Psychological Assessment For Children With Neurodevelopmental Disorders and Autism Rose M. Alvarez-Salvat, Ph.D.

Psychological Assessment For Children With Neurodevelopmental Disorders and Autism Rose M. Alvarez-Salvat, Ph.D.

What is a Developmental Delay? Milestones are not reached at expected times An ongoing major or minor delay in the process of development Delay can occur in one or many areas gross or fine motor, language/ communication, social, cognitive, adaptive skills Source: Boyse, Kyla. (2010, February). "Developmental Delay: Your Child. YourCHILD: Development and Behavior Resources. University of Michigan Health System. Retrieved October 25, 2013 from. <http://www.med.umich.edu/yourchild/topics/devdel.htm>.

Deviations: What Might They Indicate? Potential Causes Genetic Complications of pregnancy (prematurity, infections) Neurological Environmental Infections Lead poisoning Unknown Potential Disorders or Conditions Down Syndrome Fetal Alcohol Syndrome Fragile X Hearing/visual deficits Autism Spectrum Disorders Learning Disability Trauma, abuse or neglect Intellectual disability Prader-Willi Syndrome

What percentage of children have a developmental or behavioral disability? Developmental disabilities occur among all racial, ethnic, and socioeconomic groups. Recent estimates in the United States show that about 1 in 6, or about 15%, of children aged 3 through 17 years have a one or more developmental disabilities, such as: autism, intellectual disability, and Attention-Deficit Hyperactivity Disorder and other developmental delays. In addition, many children have delays in language or other areas, which also impact school readiness. However, less than 50% of these children are identified as having a problem before starting school, in this time significant delays may have already occurred and opportunities for treatment have been missed. National Center on Birth Defects and Developmental Disabilities. Developmental Screening. Centers for Disease Control and Prevention. Retrieved October 27, 2013 from http://www.cdc.gov/ncbddd/childdevelopment/screening.html

Benefits of Early Intervention Neurological evidence suggests that the brain s plasticity during early childhood allows for the creation of new neural connections that yield new behaviors and skills Provides parents social support that can in turn reduce family stress and foster family cohesion Provides parents strategies that can support their child s development

Early Screening AAP recommends that developmental surveillance be incorporated at every well-child preventive care visit. Any concerns raised during surveillance should be promptly addressed with standardized developmental screening tests. In addition, screening tests should be administered regularly at the 9-, 18-, and 24- or 30-month visits.

Red Flags by 6 months No big smiles or other warm, joyful expressions No babbling Not raising head and chest when on stomach Not visually following moving objects Can t grasp objects

Red Flags by 12 months Doesn't crawl or drags one side of body while crawling Can't stand when supported Doesn't search for objects that he/she sees being hidden Says no single words Doesn't use gestures Doesn't point to objects or pictures Can't walk (by 18 months) Doesn't walk heel-toe within a few months of walking

Red Flags at 24 months Doesn't speak at least 15 words Doesn't use two-word phrases Doesn't imitate actions or words Doesn't follow simple instructions Can't push a wheeled toy Seems disinterested in engaging with others

By 4 years Cooperates with other children; is increasingly inventive in fantasy play Names some colors; understands concepts of counting and time Speaks in sentences of five to six words Tells stories; speaks clearly enough for strangers to understand Follows three-part commands; understands "same" and "different" Can copy a cross and a square Can catch a bounced ball Hops on one foot 2 or 3 times Writes part of first name

Red Flags (for ASD) No big smiles or other warm, joyful expressions by six months or thereafter No back-and-forth sharing of sounds, smiles or other facial expressions by nine months No babbling by 12 months No back-and-forth gestures such as pointing, showing, reaching, or waving by 12 months No words by 16 months No meaningful, two-word phrases (not including imitating or repeating) by 24 months Any loss of speech, babbling or social skills at any age

Diagnosis for Autism Spectrum Disorder A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by: 1. Deficits in social-emotional reciprocity 2. Deficits in nonverbal communicative behaviors used for social interaction 3. Deficits in developing, maintaining, and understanding relationships (sharing, making friends, adjusting behavior, etc.) B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least 2 of the following: 1. Stereotyped or repetitive motor movements, use of objects, or speech (echolalia, lining up toys, idiosyncratic phrases) 2. Insistence on sameness, inflexible adherence to routine or ritualized patterns 3. Highly restricted fixated interests that are abnormal in intensity or focus 4. Hypo- or hyperactivity to sensory input or unusual interest in sensory aspects of environment (pain/ temperature, sounds/ textures, smelling/ touching/ lights, etc.)

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities) D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning E. These disturbances are not better accounted for by intellectual disability or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur (social communication should be below that expected for general developmental level).

Severity Level for Autism Spectrum Disorder Level 1- Requiring support Level 2- Requiring substantial support Level 3- Requiring very substantial support

Developmentally Delayed (DD): Ages Three through Five Years Definition A prekindergarten child with disabilities is a child who is below five (5) years of age on or before September 1 and has a sensory, physical, mental, or emotional condition which significantly affects the attainment of normal developmental milestones. A child who is developmentally delayed is three (3) through five (5) years of age and is delayed in one (1) or more of the following areas: 1.Adaptive or self-help development, 2.Cognitive development, 3.Communication development, 4.Social or emotional development, 5.Physical development including fine, or gross, or perceptual motor. This definition is found in State Board of Education Rule 6A-6.03027, F.A.C.

