Best Practice for School-Based Evaluations of Autism

Best Practice for School-Based Evaluations of Autism
This training provides an overview of the difference and implications for treatment between medical diagnoses and determination for eligibility for educational services. Discussion is focused on the development of comprehensive evaluation plans to determine eligibility and guide program development for needs across domains of functioning. Specific assessment tools are also discussed. Individual follow-up consultation is available to training participants. Training Experts in Autism for Missouri (TEAM) Education Program

Overview Evaluation Plans for Autism Preparing for Assessment
Targeted Evaluation Areas: Special Considerations for Autism Assessment Tools

Medical vs Educational ASD Evaluations
Medical Diagnosis: Seeks a diagnostic determination that leads to treatment recommendations Educational Eligibility Determines whether the child meets the state’s educational eligibility criteria for special education services IEP teams do not make medical diagnoses

Medical vs Educational ASD Evaluations
Medical/Clinical Educational Criteria Used Medical diagnostic criteria based on DSM-V Qualitative impairments in social communication Restricted repetitive and stereotyped patterns of behavior Individuals with Disabilities Education Act Autism one category for special education eligibility Section 504 of the Rehabilitation Act of 1973 Evaluation Process Healthcare professionals conduct a diagnostic evaluation for ASD or other disorder in order to make a medical diagnosis Licensed or specially trained physicians, psychologists, or mental health professionals Typically conducted at a health/medical clinic Re-evaluation on case-by-case basis Part C of IDEA – qualifies for First Steps with medical diagnosis Part B- assessments conducted by multidisciplinary team, including parents, to determine eligibility for special education services and identify areas that disability adversely affects education Re-evaluation considered triennially Intervention Planning May include recommendations for medical, supplemental therapies and education across settings Conducted by IEP team to address needs through goals, accommodations, school-based services OR 504 if appropriate Based on the Fifth Edition of the Diagnostic and Statistical Manual (DSM-V) Qualitative impairments in social communication Restricted repetitive and stereotyped patterns of behavior Healthcare professionals who make medical ASD diagnosis are licensed and/or specially trained Physicians Psychologists Mental health professionals

Evaluating Student Needs
Referral made based on concerns Evaluation plan developed Parental consent Evaluation completed General Evaluation Process Purposes of School Based Evaluations Determine categorical eligibility for special education services Does a disability exist What is the educational impact Gather information to better inform programming decisions Educational impact

Heterogeneity of Autism
Measured Intelligence Severely Impaired Gifted Social Interaction Aloof Passive Active Communication Nonverbal Verbal Behaviors Intense Mild Sensory Sensory-seeking Sensory aversions Motor Uncoordinated Coordinated Varies in severity of symptoms, age of onset, and association with other disorders Manifestations vary across children and within an individual over time Innumerable combinations of possible symptoms No single behavior that is always typical or present in every individual Talk about ASD-”s”

Evaluation Plans for Autism
A balanced assessment plan will include: Indirect assessment (parent/teacher rating scales and interviews) Direct, standardized assessments appropriate for age and development of student Structured observations across multiple settings situation may need to be contrived Emphasis on social communication both skill and performance EMPHASIZE MULTIPLE PERSPECITVES (NOT ALL FROM WITHIN THE SCHOOL) – want to see how functioning outside of the school setting – consider outside reports From Wilkinson; the following components should be included in a best practice assessment and evaluation of ASD in school-age children (California Department of Developmental Services 2002; Filipek et al. 1999; Johnson et al. 2007; National Research Council 2001; Ozonoff et al. 2005a; Volkmar et al. 1999): • record review • developmental and medical history • medical screening and/or evaluation • parent/caregiver interview • parent/teacher ratings of social competence • direct child observation • cognitive assessment • academic assessment • adaptive behavior assessment • communication and language assessment.

Consideration of Assessment Tools
Indirect Assessments: Rating Scales Pros: Gain multiple perspectives Typically easy to complete Usually not time consuming Cons: Raters may not witness the behaviors Raters may not pick up on more subtle nuances Can be more subjective Examples: -gen ed perspective across settings- EF -special educator perspective may be rosy- compare to classroom peers instead of typical

Direct Assessments: Pros: Standardized Directly test or observe the student and behaviors Cons: Student could know rote correct responses, but not perform the skills correctly Can be time consuming

Direct Observations: Pros: Watch student in natural environments Can see performance deficits Cons: May not observe at times when skills are performed Observer may not know what skills to look for (tend to focus on level of disruption/compliance) Often report what is observed, but not what is not observed (using typical peers as comparison)

