagnosed 1 ½ years later than the average. (Brock, 2009; Durand, 2014; Mandall, etal, 2002;Wilkinson, 2009)

5 Semantics Matters: Eligibility & Diagnosis Eligibility Diagnosis Educational Eligibility Educational Diagnosis Educational Evaluations Clinical Evaluations When we try to equate these things we confuse ourselves and confuse families. This causes problems for everyone.

6 Federal: IDEA 2004 (i) Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three that adversely affects a child's educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences.

7 California Code of Regs Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction; generally evident before age three that adversely affects a student's educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. The term does not apply if a student's educational performance is adversely affected primarily because the student has an emotional disturbance. A student who manifests the characteristics of autism after age three could be identified as having autism if the criteria are satisfied.

8 DSM-5 (must meet crtieria A, B, C, D, & E) A. Persistent deficits in social communication and social interaction across multiple contexts, as manifest by the following, currently or by history (examples illustrative, not exhaustive): Deficits in social-emotional reciprocity Deficits in nonverbal communicative behaviors used for social interaction Deficits in developing, maintaining, and understanding relationships

9 DSM-5 (must meet crtieria A, B, C, D, & E) B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following, currently or by history (examples illustrative, not exhaustive): Stereotyped or repetitive motor movements, use of objects, or speech Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior Highly restricted, fixated interests that are abnormal in intensity or focus Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment

10 DSM-5 (must meet crtieria A, B, C, D, & E) C. Symptoms must be present in early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life) D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delays. Intellectual disability and autism spectrum disorder frequently cooccur, to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

11 Are there meaningful similarities & differences? CA Ed Code 1. Verbal and nonverbal communication and social interaction; 2. Generally evident before age three that adversely affects a student's educational performance. 3. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. DSM-5 A. Persistent deficits in social communication and social interaction across multiple contexts, as manifest by the following, currently or by history B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following, currently or by history C. Symptoms must be present in early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life) 4. A student who manifests the characteristics of autism after age three could be identified as having autism if the criteria are satisfied. D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning

12 My child has a diagnosis of Autism from his doctor. Are they eligible for Special Education? Special Education Eligibility Evaluation purpose: Determination of eligibility for special education services. Development of individualized educational program to meet unique needs of student IDEA eligibility criteria used: Child meets the eligibility criteria Disability must adversely affect child s educational achievement/performance Medical/Clinical Diagnosis Evaluation purpose: Treatment planning DSM-5 criteria used: Child meets specific diagnostic criteria Differential diagnosis (Ruling in or out co-morbid conditions) A medical or clinical diagnosis based on DSM-5 is relevant but not sufficient to qualify a child for Special Education.

13 What does NASP Best Practices Say? A multidisciplinary approach should be utilized Parent/teacher/student interview Conduct behavioral observations across several environments The NASP Best Practices Series autism assessment authors recommend school psychologists utilize a structured autism observation method (e.g., ADOS-2) and autism-specific checklists or rating scales for school-based assessments Areas that are typically included in clinical and schoolbased evaluations are speech/language/communication, cognitive/intelligence, adaptive behavior, occupational therapy/sensory, behavioral, and academic Clark et al., 2014; Schwartz & Davis, 2014

14 Survey of Current Practices on School-Based Autism Assessments

15 Survey Contents Consisted of 50 questions- 49 close-ended questions and 1 open-ended question Created based on the NASP Best Practice series guidelines on autism assessments, California Code of Regulations for the autism eligibility criteria, California Statutes Education Code for assessment reports, and general impressions/practices of schoolbased autism assessments

16 Data Collection Procedures s were sent to CASP members from July to August 2016 The survey was on the CASP website for 7 weeks A total of 7 s were sent to CASP members to ask them to complete the survey

17 Demographic Characteristics

18 Autism Assessments Completed in the School Year

19 Current Assessment Practices for CA School Psychs

20 Parent, Teacher & Student Interview

21 Information gathered from outside service providers

22 Observations

23 What rating scales were used for autism assessments?

24 Other rating scales used

25 Scale used most frequently

26 Use of ADOS-2

27 Areas Assessed

28 Time Spent with Parents During the Evaluation

29 General Impressions

30 Litigious Reasons for ASD cases amount of services requested by parent/advocate/attorney; factors regarding the district (perception, relationship, and resources); factors regarding parents (resources, education level, grieving, understanding their rights/laws); outside agencies/professionals advocating for services deemed inappropriate per school district; adequacy of autism assessments.

