2AGENDA The New Evaluation Reality The Three Prongs of Educational EligibilityProcess ComponentsREEDEvaluation ComponentsDetermination of Eligibility (Results Review Process)Evaluation ReportIEPDifferential Eligibility Considerations
6New Reality: More Players Autism Insurance LegislationThe Autism State PlanThe Autism Council
7Michigan Autism Council Purpose: Implementation of the Autism State PlanAutism State Plan:Subcommittee WorkEarly identification and interventionAdults services and supportsEducation
8Screening and Assessment / ASD Eligibility Determination Autism CouncilSUBCOMITTEESEarly InterventionAdult ServicesEducationWorkgroupsScreening and Assessment / ASD Eligibility Determination
9current Players at the Table Special EdAutism Insurance Benefit (AIB)Private InsuranceMedicaid / MIChildCriteriaASD / MARSEASD = Autistic Disorder, AS, PDD-NOS (DSM IV)Plan for EvaluationREED / TimelineWho EvaluatesPsych, SSW, SLPLicensed Psych or PhysicianCMHPUsing What ToolsPrescriptive for Child / PurposeMust include an “Autism Diagnostic Observation Schedule” (e.g. ADOS-2)Must include ADOS-2and Developmental Family History (e.g. ADI-R)Determination of Impairment / DiagnosisIFSP / IEP Team Determines ImpairmentDiagnosis of ConditionEligibility for ServicesIFSP / IEP Team determines adverse impactTreatment prescribed or ordered by evaluatorCMHP + Medicaid Agency final approvalService PlanIFSP / IEPTreatment Plan developed by board certified or licensed providerIPOS developed through PCP processTypes of ServicesIFSP=Early Intervention services; IEP=SE, RS, and SASBehavioral Health, Pharmacy, Psychiatric, Psychological, TherapeuticABA(EIBI and ABI)Outcomes: High Quality evaluations…this is what all of this is leading to
10Acronym Deciphering Tool AIB = Autism Insurance BenefitDSM = Diagnostic and Statistical Manual of Mental DisordersPDD-NOS = Pervasive Developmental Disorder – Not Otherwise SpecifiedADOS = Autism Diagnostic Observation ScheduleADI = Autism Diagnostic InterviewCMHP = Child Mental Health ProfessionalPCP = Person-Centered PlanIPOS = Individual Plan of ServiceABA = Applied Behavioral AnalysisEIBI = Early Intensive Behavioral InterventionABI = Applied Behavioral InterventionABLLS = Assessment of Basic Language and Learning SkillsVB-MAPP = Verbal Behavioral Milestones Assessment and Placement ProgramSE = Special EducationASD = Autism Spectrum DisorderMARSE = Michigan Administrative Rules for Special EducationREED = Review of Existing Evaluation DataMET = Multidisciplinary Evaluation TeamIFSP = Individual Family Service PlanIEP = Individualized Educational ProgramSAS = Supplementary Aids and ServicesP&S = Programs & ServicesFAPE = Free and Appropriate Public EducationLRE = Least Restrictive Environment
11New Reality in Evaluations for ASD Potential increase in referralsPotential increase in pressure to accept clinical diagnosesIncreased need for collaboration across systemsCan this slide be covered during the grid slide?
12So, where do we start?Ensure quality special education eligibility evaluations for ASD(i.e. Clean up our own backyard!)
13New Reality: More Complexity Common Comorbid Conditions:Seizures and epilepsyAnxietyDepressionAttention difficultiesBipolar DisorderObsessive CompulsiveSome are considered part of ASD, so when is condition at a level that warrants an different or additional dx?