Developmentally Delayed (DD): Ages Three through Five Years (1) A prekindergarten child with disability is a child who meets the following criteria: (a) The child is below three (3) years of age and meets criteria for eligibility specified for intellectual disabilities in accordance with Rule 6A-6.03011, F.A.C.; deaf or hard of hearing in accordance with Rule 6A-6.03013, F.A.C.; visually impaired in accordance with Rule 6A-6.03014, F.A.C.; orthopedically impaired in accordance with Rule 6A-6.030151, F.A.C.; other health impaired in accordance with Rule 6A-6.030152, F.A.C., traumatic brain injury in accordance with Rule 6A-6.030153, F.A.C.; dual sensory impaired in accordance with Rule 6A-6.03022, F.A.C.; autism spectrum disorder in accordance with Rule 6A-6.03023, F.A.C.; an established condition in accordance with Rule 6A-6.03030, F.A.C.; or developmentally delayed in accordance with Rule 6A- 6.03031, F.A.C. (b) The child is three (3) through five (5) years of age and meets criteria for eligibility specified for intellectual disabilities in accordance with Rule 6A-6.03011, F.A.C.; speech impaired in accordance with Rule 6A-6.03012, F.A.C.; language impaired in accordance with Rule 6A-6.030121, F.A.C.; deaf or hard of hearing in accordance with Rule 6A-6.03013, F.A.C.; visually impaired in accordance with Rule 6A-6.03014, F.A.C.; orthopedically impaired in accordance with Rule 6A-6.030151, F.A.C.; other health impaired in accordance with Rule 6A-6.030152, F.A.C.; traumatic brain injury in accordance with Rule 6A-6.030153, F.A.C.; emotional or behavioral disabilities in accordance with Rule 6A-6.03016, F.A.C.; specific learning disabilities in accordance with Rule 6A-6.03018, F.A.C.; homebound or hospitalized in accordance with Rule 6A-6.03020, F.A.C.; dual sensory impaired in accordance with Rule 6A-6.03022, F.A.C.; autism spectrum disorder in accordance with Rule 6A-6.03023, F.A.C.; or developmentally delayed in accordance with Rule 6A-6.03027, F.A.C. http://www.fldoe.org/academics/exceptional-student-edu/early-education/ages-three-through-five.stml

Intellectual Disability Intellectual Disability (Intellectual Developmental Disorder) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. Criteria to be met: A. Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing. B. Deficits in adaptive functioning (communication, social participation, and independent living, across multiple environments- such as home, school, work, and community.) C. Onset of intellectual and adaptive deficits during the developmental period.

Specific Learning Disorder Difficulty learning and using academic skills with symptoms that have persisted for at least 6 months, despite the provision of interventions that target those difficulties The affected academic skills are substantially and quantifiably below those expected for the individual s chronological age and cause significant interference with academic performance The learning difficulties begin during the school-age years but may not become fully manifest until demands for those affected academic skills exceed the individual s limited capacities The learning difficulties are not better accounted for by other disorders (ex. visual acuity, lack of proficiency with language)

Specific Learning Disorder: A. With Impairment in Reading (Word Reading Accuracy, Reading Rate or Fluency, Reading Comprehension) B. With Impairment in Written Expression (Spelling Accuracy, Grammar and Punctuation Accuracy, Clarity or Organization of Written Expression) C. With Impairment in Mathematics (Number Sense, Memorization of Arithmetic facts, Accurate or Fluent Calculation, Accurate Math Reasoning)

Developmental Cognitive Visualmotor/ Language ADOS-2 DAS Beery VMI WJ-IV ACH Bateria Bayley Battelle-II Leiter PPVT-2 EVT-2 CELF-5 Bender WAIS WJ-IV Oral Lang CARS-2 ASRS SRS ADI-R Denver LAP-D Mullen Academic Neuropsych Emotional and behavioral WASI CTOPP-2 GORT-5 Grooved Pegboard WISC-V WISC Spanish WJ-IV Cognitive Bateria Personality Adaptive BRIEF BASC-3 MMPI-2 Vineland-II Bracken CPT CBCL MMPI-A SIB-R CTOPP-2 DKEFS CDI-2 MCMI ABAS-3 Conners-3 WRAT NEPSY MASC-2 TAT WIAT-III Stroop Roberts-2 Vineland-II WPPSI-IV WRAML Wisconsin Card Sorting Sentence Completion Rorschach

Referrals in the Community Early Steps State and federally funded program for eligible children ages 0-3 Provides evaluations and connects families to recommended services Florida Diagnostic & Learning Systems (FDLRS) State funded program for children ages 3-5 Provides pre-school screening for children who exhibit delays Partners with Miami-Dade County Public Schools Psychologists who offer psycho-developmental/ pyscho-ed/ neuropsych testing (Nicklaus Children s Hospital ) Center for Autism and Related Disabilities/ University of Miami and Nova (CARD) Provide outreach and support program For children and families with autism, developmental disorders, sensory impairments Parent to Parent of Miami- Community Parent Resource Center State and federally funded program Provides education and supportive services