31 Legal Trends/Case Law

32 OAH Case Search July 1, 2005-July 20, 2016 Search terms: Autism Assessment Best Practice A total of 233 cases were found 10 cases met the criteria- issues regarding the appropriateness of the psych eval 80% of the cases met the legal requirements

33 Discussion Considering the litigious reasons for ASD cases, discuss the follow questions with the person(s) seated next to you: 1. Did all of the cases include a parent interview? 2. How about the ADOS? 3. Was adaptive behavior assessed in each case?

34 Themes of OAH Cases Best Practices Terminology School Psychologist s Training and Expertise Inadequate Assessments

35 Best Practices Each case had a expert witness that discussed best practices Some judges sided with these best practices recommendations and stated not adhering to best practice did not render the psychoeducational assessment as legally noncompliant but other judges decided the case was inadequate if the psychologist did not follow best practice recommendations

36 School Psych s Training & Experience In the cases reviewed, the school psychologist s training and experience in administering autismspecific measures (i.e., ADOS-2) was challenged in two OAH cases Both psychs did not attend the ADOS-2 workshop ALJ deemed they were qualified to administer the ADOS-2 Not Recommended

37 Inadequate Assessments Two cases that found assessment inadequate: 1. The school psychologist did not adhere to best practice assessments per the testimony of a clinical psychologist 2. The school psychologist incorrectly used a rating scale and used terminology not included in the autism eligibility criteria when determining if a student qualified for special education services

38 Conduction Comprehensive Assessments We are evaluating A singular presentation of a global disorder Marilyn J. Monteiro, PhD Autism Conversations, 2013

39 A Comprehensive Assessment, according to IDEA, CA Education Code, NASP & APA Ethical Guidelines 1. Assessment tools are chosen and used so that they are not racially, sexually, or culturally discriminatory. 2. Assessments must be conducted in the language and form most likely to yield accurate information on what the student knows and can do academically, developmentally and functionally unless the assessment plan indicates why it is not feasible to provide or administer. 3. For students with Limited English Proficiency the assessment instruments are selected and administered in a manner that ensures that the assessment measures what is intended rather than the student s English language skills. 4. For students with sensory, motor, or speaking impairments the assessment instruments are selected and administered in a manner that ensures the assessment measures what is intended rather than the student s sensory, motor, or speaking skills.

40 A comprehensive assessment continued 5. Assessment tools and strategies are selected to provide information on the student s specific areas of educational need. 6. Assessment instruments are reliable and have been validated for the purposes for which they are going to be used. 7. Assessments are only conducted by qualified professionals. 8. No single measure or assessment is used as the sole criterion for determining whether a student has a disability. The assessment covers all areas related to the student s suspected disability and all areas of need. 9. A variety of assessment tools and strategies should be used to gather relevant functional and developmental information about a child. 10. Assessment results should be provided in written language that is understood by the consumer. 11. Reports should emphasize meaning and make recommendations that help the readers in their work with children

41 In summary The evaluation should be comprehensive use a variety of evaluation tools or approaches that gather functional and relevant data be fair use valid and reliable tools and procedures be completed by a competent evaluator be written into a report that is useful and understandable

42 Conceptualizing the Evaluation Cycle Assessment Planning Conduct Assessment Questions & Hypotheses Interpretation, Analysis & Synthesis of Data Intervention Services Treatment Eligibility/ Diagnosis

43 Common mistakes in ASD assessment Examiner not knowledgeable about general developmental milestones Not using multiple informants Using multiple informants, but not synthesizing/explaining similarities and differences Atypical behaviors in observations & other assessments are described as typical (over-normalizing ) Not "digging" deeper into student's perceptions of relationships Missing subtle symptoms that have a lasting impact Not taking history and/mental health issues into account Over-reliance on standardized assessments-no functional skills information Limited optimal or typical environmental observational opportunities Rigidity in thinking about what a child with ASD "looks like Confusion of educational achievement/performance Using measures that are not appropriate/valid/reliable

44 Commonly Used Tools for Autism Assessments *GARS-3 published in 2014 and non-gars published data not available for review.