14Today’s Guiding Principle NO OPINIONSALL DECISIONS INFORMED BY….THE LAWTHE RESEARCHTHE DATAKey Concepts:Point out human tendencies to express opinions, and how these tendencies result in opinion debates, especially relative to ASD and IEP programming. Because we do not have time to waste on opinion debates, it is critical for IEP teams to focus on what the Law, the Research, and the Data (meaning student / program specific data) supports in educating students with ASD.Discuss how in many IEPs, team members begin sentences with “I think we should…..” or “I feel like……” rather than “The data supports….,” “My observations resulted in…..,” or “the law states that……” As such, “No Opinions unless Informed by Data / Information” is the resounding principle of IEP decision-making.In the first few sections of this module, the law, the research, and the data will be covered relative to educating students with ASD.Considerations:Application:
15PRACTICE IS NOT NECESSARILY WARNINGI heard that….I was told….PRACTICE IS NOT NECESSARILYLAW, POLICY, or RULE
16We must Ensure quality evaluations All staff need to be competent at ASD screening / evaluationCurrent Issues:Not recognizing there are THREE required eligibility areasNot recognizing that “educational impact” can be in one of THREE areas (e.g. academic, behavior, social)Use of tools with no observational dataNot understanding terms:MarkedQualitativeAdverse Impact
17AGENDA The New Evaluation Reality The Three Prongs of Educational EligibilityProcess ComponentsREEDEvaluation ComponentsDetermination of EligibilityEvaluation ReportIEPDifferential Eligibility Considerations
18The Three prongs of eligibility CRITERIAIMPACTNEED
20PREPONDERANCE OF EVIDENCE GUIDING PRINCIPLE“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)
22Autism Spectrum Disorder Triad Qualitative Impairmentsin ReciprocalSocial InteractionQualitative ImpairmentsIn CommunicationASDSOCIALIZATION DIFFERENCES:1. Marked impairment in the use of nonverbal behaviors to regulate social interaction: eye to eye gaze, facial expression, body postures and gestures2. Failure to achieve developmentally appropriate peer relations3. A lack of spontaneous seeking to share enjoyment, interest, or achievements with other people: Lack of showing, bringing, or pointing to objects of interest4. Lack of social or emotional reciprocity: Identifying and responding appropriately to other’s emotional states (e.g., comfort a crying person)5. Impaired perspective taking: Viewing situations from another’s point of view and predict other’s behavior (e.g., if I take his toy he will be mad at me and won’t want to play)COMMUNICATION DIFFERENCES:1. Delay in or total lack of, the development of spoken language (with no attempt to compensate) 2. Individuals with adequate speech: impairment in ability to initiate and sustain conversation: Stereotyped and repetitive use of language or idiosyncratic language: echolalia; pronominal reversal; dysrhythmic speech3. Lack of varied, developmentally appropriate, spontaneous, make believe play or social imitative play: lining up blocks, spinning tires, building the same lego figure over and overREPETITIVE BEHAVIOR DIFFERENCES:1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest, abnormal in intensity or focus (i.e, food preferences,video interest)2. Apparently inflexible adherence to specific nonfunctional routines or rituals: Dressing rituals, driving rituals; Distress at any change3. Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex-whole body movements)4. Persistent preoccupation with parts of objects (i.e., taking wheel off toy car and repeatedly spinning it)Restrictive,Repetitive &StereotypedBehavior
23Persistent Deficits in Social Communication & Social Interaction DSM-V Change: ASDRestricted &Repetitive Patternsof BehaviorPersistent Deficits in Social Communication & Social InteractionSEVERITY RATING LEVELS 1-3:3 = Requiring very substantial support1 = Requiring support
26Michigan Definition of Autism Spectrum Disorder Characterized by qualitative impairments in:a. Reciprocal Social Interactionsb. Communicationc. Restricted Range of Interests / RepetitiveBehavior
27“Qualitative” Markedly Atypical Significantly different from other students at the same age and developmental levelOutside the typical sequence of developmentAcross all environments.Presence and AbsenceUnique to each Student
28Michigan Definition of Autism Spectrum Disorder Characterized by qualitative impairments in:Reciprocal Social InteractionsCommunicationRestricted Range of Interests / Repetitive Behavior
29Reciprocal Social Interaction A mutual exchange(e.g. of words, actions, or feelings).
