RECENT DEVELOPMENTS IN BEHAVIORAL, SOCIAL, AND CLINICAL ASSESSMENT OF CHILDREN 2015 JEROME M. SATTLER Power Point Presentation Primarily Based on Foundations.

RECENT DEVELOPMENTS IN BEHAVIORAL, SOCIAL, AND CLINICAL ASSESSMENT OF CHILDREN
2015 JEROME M. SATTLER Power Point Presentation Primarily Based on Foundations of Behavioral, Social, and Clinical Assessment of Children, by Jerome M. Sattler, Copyright © 2014 by Jerome M. Sattler Publisher, Inc.

11 ADVANTAGES OF BEING A SCHOOL PSYCHOLOGIST [1]
Being called a psychiatrist, an MD degree bestowed upon you without ever entering medical college Can fudge your own IQ! Get to use big words like crystallized intelligence

Still get to play with blocks in your 40s, 50s, etc Carrying the test kits around gives you chiseled pecs, biceps and delts You can honestly refer to yourself as “psycho”

People don’t really know what you do (and in most cases are afraid to ask) “Clinical opinion” = “My best guess” You get to explain the normal curve to people who don’t fall under it It reduces your desire to have children You never have to actually teach those kids anything

How Am I Going to Score These?
Question: Before we start, what is your name and address? Answer: Question: What is your date of birth? Answer: July fifteenth Question (follow up): What year? Answer: Every year.

Question: What are 12, 14, and 16? Answer: That’s easy; MTV, Fox, and Cartoon network. Question: What is celebrated on Thanksgiving Day? Answer: My cousin’s birthday. Question: What is the capital of Greece? Answer: G.

Question: What are the four seasons? Answer: Baseball, football, basketball, and hockey. Question: What are four other seasons? Answer: Mustard, ketchup, salt, and pepper. Question: In what way are an orange and a pear alike? Answer: Both give me hives.

Question: If I cut a pear in thirds, how many pieces will I have? Answer: One. Question: (Testing-of-limits) Are you sure I will have only one piece? Answer: Yes, and I will have the other two pieces.

Question: What does imitate mean? Answer: What does imitate mean? Question: What would you do if you were lost in the woods? Answer: I’d use my cell phone, pager, or my global positioning satellite device.

Question: We want to see if you are eligible for our memory training class. Repeat the following: 6Z4J5Y9A1P7W3D8G2S9T4K. Answer: Huh? Reply: You’re eligible. Question: What do you call a baby goat? Answer: Matilda would be a nice name.

Psychology and Other One-liners
Does the name Pavlov ring a bell? My girlfriend came from Taiwan she has a taipei personality I joined the Tourettes society today. It only took a minute to swear me in. DNA: Association of National Dyslexics When choosing a path in life, try to avoid the psychopaths

Psychology and Other One-liners
The road to ADHD is paved with bad attentions. I think my therapist is seeing other people. I'm great at multitasking. I can waste time, be unproductive, and procrastinate all at once. Calendar Note: One again, we did not schedule this month's Apathetics Anonymous Meeting.

Psychology and Other Humor
[please enter a password] ilovedogs [password must contain at least one capital] iloveparisdogs What if Google doesn't know?

Psychology and Other Humor
Contacting Your Phone Provider To wait a long time & get no help press 1 To wait a long time & get no help press 2 To wait a long time & get no help press 3 Redirecting

Revised, New, or Additional Assessment Measures [1]
Behavior Dimensions Scale, Second Edition: School Version and Behavior Dimensions Scale, Second Edition: Home Version, p. 347 Conners 3rd Edition, p. 351 Conners Comprehensive Behavior Rating Scales, p. 352 Social Skills Improvement System, p. 359

Parenting Relationship Questionnaire, p. 366 Parenting Stress Index, Fourth Edition and Parenting Stress Index, Fourth Edition–Short Form, p. 368 Koppitz Developmental Scoring System for the Bender Gestalt Test, Second Edition, p. 406 Beery VMI, p. 407

Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, p. 409 Multidimensional Anxiety Scale for Children, Second Edition, p. 439 Revised Children’s Manifest Anxiety Scale, Second Edition, p. 439 Children’s Depression Inventory, Second Edition, p. 442 Reynolds Child Depression Scale, Second Edition, p. 443

Strengths and Difficulties Questionnaire, p. 463 ADHD Questionnaire, p. 463 Attention Deficit Disorder Evaluation Scale, Fourth Edition–Home Version, Attention Deficit Disorder Evaluation Scale, Fourth Edition–School Version,

BASC–2 Progress Monitor, p. 463 Comprehensive Executive Function Inventory, p. 463 See Table 17-1 for examples of standardized achievement tests Autism Diagnostic Observation Schedule, Second Edition, p. 608 Autism Observation Scale for Infants, p. 608 Autism Spectrum Rating Scale, p. 608

Checklist for Autism Spectrum Disorder, p. 608 Childhood Autism Rating Scale, Second Edition, p. 608 PDD Behavior Inventory, p. 608 Psychoeducational Profile–Third Edition, p. 608 Scale of Pervasive Developmental Disorder in Mentally Retarded Persons,

Screening Tool for Autism in Toddlers and Young Children, p. 608 Social Responsiveness Scale, p. 608 SCAT3 (Sport Concussion Assessment Tool 3), p. 635 NEPSY–II, p. 665 NIH Toolbox, p. 669

Also see the Resource Guide for revised questionnaires, semistructured interviews, observation forms, self-monitoring forms, FBA forms, ADHD forms, SLD forms, ASD forms, Instructional handouts, miscellaneous tables, and formal and informal measures of executive functions (p. 251 and p. 258 in Resource Guide)

Video Link Fetal Alcohol Spectrum Disorders Prevention PSA

10 Indicators of Child Well-Being by Ethnicity (%), 2012-2013 [1]
Abbreviations Used in the Table NA = National Average EA = European American AA = African American As = Asian American HA = Hispanic American AI = American Indian

NA EA AA As HA AI Children in poverty 23 14 40 15 34 24 Teens not in school and not working 8 6 12 4 10 Children not attending preschool 54 51 48 63 53 Fourth graders not proficient in reading 66 55 83 49 81 61

NA EA AA As HA AI Eight graders not proficient in math 66 56 86 40 79 63 High school students not graduating on time 19 15 32 7 24 Low-birthweight babies 8 12.8 8.2

NA EA AA As HA AI Child and teen death per 100,000a, b 26 25 36 14 21 Children in single-parent families 35 67 17 42 43 Teen birth per 1,000a 29 20 44 10 46 a Not in percent. b 2010.

Source: Annie E. Casey Foundation. (2014) data book: State trends in child well-being (25th Ed.). Retrieved from

Paternal Age at Childbearing [1]
Sample All individuals born in Sweden in 1973–2001 (N = 2,615,081) Results Offspring of fathers 45 years and older, compared with offspring born to fathers 20–24 years old, were at heightened risk of ADHD (13.13 times greater) Autism (3.45 times greater)

Results (Cont.) Bipolar disorder (24.70 times greater) Psychosis (2.07 times greater) Suicide attempts (2.72 times greater) Substance use problems (2.44 times greater) Failing a grade (1.59 times greater) Low educational attainment (1.70 times greater)

Conclusions Advancing paternal age is associated with increased risk of psychiatric and academic morbidity in children In older fathers Sperm may not develop fully Sperm may have some form of genetic mutation

Conclusions (Cont.) Older fathers also may have been exposed to Environmental toxins longer than younger fathers and Long exposure to toxins may affect the DNA in the father’s sperm

Source D’Onofrio, B. M., Rickert, M. E., Frans, E., Kuja-Halkola, R., Almqvist, C., Sjölander, A., Larsson, H., & Lichtenstein, P. (2014). Paternal age at childbearing and offspring psychiatric and academic morbidity. JAMA Psychiatry. Advanced online publication. doi: /jamapsychiatry

Adverse Childhood Experiences (ACEs) California Study [1]
Year: 2008 to 2013 Representative sample of 27,745 adults Aim of study: Effects of childhood trauma on later health problems Childhood trauma defined as experiencing Physical abuse (19.9%; N = 5,521) Sexual abuse (11.4%; N = 3,163) Emotional abuse (34.9%; N = 9,683)

Adverse Childhood Experiences (ACEs) California Study [2]
Physical or emotional neglect (9.3%; N = 2,303) Household dysfunction Mental illness (15.0%; N = 4,161) Incarcerated relatives (6.6%; N = 1,831) Mother treated violently (17.5%; N = 4,855) Substance abuse (26.1%; N = 7,241) Divorce (26.7%; N = 7,408)

Findings of ACE Study [1]
38.3% experienced 0 ACE (N = 10,626) 21.7% experienced one ACE (N = 6,020) 23.3% experienced two to three ACEs (N = 6,464) 16.7% experienced four or more ACEs (referred to as polyvictimization) (N = 4,633) Overall, at least 61.7% experienced one or more ACEs (N = 17,119)

Adults who suffered 4 or more ACEs (compared to those who did not) were 5.13 times likely to suffer from depression 2.42 times more likely to have chronic obstructive pulmonary disease (COPD) 2.93 times more likely to smoke 3.23 times more likely to binge drink 7.4 times more likely to be alcoholic 12.2 times more likely to attempt suicide

Adults who suffered 4 or more ACEs (compared to those who did not) were (Cont.) 10.3 times more likely to inject drugs 2.4 times more likely to have a stroke 1.9 times more likely to have cancer 1.6 times more likely to have diabetes 21% more likely to be below Federal Poverty Level

Adults who suffered 4 or more ACEs (compared to those who did not) were (Cont.) 27% more likely to have less than a college degree 39% more likely to be unemployed

Source:

Development of Hispanic American Toddlers [1]
Participants Children born in 2001 N = 950 Hispanic American (HA) children N = 3,600 native born European American (EA) children

Methods Bayley Interviews with mothers at 9 months and 24 months of age A variety of mother-infant interactions tasks Case history information and other scales used to gather data

Findings Cognitive rate of growth lower among most HA than EA toddlers 4/5 of HA toddlers fell below the cognitive proficiency of EA toddlers Gap significantly wider for HA toddlers of foreign-born mothers than of native-born mothers

Findings (Cont.) Children in families falling below the poverty line display significantly weaker cognitive growth Children showed more robust cognitive development when their mothers Had completed some college Engaged their children in daily reading and storytelling

Findings (Cont.) These activities may serve as proxies for the mother’s Steady interaction with the toddler Own language skills Caring and closeness that plausibly boost the child’s cognitive growth EA mothers displayed praise and encouragement more frequently than HA mothers

Source Fuller, B., Bein, E., Kim, Y., & Rabe-Hesketh, S. (2015). Differing cognitive trajectories of Mexican American toddlers: The role of class, nativity, and maternal practices. Hispanic Journal of Behavioral Sciences. Advanced online publication. doi: /

Life Expectancy Tied To Education [1]
Life expectancy is 82 for individuals with more than 12 years of education Life expectancy is 75 for individuals with 12 or fewer years of education

Possible Reasons Those with less education: Are likely to have more smoking‑related diseases, such as lung cancer and emphysema—35% of Americans with an 9th to 11th grade education smoke, while only 7% with a graduate degree smoke Are likely to have lower incomes

Possible Reasons (Continued) Are likely to live in areas that have their own health threats, either through crime or poor housing conditions Are likely to have limited health insurance and limited access to health services Are more likely to agree with the statement: “It doesn't matter if I wear a seat belt, because if it’s my time to die, I'll die.”

