kelly dunlap, psy.s stephanie dyer, ed.s. education-based evaluations for asd

KELLY DUNLAP, PSY.SSTEPHANIE DYER, ED.S.

EDUCATION-BASED EVALUATIONS FOR ASD

AGENDA

• The New Evaluation Reality• The Three Prongs of

Educational Eligibility• Process Components

• REED• Evaluation Components• Determination of Eligibility

(Results Review Process)• Evaluation Report• IEP

• Differential Eligibility Considerations

New Reality:MORE KIDS

NEW REALITY: MORE PLAYERS

• Autism Insurance Legislation• http://www.michigan.gov/autism • http://autismallianceofmichigan.org/news-info/a

utism-legislation/

• The Autism State Plan• http://michigan.gov/autism

• The Autism Council

http://www.michigan.gov/autism

http://www.michigan.gov/autism

http://autismallianceofmichigan.org/news-info/autism-legislation/



http://michigan.gov/autism

MICHIGAN AUTISM COUNCIL

• Purpose: Implementation of the Autism State Plan

• Autism State Plan: http://michigan.gov/autism

• Subcommittee Work• Early identification and

intervention• Adults services and supports• Education

http://michigan.gov/autism

AUTISM COUNCIL

SUBCOMITTEES

Adult Services

Education

Early Interventio

n

Screening and Assessment / ASD Eligibility Determination

Workgroups

CURRENT PLAYERS AT THE TABLESpecial Ed Autism Insurance Benefit (AIB)

Private Insurance Medicaid / MIChild

Criteria ASD / MARSE ASD = Autistic Disorder, AS, PDD-NOS

(DSM IV)

ASD = Autistic Disorder, AS, PDD-

NOS (DSM IV)

Plan for Evaluation

REED / Timeline ------------------ -------------------

Who Evaluates Psych, SSW, SLP

Licensed Psych or Physician

CMHP

Using What Tools

Prescriptive for Child / Purpose

Must include an “Autism Diagnostic

Observation Schedule” (e.g. ADOS-2)

Must include ADOS-2and Developmental Family History (e.g.

ADI-R)

Determination of Impairment /

Diagnosis

IFSP / IEP Team Determines Impairment

Diagnosis of Condition Diagnosis of Condition

Eligibility for Services

IFSP / IEP Team determines

adverse impact

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 DECIPHERING TOOL

• 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

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 quality special education eligibility evaluations for ASD

(i.e. Clean up our own backyard!)

So, where do we start?

NEW REALITY: MORE COMPLEXITY

• 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?

•NO OPINIONS

•ALL DECISIONS INFORMED BY….• THE LAW• THE RESEARCH• THE DATA

Today’s Guiding Principle

WARNING

•I heard that….•I was told….

PRACTICE IS NOT NECESSARILY LAW, POLICY, or RULE

WE MUST ENSUREQUALITY EVALUATIONS

• 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:

• Marked• Qualitative• Adverse Impact

AGENDA



• REED• Evaluation Components• Determination of Eligibility• Evaluation Report• IEP


THE THREE PRONGS OF ELIGIBILITY

•CRITERIA

•IMPACT

•NEED

“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.” (NRC)

PREPONDERANCE OF EVIDENCE(Dave Schoemer)

GUIDING PRINCIPLE

Continuum of Skills for Individuals with Autism

Severe MR Gifted Aloof Passive Active/Odd Non-verbal Verbal Awkward Agile Hyposensitive Hypersensitive

The Advocate (2003)

Measured IQ

Social Interaction

Communication

Motor Skills Fine & Gross

Sensory

AUTISM SPECTRUM DISORDER TRIAD

Qualitative Impairments

In CommunicationQualita

tive Impairm

ents

in Reciprocal

Social Interaction

Restrictive, Repetitive & Stereotyped

Behavior

ASD

DSM-V CHANGE: ASD

Persistent Deficits in Social

Communication & Social Interaction

Restricted & Repetitive Patterns

of Behavior

SEVERITY RATING LEVELS 1-3: 3 = Requiring very substantial support1 = Requiring support

ELIGIBILITY VS DIAGNOSIS

MICHIGAN DEFINITION

OF ASD

DEPARTMENT OF EDUCATION / STATE BOARD OF EDUCATION SPECIAL EDUCATION PROGRAMS AND SERVICES

Filed with the Secretary of State on 9-7-04, and take effect on 9-15-04.

R 340.1715 Autism spectrum disorder defined; determination. Rule 15. (1) Autism spectrum disorder is considered a lifelong developmental disability that adversely affects a student’s educational performance in 1 or more of the following performance areas:

(a) Academic. (b) Behavioral. (c) Social.