30Reciprocal 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; Distinctive and noticeably different from same-aged peersPURPOSE of Nonverbal BehaviorEXAMPLES:Seems to look “through” a person, lacks eye contact to initiate or sustain interaction, has fleeting or inconsistent eye contactLacks emotion or appropriate facial affect for the social situation, lacks accurate facial expression to reflect internal feelings, facial expressions seem rehearsed or mechanicalDifficulty maintaining appropriate body space, awkward/stiff response or movement, gait challengesLacks 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
31Reciprocal Social Interaction At least 2 of the following 4 (ii) Failure to develop peer relationships appropriate to developmental level.---NOTE: that results from deficits in social reciprocity andinability 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 jokesDisruption of ongoing activities when entering play or social circlesLack of initiation or sustained interactions with othersPreference to play aloneContinuous failure in trying to understand the social nuances and follow the social rulesDesire for friendships but with multiple failed attemptsMisinterpretation of social cues or communication intent of othersTolerance of peers but no engagement in conversation or activityConfusion with the telling of liesPolicing peers (e.g. reporting rule infractions on the playground)
32Theory 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.Key Concepts:A student with AS does not recognize or understand the cues that indicate the thoughts or feelings of the other person at a level expected for someone of that age. (Attwood)This is a hallmark difficulty for students with AS. It is absolutely key for others to understand that the student with AS has this deficit.Considerations:Theory of Mind is also referred to as “mind reading” or “mind blindness” or “putting oneself in another’s shoes.” As a trainer, it is important to really understand Theory of Mind yourself. Trainers may wish to read Chapter 5 of the Attwood book (Theory of Mind) to provide a foundation for this slide.Application:To demonstrate Theory of Mind:Have a volunteer come up and hide an object somewhere in the room. After hiding the object, the volunteer should leave the room.While the volunteer is gone, move the object to a different hiding spot.Bring the volunteer back in and have them get the object. It’s not where they left it!Ask the group where they expected the volunteer to look (first hiding spot)Explain that students with AS will indicate that the volunteer would look in hiding spot #2. Theory of Mind deficits would render it difficult for the student with AS to take the perspective of the volunteer and only have knowledge of hiding spot #1. If student with AS knew that it was in hiding spot #2, then so should the volunteer.
33Developmental Trajectories Experts on peopleNormalbirthASDKey Concepts:Neurobiological differences put children on different developmental trajectories. Typically developing children become experts on people, while children with ASD become experts on things. The Yale study shown on the 20/20 clip previously shown indicates functional brain differences (areas in the brain intended for processing objects light up when child with AS looked at pictures of facial expressions).Considerations:Slide was shared courtesy of Peter Mundy at the NPDC Summer Institute 2009.Application:Experts on things
34Reciprocal Social Interaction At least 2 of the following 4 (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 eventBringing objects or items to others for the purposes of getting needs met, but not for a shared experienceShifting conversations to one’s own interest rather than responding to the interests of others
35Reciprocal Social Interaction At least 2 of the following 4 (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 othersAloofness and indifference toward othersSeemingly rude statements to others without filter or negative intent Difficulty explaining their own behaviors in context of impact on othersDifficulty predicting how others feel or thinkProblems inferring the intentions or feelings of othersFailure to understand how their behavior impacts how others think or feelProblems with social conventions (e.g. turn-taking / personal space)Lack of appropriate responding to someone else’s pain or distressCreating arbitrary social rules to make sense of ambiguous social norms
36Michigan Definition of Autism Spectrum Disorder Characterized by qualitative impairments in:Reciprocal Social InteractionsCommunicationRestricted Range of Interests / Repetitive Behavior
37Communication 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 compensateFailure to understand that words have a communicative intentAbout 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.