45 Working Collaboratively to create a Comprehensive Autism Assessment

46 Collaboration During Assessment An interactive process where professionals work together and share their diversity of knowledge and expertise to define needs, plan, implement, assess and follow up on ways of helping children develop to their fullest. Private Student Service Providers Clinical/ Medical Providers Parent(s) Comprehensive Assessment Others who have specialized knowledge about the child Teachers School Service providers

47 Assessment Planning When reviewing records and making initial contact with families and teachers where ASD is a concern, ask yourself: What is the specific referral concern? (i.e., social interaction, cognition, behavior, language development)? Developmentally, what are the signs associated with ASD? If previous evaluations have been completed, are the findings valid and or useable? What eligibilities/diagnoses best explain the student s profile? What additional information is needed to determine the student s disabilities?

48 RIOT- Comprehensive Assessment Model Review Interview Test Observe

49 RIOT: Review Review: Preschool Records, School Cumulative Files & Health File, Prior Assessments, Outside Assessments and Treatment Summaries Signs of behavior patterns present in early childhood History of social communication/interaction deficits, Signs of other risk factors (e.g., siblings with autism, other family members with autism) Potential complicating factors

50 Developmental Milestones Resources CDC Birth to 5 milestones, videos, concern, Autism case training for professionals html CDC Autism signs and symptoms ml

51 RIOT: Interview Child ability to warm to interviewer and socially connect eye-contact, voice, restricted reciprocal interactions social experiences Parents structured developmental histories or more formalized questionnaires history of restricted/ repetitive behaviors and social communication in early years structured and semi-structured clinical interview format functional skills in the community and at home Teachers social communication self-advocacy/initiation behavior patterns of restricted interests and/or repetitive behaviors classroom adaptive skills academic achievement and performance

52 Parent input is crucial! Use both informal & structured interviews to gather information about Detailed developmental history Current adaptive functioning Behavioral concerns Communication delays and concerns Friendships/Social skills

53 Parent Interview: Open Ended? Examples What are your concerns? When did you first become concerned? How did your child s development differ from that of his siblings? How does he let you know when he needs something? How did he let you know when he first started communicating? Tell me about his imitation skills; does he spontaneously copy what you do or do you have to teach him? When did he begin imitating you? How did this look? What are his interests? What are his favorite toys and games? Describe what he did/does with toys and how he played/plays? (Probe for pretend, sequencing, variety, interactions with dolls, animal or action figures) When and how does he interact with others? How does he get along with his siblings?

54 Parent Interview Questions Cont. Tell me about his friendships and interest in other kids? How does he play with other kids? What does he look like at the park or recess? How does he respond when other children approach or invite him to play? How does he communicate his feelings to you and others? How does he respond to others when they are sad or upset? Describe any sensitivities (sound, touch, texture, food) and lack of sensitivity (pain, temperature). How does he respond to changes in routines and schedules? Are there any things he seems to have to do in a particular way or order? What motivates him/her? What do you enjoy doing together? What are his/her strengths? Special skills?

55 Teacher input is crucial! Strengths/concerns Behavioral concerns Communication delays and concerns Friendships/Social skills (classroom and recess) Attention Transitions between activities Generalizing skills and concepts Performing upon request Motivation to perform Classroom adaptive skills Problem solving skills Fine motor, writing, and drawing skills Understanding abstract concerns (reading comp, Common core math)

56 Interview : Rating Scales Adaptive Individuals with ASD have adaptive skill deficits Comprehensive Examples: Vineland-3, Adaptive Behavior Assessment Scale (ABAS-3) Social Communication and Skills Development Examples: Social Communication Questionnaire-Current or Lifetime (SCQ), Social Responsiveness Scale-2 (SRS-2), Social Skills Improvement System (SSIS)