Autism spectrum disorder is typically manifested before 36 months of age. A child who first manifests the characteristics after age 3 may also meet criteria. Autism spectrum disorder is characterized by qualitative impairments in reciprocal social interactions, qualitative impairments in communication, and restricted range of interests/repetitive behavior. (2) Determination for eligibility shall include all of the following:

(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.

(b) Qualitative impairments in communication including at least 1 of the following: (i) Delay in, or total lack of, the development of spoken language not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime. (ii) Marked impairment in pragmatics or in the ability to initiate, sustain, or engage in reciprocal conversation with others. (iii) Stereotyped and repetitive use of language or idiosyncratic language. (iv) Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.

(c) Restricted, repetitive, and stereotyped behaviors including at least 1 of the following: (i) Encompassing preoccupation with 1 or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus. (ii) Apparently inflexible adherence to specific, nonfunctional 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.

(3) Determination may include unusual or inconsistent response to sensory stimuli, in combination with subdivisions (a), (b), and (c) of subrule 2 of this rule. (4) While autism spectrum disorder may exist concurrently with other diagnoses or areas of disability, to be eligible under this rule, there shall not be a primary diagnosis of schizophrenia or emotional impairment. (5) A determination of impairment shall be based upon a comprehensive evaluation by a multidisciplinary evaluation team including, at a minimum, a psychologist or psychiatrist, an authorized provider of speech and language under R 340.1745(d), and a school social worker.

MICHIGAN DEFINITION OF AUTISM SPECTRUM DISORDER

Characterized by qualitative impairments in:

a. Reciprocal Social Interactions

b. Communication

c. Restricted Range of Interests / Repetitive Behavior

“QUALITATIVE”

• Markedly 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



Reciprocal Social Interactions

Communication

Restricted Range of Interests / Repetitive Behavior

RECIPROCAL SOCIAL INTERACTION

A mutual exchange (e.g. of words, actions, or

feelings).

RECIPROCAL SOCIAL INTERACTIONAT 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; Distinctive and noticeably different from same-aged peers

• PURPOSE of Nonverbal Behavior

•EXAMPLES:• Seems to look “through” a person, lacks eye contact to

initiate or sustain interaction, has fleeting or inconsistent eye contact

• Lacks emotion or appropriate facial affect for the social situation, lacks accurate facial expression to reflect internal feelings, facial expressions seem rehearsed or mechanical

• Difficulty maintaining appropriate body space, awkward/stiff response or movement, gait challenges

• Lacks understanding of the use of nonverbal cues (e.g. pointing, head nod, waving), does not respond to communication partner signals to start or end a conversation


(ii) Failure to develop peer relationships appropriate to developmental level.

---NOTE: that results from deficits in social reciprocity and

inability to understand the perspectives of others, another’s point of view, or predict another’s

behavior.

•Examples:• Lack of understanding of age-appropriate humor and jokes• Disruption of ongoing activities when entering play or social circles• Lack of initiation or sustained interactions with others• Preference to play alone• Continuous failure in trying to understand the social nuances and

follow the social rules• Desire for friendships but with multiple failed attempts• Misinterpretation of social cues or communication intent of others• Tolerance of peers but no engagement in conversation or activity• Confusion with the telling of lies• Policing peers (e.g. reporting rule infractions on the playground)

THEORY OF MIND

(ToM) means the ability to recognize and understand thoughts, beliefs, desires and intentions of other people in order to make sense of their behavior and predict what they are going to do.(Atwood, 2007)

TOM—ability to understand the feelings, intentions and perspectives of others and recognize that they are different from our own.

Experts on people

Experts on things

birth

Normal

ASD

DEVELOPMENTAL TRAJECTORIES

(iii) Marked impairment in spontaneous (i.e. without prompting) seeking to share enjoyment, interests, or achievements with other people, for example, by a lack of showing, bringing, or pointing out objects of interest. (i.e. Joint / Shared Attention)

•Examples:• Deficits in the use of pointing to orient another to an

object or event• Bringing objects or items to others for the purposes of

getting needs met, but not for a shared experience• Shifting conversations to one’s own interest rather than

responding to the interests of others


(iv) Marked impairment in the areas of social or emotional reciprocity (i.e. Identifying and responding appropriately to other’s emotional states (e.g., comfort a crying person))

•EXAMPLES:• Lack of social smiling; Lack of interest in the ideas of others• Aloofness and indifference toward others• Seemingly rude statements to others without filter or negative intent

Difficulty explaining their own behaviors in context of impact on others• Difficulty predicting how others feel or think • Problems inferring the intentions or feelings of others• Failure to understand how their behavior impacts how others think or feel• Problems with social conventions (e.g. turn-taking / personal space)• Lack of appropriate responding to someone else’s pain or distress• Creating arbitrary social rules to make sense of ambiguous social norms





Communication


COMMUNICATIONAT 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

• Failure to understand that words have a communicative intent

• About 40% of children with an ASD do not talk at all.