38Communication(ii) Impairment in Pragmatics: The ability to initiate, sustain, orengage in reciprocal conversation with othersUsing 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
39EXAMPLESDifficulty 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 othersDifficulty using repair strategies when communication breaks downTalking for extended periods of time about a subject of the student’s liking, regardless of the listener’s interestTalking at someone in a monologue rather than conversing
40RECEPTIVE & EXPRESSIVE LANGUAGE are not equal I didn’t say she stole my money.
41Communication(iii) Stereotyped / repetitive use of language / idiosyncraticIdiosyncratic = 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:EcholaliaRepeat videos / scriptsNonsense languageVerbal Fascinations
42Compared to Developmental Level (iv) Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.Compared to Developmental LevelExtremely StiltedEmbracing Play
44Michigan Definition of Autism Spectrum Disorder Characterized by qualitative impairments in:Reciprocal Social InteractionsCommunicationRestricted Range of Interests / Repetitive Behavior
45(iv) Persistent preoccupation with parts of objects. 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 activitiesDISTRESS OVER DISRUPTION(ii) Apparently inflexible adherence to specific, nonfunctional (e.g. no purpose) routines or rituals.Eat only one type, color, texture of foodSelf 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.
47Cautions – Prioritize Criteria Comprehensive Evidence of ASD (iii) Stereotyped and repetitive motor mannerisms, for example, hand or finger flapping or twisting, or complex whole-body movements.Cautions – Prioritize CriteriaComprehensive Evidence of ASD
48(iv) Persistent preoccupation with parts of objects. Observations and Interactions Over TimeDave – Air Conditioner Parts
49The Three prongs of eligibility CRITERIAIMPACTNEED
51Michigan 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: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.)
52Establishing Need IDEA §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.
53Michigan Definition of ASD AGESENSORYNot Primary EITEAM
54CET: Centralized Evaluation Team Objective 3-person teamSole purpose is ASD eligibilityStart with the child, not the characteristics (e.g. does the ASD dominate the child’s thinking?)Use the quadrants for observation and organizing informationConduct a home visit with all 3 membersMET meeting to determine eligibility (Meeting Mechanics)Preponderance of evidenceOne combined reportReport follows the MARSE criteriaMeet with parents BEFORE the IEP meeting
57TEAM evaluation Collaboration One voice One contact One report Strategic assignment of teams
58AGENDA The New Evaluation Reality The Three Prongs of Educational EligibilityProcess ComponentsREEDEvaluation ComponentsDetermination of EligibilityEvaluation ReportIEPDifferential Eligibility Considerations
59Evaluation Components Determination of Eligibility Evaluation Report PROCESS COMPONENTSREEDEvaluation ComponentsDetermination of EligibilityEvaluation ReportIEP
60REED (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.
61ConsiderationsWe still have obligation to address MARSE eligibility criteria (ex: ADHD)What do we know from what they provided?Diagnostic information/rating scale scoresDevelopmental historyADOS scoreWhat do we still need to know?What does child look like across settings?Impact on social, behavioral, academicAdditional parent/teacher info specific to triadCommunicate with evaluator
62Other considerations Consideration of ALL potential disabilities Information to assist in differential eligibilityGather information to assist in developing the IEPCommunication needs of the student including assistive technologyThe student’s social needs including peer to peer supportThe student’s behavioral needs including the need for a functional behavioral assessment, positive behavioral support plan, or an emergency crisis planAcademic needs of the student (i.e. accommodations and differentiation)
63Evaluation Components Determination of Eligibility Evaluation Report PROCESS COMPONENTSREEDEvaluation ComponentsDetermination of EligibilityEvaluation ReportIEP
64Evaluation components Teacher / Building Staff InterviewsParent / Family Interviews & Home VisitObservations Across SettingsStandardized Assessment Domain Considerations
66Clinton County RESA Example Attended by MET members (Psych, SSW, SLP)Critical for coordination of schedulingDiscussion and assignments of evaluation componentsAllows time for training, questions, problem solving, etc.