Summary and Recommendations The less affluent and less educated are also, invariably, less healthy Disparities in health are a major challenge in the United States Health is not a product of health care per se, but of one's life course and opportunities

Summary and Recommendations (Cont.) The less educated must learn the following: “It does matter. Life is uncertain, but that's no reason to surrender to fate” Fighting poverty and improving education are keys to increasing life expectancy among less‑advantaged Americans

Summary and Recommendations (Cont.) Source: Meara, E. R., Richards, S., & Cutler, D. M. (2008). The gap gets bigger: Changes in mortality and life expectancy, by education, 1981–2000. Health Affairs, 27, 350–360.

Equity and Educational Opportunities In US Schools [1]
Office for Civil Rights, Civil Rights Data Collection Sample Statistics Year of study: 2009–2010 Representative sample Covering approximately 85% of nation’s students

Equity and Educational Opportunities US Schools [2]
Key Findings African-American students represent 18% of students in sample and 35% of students suspended once 46% of students suspended more than once 39% of students expelled

Key Findings (Cont.) Hispanic-American students represent 24% of students in sample and 25% of students suspended once 25% of students suspended more than once 24% of students expelled

Key Findings (Cont.) Asian-American students represent 6% of students in sample and 3% of students suspended once 1% of students suspended more than once 2% of students expelled

Key Findings (Cont.) American-Indian-American students represent 1% of students in sample and 1% of students suspended once 1% of students suspended more than once 1% of students expelled

Key Findings (Cont.) European-American students represent 51% of students in sample and 36% of students suspended once 29% of students suspended more than once 33% of students expelled

Key Findings (Cont.) Referred to Law Enforcement 25% of European American students (51% in sample) 42% of African American students (18% in sample) 29% of Hispanic American students (24% in sample)

Key Findings (Cont.) School Related Arrests 21% of European American students (51% in sample) 37% of African American students (18% in sample) 35% of Hispanic American students (24% in sample)

Key Findings (Cont.) Sex of Students Expelled Males 74% (about 50% of sample) Females 26% (about 50% of sample)

Key Findings (Cont.) Disability Status of Students Suspended 13% of students with disabilities covered by IDEA were suspended 6% of Non-IDEA students were suspended

Key Findings (Cont.) Disability Status of Students (Cont.) Referred to Law Enforcement Students with disabilities covered by IDEA 25% (but 12% of student population) Non-IDEA students 75% (but 88% of student population)

Key Findings (Cont.) English Language Learners Suspended 7% (but 10% of student population)

Sources:

Reducing Suspensions and Expulsions [1]
Education Development Center May 2011 Recommendations Schools and mental health, juvenile justice, and law enforcement agencies Must collaborate to improve outcomes for youth, especially those at risk for suspension or expulsion

Recommendations (Cont.) Schools and mental health, juvenile justice, and law enforcement agencies (Cont.) Must employ improved information-sharing and data collection systems to identify, serve, and communicate about at-risk students

Recommendations (Cont.) State standards are needed to guide schools’ practices related to Promoting students’ mental health Identifying students who need mental health services Assisting students to access services

Recommendations (Cont.) School districts should Focus on implementing, adapting, and evaluating evidence-based interventions Have policies that require programs and services for at-risk youth Consistently apply suspension and expulsion policies so that existing racial and ethnic disparities are not perpetuated

Recommendations (Cont.) School districts should (Cont.) Identify effective strategies to engage and collaborate with parents Provide support to enable expelled students to rejoin the school community (and community partners)

Source:

Outcomes in Serious Youthful Offenders [1]
Why do some serious adolescent offenders stop offending while others continue to commit crimes? Investigators interviewed 1,354 young offenders in the US Mean age = 16.2 years Years of offense: 2000 to 2003 Year of data collection: 2010

FINDINGS Other than those with substance abuse problems, those with behavioral health problems were at no greater risk than those without behavioral health problems for Rearrest or Engaging in antisocial activities

FINDINGS (Cont.) More frequent aftercare services (e.g., frequent supervision and involvement in community activities) significantly reduced the odds of An arrest or Return to an institution during the 6-month aftercare period

FINDINGS (Cont.) Those with substance use disorders, in comparison with those without substance abuse, disorders had more negative outcomes

Source Schubert, C. A. & Mulvey, E. P. (2014). Behavioral health problems, treatment, and outcomes in serious youthful offenders. Retrieved from

Executive Functions (EF; Appendix M, pp. 246–262 in RG)

Executive Functions [1]
Cognitive abilities responsible for Complex goal-directed behavior Adaptation to environmental changes and demands Development of social and cognitive competence Development of self-regulation of behavior

EF enable individuals to modulate, control, organize, and direct Cognitive activities Emotional activities Behavioral activities

EF help individuals Make personal and social decisions Distinguish relevant from irrelevant material Follow general rules Make use of existing knowledge in new situations

EF important for Daily living Academic performance Work-related activities Social relationships

Primary Executive Functions (RG, p. 247)[1]
Planning and goal setting: ability to plan and reason conceptually, monitor one’s actions, and set goals Organizing: ability to organize ideas and information Prioritizing: ability to focus on relevant themes and details Working memory: ability to temporarily hold and manipulate information in memory

Primary Executive Functions (RG, p. 247) [2]
Shifting: ability to alternate between different thoughts and actions, to devise alternative problem-solving strategies, and to be cognitively flexible Inhibition: ability to inhibit thoughts and actions that are inappropriate for a situation Self-regulation: ability to regulate one’s behavior and monitor one’s thoughts and actions

Developmental Aspects of Executive Functions [1]
EF most closely associated with the frontal lobes of the brain Maturational changes in brain structure and function and in social experiences govern the development of EF (see Table M-1 on p. 249 in RG)

Begin to develop as early as 2 months of age Self-exploration Emerging understanding of volitional actions At 1 year of age Working memory Ability to detect another’s attentional and intentional states

EF improves throughout development; gains noted in Working memory Strategic thinking and fluency Goal-directed behavior Monitoring of behavior Flexibility

EF improve throughout development gains in (Cont.) Understanding of emotions, intentions, beliefs, and desires Deciphering of metaphors and understanding of faux pas Processing speed Problem solving

Overall EF has elements Of uniformity—common evolution across EF Of individuality and variation—unique evolution across EF

Intelligence and EF [1] Tests of intelligence correlate moderately—
about .40 to .60—with tests of EF Working memory more closely related to fluid and crystallized intelligence Inhibition and flexibility less closely related to fluid and crystallized intelligence

Intelligence and EF [2] Correlations moderate because IQ tests do not require Shifting between different tasks Shifting between competing demands Using self-regulation strategies to maximize long-term objectives Inhibiting less favorable responses

Achievement and EF [1] Writing Essays
Planning and defining the first step Rephrasing and paraphrasing one’s own work and the work of others (cognitive flexibility) Organizing and prioritizing Using accurate syntax

Reading Comprehension
Achievement and EF [2] Reading Comprehension Planning what to read first and which sections to focus on most Organizing the material mentally by its most important points Monitoring one’s comprehension by summarizing material

Independent Studying, Completing Homework, and Long-Term Projects
Achievement and EF [3] Independent Studying, Completing Homework, and Long-Term Projects Planning ahead (time management) Acquiring materials and information (information processing) Setting long-term goals (completing tasks) Self-regulation (balancing needs)

Achievement and EF [4] Independent Studying, Completing Homework, and Long-Term Projects (Cont.) Self-monitoring (remembering to submit completed assignments by a specific time) Cognitive flexibility (ability to modify how one goes about doing projects)

Achievement and EF [4] Test-Taking
Prioritizing and focusing on relevant themes Managing time to study and answer questions

How EF Are Compromised? By Mental disorder Brain injury
Learning disability Attention difficulties Fatigue Anxiety Stress Depression Motivational deficits

Examples of Disabilities Where EF are Compromised
Planning: ASD, TBI, SLD Goal setting: ASD, TBI, SLD Inhibition: ASD, ADHD, TBI Self-regulation: ASD, ADHD, TBI, SLD Shifting: ADHD, TBI, SLD Prioritizing: SLD Working memory: TBI Organizing: ADHD, SLD

Assessment of EF [1] Neuropsychological tests (see Table M-2 on pp. 251–257 in RG) Psychological tests (see Table M-2 on pp. 251–257 in RG)

Assessment of EF [2] Interviews with
Child (see Table M-3 on pp. 258–259 in RG) Parents (see Tables M-3 on pp. 258–259 in RG and B-9 on pp. 40–43 in RG) Teachers (see Table B-15 on pp. 67–70 in RG)

General Assessment Considerations
Assessment of EF [3] General Assessment Considerations Measures of information processing and academic skills are indirect measures of EF Amount and nature of EF involved in each task varies No single measure provides an accurate estimate of all types of EF

Assessment of EF [4] Observing child at school, home, and during the assessment (see Table M-3 on pp. 258–259 in RG) Analyzing samples of the child’s schoolwork and written homework assignments (see Table H-8 on p. 137 in RG) See Table L-18 (p. 242 in RG) for a checklist for rating EF

Assessment of EF [5] Conclusion
A multifaceted, comprehensive assessment is required for the assessment of EF

Improving Deficits in EF
See pp. 259 and 260 in RG See Handout K-1 (for parents, begins on p. 162) and Handout K-3 (for teachers, begins on p. 185) in RG

IDEA 2004—Sec. 614. EVALUATIONS PROCEDURES (Chapter 1)[1]
Assessment Considerations Information about Functional Developmental Academic functioning No single measure as the sole criterion for determination of a disability Use of technically sound instruments

Assessment Considerations (Cont.) Selected and administered so as not to be discriminatory on a racial or cultural basis Administered in the language and form most likely to yield accurate information Child is assessed in all areas of suspected disability

Assessment Considerations (Cont.) Consider information obtained from Parents Current classroom-based, local, or state assessments Classroom-based observations Present levels of academic achievement Developmental needs of child

IDEA 2004 and Specific Learning Disabilities (SLD; Chapter 16)[1]
SEC DEFINITIONS (30) SPECIFIC LEARNING DISABILITY— (A) IN GENERAL—The term “specific learning disability” means a disorder in 1 or more of the basic psychological processes involved in understanding or in using language, spoken or written, which disorder may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations.

