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1
High Quality School-Based
Evaluations for ASD
Presenters:
Kelly Dunlap, Psy.S.
Stephanie Dyer, Ed.S.
AGENDA
• The New Reality in Evaluations for ASD
• Improving School-Based Evaluations for
ASD:
–CRITERIA
–TOOLS
–PROCESS
–REPORT
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1989 19901991 1992 199319941995 1996 199719981999 2000 200120022003 2004 200520062007 2008 200920102011 2012 2013
Nu
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Michigan Students with an ASD Eligibility
1,208
17,415
New Reality #1: More Kids
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
Age
Number of Michigan Students with ASD by Age* Based on 2013 MDE, OSE Eligibility Count
New Reality #2: More Players
• Autism Insurance Legislation – http://www.michigan.gov/autism
– http://autismallianceofmichigan.org/news-info/autism-legislation/
• The Autism State Plan – http://michigan.gov/autism
• The Autism Council
Autism Council
SUBCOMITTEES
Adult
Services Education
Early
Intervention
Screening and
Assessment /
ASD Eligibility
Determination
Workgroups
2
Current Players at the Table Special Education AIB
Private Insurance Medicaid / MIChild
Criteria ASD / MARSE ASD =DSM 5 / ADOS ASD =DSM 5 / ADOS
Plan for Evaluation REED/30-day timeline ------------------ -------------------
Who Evaluates Evaluation Team: Psych,
SSW, Speech
Licensed psych or physician CMHP
Using What Tools Prescriptive for Child /
Purpose
“autism diagnostic
observation schedule”
(e.g. ADOS-2)
Must include ADOS-2
Developmental Family
History (e.g. ADI-R),
cognitive & adaptive
Determination of ASD IFSP / IEP Team
Determines Impairment
Diagnosis of Condition for
Eligibility
Diagnosis of Condition for
Eligibility
Eligibility for Services IFSP / IEP Team Treatment prescribed or
ordered by evaluator
CMHP + Medicaid Agency
final approval
Service Plan IFSP / IEP Treatment Plan developed by
board certified or licensed
provider
IPOS developed through
PCP process
Types of Services IFSP=Early Intervention
services; IEP=SE, RS,
and SAS
Behavioral Health,
Pharmacy, Psychiatric,
Psychological, Therapeutic
ABA
(EIBI and ABI)
Acronym Desriptions
• SE = Special Education
• ASD = Autism Spectrum Disorder
• MARSE = Michigan Administrative
Rules for Special Education
• REED = Review of Existing
Evaluation Data
• MET = Multidisciplinary Evaluation
Team
• IFSP = Individual Family Service
Plan
• IEP = Individualized Educational
Program
• SAS = Supplementary Aids and
Services
• P&S = Programs & Services
• FAPE = Free and Appropriate Public
Education
• LRE = Least Restrictive
Environment
• AIB = Autism Insurance Benefit
• DSM = Diagnostic and Statistical
Manual of Mental Disorders
• PDD-NOS = Pervasive Developmental
Disorder – Not Otherwise Specified
• ADOS = Autism Diagnostic
Observation Schedule
• ADI = Autism Diagnostic Interview
• CMHP = Child Mental Health
Professional
• PCP = Person-Centered Plan
• IPOS = Individual Plan of Service
• ABA = Applied Behavioral Analysis
• EIBI = Early Intensive Behavioral
Intervention
• ABI = Applied Behavioral Intervention
• ABLLS = Assessment of Basic
Language and Learning Skills
• VB-MAPP = Verbal Behavioral
Milestones Assessment and
Placement Program
More Players = Herding Cats New Reality #3
Increase in Complexity of the Disorder
• Common Comorbid Conditions:
– Seizures and epilepsy
– Anxiety
– Depression
– Attention difficulties
– Bipolar Disorder
– Obsessive Compulsive
• Some are considered part of ASD, so when is
condition at a level that warrants an different or
additional dx?