67Interviews; Surveys; Home Visit SchoolFacilitated MeetingFace to FaceSurveysHomeIn the homeWHY?Build RelationshipPervasiveness of CharacteristicsDescribe Behaviors from another perspectiveSocial InteractionCommunicationOTHER (e.g. academic, cognitive functioning)BehaviorsSensoryWhat makes you think the child / student has ASD?
68Other survey questions Talking Points vs. QuestionsChallenges with published tools:Don’t match MARSE criteriaDon’t focus on impact and needMay not facilitate robust discussionAREAS TO CONSIDERReciprocal Social InteractionCommunicationRestrictive / Repetitive BehaviorDifferential Eligibility:Developmental HistoryMedical HistoryCognitive / Adaptive SkillsEducational Skills
69Evaluation components Teacher / Building Staff InterviewsParent / Family Interviews & Home VisitObservations Across SettingsStandardized Assessment Domain Considerations
70OBSERVATIONS Public 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 ContextINVESTIGATE: Dig down below the surfacePARTICIPATE to get more detailed informationCONDUCT mini experiments to see the impact or response
71Observations All team members need to conduct observations Make sure all settings, times of day, contexts are coveredAllow room in schedule for additional observationsPowerful…allows for considering function of behavior (“eyes on kid, eyes on kid…”)Dig down below the surface
72Direct Observation “EYES ON KID” Qualitative Impairment in CommunicationQualitative Impairment in Reciprocal Social InteractionRestrictive, Repetitive and Stereotyped BehaviorsSensory
75Observations 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
76CAUTION: Attribution Theory ASDEI / SM??Key Concepts:Now that you know that there are different outcomes based upon our own attributions and attribution errors, we have choices and options. It is our professional responsibility to be aware of our attribution errors and minimize them.Considerations:Trainers should mention that the rest of the module is going to guide the participants down Path A and Path B with regard to students with AS. When you click this slide, the outcome box of Path B will come down first. That’s because that’s the one that we typically go down. Path A is the path of looking through the lens of AS and viewing the behaviors within that context. Path B (B, blue, bad!) is the path of attributing behaviors to the student’s disposition– or who they are as a person, resulting in negative outcomes.Application:
77Fundamental Attribution Error Jarod - Outcomes Told the teacher he liked her moustacheASDEI / SMKey Concepts:The attribution errors that we make can dramatically affect the outcomes for the students.We need to be aware of the link between our attributions and outcomes. Our attribution errors have consequences.Considerations:Application:Share the behaviors of concern that resulted from Jared’s lack of understanding of social communication. He told the teacher that he really liked her moustache.Ask “If we view Jarod’s behavior through the lens of Aspergers and its neurobiology, what are the likely outcomes for Jarod? What if we view his behavior as being a reflection of who he is (rude, disrespectful)? What are the outcomes then?”EXPLAIN BEHAVIOREXPLAIN BEHAVIOR?