IDEA 2004 and SLD (Chapter 16)[2]
SEC DEFINITIONS (Cont.) (B) DISORDERS INCLUDED—Such term includes such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.

IDEA 2004 and SLD (Chapter 16)[3]
SEC DEFINITIONS (Cont.) (C) DISORDERS NOT INCLUDED—Such term does not include a learning problem that is primarily the result of visual, hearing, or motor disabilities, of intellectual disability, of emotional disturbance, or of environmental, cultural, or economic disadvantage.

Some Facts About SLD [1] In 2010, almost 5 million U.S. children ages 3–17 years had a SLD (8%). About 2.4 million students diagnosed with SLD receive special education services each year, representing 41% of all students receiving special education Approximately 80% of children with a SLD have a reading disorder

Some Facts About SLD [2] Approximately 7% of children with a SLD have an arithmetic disorder Approximately 6% to 15% of children with a SLD have a disorder of written expression The prevalence rate of SLD is higher for boys than for girls by a ratio of about 1.5 to 1 (9% vs. 6%)

Some Facts About SLD [3] Ethnic composition
African American children (10%) European American children (8%) Asian American children (4%) In families with incomes of $35,000 or less, the percentage of children with a SLD (12%) is twice that in families with incomes of $100,000 or more (6%)

Some Facts About SLD [4] Close to half of secondary students with SLD perform at more than three grade levels below their enrolled grade in essential academic skills (45% in reading, 44% in math)

Some Facts About SLD [5] Children in single-mother families are about twice as likely to have SLD as children in two-parent families (12% vs. 6%) Children with poor health are almost five times more likely to have SLD than children in excellent or very good health (28% vs. 6%)

DSM-5 The affected academic skills are substantially and quantifiably below those expected for the individual’s chronological age Cause significant interference with academic or occupational performance, or with activities of daily living Confirmed by individually administered standardized achievement measures and comprehensive clinical assessment

Reasons for Poor Performance of Children with Readings Disorders [p
Problem areas Attention and concentration Phonological awareness Orthographic awareness Word awareness Semantic or syntactic awareness Rapid decoding

Possible Reasons for Poor Performance With Children with Readings Disorders [p. 483-2]
Problem areas (Cont.) Rapid naming Verbal comprehension Pragmatic awareness

Overall Comment on SLD [1]
Academic underachievement is a key characteristic usually shared by children with SLD Language-based dysfunctions underlie many children with SLD Reading disability most frequent disability

Examine patterns of cognitive and linguistic functioning Don’t rely on somewhat arbitrary cutoff scores Don’t depend exclusively on RTI Use the child’s unique pattern of abilities and other assessment results to serve as the foundation for developing interventions

Important to evaluate Cognitive-academic deficits Information-processing and executive functioning deficits Perceptual deficits Social-behavioral deficits See Table 16-1, p. 481 in main text for list of deficits in each of above areas

SLD and English Language Learners (ELL) [1]
Assessment Considerations Experiential background. Consider their: Length of residence in their new country Quality of instruction in school School attendance record Health history Family history

Assessment Considerations (Cont.)
SLD and ELL [2] Assessment Considerations (Cont.) Language ability of peers. Compare their language abilities with peers with similar Linguistic/cultural backgrounds Exposure to second language instruction

SLD and ELL [3] Assessment Considerations (Cont.) Language ability of siblings. Compare their language abilities with those of their siblings when they were of the same age Typical difficulties in learning a second language. Compare their learning difficulties with those of other English language learners

SLD and ELL [4] Assessment Considerations (Cont.) Linguistic proficiency. Compare their linguistic proficiency in their primary language and in English Appropriate assessment battery Standardized tests Checklists Language samples Interviews

SLD and ELL [5] Assessment Considerations (Cont.) Appropriate assessment battery (Cont.) Questionnaires Observations Portfolios Journals Work samples Curriculum-based measures Language-reduced measures

Reasons for Poor School Performance of ELL
Experiential differences Family expectations Limited English proficiency Stress associated with acculturation and discrimination Cognitive styles and learning strategies that differ from those of the majority group

Children with Reading Disorder
Children with reading disorder may have difficulties in cognitive, perceptual, and linguistic areas See p. 483 in main text for a listing of these difficulties

Nonverbal Learning Disability [1]
Definition: A subtype of learning disability associated with a dysfunction in the right cerebral hemisphere

Strengths Auditory perceptual ability Receptive language Vocabulary Verbal expression Rote verbal memory Attention to small details

Weaknesses Reading comprehension Interpreting messages literally Math ability Abstract reasoning ability Coordination and psychomotor skills Ability to interact with others

Weaknesses (Cont.) Ability to correctly perceive gestures, facial expressions, and other nonverbal social cues Ability to adapt to changes and new situations Common sense Self-esteem

IDEA 2004 and SLD [1] Assessment Process
A local educational agency shall not be required to take into consideration whether a child has a Severe discrepancy between achievement and intellectual ability in various academic areas But it may use a process that determines if the child responds to scientific, research-base intervention as a part of the evaluation procedures

Limitations of IDEA Guidelines
IDEA 2004 and SLD [2] Limitations of IDEA Guidelines IDEA does not define how a severe discrepancy between achievement and intellectual ability should be determined. IDEA does not provide any guidance as to how the response to intervention process should be conducted.

Identifying SLD: RTI [1]
Problem-Solving Approach The teacher uses achievement test scores to identify children who are at risk The teacher consults with others about needed instructional modifications If the interventions are not successful, the school support team considers possible causes and selects, implements, and evaluates interventions

Problem-Solving Approach (Cont.) If additional interventions not successful a comprehensive assessment will be needed

Standard Protocol Approach Involves intensive tutoring using a standard method of teaching All children who have similar difficulties are given the same intensive instruction

RTI and Needed Implementation Decisions Timing of the assessment (e.g., pre- and post-treatment, weekly, daily) Method for measuring responsiveness Norms (national norms, local norms, or norms for children who are at risk) Method for training teachers or tutors

RTI and Needed Implementation Decisions (Cont.) Intensity of interventions Procedures to use with culturally and linguistically diverse children Need for a comprehensive evaluation for the identification of SLD

Comment on RTI How does RTI help in distinguishing underachieving students from those with neurologically based SLD? Is RTI working effectively in diagnosing SLD? See discussion of RTI on pp. 494–496 in main text

Identifying SLD: Discrepancy Model
Simple difference method Regression method See pp. 496–497 in main text

Identifying SLD: Patterns of Strengths and Weaknesses (PSW) Models [1]
Discrepancy-Consistency Model Aptitude-Achievement Consistency Model Cognitive Hypothesis Testing Model See pp. 497–498 in main text

PSW models assume that in children with SLD: There are strengths and weakness in academic areas and psychological processing areas There is a relationship between areas of weakness in psychological processing and academic deficits

Determining Weaknesses Below Average Academic Performance (Below 10th or 15th percentile rank) Classroom tests National standardized achievement tests State standardized tests Significant intraindividual differences on cognitive ability subtests that relate to the academic deficits

Determining Weaknesses (Cont.) Below Average Psychological Processing (Below 10th or 15th percentile rank) Measures of phonological processing Measures of working memory Measures of processing speed Measures of rapid automatic naming.

Examples of Standardized Achievement Tests [1]
Phonological Awareness and Phonological Memory Tests Rapid Naming and Retrieval Fluency Tests Orthographic Processing Tests Print Awareness, Word Recognition, and Decoding Tests Reading Fluency Tests

Examples of Standardized Achievement Tests [2]
Reading Comprehension Tests Reading Inventories Written Expression Tests Oral Language Tests Mathematics Tests See Table 17-1 on pp. 500–501 in main text for a list of tests

Interviewing for SLD: Written Expression
See p. 504 in main text for interview questions

Interventions for SLD Table 17-6 (p. 508 in main text) for young children with reading disorders Table 17-7 (p. 508 in main text) for children with SLD Table 17-8 (p. 509 in main text) for examples of metacognitive strategies for children with reading disorders

Older Adolescents and Young Adults with SLD [1]
Help with (by using role-playing and supervised job training): Filling out applications for college Finding job training Reading want ads Filling out job applications Interviewing

Help with (by using role-playing and supervised job training): (Cont.) Following directions on the job Learning job skills Taking criticism Finishing work on time Paying attention on the job Working carefully

Help with (by using role-playing and supervised job training): (Cont.) Learning about their legal rights on the job Learning how to advocate for necessary job accommodations

Adjustment and Employment Success Consider: Abilities required in a particular career Ability to set reasonable goals Access to appropriate guidance Attitude toward life challenges Available support systems

Adjustment and Employment Success (Cont.) Consider: Awareness of limitations and strengths Coping skills Cognitive ability Family’s, peers’, and teachers’ attitudes toward them