• About 25%–30% of children with an ASD have some words at 12 to 18 months of age and then lose them.

• Remaining children speak, but sometimes not until later in childhood and/or non-functional speech.

http://www.cdc.gov/ncbddd/autism/signs.html

COMMUNICATION

(ii) Impairment in Pragmatics: The ability to initiate, sustain, or engage in reciprocal conversation with others

• Using language for varying purposes (e.g. greeting, informing, promising, requesting, etc.)

• 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)

• Following rules of conversations and storytelling (e.g., taking turns in conversation, staying on topic, rephrasing when misunderstood, proximity, use of eye contact

EXAMPLES

• Difficulty with the social aspects of language (e.g. understanding non-literal language used in conversation)

• Issues with prosody (e.g. flat and emotionless or high and pitchy with atypical rhythm or rate)

• Difficulty initiating, sustaining, or ending conversations with others

• Difficulty using repair strategies when communication breaks down

• Talking for extended periods of time about a subject of the student’s liking, regardless of the listener’s interest

• Talking at someone in a monologue rather than conversing

RECEPTIVE & EXPRESSIVE LANGUAGE ARE NOT EQUAL

• I didn’t say she stole my money.• I didn’t say she stole my money.• I didn’t say she stole my money.• I didn’t say she stole my money.• I didn’t say she stole my money.• I didn’t say she stole my money.• I didn’t say she stole my money.

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

(IV) LACK OF VARIED, SPONTANEOUS MAKE-BELIEVE PLAY OR SOCIAL IMITATIVE PLAY APPROPRIATE TO DEVELOPMENTAL LEVEL.

•Compared to Developmental Level

•Extremely Stilted •Embracing Play




Communication


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.

• Intrusive; frequent, interfere with participation in daily activities

• DISTRESS OVER DISRUPTION

(ii) Apparently inflexible adherence to specific, nonfunctional (e.g. no purpose) routines or rituals.

• Eat only one type, color, texture of food• Self imposed rules (must touch 3 doors before opening)

(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.

(III) STEREOTYPED AND REPETITIVE MOTOR MANNERISMS, FOR EXAMPLE, HAND OR FINGER FLAPPING OR TWISTING, OR COMPLEX WHOLE-BODY MOVEMENTS.

•Cautions – Prioritize Criteria

•Comprehensive Evidence of ASD

(IV) PERSISTENT PREOCCUPATION WITH PARTS OF OBJECTS.

•Observations and Interactions Over Time

•Dave – Air Conditioner Parts

THE THREE PRONGS OF ELIGIBILITY

CRITERIA

•IMPACT

•NEED

MICHIGAN DEFINITION

OF ASD











IMPACT


#1. Considered a lifelong developmental disability that adversely affects a student’s educational performance in 1 or more of the following areas:

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.)

ESTABLISHING NEEDIDEA §300.306

• To be eligible for special education services, the educational impact of the student’s ASD must necessitate special education or related services.

• Special education is defined as specially designed instruction which means “adapting, as appropriate to the needs of an eligible child…”

• Specialized instruction must be needed for the student to make progress in school and benefit from general education instruction to be eligible for services.

• Effectiveness of previously implemented interventions is one way to determine the need for specialized instruction.

MICHIGAN DEFINITION

OF ASD











AGE

SENSORY

Not Primary EI

TEAM

CET: CENTRALIZED EVALUATION TEAM

• Objective 3-person team• Sole purpose is ASD eligibility• Start with the child, not the characteristics (e.g. does

the ASD dominate the child’s thinking?)• Use the quadrants for observation and organizing

information• Conduct a home visit with all 3 members• MET meeting to determine eligibility (Meeting

Mechanics)• Preponderance of evidence• One combined report• Report follows the MARSE criteria• Meet with parents BEFORE the IEP meeting

TEAM CONFIGURATIONS

☺ Collaboration

☺ One voice

☺ One contact

☺ One report

TEAM EVALUATION

AGENDA





PROCESS COMPONENTS

•REED•Evaluation Components•Determination of Eligibility•Evaluation Report•IEP

REED (REVIEW OF EXISTING EVALUATION

DATA)• Required at re-evaluations and at termination of eligibility. • Recommended at initial evaluation, especially if evaluation

data from outside sources is available (e.g. diagnostic reports from a private clinic). (NOTE: COLLABORATION OPPORTUNITY)

• Purpose of the REED is to:• Review available information and assessment data (e.g. ADOS,

developmental history, rating scale results);• Determine if the information is sufficient to make a

determination of eligibility (i.e. meets eligibility criteria that impacts academic, behavioral, or social progress in school that necessitates special education);

• If not, determine what else is needed to make a determination of eligibility (e.g. observations to determine impact on educational performance);

• Establish a plan for gathering the additional information.