78Identifying Underlying Issue Antecedents Behavior ConsequenceContext ContextUnderlying 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)
79Identifying Underlying Issue Antecedents Behavior ConsequenceTeacher instructs Ss tries to be first in Teacher re-states“time to get in line” line and yells and who the line-leader isscreams when preventedUnderlying ASD: Underlying EI:--Deficits in Social Reciprocity Difficulty regulating emotion--Deficits in Theory of Mind low self-esteem / worth
80Think 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.Key Concepts:We have to carefully look at situations and context in order to reduce our changes of making a fundamental attribution error.Considerations:This slide is the first of two that work together. Once you complete the first part of this activity, then click the mouse and the rest of the words will fill into the slide.Application:Ask a volunteer to read this slide.Ask participants to talk with a partner for a minute about what their response to this behavior would be? What do they think of Marci’s behavior? Is it intentional? Is she mean and aggressive?Take a few report outs
81The 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.Key Concepts:We have to carefully look at situations and context in order to reduce our changes of making a fundamental attribution error.Looking at context makes a huge difference.Considerations:Marci is a real 4 year old with AS. Now, with context available, we are better able to see her behaviors through the lens of AS.Remind participants that now we are able to respond via Path A, which will result in understanding, teaching, and support for Marci, as opposed to Path B, with getting kicked out of this preschool. Powerful, powerful stuff!!Application:Ask a volunteer to read this slide again with the new information included.Ask participants to talk with a partner for a minute about what their response to this behavior would be? What do they think of Marci’s behavior now? Is it intentional? Is she mean and aggressive? Have their opinions and assumptions changed? Why?Take a few report outs
82The 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.Key Concepts:We have to carefully look at situations and context in order to reduce our changes of making a fundamental attribution error.Looking at context makes a huge difference.Considerations:Now, we have superimposed behaviors of a preschool girl with a behavior disorder. Even though we aren’t dealing with AS, we still have the responsibility to implement positive behavior supports.Emphasize how important the context is. You may have to do repeated observations.Remind participants that now we are able to respond via Path A, which will result in understanding, teaching, and support for Marci, as opposed to Path B, with getting kicked out of this preschool. Powerful, powerful stuff!!Application:Ask a volunteer to read this slide again with the new information included.Ask participants to talk with a partner for a minute about what their response to this behavior would be? What do they think of Marci’s behavior now? Is it intentional? Is she mean and aggressive? Have their opinions and assumptions changed? Why?Take a few report outs
86Evaluation Methods/Tools Predominantly OBSERVATION and INTERVIEWNot YES/NO, Black/White…Qualitative EvaluationAutism Diagnostic Observation Schedule (ADOS): Not score, but observation opportunitySpecific diagnostic tests (communication, cognitive, social, sensory, adaptive)Caution: Questionnaires? CARS?
87Be 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 rapportLack of motivation to pleaseChallenges with attention, engagement, and persistence in task demandsDifficulty transitioningLanguage deficitsInterfering and challenging behaviorsTools are only as good as their technical adequacy
88Technical Adequacy Sample Reliability Validity EXAMPLE: ADOS-2: Test / Re-test Reliability—2 Weeks:Classification changed for 9 of the 39 children (23%)
89ASIEP-3 (Autism Screening instrument for educational planning) Consists of 5 Separate MeasuresThe Autism Behavior Checklist (ABC) = 47 item checklistResults indicate the probability of the student having ASDContent 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”
90Assessment Tools Central Assessment Lending Library (CALL) https://www ASIEP-3: Autism Screening Instrument for Educational PlanningADOS-2 (Autism Diagnostic Observation Schedule)ADI-R: Autism Diagnostic InterviewCARS-2: Childhood Autism Rating ScaleGARS-2: Gilliam Autism Rating ScaleGADS: Gilliam Asperger Disorder ScaleKADI: Krug Asperger Disorder IndexPEP-3: Psycho-Educational ProfileABLLS-R: Assessment of Basic Language and Learning SkillsVB-MAPP: Verbal Behavior – Milestones Assessment and Placement Program
91Questions 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)?
92Creative 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”);
93Complete Evaluation Components Determination of Eligibility PROCESS COMPONENTSREEDComplete Evaluation ComponentsDetermination of EligibilityEvaluation ReportIEP
94Clinton County RESA Example Meeting MechanicsReview Information / Data using 4 quadrantsDifferential EligibilityNote-taking / Beginning of Report WritingAny more information needed to make determination?
