Assessment is a CRUCIAL Leadership Skill and Tool “Assessment is the estimation or evaluation of the nature, quality, or ability of someone or something. It is a systematic process of information gathering about some phenomenon, conducted in a reliable manner. It's completion then allows one to make a judgment about something.” Assessment is a CRUCIAL Leadership Skill and Tool

Dr. Richard Kiefer-O’Donnell Standardized Assessment and Individuals with Neurodevelopmental Disorders The first of five sessions over the LEND experience aimed at targeting Leadership/Interdisciplinary Teamwork with this service area. Dr. Richard Kiefer-O’Donnell Oct 24th, 2014

Agenda for today Results of Skills Analysis Discussion on Sally Ozonoff’s overview, assessment questions and impact on you as LEND Fellows Overview of the 5 Assessment-related sessions and goals relative to LEND ASD Assessment and new DSM 5 diagnostic criteria

Survey findings (8 of 11 Fellows) Academic training experience Employing tools: distributed Planning/use of findings: slightly skewed to having had coursework coverage Employment or family training experience Employing tools: skewed – at least workshop but often more intense Planning/use of findings: skewed to having had workshop and beyond. Everyone has had some exposure Current role/responsibility Screening: distributed but intermittent role or less Diagnosis: Rare, but a couple have implementation and leadership role Admin/intervention: distributed but most have at least some role; again, a couple have regular if not team leadership role Converting % to actual number of respondents 1 = 12.5% 2 = 25% 3 = 37.5% 4 = 50% 5 = 67.5%

Ozonoff’s Reasons for Engaging in Assessment Feedback on streamed video? National role of MIND Institute Levels and AAP Tools anchored in DSM-IV TR Differential diagnosis versus co-morbidity HFA versus Asperger’s Assessment function represented in “questions” associated with referral

Ozonoff’s Reasons for Engaging in Assessment

Interdisci-plinary teaming role Cultural compe-tence role Assessment and LEND Assessment Concern Leader-ship role Interdisci-plinary teaming role Family support role Cultural compe-tence role Diagnosis of young children who potentially experience a neurodevelopmental disorder Determine eligibility for services Annual client evaluation of progress Target intervention Program evaluation

Overview of five sessions Emerging LEND, Leadership/ Teaming and Assessment - from the 20,000 foot level; DSM 5 Criteria. Partial Demonstration of ADOS-2 Autism Diagnostic Observation Schedule, Second Edition Interdisciplinary Assessment Ideal Real Overview of five sessions Criterion-referenced Assessment And Program Planning

Where were we with DSM-IV Where were we with DSM-IV? – Incidence rate across these 3 most common groups CDC Prevalence (8 year olds) 1 in 68 children State reported Incidence: 6 in 1000 students nationally (Suggested from several sources)

DSM-IV TR: Diagnostic Criteria for Autistic Disorder Six or more items from A (1), (2), and (3), with at least two from A1, and one each from A2 and A3. qualitative impairment in social interaction – a) marked impairment in the use of multiple nonverbal behaviors , b) failure to develop peer relationships, c) a lack of spontaneous seeking to share enjoyment/interests, and d) lack of social or emotional reciprocity qualitative impairments in communication – a) delay in, or total lack of, the development of spoken language, b) marked impairment in the ability to initiate or sustain a conversation, c) stereotyped and repetitive use of language and d) lack of varied, spontaneous make-believe play  restricted repetitive and stereotyped patterns of behavior, interests, and activities – a) preoccupation with one or more stereotyped and restricted patterns of interest, b) inflexible adherence to specific, nonfunctional routines or rituals, c) repetitive motor manners, and d) persistent preoccupation with parts of objects Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative Disorder

DSM-IV TR: Diagnostic Criteria for Asperger's Qualitative impairment in social interaction, as manifested by at least two of the following: 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 Failure to develop peer relationships appropriate to developmental level A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people) Lack of social or emotional reciprocity Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus Apparently inflexible adherence to specific, non-functional routines or rituals Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) Persistent preoccupation with parts of objects

DSM-IV TR: Diagnostic Criteria for Asperger's The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years) There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

DSM-5: Diagnostic Criteria for Autism Spectrum Disorder The individual must meet all four of the following criteria. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people.

DSM-5: Diagnostic Criteria for Autism Spectrum Disorder The individual must meet all four of the following criteria. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypes, echolalia, repetitive use of objects, or idiosyncratic phrases). Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes). Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).

DSM-5: Diagnostic Criteria for Autism Spectrum Disorder The individual must meet all four of the following criteria. C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities) D. Symptoms together limit and impair everyday functioning