New Reality in Evaluations for ASD
• Potential increase in referrals
• Potential increase in pressure to
accept clinical diagnoses
• Increased need for collaboration
across systems
Ensure high quality special education
eligibility evaluations for ASD
(i.e. Clean up our own backyard!)
So, where do we start?
3
Improving School
Evaluation Processes
• All staff need to be competent at ASD
screening / evaluation
• Current Issues: – Not recognizing there are THREE required eligibility areas
– Not recognizing that “educational impact” can be in one of
THREE areas (e.g. academic, behavior, social)
– Use of tools with no observational data
– Not understanding terms:
• Pervasive
• Marked
• Qualitative
• Adverse Impact
CRITERIA
TOOLS
PROCESS
REPORT
Components of High Quality School-Based
Evaluations for ASD Eligibility
“There is no single behavior
that is always typical of
Autism and no behavior that
would automatically exclude
an individual child from a
diagnosis of Autism.”
National Research Council
Special Education Eligibility
Determination is a 3-Pronged Process
• Student meets the MARSE
eligibility CRITERIA,
• Disabling condition has an
IMPACT on student’s
education,
• Impact is so great it requires
SPECIAL EDUCATION
MICHIGAN DEFINITION OF AUTISM SPECTRUM DISORDER
1. Considered a lifelong developmental disability that adversely affects a student’s educational performance in 1 or more of the following areas: (IMPACT and NEED for SPECIAL EDUCATION--prongs 2 and 3)
a) Academic (e.g. ability to meaningfully participate and progress in the
general curriculum including lack of initiation, impaired quality of
participation, low grades, etc.)
(b) Behavioral (e.g. disruption, aggression, lack of appropriate
engagement, eloping, tantrums, etc.)
(c) Social (e.g. ability to develop and maintain relationships/friendships,
responses to social situations that alienates others and diminishes
acceptance, etc.)
(a) Academic
4
MICHIGAN DEFINITION OF AUTISM SPECTRUM DISORDER
2. Characterized by qualitative impairments in:
Reciprocal Social Interactions
Communication
Restricted Range of Interests / Repetitive Behavior
“QUALITATIVE”
• Atypical
• Significantly different from other students at
the same age and developmental level
• Outside the typical sequence of
development
• Across all environments.
• Presence and Absence
• Unique to each Student
MICHIGAN DEFINITION SOCIALIZATION (A) QUALITATIVE IMPAIRMENTS IN RECIPROCAL SOCIAL
INTERACTIONS INCLUDING AT LEAST 2 OF THE FOLLOWING AREAS:
(i) Marked impairment in the use of multiple nonverbal behaviors
such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.
(ii) Failure to develop peer relationships appropriate to developmental level.
(iii) Marked impairment in spontaneous seeking to share enjoyment, interests, or achievements with other people, for example, by a lack of showing, bringing, or pointing out objects of interest.
(iv) Marked impairment in the areas of social or emotional reciprocity.
RECIPROCAL SOCIAL INTERACTION
A mutual exchange
(e.g. of words, actions, or feelings).
RECIPROCAL SOCIAL INTERACTION AT LEAST 2 OF THE FOLLOWING 4
(i) Marked impairment in the use of multiple nonverbal
behaviors such as eye-to-eye gaze, facial expression,
body postures, and gestures to regulate social
interaction.
• Marked = Substantial & Sustained; Clearly Evident:
Behaviors are distinctive and noticeably different
from same-aged peers
• FUNCTION of Nonverbal Behavior
RECIPROCAL SOCIAL INTERACTION AT LEAST 2 OF THE FOLLOWING 4
Failure to develop peer relationships
appropriate to developmental level
• Social Skill Deficit vs.