• We still have obligation to address MARSE eligibility criteria (ex: ADHD)

• What do we know from what they provided?

Diagnostic information/rating scale scores Developmental history ADOS score

• What do we still need to know? What does child look like across settings? Impact on social, behavioral, academic Additional parent/teacher info specific to triad Communicate with evaluator

Considerations

OTHER CONSIDERATIONS

• Consideration of ALL potential disabilities

• Information to assist in differential eligibility

• Gather information to assist in developing the IEP

• Communication needs of the student including assistive technology

• The student’s social needs including peer to peer support• The student’s behavioral needs including the need for a

functional behavioral assessment, positive behavioral support plan, or an emergency crisis plan

• Academic needs of the student (i.e. accommodations and differentiation)

PROCESS COMPONENTS

•REED•Evaluation Components•Determination of Eligibility•Evaluation Report•IEP

EVALUATION COMPONENTS

• Teacher / Building Staff Interviews

• Parent / Family Interviews & Home Visit

• Observations Across Settings

• Standardized Assessment Domain Considerations

EVALUATION PLAN

CHECKLIST

Clinton County RESA Example

Attended by MET members (Psych, SSW, SLP)

Critical for coordination of scheduling

Discussion and assignments of evaluation components

Allows time for training, questions, problem solving, etc.

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&docid=H7XhPtAZVgd5lM&tbnid=Z3s-RwN4nsfFgM:&ved=0CAUQjRw&url=http%3A%2F%2Fcomeniuspiazza.wordpress.com%2F2013%2F10%2F14%2Ffirst-meeting%2F&ei=vvMIU9_EFdGWqAHKpIHwDg&bvm=bv.61725948,d.aWc&psig=AFQjCNEtfyQqXnDdhINGcxY3c-TfJct6qw&ust=1393182010585092


http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&docid=qGKGnT_jZOd0-M&tbnid=L_dV0DGYNyR9mM:&ved=0CAUQjRw&url=http%3A%2F%2Forangeblogs.org%2Fxp3students%2F2013%2F10%2F15%2F3-components-to-an-effective-leaders-meeting%2F&ei=z_MIU9efGYHTqQG2-ICoDg&bvm=bv.61725948,d.aWc&psig=AFQjCNEtfyQqXnDdhINGcxY3c-TfJct6qw&ust=1393182010585092


http://orangeblogs.org/xp3students/wp-content/uploads/sites/5/2013/10/clipart_people_desk_meeting_19909_1920x1200.jpg

INTERVIEWS; SURVEYS; HOME VISIT

Social Interaction

Communication

OTHER (e.g. academic, cognitive

functioning)

Behaviors Sensory

• School• Facilitated

Meeting

• Face to Face• Surveys

• Home• In the home

WHY?• Build Relationship• Pervasiveness of

Characteristics• Describe Behaviors

from another perspective

What makes you think the child / student has ASD?

OTHER SURVEY QUESTIONS

AREAS TO CONSIDER

•Reciprocal Social Interaction

•Communication

•Restrictive / Repetitive Behavior

•Differential Eligibility:• Developmental History• Medical History• Cognitive / Adaptive Skills • Educational Skills

• Talking Points vs. Questions

• Challenges with published tools:• Don’t match MARSE

criteria• Don’t focus on impact

and need• May not facilitate robust

discussion

OBSERVATIONSPUBLIC SCHOOL INVESTIGATOR

• 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 but NOT interpretation!!! <that meeting is coming!!>

• The Importance of Context

• INVESTIGATE: Dig down below the surface

• PARTICIPATE to get more detailed information

• CONDUCT mini experiments to see the impact or response

OBSERVATIONS

• All team members need to conduct observations

• Make sure all settings, times of day, contexts are covered

• Allow room in schedule for additional observations

• Powerful…allows for considering function of behavior (“eyes on kid, eyes on kid…”)

• Dig down below the surface

DIRECT OBSERVATION“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

Observations in ContextThe 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

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=fuOEEcH_xwj9BM&tbnid=MUm5qCsmuXsbvM:&ved=0CAUQjRw&url=http%3A%2F%2Fppahs.org%2F2011%2F11%2F30%2Ferrors-with-patient-controlled-analgesia-pca-just-the-tip-of-the-iceberg%2F&ei=4MWNU9b-LIihyASZoYGgDA&bvm=bv.68191837,d.aWw&psig=AFQjCNFYpf_6gB80fCnXj3nriGCwv30T2Q&ust=1401886548067941

CAUTION: Attribution Theory

ASD EI / SM

??

Fundamental Attribution ErrorJarod - Outcomes

ASD EI / SM

EXPLAIN BEHAVIOR EXPLAIN BEHAVIOR?