Adjustment and Employment Success (Cont.) Consider: Motivation and perseverance Presence of comorbid disorders Self-concept

Functional Behavioral Assessment (FBA; Chapter 13)

Functional Behavioral Assessment [1]
A comprehensive, multimethod, and multisource approach designed to help you Arrive at an understanding of the relationship between the problem behavior and the specific environmental events Develop a behavioral intervention plan (BIP)

Need to consider Type of problem behavior Conditions under which the problem behavior occurs

Need to consider (Cont.) Probable reasons for the problem behavior Biological Social Cognitive Affective Environmental Functions served by problem behavior

Guidelines for Conducting FBA [1]
Define the problem behavior See Tables F-1, F-2, and F-3 (pp. 113– 118 in RG) for FBA forms

Perform the assessment. Review Prior psychological or psychoeducational evaluations Teachers’ comments on report cards Disciplinary records Anecdotal home notes Medical reports Prior interventions and results

Perform the assessment. (Cont.) Conduct systematic behavioral observations (see Chapters 8 and 9) Interview student, teacher, parents, and others as needed (see Chapters 5, 6, and 7) Conduct other formal and informal assessments as needed

Evaluate assessment results and also consider the questions on p. 416 in main text

Develop hypotheses to help explain relationship between problem behavior and situations in which problem behavior occurs Formulate a behavioral intervention plan Start the behavioral intervention as soon as possible Evaluate the effectiveness of the behavioral intervention

Assessing Problem Behavior Through Observations
See Chapters 8 and 9 in main text See Tables C-1 and C-2 (pp. 78–80 in RG)

Assessing Problem Behavior Through Interviews [1]
See Chapters 5, 6, and 7 in main text See Table B-1 (p. 20 in RG) Examples of questions to ask a student (See pp. 417–418 in main text) Example of questions to ask a teacher (See p. 418 in main text)

Assessing Problem Behavior Through Interviews [9]
See Table B-15 (p. 67 in RG) to interview teacher See questionnaires in Tables A-1, A-2, and A-3 (pp. 1–17 in RG) for parent, child, and teacher to complete See Table B-9 (p. 40 in RG) to interview parent

Formulating Hypotheses About Problem Behavior
See guidelines on pp. 419–420 in main text for formulating hypotheses

Monitoring the Behavioral Intervention Plan (BIP)
See p. 423 in main text for a list of questions to aid in monitoring the BIP

Bullying and Cyberbullying (Appendix N in RG)

Court Strikes Down Cyberbullying Law [1]
Decision On July 1, 2014, New York Court of Appeals (5 to 2) struck down an Albany, NY law that made cyberbullying a crime Court said that the law violates the First Amendment of the US Constitution Law made it a crime to engage in cyberbullying against any minor or person

Cyberbullying defined in the law as: Any act of communicating by mechanical or electronic means, including Posting statements on the internet or through a computer or network Disseminating embarrassing or sexually explicit photographs Disseminating private, personal, false or sexual information

Cyberbullying defined in the law as: Or sending hate mail with no legitimate private, personal, or public purpose With the intent to Harass Annoy Threaten Abuse Taunt

Cyberbullying defined in the law as: With the intent to (Cont.) Intimidate Torment Humiliate Or otherwise inflict significant emotional harm on another person

Case Marquan W. Mackey-Meggs, a 15-year-old student, was the first to be charged under the Albany law He posted photos on Facebook of other teenagers with captions that included graphic and sexual comments Majority of the court ruled that the law was not drafted properly

Source: People v. Marguan M., NY Slip OP (NY. Ct. App. 2014)

Are Anti-Bullying Laws Unconstitutional or Unneeded?[1]
MLA Jansen, a Calgary Associate Minister, says bullying laws do not necessarily address the complexities of the issue “It’s much more effective to teach people resilience so they can stand up to bullying and encourage others to stand up too.”

Are Anti-Bullying Laws Unconstitutional or Unneeded? [2]
Source:

Examples of Bullying [1]
See Table N-1 (p. 264 in RG) for examples of types of bullying

Effects of Bullying [1] Physical and mental health Of victim
Of victim’s peers, family, schools, community, and society Short- and long-term psychological, academic, and physical consequences for Victim Perpetrator Bystanders

Effects of Bullying [2] Short-Term Effects Physical effects
Behavioral effects Emotional effects See Table N-4 on p. 269 in RG for signs of distress displayed by victims of bullying

Long-Term Effects: Research Study
Effects of Bullying [3] Long-Term Effects: Research Study Sample: British children (N = 7,771) Bullied at ages 7–11 years Followed up at ages 23–50 years

Long-Term Effects: Reasearch Study (Cont.)
Effects of Bullying [4] Long-Term Effects: Reasearch Study (Cont.) Results: At age 23 years and at age 50 years, victims, in comparison to their nonvictimized peers, had higher rates of Depression Anxiety disorders Suicidality

Long-Term Effects: Research Study (Cont.)
Effects of Bullying [5] Long-Term Effects: Research Study (Cont.) Results (Cont.): At age 50 years, victims also had poor Social relationships Economic hardship Quality of life

Effects of Bullying [6] Long-Term Effects: Research Study (Cont.) Conclusion: Children who are bullied at a young age are at risk for a wide range of social, health, and economic problems nearly four decades after victimization

Effects of Bullying [7] Long-Term Effects: Research Study (Cont.) Source: Takizawa, R., Maughan, B., & Arseneault, L. (2014). Adult health outcomes of childhood bullying victimization: Evidence from a five-decade longitudinal British birth cohort. American Journal of Psychiatry, 171(7), 777–784. doi: /appi.ajp

Dear Colleague Letter Aug. 20, 2013 [1]
US Dept of Education Office of Special Education and Rehabilitative Services Melody Musgrove, Ed. D., Director, Office of Special Education Programs Michael K. Yudin, Acting Assistant Secretary

Students with disabilities are disproportionately affected by bullying Bullying may prevent students from receiving free and appropriate education under IDEA IEP Team needs to determine whether students’ needs have changed as a result of bullying

If so, what extent additional or different special education or related services are needed If students with a disability engaged in the bullying, IEP Team needs to address the inappropriate behavior IEP Team needs to study environment where bullying occurred to see if changes are warranted

Rate of Victimization Students with Disabilities [1]
Rate for all students between 15% to 28% Rate for students with disabilities 25% to 34% Elementary school 25% Middle school 34% High school 27% Rate is 1 to 1½ times higher than for all students

Highest rates for students with Emotional disturbance 39% to 52% Other health impaired 29% to 40% Highest rates for repeated victimization Autism spectrum disorder (in elementary and middle school) Orthopedic impairments (in high school)

Source: Blake, J. J., Lund, E. M., Zhou, Q., Kwok, O., & Benz, M. R. (2012). National prevalence rates of bully victimization among students with disabilities in the United States. School Psychology Quarterly, 27(4), 210–222. doi: /spq

Various Roles in Bullying
Bully who takes the initiative Follower who joins in Reinforcer who encourages the bully or who laughs at the victim Intervener who tries to stop the bullying Bystander who looks on but does not participate Victim who is the object of the bullying

Characteristics of Bullies [1]
Attempt to Control Dominate Subjugate others Through the use of power Bullies aim to disempower their victims by undermining their worth and status

Two key components of bullying Repeated harmful acts An imbalance of power

Their families Less cohesive (low parent-child involvement, warmth, and affection) More conflictual (angry, hostile parent-child interactions) Less organized More disadvantaged

Characteristics of Victims [1]
Displays vulnerability or insecurity Dresses differently and doesn’t conform to the norm Has learning, speech, or other physical or mental disabilities Has low self-esteem

Has physical attributes that differ from the norm Overweight Underweight Very short Very tall Has poor communication skills Has poor social skills

Is a member of an ethnic or religious group viewed as different Is bright, talented, or gifted Is clumsy or immature

Is or is perceived to be Lesbian Gay Bisexual Transgendered Is new to the school Is nonasssertive and refuses to fight Is physically weak

Is annoying, provocative, or aggressive Is richer or poorer than the majority of classmates Is shy, reserved, timid, or submissive Is the smallest or youngest child in school

Children with Special Needs [1]
May also act as bullies if they: Want to protect themselves from further victimization Feel extremely anxious and have limited frustration tolerance Cannot size up a situation realistically and distinguish good-natured kidding from bullying 211

Bullying and Children with Disabilities [1]
Students with disabilities are disproportionately affected by bullying Bullying may prevent students from receiving free and appropriate education under Individuals with Disability Education Act (IDEA) Individualized Education Program (IEP) Team needs to determine whether students’ needs have changed as a result of bullying

Bullying and Children with Disabilities [2]
If needs have changed, what extent additional or different special education or related services are needed? If students with a disability engaged in the bullying, IEP Team needs to address the inappropriate behavior IEP Team needs to study environment where bullying occurred to see if changes are warranted

Children with Disabilities [1]
May also act as bullies if they: Want to protect themselves from further victimization Feel extremely anxious and have limited frustration tolerance Cannot size up a situation realistically and distinguish good-natured kidding from bullying 214

May also act as bullies if they: (Cont.) Feel they are being pushed too far or feel that their resources are exhausted Fail to realize that their “playful” behavior can hurt others

Bullying may have harmful effects on children with disabilities: Limit motivation to achieve and lower their grades Interfere with their compliance with treatment regimens and use of assistive technology Increase frequency and strength of their symptoms

“Welcome to My Life” by Simple Plan[1]
Lyrics (Partial) Do you ever feel like breaking down? Do you ever feel out of place, Like somehow you just don't belong And no one understands you? Do you ever wanna run away? Do you lock yourself in your room With the radio on turned up so loud That no one hears you're screaming?