95Results Review Meeting Only Eval Team present (Psy, SSW, SLP)List all 12 criteria on boardColor 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 reachedReport writer (on computer)
96Reciprocal Social Interaction Restrictive and Repetitive Behaviors Go to the board!CommunicationReciprocal Social InteractionRestrictive and Repetitive BehaviorsSensory
97Determining Eligibility Start with the child, not the characteristicsIntegrate quantitative & qualitative informationWithin qualitative assessment, discover whether student meets criteria for Autism Spectrum Disorder“Preponderance of the evidence”
100Results Review Meeting cont… ProcessAll data sourcesDetermine eligibility / DECISIONIf 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
101Of primary concern is Johnny’s level of independence 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
102Complete Evaluation Components Determination of Eligibility PROCESS COMPONENTSREEDComplete Evaluation ComponentsDetermination of EligibilityEvaluation ReportIEP
103Critical Report Considerations Write ONE ReportCustomize 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 SkillsExplain what does NOT align (e.g. standardized scores, parent reports of behaviors, etc.)
106Complete Evaluation Components Determination of Eligibility PROCESS COMPONENTSREEDComplete Evaluation ComponentsDetermination of EligibilityEvaluation ReportIEP
107Goals and Objectives or Benchmarks Supplementary Aids & Services Informing the IEPGoals and Objectives or BenchmarksPLAAFPSupplementary Aids & Services
108The PLAAFPPresent Levels of Academic Achievement and Functional PerformanceWhat about the ASD impacts access and progress in:The general education CURRICULUMGeneral education ENVIRONMENTS (including social skill development, independent skills, etc.)?Further education, employment, and independent livingKey Concepts:This slide describes the critical questions to ask in order to develop the PLAAFP. Be sure to focus on how the DISABILITY (in this case, ASD) impacts 1. Access to; 2. Participation in; and 3. Progress (success) in BOTH the CURRICULUM and the ENVIRONMENTS (considering both social competence and independent skills).Remind participants of the mistakes discovered during the Ed Benefit Review process as well as those discussed that occurring frequently in practice (e.g. list of standard scores, list of EVERY deficit the student has related to academic performance, etc.). How might asking the question in this way change the PLAAFP information?Discuss how it is no wonder that IEP teams interpreted the PLAAFP statement to be a list of academic performance deficits as the title itself says “Present Levels of Academic Achievement”… then proceed to the next slide….Considerations:Application:
109The impact statement 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..Key Concepts:Perfect PLAAFP statements are not provided as it is human nature to get the “cut and paste” effect.Guided practice allows participants to really problem solve the information and consider alternative ways to provide or gather it. Such practice increases implementation fidelity of the process.Words in red are “wiggle” words (i.e. words that are loosely defined and can easily be misinterpreted). Have participants discuss what data they might need to change the wiggle word into actual data.It is not by accident that socialization and independent skills were used for guided practice.Read each statement and allow for discussion / practice.Considerations:Application:
110AGENDA The New Evaluation Reality The Three Prongs of Educational EligibilityProcess ComponentsREEDEvaluation ComponentsDetermination of EligibilityEvaluation ReportIEPDifferential Eligibility Considerations
111Differential eligibility Don’t you think its ___________________?ECDD…SLI…CI…EI
112Considerations for young children Given complexities and range of developmental changes, we need solid understanding of typical development and disorders that mirror ASD in young childrenHigher threshold for determining communication, social, and behavior impairment may need to be considered
113Considerations for young children Not appropriate to recommend alternative eligibility (such as SLI or ECDD) in order to prolong or avoid the ASD eligibilityAccording 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.
114EI (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..
115EI (Emotional Impairment) Criteria, cont. The problems result in behaviors manifested by 1 or more of the following characteristics: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.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.
116EI (Emotional Impairment) Criteria, cont. 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).