Told the teacher he liked her moustache

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)


Identifying Underlying Issue

Antecedents Behavior Consequence

Teacher instructs Ss tries to be first in Teacher re-states“time to get in line” line and yells and who the line-leader is

screams when prevented

Underlying ASD: Underlying EI:--Deficits in Social Reciprocity --Difficulty regulating emotion

--Deficits in Theory of Mind --low self-esteem / worth


THINK IN FUNCTION / PURPOSE

• Marci was observed grabbing toys and objects from others and appeared unaware that the other child was using or playing with the object. Marci was observed tickling peers under the chin while giggling, moving from one peer to the next. None of the children appeared to be enjoying this, but Marci did not seem to recognize their displeasure.

• Marci was observed pulling at girls’ ponytails and accessories; Marci has not been noted to pull hair other than in pony/pigtails or when there are accessories present. Marci was noted to state, “I want to poke her in the eye” and “I want to kick her” in a very unemotional manner not directed at anyone. Despite her statement, Marci has not attempted to do the things that she says.

THE IMPORTANCE OF CONTEXT

Marci was observed grabbing toys and objects from others and appeared unaware that the other child was using or playing with the object. Marci was observed tickling peers under the chin while giggling, moving from one peer to the next. None of the children appeared to be enjoying this, but Marci did not seem to recognize their displeasure.

Marci was observed pulling at girls’ ponytails and accessories; Marci has not been noted to pull hair other than in pony/pigtails or when there are accessories present. Marci was noted to state, “I want to poke her in the eye” and “I want to kick her” in a very unemotional manner not directed at anyone. Despite her statement, Marci has not attempted to do the things that she says.

THE IMPORTANCE OF CONTEXT

Marci was observed grabbing toys and objects from others, while yelling, “I had it first!” and pushing peers away. Marci was observed tickling peers under the chin while giggling, moving from one peer to the next. None of the children appeared to be enjoying this, but Marci kept saying, “Am I bugging you yet?” and “Isn’t this so funny?”

Marci was observed pulling at girls’ ponytails and accessories; she will say, “I don’t like your hair like that-it looks stupid.” Marci was noted to state, “I want to poke her in the eye” and “I want to kick her” while being redirected from an argument with a peer. Marci has previously shoved, kicked and poked this girl when she doesn’t do what Marci wants her to do.

OBSERVATIONS

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=f6Bb1lcOL6dd3M&tbnid=9eSQKmdlOms5wM:&ved=0CAUQjRw&url=http%3A%2F%2Ftucsonholisticcounseling.com%2F%3Fp%3D510&ei=BGWUU62TOYeqyASKmIBw&bvm=bv.68445247,d.aWw&psig=AFQjCNHGfn1Clo-hNcepDvBSYZQ6kxuoKw&ust=1402320491408753

OTHER SUPPORTING EVIDENCE

•Checklists

•Interview Forms

•Direct Assessment Tools

EVALUATION METHODS/TOOLS

• Predominantly OBSERVATION and INTERVIEW

• Not YES/NO, Black/White…Qualitative Evaluation

• Autism Diagnostic Observation Schedule (ADOS): Not score, but observation opportunity

• Specific diagnostic tests (communication, cognitive, social, sensory, adaptive)

• Caution: Questionnaires? CARS?

BE INTENTIONAL WITH STANDARDIZED TOOLS

• Remember: Tools were not designed to align with the MARSE criteria or measure impact / need.

• ASD characteristics that may negate results:• Difficulty establishing rapport • Lack of motivation to please• Challenges with attention, engagement,

and persistence in task demands• Difficulty transitioning• Language deficits • Interfering and challenging behaviors

• Tools are only as good as their technical adequacy

• Sample• Reliability• Validity

• EXAMPLE: ADOS-2:• Test / Re-test Reliability—2 Weeks:• Classification changed for 9 of the

39 children (23%)

Technical Adequacy

ASIEP-3 (AUTISM SCREENING INSTRUMENT

FOR EDUCATIONAL PLANNING)• Consists of 5 Separate Measures

• The Autism Behavior Checklist (ABC) = 47 item checklist

• Results indicate the probability of the student having ASD

• Content Validity: Items were developed based on an extensive review of the literature describing the characteristics of autism

• “The ability of the ABC to discriminate among different diagnostic groups needs to be examined further”

ASSESSMENT TOOLSCENTRAL 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

https://www.cmich.edu/colleges/chsbs/Psychology/call/pages/default.aspx/

QUESTIONS TO GUIDE THE USE OF STANDARDIZED TOOLS

• Does the tool have adequate technical adequacy?

• What is the purpose or intended outcomes?

• What questions are you attempting to answer and will the tool provide that information?

• What are the language requirements and do they match the ability level and communication modality of the student?

• Given the student’s behavioral challenges, will the tool likely produce reliable and valid results?