“Welcome to My Life” by Simple Plan[2]
No, you don’t know what it’s like When nothing feels all right You don’t know what it’s like To be like me

“Welcome to My Life” by Simple Plan [3]
To be hurt To feel lost To be left out in the dark To be kicked when you’re down To feel like you’ve been pushed around To be on the edge of breaking down And no one’s there to save you No, you don’t know what it’s like Welcome to my life

Bullying and Morality [1]
Bullying has been described as an immoral action because it humiliates and oppresses innocent victims (Gini, Pozzoli, & Hauser, 2011) Bullies have adequate moral competence–that is, they have knowledge of right and wrong and an understanding of moral norms

But paradoxically they do not have moral compassion–that is, emotional awareness and sensitivity about their moral infractions In fact, bullies may disregard the harmful effects of their actions and blame the victim for causing the bullying behavior

Source: Gini, G., Pozzoli, T., & Hauser, M. (2011). Bullies have enhanced moral competence to judge relative to victims, but lack moral compassion. Personality and Individual Differences, 50(5), 603–608. doi: /j.paid

Factors That May Lead to Bullying
See Table N-2 on p. 265 in RG

Differences Between Bullying and Cyberbulling [1]
Victim can hide from bully when at home Event is discrete and audience limited Bully is present, not anonymous, and can see suffering of victim Bully has opportunities for empathy and remorse

Bullying (Cont.) Bystanders can intervene Bully may gain status by showing abusive power

Cyberbullying Victim cannot hide from bully when at home Event can be continuous and audience potentially large Bully is invisible, may be anonymous, and cannot see suffering of victim Bully has few opportunities for empathy and remorse

Cyberbullying (Cont.) Bystanders have little opportunity to intervene Bully lacks opportunity to show his or her abusive power immediately

Cyberbullies But… Cyberbullies are not a new class of bullies—they also may engage in overt aggressive and social bullying

Incidence of Bullying [1]
Sound statistics difficult to obtain Victims may be reluctant to report Fearing retaliation Feeling shame at not being able to stand up for themselves Fearing they would not be believed Not wanting to worry their parents

Incidence of Bullying [2]
Victims may be reluctant to report (Cont.) Having no confidence that anything would change as a result Thinking their parents’ or teacher’s advice would make the problem worse Fearing their teacher would tell the bully who told on him or her Thinking it would be worse to be thought of as a snitch

USA Cyberbullying Surveys
In % of children ages 10–17 years harassed online Majority (69%) being female 1999–2000 6% of online users were harassed Over a 10-year period, online harassment increased by about 83%

Jamey Rodemeyer [1] On Sept. 8, 2011 Jamey Rodemeyer, a 14 year old, wrote on his website: “No one in my school cares about preventing suicide, while you're the ones calling me [gay slur] and tearing me down.” A day later he wrote: “I always say how bullied I am, but no one listens. What do I have to do so people will listen to me?"

Jamey Rodemeyer [2] Then he posted the lyrics to a song by the Hollywood Undead: “I just wanna say good bye, disappear with no one knowing I don't wanna live this lie, smiling to the world unknowing I don’t want you to try, you've done enough to keep me going I'll be fine, I'll be fine, I'll be fine for the very last time”

Jamey Rodemeyer [3]

Jamey Rodemeyer [4] About 10 days later, on Sept. 18, 2011 Jamey Rodemeyer committed suicide.

Why are Bystanders Reluctant to Report Bullying? [1]
They know that bullying is wrong but . . . Don’t want to raise the bully’s wrath and become the next target Don’t want to be thought of as a snitch and be rejected by their peers May wrongly believe that they are not responsible for stopping the bullying May think that bullying is acceptable

Why are Bystanders Reluctant to Report Bullying? [2]
May assume that school personnel don’t care enough to stop the bullying May feel guilty for not reporting the bullying May have heightened anxiety, depression, or substance abuse May become bullies themselves because they think that this is a way to become part of a group

Why do Some Bystanders Intervene?
Are victim’s friends Believe that their parents expect them to support victims Believe that it is the moral and proper thing to do Believe that their peer group supports their actions

Quotes The bully survives on your silence. —Christine Farrell Crotty
Bystanders who are helpless in the presence of another student’s victimization learn passive acceptance of injustice. —Linda R. Jeffrey, DeMond Miller, and Margaret Linn

Assessment of Bullying
See Tables B-17 to B-20 in RG (pp. 71–75) for four semistructured interviews on bullying

Helping Victims of Bullying [1]
Help them develop: Problem solving skills Conflict resolution skills Emotional regulation skills, including how to handle anxiety, depression, and anger

Helping Victims of Bullying [2]
Help them develop: (Cont.) Self-adequacy skills, including assertiveness skills and ability to say “no” or “stop that” Ability to know when to go to a safe room when under severe stress

Helping Bullies [1] Change habitual patterns of thought and action that support bullying Develop new skills Challenge old beliefs Replace impulsive with reflective decision-making

Helping Bullies [2] Helping children who are bullies
Develop anger management skills Develop empathy skills and appreciate the harm they cause their victims Recognize that they can engage in responsible and moral behavior Give up self-justifying mechanisms, egocentric reasoning, and distortions in morality

Effective Strategies To Counter Bullying In Schools [1]
Designing comprehensive intervention strategies involving students, teachers, administrators, families, and communities Building bullying prevention programs based on principles of science and supported by scientifically valid evidence of effectiveness

Applying school discipline rules, policies, and sanctions fairly and consistently Implementing policies at all levels, including primary, junior, intermediate, and high school

Motivating students, teachers, administrators, and parents to understand that Bullying is a serious and preventable problem Antibullying programs must be given a chance to work They themselves can make a difference

Motivating students, teachers, administrators, and parents to understand that (Cont.) Having a defender means that victims may be less likely to be bullied in the future

Presenting strategies that are clear, relevant, and comprehensible to both teachers and students Encouraging bystanders to report bullying

Partnering with law enforcement and mental health agencies to identify and address serious cases of bullying Assessing the frequency of bullying, the effectiveness of any intervention program, and making adjustments as needed (see Delaware Attorney General, n.d.; Hamburger et al., 2011; Safe School Survey, 2003)

Delaware Attorney General. (n.d.). Bully Worksheet Questionnaire. Retrieved from

Hamburger, M. E., Basile, K. C., Vivolo, A. M. (2011). Measuring bullying victimization, perpetration, and bystander experiences: A compendium of assessment tools. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Retrieved from

Safe School Survey. (2003). Safe School Survey sample menu. Retrieved from

Meta-Analysis of School-Based Anti-Bullying Programs [1]
Objective Meta-analysis of 13 studies (N = 19,619) published in 2005 to 2010 that examined anti-bullying programs conducted in several countries Results School-based anti-bullying programs have a small to moderate effect on victimization

Conclusion Best results were when anti-bullying programs had Training in emotional control Peer counseling Establishment of a school policy on bullying

Source: Lee, S., Kim, C. J., & Kim, D. H. (2013). A meta-analysis of the effect of school-based anti-bullying programs. Journal of Child Health Care. Advanced online publication. doi: /

Bystander Intervention
Needs to be taught in early school grades Education needs to be continued in later school grades Accompanied by programs that encourage peer support for victims of bullying

10 Tips for Parents [1] Talk often with your child, listen carefully, and note any changes in your child’s behavior Talk about what bullying and cyberbullying means. See such websites as and Remind your child that real people with real feelings are behind screen names and profiles

10 Tips for Parents [2] Tell your child:
To tell you when he or she is being bullied and discourage your child from bullying others To tell a member of the school staff if he or she sees a child being bullied To refuse to join in if he or she sees another child being bullied

10 Tips for Parents [3] Tell your child: (Cont.)
To learn about the school’s rules and sanctions about bullying and cyberbullying To post only information that he or she is comfortable with others seeing, and never to share passwords with anyone except you and another close family member

10 Tips for Parents [4] Tell your child: (Cont.)
To take Internet harassment seriously because it is harmful and unacceptable That you may review his or her online communications if you think there is reason for concern about his or her safety

10 Tips for Teachers [1] Explain to students the difference between playfulness and bullying or cruelty Let students know that bullying is unacceptable and against school rules Tell students, whether they are victims or bystanders, to report bullying or cyberbullying immediately to a member of the school staff

10 Tips for Teachers [2] Emphasize the difference between tattling and telling on someone who is bullying another student Identify and intervene upon undesirable attitudes and behaviors that could be “gateway behaviors” to bullying and cyberbullying Watch for signs of bullying and cyberbullying and stop either one immediately

10 Tips for Teachers [3] Listen receptively to parents who report bullying or cyberbullying Report all incidents of bullying and cyberbullying to the school administration Always respond to requests of help from victims of bullying and make sure that they know that being bullied is not their fault

10 Tips for Teachers [4] Closely monitor students’ use of computers at school and become familiar with cyberbullying and its dangers

Resources Strategies for Preventing and Dealing with Bullying, Cyberbullying, and Other Internet Issues in RG Handout K-2 for parents (pp. 177–184) Handout K-4 for teachers (pp. 210–217) Bullying Preventions Programs and Other Resources Exhibit N-2 (pp. 274–275)

Concluding Comment John Palfrey (2010), a professor of law at Harvard Law School, pointed out that “No one federal law will prevent tragedies from happening. Most of the time, we have the laws on the books that we need. It’s a commitment to teaching and mentoring, to being supportive and to being tough where we have to be, that can help.”

Video Links President Obama speaking at White House conference on bullying: Jamey Rodemeyer StopBullying.gov Webisode 11: Power in Numbers

Views from the Teacher’s Desk (Notes from Parents to Teachers) [1]
Please excuse ray friday from school. He has very loose vowels.

Please excuse my daughter’s absence. She had her periodicals.

Please excuse mary for being absent yesterday. She was in bed with gramps.

Dear school: please ecsc's john being absent on jan. 28, 29, 30, 31, 32 and also 33.

Please exkuce lisa for being absent she was sick and i had her shot.