117Example Characteristics Inability to Maintain RelationshipsInappropriate Behaviors or FeelingsUnhappiness or DepressionPhysical Symptoms / FearsIn ability to maintain relationships due to:Responding aggressively toward othersShort temperStarts fightsWithdrawnHas intense emotional responses to typical peer disagreementsDemonstrates inappropriate sexual behaviorsSeeks excessive approval from othersOver-reacts to everyday occurrences (i.e. rage, excessive laughter, hysterics)Exhibits catastrophic or panic reactions to everyday occurrencesDemonstrates flat, distorted or excessive affectExhibits self-abusive behaviorsExhibits delusions and/or hallucinations or thought disordersDemonstrates extreme mood swingsDecreased interest / pleasure in previously enjoyed activitiesExcessive guilt and/or self-criticismExpresses feelings of extreme sadnessPredicts failure or refuses to attempt tasks (projects hopelessness)Demonstrates agitation or lethargyDifficulty concentrating and/or making decisionsChronic Somatic complaints (i.e. headaches, stomach aches)Intense anxiety not associates with a specific stimuliExtreme fear in response to a specific stimuliPanic reactions to everyday occurrences
118EI (Emotional Impairment) Criteria, cont. (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 literatureUnderstanding is derived from the educational literature and practice, administrative decisions and court interpretationsOften associated with clinical Dx of CD, ODD, or AntisocialDefinition Components:Pervasive intentional behaviors that violate socially acceptable rules and normsAccepting no responsibility for actionsDemonstrating little to no remorseBlame and intimidate / charm others while manipulating the situation to meet own needs
119ASD vs. EI / SM BEHAVIORS: DISTINGUISH BETWEEN: Refusal to do academic workNot following school expectations / rulesAggression toward peersDISTINGUISH 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.Key Concepts:We have to carefully look at situations and context in order to reduce our changes of making a fundamental attribution error.Considerations:The behavior in red is the same behavior. The difference is the situation or context.Application:Ask the group to identify the function of the behavior in each context (Suggestion: first one is avoiding peers; second one is seeking adult attention)Point out the importance of determining the function, rather than just focusing on the behaviorAsk, “Wouldn’t we implement different supports or teach different skills in each scenario?” Make sure the group sees the importance of the context/situation and the importance to determining function of behavior. This drives the type of strategies that should be implemented.
120Preponderance of Evidence Compare & Contrast The Results Review MeetingSocialCommunicationOTHERBehaviorSensory
121Preponderance of Evidence Compare & Contrast Developmental History ASDEIDevelopmental delays (e.g. language, joint attention)Uneven developmentUnusual skills / interests (e.g. door hinges, refrigerator letters – making words)RitualisticNuance in restricted nature / ritualsSophistication above developmental levelFamily history / concernsHyperactivityEmotional extremes outside typical developmental normsCAUTION: Wrong Dx
122Compare & Contrast History of Interventions Visual SupportsSocial FactsSocial ReinforcementCounselingSelf Management
123Compare / Contrast Specific Behaviors Social Maladjustment vs. ASD Pervasive intentional behaviors that violate socially acceptable rules and normsAccepting no responsibility for actionsDemonstrating little to no remorseBlame and intimidate / charm others while manipulating the situation to meet own needsEXAMPLE: Jonathon
124Preponderance of Evidence Compare & Contrast Characteristics
125Cognitive 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.
126Making a Final Decision Preponderance of EvidenceNo 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 alignMUST build a case for your conclusionHowever & DespiteIntelligent People can Disagree!!
127What if there is disagreement? (e.g. Medical says “yes” and School says “no”)Remember, different purposes (diagnosis versus special education eligibility and IEP development)Adherence to strong evaluation process, report is defendableCommitment to communicationMake sure to meet student needsImplementation of Universal SupportsUse of SW-PBIS practices
128Selected References MARSE Rules ISD Guidelines for Determining Eligibility of Emotional ImpairmentMacombChar-EmOttawaOCALI Online Identification ModuleOther State GuidelinesNATTAP (Network of Autism Training and Technical Assistance Providers) 2008 Conference Session “Compare and Contrast EBD & ASD”—Columbus, OHTrammell, B., et.al. (2013) Assessment and Differential Diagnosis of Comorbid Conditions in Adolescents and Adults with ASD. Psychology in the Schools, 5 (9).