• How current is the tool (e.g. when was it published and standardized)?

• What are the potential challenges in using the tool (e.g. results are not consistent with other information)?

CREATIVE USES OF STANDARDIZED TOOLS

“BREAKING STANDARDIZATION”• Observe performance under various conditions (e.g. use of visuals

supports)• Create conditions not easily observed in natural settings. • NOTE: Such expansions can be beneficial in capturing rich

information on the student’s learning needs, strengths, and challenges, but invalidates obtained scores. Avoid by first administering under standardized conditions.

• Some options for breaking standardization include the following:• Administer subscales or items within subscales in a different order so

highly preferred tasks can follow less preferred ones to increase motivation;

• Start at the beginning of a particular subscale (easiest item) rather than the age-suggested starting point to create behavioral momentum;

• Take frequent breaks; Use tangible reinforcers;• Use a multiple-choice or fill-in-the-blank formats rather than an open-

ended;• Paraphrase instructions and/or simplify language to match child’s level;• Use terms and phrases that are familiar to the child (e.g., “match” vs.

“find me another one just like this”);

PROCESS COMPONENTS

•REED•Complete Evaluation Components

•Determination of Eligibility•Evaluation Report•IEP

Clinton County RESA Example

Meeting MechanicsReview Information / Data using 4 quadrantsDifferential EligibilityNote-taking / Beginning of Report WritingAny more information needed to make determination?





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)

GO TO THE BOARD!

Communication Reciprocal Social Interaction

Restrictive and Repetitive Behaviors

Sensory

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”

TAKE NOTES

Centralized Evaluation Team Evaluation Form Student’s Name:_______DREW__________________ Date:__________ CET: Pam, Kathy, Kelly

Social home/parent report staff observation:

Brother / tolerates but on own terms school recess / tolerates-proximity-

lone acts integrated with peers at recess unifix—peers approached wiggles—by himself compartmentalizes people and need unifix cubes no response to other students

verbally greeting others?? Just naming??

Behavior unifix—interacting with Mr.

Wiggles? – followed a routine (unique to doll-scripted)

Plays out script when dressing up (not imaginary)

Certain people for certain needs Thomas the tank throughout the

house Intrusive: all over the house Noticed when change occurred with

location of items Movies with plots / plays out plot

with figures—very elaborate Uses unifix cubes Wiggles not available / imaginative

play? Recess interrupted –putting clothes

in order Lined up food / stabbed food number

of times before taking a bite Work tasks—required prompting Completes highly preferred activities Plays out plot from movies with

figures Unifix cubes

Communication Parent reports—request action Single words “no”-respond to

demand Limited verbal interaction Physically directs others to

communicate No response to other students

verbally Echolalia—repeats last word

someone says Mumbles songs / cartoons

Sensory Clothes – orderly, summer (long

pants) winter (shorts) Takes off clothes at home and wraps

self in blankets

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

RESULTS REVIEW MEETING CONT…

• Process• All data sources• Determine eligibility / DECISION• If eligible as ASD, determine how the ASD is

impacting progress in gen ed in the areas of socialization, independence, communication, transition, self-regulation…

• Feedback/recommendations provided to building team, parents, coach, sped rep

Of primary concern is Johnny’s level of independence. Due to difficulties in pragmatic language and communication, sensory modulation, and socialization, Johnny’s independence is limited. In order to participate with the routines and activities of the classroom, Johnny currently requires considerable physical and verbal prompting from adults. His independence is significantly impacted in the following areas:• Transition (task to task and place to place)• Group participation• Direction following• Self care• Interactions with peers• Outside play• Inside play with free choice time• Spontaneous conversation

PROCESS COMPONENTS



CRITICAL REPORT CONSIDERATIONS

• Write ONE Report

• Customize to the M.E.T. Form ( ASD Criteria)

• Build a case for your conclusion (e.g. you shouldn’t get to end and question eligibility recommendation)

• Avoid “cut and paste” process (makes it challenging to cohesively build a case)

• Use Persuasive Writing Skills

• Explain what does NOT align (e.g. standardized scores, parent reports of behaviors, etc.)

REPORT ORGANIZATION

CONTEXTUALIZED REPORT STRUCTURE

PROCESS COMPONENTS



INFORMING THE IEPSupplementary Aids & Services

Goals and Objectives or BenchmarksPLAAFP

PLAAFP Development Schedule Matrix Guide

This tool is intended to be used by IEP and behavioral planning teams to assist in goal development and identification of necessary supports and strategies.

Student Schedule Expectations &

Instructional Outcomes Current Level of Skills (Compared to Peers)

Current Supports, Strategies & EBPs

Potential Goals & Strategies Needed

In this column, list the

student’s daily schedule including all primary

activities, courses / classes and/or transitions.