Autism Spectrum Disorder (ASD; Chapter 22)

Video Link Bringing the Early Signs of Autism Spectrum Disorders Into Focus

DSM-5 Definition A neurodevelopmental disorder characterized by persistent deficits in social communications and social interactions and by repetitive or restricted behaviors, interests, and activities

Prevalence Rates of ASD in Four Countries [1]
Research Study Western Australia, Denmark, Finland, and Sweden Compared rates of ASD in 2000 and 2011 in children aged 10 years

Found increases in ASD diagnoses 96% in Finland 121% in Western Australia 175% in Denmark 354% in Sweden Source: See next slide

Atladottir, H. O., Gyllenberg, D., Langridge, A., Sandin, S., Hansen, S. N., Leonard, H., Gissler, M., Reichenberg, A., Schendel, D. E., Bourke, J., Hultman, C. M., Grice, D. E., Buxbaum, J. D., & Parner, E. T. (2014). The increasing prevalence of reported diagnoses of childhood psychiatric disorders: a descriptive multinational comparison. European Child and Adolescent Psychiatry. Advanced online publication. doi: /s

Some Facts about ASD [1] In 2011–2012, about 1 in 50 children in the United States had a diagnosis of ASD, with a prevalence rate of about 2% for children ages 6–17 years ASD occurs in all ethnic and socioeconomic groups Parents of children ages 6–17 years with ASD reported that 58.3% of cases were mild, 34.8% were moderate, and 6.9% were severe

Some Facts about ASD [2] ASD is almost five times more common among boys (3.23%) than among girls (.70%) Approximately 40% of children with ASD do not speak Approximately 25% to 30% of children with ASD begin speaking at 12 to 18 months of age but then stop speaking

Some Facts about ASD [3] Before child’s first birthday, parents may have concerns about child’s Social, communication, and fine-motor skills Vision and hearing

Some Facts about ASD [4] Children with higher IQs
Tend to show fewer symptoms Usually are identified as having an ASD at a later age

Some Facts about ASD [5] Children with other developmental disorders, such as Language disorder or Intellectual disability may also exhibit behaviors that suggest a possible ASD (see Table 22-1 on p. 601 in main text)

Lifetime Costs of ASD in USA and UK [1]
Research Study Aim of study: Conduct a literature review on the cost of ASD for individuals and families. Year: 2013 Countries: United States and United Kingdom

Findings Costs associated with ASD: Special education services Loss of parental productivity Residential care as adults Supportive living services as adults Individual productivity costs Medical costs

Results Individuals with ASD and with intellectual disability: $2.4 million in United States $2.2 million in United Kingdom Individuals with ASD and without intellectual disability: $1.4 million in United States $1.4 million in United Kingdom

Comment What are the most effective interventions that make the best use of scarce societal resources? How can we best coordinate services across many different service systems? How can we best deal with the enormous effect of ASD on children, their families, their schools, and society?

Source Buescher, A. V. S., Cidav, Z., Knapp, M., & Mandell, D. S. (2014). Costs of autism spectrum disorders in the United Kingdom and the United States. JAMA Pediatrics. Advanced online publication. doi: /jamapediatrics

Why Are More Children Diagnosed with ASD?
Greater public awareness More clearly defined public policies Availability of more extensive social services and education Availability of better and more sensitive diagnostic tools

Etiology of ASD [1] Genetic Causes
Identical twins are more likely to have ASD than nonidentical twins Increased rates of ASD among siblings and first-degree relatives ASD tends to occur about 10% of the time in children who have genetic or chromosomal disorders

Etiology of ASD [2] Genetic Causes (Cont.)
Genetic mechanisms may produce an excessive number of brain cells in the prefrontal cortex Older fathers may pass on significantly more random genetic mutations to their offspring than younger fathers Older mothers are at a 30% higher risk of having a child with ASD than younger mothers

Autism Occurrence by MMR Vaccine
Etiology of ASD [3] Autism Occurrence by MMR Vaccine Findings N = 95,727. Years of study = Results showed that children receiving the MMR vaccine did not have an increased risk of ASD regardless of whether older siblings had ASD

Etiology of ASD [4] Reference Jain, A., marshall, J., Buikema, A., Bancroft, T., Kelly, J. P., & Newschaffer, C. J. (2015). Autism occurrence by MMRVaccine status among U.S. children with older siblings with and without autism. Journal of the American Medical Association, 313(15), 1534–1540. doi: /jama

Environmental Factors
Etiology of ASD [5] Environmental Factors Some children with ASD have spontaneous DNA mutations Adverse fetal environment may place the fetus at increased risk for developing ASD Antibodies in the mother’s blood during pregnancy may interfere with fetal brain development by attacking healthy tissue

Environmental Factors (Cont.)
Etiology of ASD [6] Environmental Factors (Cont.) Toxic chemicals in the environment Lead and mercury can interfere with normal brain development in the fetus

Etiology of ASD [7] Environmental Factors (Cont.) Variations in brain structure and function are thought to play a role in ASD Rate of growth of the amygdala (an almond-shaped mass of nuclei located deep within the temporal lobe of the brain) may be abnormal and disproportionate to total brain growth in very young children with ASD

Etiology of ASD [8] Environmental Factors (Cont.) Research Study on ASD and Prenatal Pesticides Sample: 970 children (developmental delay, normal development, and ASD) studied during 1997–2008

Etiology of ASD [9] Environmental Factors (Cont.) Results: Residential proximity to organophosphate pestisides at some point during gestation was found to be associated With a 60% increased risk for ASD Highest during the 3rd trimester

Etiology of ASD [10] Environmental Factors (Cont.) Organophosate pestisides are variety of organic compounds that contain phosphorus and often have intense neurotoxic activity Conclusion: Results strengthen evidence linking neurodevelopmental disorders with gestational pesticide exposure, particularly, organophosphates

Etiology of ASD [11] Environmental Factors (Cont.) Source: Shelton, J. F., Geraghty, E. M., Tancredi, D. J., Delwiche, L. D., Schmidt, R. J., Ritz, B., Hansen, R. L., & Hertz-Picciotto, I. (2014). Neurodevelopmental disorders and prenatal residential proximity to agricultural pesticides: The CHARGE study. Environmental Health Perspectives. Advanced online publication. doi: /ehp

Etiology of ASD [12] Environmental Factors (Cont.) Research Study on ASD and Prenatal Exposure to Selective Serotonin Reuptake Inhibitors (SSRIs) Sample: 968 mother-child pairs Results: Prenatal exposure to SSRIs (antidepressants like Prozac and Zoloft) in boys may increase their susceptibility to ASD (effect stronger in boys than girls)

Etiology of ASD [13] Environmental Factors (Cont.) Conclusion: Research findings, however, remain inconsistent about the relationship between SSRIs and ASD

Etiology of ASD [14] Environmental Factors (Cont.) Source: Harrington, R. A. Lee, L-C., Crum, R. M., Zimmerman, A. W., & Hertz-Picciotto, I. (2014). Prenatal SSRI use and offspring with autism spectrum disorder or developmental delay. Pediatrics, 133(5), e1241–e1248. doi: /peds

DSM-5 Diagnostic Criteria for ASD [1]
A. Persistent deficits in social communication and social interaction across multiple contexts 1. Deficits in social-emotional reciprocity 2. Deficits in nonverbal communicative behaviors used for social interaction 3. Deficits in developing, maintaining, and understanding relationships

B. Restricted, repetitive patterns of behavior, interests, or activities 1. Stereotyped or repetitive motor movements, use of objects, or speech 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior

B. Restricted, repetitive patterns of behavior, interests, or activities (Cont.) 3. Highly restricted, fixated interests that are abnormal in intensity or focus 4. Hyperreactivity or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment

Features Associated with ASD [2]
Regression in development Difficulties in eating or sleeping Aggressive behavior (toward themselves like self-injurious behavior or toward other people)

Savant skills Ability to calculate extremely difficult mathematical equations without a calculator but not calculate the correct change when purchasing items Ability to draw highly accurate and detailed perspective drawings Ability to sing with perfect pitch

Savant skills (Cont.) Ability to state the day of the week for a date far in the past or future Ability to play a piano concerto after hearing it once

Early Identification Instrument
Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) Robins, Fein, & Barton, 2009 A 2-stage parent-report screening tool to assess risk of ASD Available for free download for clinical, research, and educational purposes

Research on Signs of ASD Related to Age [1]
Early Identification (Around ages 2–5 years) Impairments in Nonverbal communication Pretend play Inflexible routines Repetitive motor behaviors

Later Identification (Around ages 5–8 years) Impairments in Peer relations Conversational ability Idiosyncratic speech

Authors concluded that the number of diagnostic behaviors are inversely associated with the age of identification of children with ASD

Source: Maenner, M. J., Schieve, L. A., Rice, C. E., Cunniff, C., Giarelli, E., Kirby, R. S., Lee, L.-C., Nicholas, J. S., Wingate, M. S., & Durkin, M. S. (2013). Frequency and pattern of documented diagnostic features and the age of autism identification. Journal of the American Academy of Child & Adolescent Psychiatry, 52(4), 401–413. doi: /j.jaac

Disorders Comorbid with ASD [1]
Medical Asthma Skin allergies Food allergies Ear infections Frequent severe headaches Sleep disorders Sensory processing problems Feeding disorders

Psychiatric Disorder Social anxiety disorder ADHD Oppositional defiant disorder Anxiety disorder Language disorder Depressive disorder

Neurological disorders Chromosomal Genetic disorders

Intellectual Functioning of Children with ASD [1]
About 50% to 62% have IQs of 70 or above “Low functioning” used to describe those with IQs of 69 or below “High functioning” used to describe those with IQs of 70 or above IQs tend to be stable No specific cognitive profile

No cognitive profile can reliably distinguish children with ASD from children with other disorders But children with ASD have relative strengths on some Wechsler subtests Block Design Matrix Reasoning Picture Concept

And have relative weaknesses on other Wechsler subtests Comprehension Vocabulary Symbol Search Coding IQs may improve as a result of intensive early interventions

Children with ASD have higher IQs when they have Adequate conversational speech or Social relationships

Poorly developed language skills in children with ASD include Imitation Sequencing Organization Seeing relations between pieces of information

Poorly developed language skills in children with ASD include (Cont.) Identifying central patterns or themes Distinguishing relevant from irrelevant information Deriving meaning from the bigger picture

Relatively well-developed skills in children with ASD include Perceptual discrimination Retrieval of visual knowledge Visual reasoning Attention to visual detail Rote memory

Children with ASD and savant abilities tend to have low IQs Children with ASD usually have Selective memory deficits rather than widespread and all-encompassing ones

Observing Children with ASD [pp. 606–607; 1]
Areas to Observe Use of Eye contact Facial expressions Gestures Vocalizations Interactions with others Interactions with examiner

Observing Children with ASD [pp. 606–607; 2]
Areas to Observe (Cont.) Transitions Use of language Play Motor behavior Attention and activity level Awareness of social cues and expectations