Reciprocal Incapacities
Typical of ASD
• Theory of the Mind
• Sally Anne Experiment
5
THEORY OF MIND
Ability to attribute mental
states to oneself and others
and to understand that others
have beliefs, desires, and
intentions that are different
from one’s own
This ability (theory of mind) dominates the perception of
typical people to such a degree that we become
anthropomorphic and project human social behaviour on
animals and even objects. (Michelle Garcia, 11-08)
Anthropomorphic--Allstate RECIPROCAL SOCIAL INTERACTION
AT LEAST 2 OF THE FOLLOWING 4
(ii) Failure to develop peer relationships appropriate to
developmental level.
• Impaired perspective taking: viewing situations
from another’s point of view and predicting other’s
behavior
• Examples: not understanding humor / jokes,
disrupting activities (play), rarely initiates or
sustains interaction, tolerates peers but not
engaged in interaction
MICHIGAN DEFINITION SOCIALIZATION (A) QUALITATIVE IMPAIRMENTS IN RECIPROCAL SOCIAL
INTERACTIONS INCLUDING AT LEAST 2 OF THE FOLLOWING AREAS:
(i) Marked impairment in the use of multiple nonverbal behaviors
such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.
(ii) Failure to develop peer relationships appropriate to developmental level.
(iii) Marked impairment in spontaneous seeking to share enjoyment, interests, or achievements with other people, for example, by a lack of showing, bringing, or pointing out objects of interest.
(iv) Marked impairment in the areas of social or emotional reciprocity.
AUTISM, THE CHILD: JOINT ATTENTION CAUTION: USE OF “R” WORD
6
COMMUNICATION AT LEAST 1 OF THE FOLLOWING 4
(i) Delay in, or total lack of, the development of spoken language not accompanied by an attempt to compensate
(ii) Impairment in Pragmatics:
(iii) Stereotyped / repetitive use of language / idiosyncratic
(iv) Lack of varied / spontaneous make-believe play or social imitative play
• Precursor to symbol development needed in language
COMMUNICATION
(ii) Impairment in Pragmatics:
The ability to initiate, sustain, or engage in reciprocal conversation with others
a. Using language for varying purposes (e.g. greeting, informing, promising, requesting, etc.)
b. Changing language according to the needs of the listener or situation (e.g., giving background information to an unfamiliar listener, speaking differently in a classroom than on a playground)
c. Following rules of conversations and storytelling (e.g., taking turns in conversation, staying on topic, rephrasing when misunderstood, proximity, use of eye contact
COMMUNICATION
(iii) Stereotyped / repetitive use of language / idiosyncratic
• Idiosyncratic = contextually irrelevant or not understandable to the listener; may have private meaning / be understood by the speaker or to those familiar to the situation (e.g. movie lines)
• Can include:
• Echolalia
• Repeat videos / scripts
• Nonsense language
• Verbal Fascinations
RESTRICTIVE, REPETITIVE, STEREOTYPED BEHAVIORS
AT LEAST 1 OF THE FOLLOWING 4
(i) Encompassing preoccupation with 1 or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus.
• DISTRESS OVER DISRUPTION
(ii) Apparently inflexible adherence to specific, nonfunctional (e.g. no purpose) routines or rituals.
(iii) Stereotyped and repetitive motor mannerisms, for example, hand or finger flapping or twisting, or complex whole-body movements.
(iv) Persistent preoccupation with parts of objects.
MICHIGAN DEFINITION OF AUTISM SPECTRUM DISORDER
1. Considered a lifelong developmental disability that adversely affects a student’s educational performance. 2. Characterized by qualitative impairments in:
a. Reciprocal Social Interactions, b. Communication c. Restricted, Repetitive, & Stereotyped Behaviors
3. Determination may include unusual or inconsistent response to sensory stimuli in combination with a, b, and c, above. 4. There shall not be a primary diagnosis of schizophrenia or emotional impairment. 5. Determination shall be based on up a full and individual evaluation by a MET including a psychologist (or psychiatrist), authorized provider of speech and language, and a school social worker.