In this column, identify the expectations & instructional

outcomes for all students during this part of the

schedule. Expectations and instructional outcomes

include:

Independence Skills Social Interaction Skills Communication Skills Behavioral Skills Academic Skills

including task initiation, engagement, & output

For example, during

“arrival,” the instructional outcomes may include

independently taking off outerwear, getting materials

ready, taking a seat, and completing morning work.

Also include in this section

any specific IEP goals targeted during particular

times in the schedule for the student with ASD.

In this column, identify the

student’s performance, compared to peers, in this

part of the schedule.

Include the following:

Independent Skills Social Interaction Skills Communication Skills Behavioral Response Task Initiation,

Engagement, & Output Deficits in these areas will be targeted for intervention and should be included in the last column.

List in this column, all the supports, strategies, and/or supplementary aides and

services currently in place to support the student. These

include but are not limited to:

Visual / Organizational Supports / Strategies

Peer to Peer Supports Functional

Communication System Positive Behavioral

Interventions & Supports Evidence-Based

Practices Accommodations /

Modifications Behavioral Response

Plan / Crisis Plan Adult (Paraprofessional /

TA Support)

In this column, based on

information in the previous columns, list potential goal areas (areas of need) and

additional strategies needed for the student to

independently make adequate progress in all areas.

Present Levels of Academic Achievement

and Functional Performance

The PLAAFP

What about the ASD impacts access and progress in:

• The general education CURRICULUM

• General education ENVIRONMENTS (including social skill development, independent skills, etc.)?

• Further education, employment, and independent living

IMPACT

How does the ASD impact access and progress in

general education

curriculum and environments?

Due to Sean’s lack of reciprocity and restricted range of interests, he does not independently engage in and navigate the daily schedule and requires 6-7 verbal and visual prompts by adults before following simple tasks. He also does not independently get materials he needs to complete classroom activities and tasks, and requires up to 10 adult prompts to complete his classroom work. As many as 6 times an hour, Sean attempts to leave the classroom to seek out his preferred activity (basketball) and as a result, he misses instruction 3-4 times per day for 5-10 minutes.

.

THE IMPACT STATEMENT

AGENDA





DIFFERENTIAL ELIGIBILITY

• Don’t you think its ___________________?

ECDD…SLI…CI…EI

CONSIDERATIONS FOR YOUNG CHILDREN

• Given complexities and range of developmental changes, we need solid understanding of typical development and disorders that mirror ASD in young children

• Higher threshold for determining communication, social, and behavior impairment may need to be considered

CONSIDERATIONS FOR YOUNG CHILDREN

• Not appropriate to recommend alternative eligibility (such as SLI or ECDD) in order to prolong or avoid the ASD eligibility

• According to MARSE, ECDD eligibility should be used only when:

“primary delays cannot be differentiated through existing criteria within [other eligibility categories].”

• Policies that indicate age cutoffs for finding a student eligible under the ASD classification should also be eliminated.

EI (Emotional Impairment) Criteria(1) Emotional impairment shall be determined through manifestation of behavioral problems—

•Primarily in the affective domain---The affective domain involves the influence of emotion on behavior and may include areas such as emotional stability and control, interaction with, response to, and ability to work with others, and self-control. This item implies that emotional and behavioral functioning departs from generally accepted and developmentally appropriate norms.

•Over an extended period of time—Implies the student exhibits these behavioral problems for at least ninety (90) school days. Selected period allows time for resolution of situational responses as well as time for targeted interventions to be attempted. For severe or dangerous behaviors, an abbreviated timeline may be needed (give rationale that problem will continue without special education support).

•Which adversely affect the student’s education (implies pervasive and marked impact (frequency, duration or intensity) in academic performance or social functioning) to the extent that the student cannot profit from learning experiences without special education support..

EI (Emotional Impairment) Criteria, cont.

The problems result in behaviors manifested by 1 or more of the following characteristics:

a.Inability to build or maintain satisfactory interpersonal relationships within the school environment. Interpersonal relationships refer to developmentally appropriate actions and reactions to peers and adults. To meet this criteria, a student should demonstrate pervasive (generally all teachers and peers) aberrant behaviors that occur at a greater frequency, intensity and duration for others at that developmental level.

b.Inappropriate types of behavior or feelings under normal circumstances. This criterion implies atypical behaviors for which no observable reason exists. Mere misconduct or refusal to comply does not qualify a student in this category. The pervasiveness and frequency, intensity, and duration should also be considered.


c. General pervasive mood of unhappiness or depression. This criterion means a student must exhibit depressive symptomatology which typically involves changes in all four major areas: (1) affective (emotions), (2) motivation (loss of interest), (3) physical/motor functioning (e.g. weight / appearance), and (4) cognition. Pervasiveness implies impact in almost all aspects of a person’s life. NOTE: Aggression and non-compliance can mask depression.

d. Tendency to develop physical symptoms or fears associated with personal or school problems. First consider a student’s medical condition before considering eligibility under this criterion. This criterion is related to conditions like school phobia and other intense anxiety disorders that result in physical symptomology and somatic complaints (e.g. headache, tics, stomachache).