Tips for Testing Children with ASD [1]
Adapt the environment Select a room in a quiet area Have comfortable lighting Wear little or no perfume or cologne Change room if sensory stimuli are distracting (e.g., child is screaming, avoiding, or covering ears) Use tangible rewards (e.g., food reinforcers with permission or games)

Use frequent breaks Make sure you have the child’s attention when you speak Talk slowly Use short and simple phrases Be concrete Avoid complex grammatical forms Repeat or rephrase sentences

Avoid reliance on purely auditory cues Use visual cues when possible to help children understand language Use simple written to-do lists Use a picture schedule of activities

Learn about Child’s Communication Skills
Ask parents and teachers for advice on how to best work with the child Observe the child in his or her classroom See list of questions on p. 607 in main text Under no condition should you use facilitated communication to interview a child with ASD (see pp. 607–608 in main text)

Assessment Measures for ASD
See p. 608 in main text

Useful ASD Forms [1] Table J-1. Observation Form for Recording Behaviors That May Reflect Autism Spectrum Disorder and Positive Behaviors (p. 155 in RG) Table J-2. Modified Checklist for Autism Disorder in Toddlers (M-CHAT) (p. 157 in RG) Table J-3. Autism Spectrum Disorder Questionnaire for Parents (p. 158 in RG)

Useful ASD Forms [2] Table J-4. Checklist of Possible Signs of an Autism Spectrum Disorder (p. 160 in RG) Table J-5. DSM-5 Checklist for Autism Spectrum Disorder (p. 161 in RG)

Evaluating Assessment Information
See questions in Table 22-3 for evaluating assessment information in cases of ASD (pp. 609–610 in main text)

Interventions for Children with ASD [1]
See pp. 609–614 in main text for a discussion of interventions for ASD See Handouts K-1 to K-4 (pp. 162–217 in RG) for parents and teachers Interventions are designed to improve Communication skills Executive functions skills Problem-solving skills Organizational skills

Interventions are designed to improve (Cont.) Interpersonal and social skills Learning readiness skills Academic skills Motor skills

And to reduce Restricted behaviors Repetitive behaviors Intense behaviors and interests that interfere with functioning or cause harm to the individual or to others

Alternative ASD Therapies [1]
The Following ASD Therapies Are Not Supported By Research Auditory integration training (listening through headphones to electronically modified music, voices, or sounds) Chelation (heavy metal removal) Gluten- and casein-free diets (gluten is a protein found in wheat and other grains, and casein is a protein found in milk and milk products)

The Following ASD Therapies Are Not Supported By Research (Cont.) Herbal remedies (e.g., St. John’s wart, ma huang, kava kava) Hyperbaric oxygen chamber treatment (use of a pressure chamber to administer oxygen at higher pressure than in the atmosphere)

The Following ASD Therapies Are Not Supported By Research (Cont.) Intravenous immunoglobulin (injection of pooled antibodies separated from the plasma of multiple donors) Manipulation or craniosacral massage (physical manipulation of the skull and cervical spine)

The Following ASD Therapies Are Not Supported By Research (Cont.) Melatonin treatment (a nutritional supplement used to promote sleep) Vitamins A, B6, and C, megavitamins, and magnesium treatment (designed to address supposed metabolic abnormalities in children with ASD)

Prognosis for Children with ASD [1]
Many behaviors associated with ASD may change, diminish, or completely fade over time However, communication and social deficits may continue in some form throughout life

More favorable prognosis is for children with ASD who have Early and intensive intervention Some communicative speech before 5 years of age IQs above 70

Prospect for employment is not encouraging In 2009 about 53% worked for pay outside the home since leaving high school

Traumatic Brain Injury (TBI; Chapter 23)

TBI [1] Approximately 1 million children in the US each year sustain head injuries from Falls Physical abuse Recreational accidents Motor vehicle accidents Approximately 75% of TBIs are mild Still, TBI account for 30.5% of all injury-related deaths among children

TBI [2] TBI in infants under the age of 1 year associated with
Physical abuse Shaken baby syndrome Thrown infant syndrome TBI in toddlers and preschoolers associated with Falls

TBI [3] TBI in children over the age of 5 years associated with
Bicycle injuries Motor vehicle injuries Sports-related accidents and injuries

TBI [4] Children under 20 years who are treated in emergency departments for TBI sustain their injuries from Sports and recreation activities 30% Motor vehicle collisions 20%

Observable Effects of TBI in Children [1]
TBI may produce physical, cognitive, and behavioral symptoms (see Table 23-2 on p. 632 in main text) Contact health care provider if a child shows any of these symptoms after sustaining a head injury Changes in play Changes in school performance Changes in sleep patterns

Contact health care provider if any of these symptoms show after a child sustains a head injury (Cont.) Convulsions or seizures Persistent headaches Inability to recognize people or places Irritability, crankiness, or crying more than usual

Contact health care provider if any of these symptoms show after a child sustains a head injury (Cont.) Lack of interest in favorite toys or activities Loss of balance or unsteady walking Loss of consciousness Loss of newly acquired skills

Contact health care provider if any of these symptoms show after a child sustains a head injury (Cont.) Poor attention Refusal to eat or nurse Slurred speech Tiredness or listlessness Vomiting Weakness, numbness, or decreased coordination

Effects of TBI Related to Several Factors
Location, extent, and type of brain injury Child’s age Child’s preinjury Temperament Personality Cognitive and psychosocial functioning Type, promptness, and quality of treatment

School Problems in Children After Concussions [1]
Study Sample N = 349 students and parents sampled 4 weeks post injury Ages 5 to 18 Sample divided Continuing to experience problems following head injuries Fully recovered

Results Severity of the concussion symptoms directly related to the degree of academic problems among all grade levels 88% not fully recovered still had problems with Concentration Headaches Fatigue

Results (Cont.) 77% of those same children had problems Taking notes Doing homework (needing more time) Studying for exams

Summary and Recommendations School professionals need to monitor children with symptoms of concussion because children’s school work is compromised School systems and medical professionals need to work together to support students in the recovery phase

Summary and Recommendations (Cont.) High school students have more learning problems than middle or elementary school children Supports are particularly necessary for older students because they face greater academic demands than their younger peers

Source Ransom, D. M., Vaughan, C. G., Pratson, L., Sady, M. D., McGill, C. A., & Gioia, G. A. (2015). Academic effects of concussion in children and adolescents. Pediatrics, 135(6), 1043–1050. doi: /peds

Sports-Related Concussions [1]
About 40 to 50 million children in US participate in organized sports

Incidence of mild TBI in children who participate in sports is high—about 1,275,000 annually Football (22.6%) Bicycling (11.6%) Basketball (9.2%) Soccer (7.7%) Snow skiing (6.4%)

Rates of Concussion Highest in full-contact sports (e.g., football, boy’s lacrosse, ice hockey, rugby) Moderate in moderate-contact sports (e.g., basketball, soccer) Lowest in minimal contact sports (e.g., volleyball, baseball, softball)

Consider the cumulative effects of sports-related concussions Possibility of long-term permanent damage in the form of chronic traumatic encephalopathy See Table 23-3 for list of symptoms of a possible concussion (p. 636 in main text)

If one or more of these symptoms are present, adults on the scene should Call 911 Contact the child’s parents immediately This is especially critical because concussions can result in an intracranial hemorrhage, which is life-threatening

Brief Mental Status and Follow-UP Examinations
Use SCAT3 (see p. 635 in main text) Or ask questions on p. 636 in main text Ask follow-up questions on p. 636 in main text Refer child to a health-care provider if coaching staff or parents report that the child shows any of the symptoms on p. 637 in main text

Rehabilitation Programs in Schools [1]
When child returns to school note the behaviors shown on p. 637 in main text Consider guidelines shown on p. 638, 640 in main text and in Exhibit 23-2 on p. 639 in main text in setting up a rehabilitation program

Rehabilitation Programs in Schools [2]
Help teachers carry out appropriate strategies for Reducing or eliminating barriers to learning Reintegrating the child into the classroom Establishing objectives Using effective instructional procedures Give teachers Handout K-3 (pp. 185–209 in RG)

Protecting Children from TBI
See list of suggestions on pp. 643–644 in main text Research should continue to focus on ways to reduce the severity and occurrence of sports-related injuries

NIH Toolbox [1] A set of royalty-free neurological and behavioral tests designed to assess in children and adults between the ages 3–85 years Cognitive functions Sensory functions Motor functions Emotional functions

NIH Toolbox [2] See Table 24-7 on pp. 670–671 in main text
NIH Toolbox tests are also available in Spanish See reference—National Institutes of Health and Northwestern University (2012)— for link to tests

Attention‑Deficit/ Hyperactivity Disorder (ADHD; Chapter 15)

Definition of ADHD A neurobehavioral syndrome marked by inattention and/or hyperactivity and impulsivity (DSM-5)

Video Link How to Recognize ADHD Symptoms in Children

Some Facts about ADHD [1]
In 2011 about 6.4 million children ages 4–17 years had parent-reported ADHD (about 11% of the U.S. population) 69% were taking medications (3.5 million children) A 42% rate of increase from 2003 to 2011 Boys were more than twice as likely as girls to have ADHD (12.1% vs. 5.5%)

Some Facts about ADHD [2]
Incidence in different ages Children younger than 10 years (6.8%) Children ages 11–14 years (11.4%) Children ages 15–17 years (10.2%) 33.2% fail to graduate from high school on time vs. 15.2% of children without any psychological disorder

DSM-5 Diagnostic Criteria for ADHD
Two main types of symptoms Inattention Hyperactivity and impulsivity Three types of ADHD Combined presentation Predominately inattentive presentation Predominately hyperactive/impulsive presentation

Disorders Comorbid With ADHD [1]
Children with ADHD represent a heterogeneous population Often display a diversity of behavior problem and have a comorbid disorder

Disorders Comorbid with ASD Oppositional defiant disorder (about 40% to 50%) Conduct disorder (about 25%) Disruptive mood dysregulation (majority of children) Specific learning disorder (50% or more) Anxiety disorder (about 30%)