CRITERIA
TOOLS
PROCESS
REPORT
Components of High Quality School-
Based Evaluations for ASD Eligibility
7
EVALUATION METHODS / TOOLS
Predominately
Observations and Interviews
Evidence of presence / absence
of behaviors across settings
Is the ASD dominating the
child’s interaction with the environment?
“JUST THE FACTS”— examples / non-examples
NOT interpretation!!! <that meeting is coming!!>
Observations in Context The Tip of the Iceberg Analogy
• The tip is the observable
behavior;
• The context cues us into
what underlies the
behavior (e.g.
motivation, intent,
function)
• Function = Differential
Eligibility
Public School Investigator
• All team members MUST conduct observations
• Multiple settings, days, & times
• Contextual Observation
– Interaction with other students
– Others in response to the student
– Transitions
• INVESTIGATE: Dig down below the surface
• PARTICIPATE to get more detailed information
• CONDUCT mini experiments to see the impact or
response
CET DIRECT OBSERVATION QUADRANT
“EYES ON KID”
Qualitative Impairment
in Communication
Qualitative Impairment
in Reciprocal Social
Interaction
Restrictive, Repetitive
and Stereotyped
Behaviors
Sensory
ASD EVALUATION TEAM – RESULTS REVIEW MEETING TEMPLATE
SOCIAL: Qualitative impairments in reciprocal social interactions including at least 2 of the following 4 areas:
SOCIAL 1
Marked impairment in use of multiple nonverbal behaviors to regulate social interactions 3/4
Parent
Teacher
Evaluation Team
SOCIAL 2
Failure to develop peer relationships appropriate to developmental level.
Parent
Teacher
Evaluation Team
CHAR-EM ELIGIBILITY GUIDELINES
8
CAUTION: Attribution Theory
ASD EI / SM
? ?
Identifying Underlying Issue
Antecedents Behavior Consequence
Context Context
Underlying ASD: Underlying EI / SM: --Deficits in Social Reciprocity --Emotional Dysfunction
--Deficits in Theory of Mind --Abuse / Trauma
--Communication Deficits --Mental Health Dx
--Restrictive / Repetitive Behavior --Risk Factors (e.g. SES)
ASD vs. EI / SM
• BEHAVIORS:
– Refusal to do academic work
– Not following school expectations / rules
– Aggression toward peers
• DISTINGUISH BETWEEN:
– I don’t care about your rule vs. I don’t understand the
rules and the rules frequently change;
– ODD vs. I already know how to do this and if I know,
then you should know;
– I don’t care about your thoughts or feelings vs. I
don’t understand you have different thoughts or
feelings from me.
EVALUATION METHODS / TOOLS
• What about standardized tests?: “No test or rating scale
should be used as the sole criterion... Instead,
consideration should be given to the student’s
developmental history, systematic direct observation…,
and interview information with various individuals who
know the student well. “ (CALL)
• What question is the tool/test going to answer for you?
• Most tools don’t match MARSE rules
• Impact (2nd prong): NO tool can provide information
on the impact
SUPPORTING EVIDENCE
•Checklists
•Interview Forms
•Direct Assessment Tools
• Sample
• Reliability
• Validity
• EXAMPLE: ADOS-2: • Test / Re-test Reliability—2 Weeks:
• Classification changed for 9 of the 39 children
(23%)
Technical Adequacy
9
Assessment Tools
Central Assessment Lending Library (CALL)
https://www.cmich.edu/colleges/chsbs/Psychology/call
/pages/default.aspx/
• ASIEP-3: Autism Screening
Instrument for Educational
Planning
• ADOS-2 (Autism Diagnostic
Observation Schedule)
• ADI-R: Autism Diagnostic
Interview
• CARS-2: Childhood Autism
Rating Scale
• GARS-2: Gilliam Autism
Rating Scale
• GADS: Gilliam Asperger
Disorder Scale
• KADI: Krug Asperger Disorder
Index
• PEP-3: Psycho-Educational
Profile
• ABLLS-R: Assessment of
Basic Language and Learning
Skills
• VB-MAPP: Verbal Behavior –
Milestones Assessment and
Placement Program
CRITERIA
TOOLS
PROCESS REED PROCESS----
• Gathering Information
• Integrate Qualitative and Quantitative Information
• Differential Eligibility
• Team-based Decision-Making
REPORT
Components of High Quality School-
Based Evaluations for ASD Eligibility
• Review available information: • Clinical Diagnostic Reports (e.g. ADOS)
• Previous Assessments / Observations
• Determine if the information is sufficient to
make a determination of eligibility
• If not, determine what else is needed to make
a determination of eligibility: • Observations to determine impact on educational
performance
• Establish a plan for gathering the additional
information.