57 Interview : Rating Scales cont Behavior and Social Emotional Functioning We are evaluating for behavioral difficulties and social skills though poor emotional regulation, limited coping strategies, self awareness, insight, ability to attend to others reactions / preferences, and flexibility may also impact overall mental health Broad Band Examples: Behavior Assessment System for Children- 3 (BASC-3), Child Behavior Checklist (CBCL), Social Skills Improvement System (SSIS), Beck Youth Inventories-2 (BYI-2) Singular Examples: Multidimensional Anxiety Scale for Children (MASC)

58 RIOT: Observations General: Observe the child in multiple settings over multiple days: arrival and departure, transitions, structured and unstructured activities, and classroom/non-classroom settings, with adults and peers Where are there problems? Why? Where is the child successful? Why?

59 Example: Observations Social Interaction & Communication Ability to initiate and sustain social interactions (reciprocal communication) Failure to initiate or respond Poorly integrated verbal and nonverbal communication Abnormalities in eye contact (too much or too little) Ability to express/read emotions Tone of voice Difficulty with idioms or pragmatic language One-sided conversation patterns Directing play Behavior Patterns Selected interests Need for routines/sameness Difficulty with transitions Fine and/or gross motor difficulties Stereotypical behaviors: flapping, rocking, posturing, etc. Other sensory seeking or stimulating behaviors

60 Systematic Direct Observations Informal (On your own ) Anecdotal/Naturalistic Time Sampling Event/Frequency Recording Environmental/Setting Formal (Published) BASC-2, Structured Observation System Behavior Observation of Students in School (BOSS) Childhood Autism Rating Scales-2 (CARS-2) Autism Diagnostic Observation Schedule-2 (ADOS-2)

61 Structured Observations: The ADOS-2? Why Use It? Psychometrically strong Pulls for ASD-specific behaviors Creates context to observe diagnostic behaviors Takes into account expressive language level and age of child Yields rich clinical data (qualitative & quantitative) Cautions Requires extensive training Requires practice and routine use Scores based on behavior exhibited during administration only Results in classification, not diagnosis Use of an incorrect module can result in over or under classification

62 RIOT: Test Standardized assessment tools alone will not be sufficient in diagnosing or assessing fully for ASD. Don't neglect the RIO! After Review-Interview-Observe (RIO), determine: What areas need to be directly assessed or test? How much formal/standardized testing is needed? How do we maximize the overall evaluations validity?

63 BUT STUDENTS WITH ASD TEND TO HAVE DIFFICULTY WITH ESSENTIAL TEST TAKING BEHAVIORS: Attention span Response on demand Imitation Motivation Desire to please

64 Assessment support tools and strategies Give Choices Visual Schedule Sticky Pads White Boards Timer Tally Marks First-Then cards Reinforcers/Sticker Charts Game/Play/Movement Breaks

65 Cognitive Assessment Selection All instruments are not created equally Choose a test that taps into the child s current abilities and developmental level Measure both verbal and nonverbal skills Look at the pattern of strengths and weaknesses

66 Cognitive Assessments Preschool Examples Differential Ability Scales-2, Early Years Mullen Scales of Early Learning Bayley Scales of Infant and Toddler Development-III (Bayley III) School Age Examples Differential Ability Scales-2, School Age Kaufman Assessment Battery for Children-2 (KABC-2) Wechsler Intelligence Scale for Children-5 (WISC-5) Woodcock Johnson-Tests of Cognitive Ability (WJ-3) School Age + Examples Stanford-Binet Intelligence Scales, Fifth Edition (SB-5) Leiter International Performance Scale-3 ( Leiter-3

67 Assessment Planning/Data Synthesis: Schoolbased organization of an assessment

68 Why is this important?

69 Individually Take a moment to think about your current practice or a recent case and fill in as much of the Assessment Planning/Data Synthesis matrix as possible.

70 In small groups, discuss What does your assessment of autism look like? What are you doing to support a comprehensive assessment? Model (Planning tool)? Convergent data? Multiple sources/informants? Is data relevant and functional? Supports intervention/treatment planning? What steps or changes can you make toward a more comprehensive evaluations? What will you take back to your school, team, and colleagues?

71 Questions, comments, concerns? Angela Davis Jeanne Anne Carriere Kelly Kennedy