Disorders Comorbid with ASD (Cont.) Depressive disorder (about 20%) Substance use disorder (minority of children) Obsessive-compulsive disorder (minority of children) Autism spectrum disorder (minority of children)

ADHD and Conduct Disorder [1]
A distinct subtype and may have a genetic basis Increased risk for Antisocial behaviors Substance abuse Peer rejection Low self-esteem Depression Personality disorders

Increased risk for (Cont.) Difficulties in processing social information Suspension from school

Parents and Familial Factors Parents face increased stress, frustration, and despair Families tend to be nonintact and of low-income Mothers are unhappy Parents are uninterested in their children’s activities

Children with ADHD at Adulthood
Adults have Less education, including fewer college degrees Lower incomes Higher divorce rates More antisocial personality disorders More substance-related disorders Increased risk for criminal behavior

Other Types of Deficits in ADHD
Cognitive deficits Including deficits in executive functions; see Appendix M in RG (p. 246) Social and adaptive functioning deficits Difficulty assuming responsibility Motivational and emotional deficits Limited interest in achievement Motor, physical, and health deficits Fine and gross-motor deficits

Etiology of ADHD [1] No single cause but likely multiple factors
Genetic factors Runs in families Neurological factors Different brain structures Imbalance or deficiency in one or more neurotransmitters

Etiology of ADHD [2] Prenatal factors Exposure of the fetus to
Nicotine Alcohol Other drugs Maternal psychosocial stress during pregnancy Postnatal exposure to toxic substances Lead, methylmercury, and pesticides

Study of Acetaminophen Use During Pregnancy
Etiology of ADHD [3] Study of Acetaminophen Use During Pregnancy Sample: Danish children (N = 64,322) whose mothers used acetaminophen during pregnancy (data from the Danish National Birth Cohort during ) Results: Children were at higher risk for receiving a diagnosis of ADHD

Study of Acetaminophen Use During Pregnancy (Cont.)
Etiology of ADHD [4] Study of Acetaminophen Use During Pregnancy (Cont.) Source: Liew, Z., Ritz, B., Rebordosa, C., Lee, P.-C., & Olsen, J. (2014). Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders. JAMA Pediatrics. Advanced online publication. doi: /jamapediatrics

Assessment of ADHD [1] Comprehensive history
Review of the child’s cumulative school records Attendance history Reports of behavioral problems School grades Standardized test scores Number of schools attended

Assessment of ADHD [2] Review of relevant medical information
Review of previous psychological evaluations Interviews with parents, teachers, and child Observations of child in classroom and playground Administration of rating scales to parents, teachers, and child

Assessment of ADHD [3] Administration of psychological tests to child
See Appendix G (pp. 119–126) in RG for additional assessment forms See pp. 460–465 in main text for additional information about assessment of ADHD

Evaluation of ADHD Assessment Findings [1]
Presence of inattention, hyperactivity, and impulsivity Number, type, severity, and duration of symptoms Situations in which symptoms are displayed Verbal abilities Nonverbal abilities

Evaluation of ADHD Assessment Findings [2]
Short- and long-term memory abilities Other cognitive abilities See Table L-18, p. 242 in RG for an executive functions checklist Comorbid disorders Social competence Adaptive behavior Educational and instructional needs

Comment on Assessment of ADHD [1]
Diagnosis of ADHD is not easy Restlessness, inattention, and overactive behavior are common in children Parents may find it difficult to judge child’s behavior Rating scales usually do not provide for a functional analysis of the variables that interact with children’s behaviors

Teachers tend to assign more symptoms consistent with ADHD to younger children than to older children Symptoms of ADHD can be displayed In different ways across different settings In different relationships

A comprehensive assessment requires a multi-method approach with Multiple informants Multiple contexts Multiple psychological tests Multiple use of rating scales See Table 25-1 in Chapter 25 (pp. 697–701 in main text) for questions to consider in preparing a report

Interventions for ADHD [1]
Pharmacological Approximately 70% to 80% of children who exhibit hyperactive symptoms respond positively to stimulant medications

Behavioral Positive reinforcement Verbal praise Withdrawal of reinforcement Time out A response-cost program Point system Token economy

Behavioral (Cont.) Contracts between parents/teachers and children Stipulate desired and expected behaviors at home and/or at school Consequences for failure to perform the desired behaviors Cognitive-behavioral Self-monitoring programs

Family Parent training programs Educational Teaching new skills Establishing routines Promoting attention Improving study skills Improving memory

Educational (Cont.) Improving listening skills See Handout K-3 for suggestions (pp. 185–209 in RG)

Alternative interventions that have little scientific support Dietary interventions Antimotion sickness medicines Manipulation of bones in the body Exercises to improve eye tracking Enhancing the ability to hear certain frequencies of sound Neurofeedback

INTELLECTUAL DISABILITY (ID; Chapter 18)

American Association on Intellectual and Developmental Disabilities (AAIDD) Definition
“Intellectual disability is characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. This disability originates before age 18” (AAIDD, 2010, p. 5).

AAIDD Definition of Intellectual Functioning
“. . . an IQ score that is approximately two standard deviations below the mean, considering the standard error of measurement for the specific assessment instruments used and the instruments’ strengths and limitations” (AAIDD, 2010, p. 27)

AAIDD Definition of Adaptive Behavior
“. . . approximately two standard deviations below the mean of either (a) one of the following three types of adaptive behavior: conceptual, social, and practical or (b) an overall score on a standardized measure of conceptual, social, and practical skills” (AAIDD, 2010, p. 27)

Age of Onset Limitations must be manifest prior to the age of 18 years

ID Categories Not Used AAIDD classification system does not use categories (e.g., mild, moderate, severe, profound) to classify intellectual disability, but the World Health Organization does recommend their use (See slide later in presentation)

AAIDD and Other Considerations [1]
Limitations in present functioning must be considered within the context of community environments typical of an individual’s age, peers, and culture Valid assessment considers cultural and linguistic diversity as well as differences in communication, sensory, motor, and behavioral factors

AAIDD and Other Considerations [2]
Limitations often coexist with strengths; individuals with intellectual disability have gifts as well as limitations An important purpose of describing limitations is to develop a profile of needed supports The life functioning of individuals with intellectual disability generally will improve with appropriate supports over a sustained period (AAIDD, 2010, p. 7, with changes in notation)

DSM-5 [1] Definition similar to AAIDD
Adds two related diagnostic categories Global developmental delay for children under the age of 5 years when evaluation is not possible Unspecified intellectual disability for children over the age of 5 years when assessment is not possible

DSM-5 [2] Diagnosis of ID does not rule out the coexistence of other disorders A diagnosis of intellectual disability is inappropriate when an individual is meeting the demands of his or her environment adequately

World Health Organization’s Working Group on ICD-11
Severity level of intellectual developmental disorder needs to be considered 85% in mild level 10% in moderate level 3.5% in severe level 1.5% in profound level See Tables 18-1 and 18-2 on p. 520 in main text for severity levels and adaptive behavior examples

Some Facts about ID [1] Prevalence about 1% in general population
During the 2009–2010 school year, 463,000 children between ages 3–21 years in special education programs Prevalence about 7.1% in special education population

Some Facts about ID [2] More males than females receive diagnosis
1.6:1 for mild ID 1.2:1 for severe ID Mild ID more common in rural areas and in low-income groups Correlation between measured intelligence and adaptive behavior ranges from about .30 to .50

Etiology of ID [1] Genetic disorders Chromosomal anomalies
Cranial malformations Perinatal disorders Postnatal disorders Unknown causes See Table 18-3 on pp. 523–528 in main text for a list of disorders and conditions associated with ID

Co-Occurring Disorders with ID
Attention-deficit/hyperactivity disorder Depressive and bipolar disorders Anxiety disorders Autism spectrum disorder Stereotypic movement disorder Impulse control disorders Major neurocognitive disorder

Support Areas and Goals for ID
See Table 18-4 on p. 532 in main text

Concluding Comment on ID [1]
Measures of intelligence and adaptive behavior are for example used to Determine eligibility for disability benefits by Social Security Administration Determine whether an individual can stand trial and whether a defendant can be sentenced to death

Concluding Comment on ID [2]
Evaluation of intellectual disability thus has extremely far-reaching consequences

Additional Resources [1]
Morgan, E., Salomon, N., Plotkin, M., & Cohen, R. (2014). The school discipline consensus report: Strategies from the field to keep students engaged in school and out of the juvenile justice system. New York, NY: The Council of State Governments Justice Center. Retrieved from

Williams, S. T. (2008). Mental health screening and assessment tools for children: Literature review. Retrieved from

Willamette Education Service District. (n.d.). Student threat assessment. Retrieved from Synapse. (2013). Acquired brain injury: The facts (4th ed.). Retrieved from

Also see SPsych Everything for valuable links (Also on

Spelling Chequer [1] Eye halve a spelling chequer
It came with my pea sea It plainly marques four my revue Miss steaks eye kin knot sea. Eye strike a key and type a word And weight four it two say Weather eye am wrong oar write It shows me strait a weigh.

Spelling Chequer [2] As soon as a mist ache is maid
It nose bee fore two long And eye can put the error rite Its rare lea ever wrong. Eye have run this poem threw it I am shore your pleased two no Its letter perfect awl the weigh My chequer tolled me sew.

Children Learn What They Live by Dorothy Law Nolte [1]
If children live with criticism, They learn to condemn. If children live with hostility, They learn to fight. If children live with ridicule, They learn to be shy. If children live with shame, They learn to feel guilty. If children live with encouragement, They learn confidence.

Children Learn What They Live by Dorothy Law Nolte [2]
If children live with tolerance, They learn to be patient. If children live with praise, They learn to appreciate. If children live with acceptance, They learn to love. If children live with approval, They learn to like themselves.

RECENT DEVELOPMENTS IN BEHAVIORAL, SOCIAL, AND CLINICAL ASSESSMENT OF CHILDREN 2015 JEROME M. SATTLER Power Point Presentation Primarily Based on Foundations.

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RECENT DEVELOPMENTS IN BEHAVIORAL, SOCIAL, AND CLINICAL ASSESSMENT OF CHILDREN 2015 JEROME M. SATTLER Power Point Presentation Primarily Based on Foundations.

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