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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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Michigan Students with an ASD Eligibility

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New Reality #1: More Kids

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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?

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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

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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

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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

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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

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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

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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

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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

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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”

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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!!

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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…