Purpose of the REED CET
Components
Selected
TEAM TEAM
TEAM TEAM
Evaluations are
conducted as a
team!
☺ Collaboration
☺ One voice
☺ One contact
☺ One report
Minimum:
Psych, SSW, SLP…
Collaborative Team Approach
10
Evaluation Checklist Meeting
• Occurs AFTER the REED (or during)
• Attended by assessment team members
(Psych, SSW, SLP)
• Critical for coordination of scheduling (ie.
IEP, RRM, observations…)
• Discussion and assignments of evaluation
components (evaluation checklist)
• Allows time for training, questions, case
study, problem solving
Non-Negotiable
Evaluation Components
• Parent/Family Interview(s) and Home Visit
• Teacher/Service Provider Interview(s)
• Observations (Multiple Times/Settings by all
team members)
• ADOS (Viewed/scored by TEAM)
• Other Information as Determined by
Evaluation Team
Results Review Meeting
• Only Eval Team present (Psy, SSW, SLP)
• List all 12 criteria on board
• Color code information (teacher, parent, eval team)
• Ask BIG question in each area: Is there a qualitative impairment in socialization?...
• Discuss each criterion; check criterion that has been reached
• Report writer (on computer)
Data Analysis? Determining Eligibility
• Start with the child, not the
characteristics
• Integrate quantitative & qualitative
information
• Within qualitative assessment,
discover whether student meets
criteria for Autism Spectrum Disorder
• “Preponderance of the evidence”
11
DIFFERENTIAL ELIGIBILITY
• Don’t you think its ___________________?
• What do we ask?
EI CI
Preponderance of Evidence Compare & Contrast
The Results Review Meeting
Social Communication OTHER
Behavior Sensory
Preponderance of Evidence Compare & Contrast Developmental History
ASD EI
• Developmental delays (e.g.
language, joint attention)
• Uneven development
• Unusual skills / interests (e.g.
door hinges, refrigerator letters
– making words)
• Ritualistic
• Nuance in restricted nature /
rituals
• Sophistication above
developmental level
• Family history / concerns
• Hyperactivity
• Emotional extremes outside
typical developmental norms
CAUTION: Wrong Dx
Preponderance of Evidence
Compare & Contrast Characteristics Making a Final Decision
• Preponderance of Evidence
• No one behavior includes or excludes
any specific eligibility area: – There are always going to be instances that don’t fit
the criteria!!
– MUST explain what does not align
– MUST build a case for your conclusion
– However & Despite
• Intelligent People can Disagree!!
12
CRITERIA
TOOLS
PROCESS
REPORT
Components of High Quality School-
Based Evaluations for ASD Eligibility Critical Report Considerations
• Customize to the MET Form
• Details are important – Define characteristics that
either support the eligibility of ASD or do not.
• Build a case for your conclusion (e.g. you shouldn’t
get to end and question eligibility recommendation)—
Persuasive Writing Skills
• Avoid “cut and paste” from each evaluators report
(makes it challenging to cohesively build a case)
• Explain what does NOT align (e.g. standardized scores,
parent reports of behaviors, etc.)
Contextualized Report Structure REPORT ORGANIZATION
Don’t let the barriers paralyze you…