Example CharacteristicsInability to Maintain

RelationshipsInappropriate

Behaviors or FeelingsUnhappiness or

DepressionPhysical Symptoms /

Fears

In ability to maintain relationships due to:•Responding aggressively toward others•Short temper•Starts fights•Withdrawn•Has intense emotional responses to typical peer disagreements•Demonstrates inappropriate sexual behaviors•Seeks excessive approval from others

• Over-reacts to everyday occurrences (i.e. rage, excessive laughter, hysterics)

• Exhibits catastrophic or panic reactions to everyday occurrences

• Demonstrates flat, distorted or excessive affect

• Exhibits self-abusive behaviors

• Exhibits delusions and/or hallucinations or thought disorders

• Demonstrates extreme mood swings

• Decreased interest / pleasure in previously enjoyed activities

• Excessive guilt and/or self-criticism

• Expresses feelings of extreme sadness

• Predicts failure or refuses to attempt tasks (projects hopelessness)

• Demonstrates agitation or lethargy

• Difficulty concentrating and/or making decisions

• Chronic Somatic complaints (i.e. headaches, stomach aches)

• Intense anxiety not associates with a specific stimuli

• Extreme fear in response to a specific stimuli

• Panic reactions to everyday occurrences


(2) Emotional impairment also includes students who, in addition to the characteristics specified in subrule (1) of this rule, exhibit maladaptive behaviors related to schizophrenia or similar disorders. The term “emotional impairment” does not include persons who are socially maladjusted, unless it is determined that the persons have an emotional impairment.

What is Social Maladjustment?

•Not defined by federal or state departments or clinical literature

•Understanding is derived from the educational literature and practice, administrative decisions and court interpretations

•Often associated with clinical Dx of CD, ODD, or Antisocial

•Definition Components: – Pervasive intentional behaviors that violate socially acceptable rules and norms– Accepting no responsibility for actions– Demonstrating little to no remorse– Blame and intimidate / charm others while manipulating the situation to meet own needs

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.

Preponderance of EvidenceCompare & Contrast

The Results Review Meeting

Social Communication OTHER

Behavior Sensory

Preponderance of EvidenceCompare & 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

Compare & Contrast History of Interventions

• Visual Supports

• Social Facts

• Self Management

• Social Reinforcement

• Counseling

Compare / Contrast Specific BehaviorsSocial Maladjustment vs. ASD

Social Maladjustment– Pervasive intentional behaviors that violate socially

acceptable rules and norms– Accepting no responsibility for actions– Demonstrating little to no remorse– Blame and intimidate / charm others while

manipulating the situation to meet own needs

•EXAMPLE: Jonathon

Preponderance of EvidenceCompare & Contrast Characteristics

COGNITIVE IMPAIRMENT(1) Cognitive impairment shall be manifested during the developmental period and be determined through the demonstration of all of the following behavioral characteristics:

(a) Development at a rate at or below approximately 2 standard deviations below the mean as determined through intellectual assessment.(b) Scores approximately within the lowest 6 percentiles on a standardized test in reading and arithmetic. This requirement will not apply if the student is not of an age, grade, or mental age appropriate for formal or standardized achievement tests.(c) Lack of development primarily in the cognitive domain.(d) Impairment of adaptive behavior.(e) Adversely affects a student’s educational performance.

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!!

• Remember, different purposes (diagnosis versus special education eligibility and IEP development)

• Adherence to strong evaluation process, report is defendable

• Commitment to communication

• Make sure to meet student needs Implementation of Universal Supports Use of SW-PBIS practices

What if there is disagreement?(e.g. Medical says “yes” and School says “no”)

Selected References• MARSE Rules• ISD Guidelines for Determining Eligibility of Emotional

Impairment– Macomb– Char-Em– Ottawa

• OCALI Online Identification Module• Other State Guidelines• NATTAP (Network of Autism Training and Technical

Assistance Providers) 2008 Conference Session “Compare and Contrast EBD & ASD”—Columbus, OH

• Trammell, B., et.al. (2013) Assessment and Differential Diagnosis of Comorbid Conditions in Adolescents and Adults with ASD. Psychology in the Schools, 5 (9).

kelly dunlap, psy.s stephanie dyer, ed.s. education-based evaluations for asd

Documents

autism insurance benefitdsm

autism state planhttp

autism spectrum disordermarse

sas behavioral health

autistic disorder

servicesifsp iep team

interventionadults services

individual plan of serviceaba