Other considerations: Consider settings- students with ASD typically perform better and appear more skilled in structured vs. unstructured settings Consider language and intellectual impact Consider behavioral interference – i.e. can look worse if have ADHD

Preparing for Evaluation

Preparing Team for Evaluation
Entire team to give input into what assessments should go onto the evaluation plan prior to getting consent Share with team the evaluation plan, timeline and expectations of participation Plan in advance for timelines

Preparing Team for Evaluation
Get tips from the teachers and/or caregivers on how to best support the student Talk with team members specifically about observation needs to ensure appropriate observation times Prepare team members to not: Point out the student to you in an obvious way Talk about the student in front of others or in front of the student If pointed out for the observer- the social context may be changed

Supporting the Student
Prior to Testing: Prepare student for disruption of schedule Build rapport with student Be prepared to explain purpose of testing Prepare for possible testing modifications Document any adjustments or broken standardization

During Testing Be flexible with test administration: Location of testing (floor) Providing frequent breaks (snacks) Increased examiner excitement/praise Additional teaching trials on how to respond

During Testing: If Applicable Use visual supports (schedule, checklist, timer) Use a reinforcement system pro-actively Provide choice on testing activities (e.g., order) Visually organize materials not to overwhelm Examiner position to the side of the student If applicable, assistant sit next to the student

Targeted Evaluation Areas

Autism Symptomology

Evaluating for Symptomology
Criteria for ASD eligibility (currently DESE – DSM-IV) Disturbance of Communication Process Disturbance in the Capacity to Relate Appropriately Educational Impact

The Diagnostic & Statistical Manual-5th Edition (DSM-5)
One diagnosis: Autism Spectrum Disorder The DSM-5 no longer recognizes specific diagnoses, such as Autistic Disorder, Asperger’s Syndrome, or PDD-NOS Two Core Domains Deficits in social communication and social interaction Presence of restricted and repetitive patterns of behavior IF OUTSIDE REPORT IS CURRENTLY GIVING PDD OR ASPERGERS = NOT A GOOD REPORT/EVAL

Dimensional Ratings for DSM V ASD
Severity Levels Dimensional Ratings for DSM V ASD Level 3 Requires very substantial support Level 2 Requires substantial support Level 1 Requires support Severity levels are now included ranging from level 3 (requiring very substantial support) to level 1 (requiring support)

Review of Developmental History Autism Specific Assessments
Identifying Autism Review of Developmental History Autism Specific Assessments Observations It is essential to consider information from all three areas when making a determination regarding the presence of autism

Know the purpose of the tools you are using and sensitivity and specificity False positives: social difficulties may be associated with other eligibility categories and disabilities False negatives: may not have the sensitivity to identify nuanced social difficulties Gender differences Males more often captured by screening tools Population differences Non-white and Hispanic, especially from lower educational backgrounds, less likely to be identified medically Ex screening tools (mchat, scq)

Autism Diagnostic Observation Schedule 2 (ADOS-2) Semi-structured assessment of communication, social interaction and play 5 modules to meet particular age, developmental, and language level Administered in about minutes by trained evaluator Autism Diagnostic Interview-Revised (ADI-R) Interview regarding development and behavior with primary caregiver Administered in about 2 hours by trained evaluator ADOS: Reliability: interrater correlations between , interclass , test-retest (9 months) Validity- specificity values in upper 80% to low 90%, sensitivity in the upper 90% range ADI- not typically used in schools, not feasible, training not often received Reliability: Children 3-5- weighted kappa , people 5-29 weighted kappa , interclass Validity: compared with the SCQ

Record review – medical, outside evaluations, mental health In Depth Social History Interview Prenatal history Perinatal history Developmental milestones Medical history, including developmental and mental health (past, current, and family) Current presentation in communication, social, emotional, behavioral, cognitive ability, learning, memory, adaptive behavior and independence TEAM example ASD social history MOVER TO CORE SYMPTOMS

Social History Interview
TEAM Autism Social History Supplement

Social History Interview
TEAM Autism Social History Checklist

Targeted Evaluation Areas

Language and Communication

Language and Communication
Special Considerations Caution against ruling out Autism when average scores on standardized tests of language Understand that the profile may emerge that expressive language is higher than receptive in some cases of HFA When presentation and/or assessment data is unclear, or there are possible alternative diagnoses, consider the child’s desire to communicate Consider the impact on post-secondary success TC cautions against ruling out ASD just because a child scores average on standardized tests of language, including pragmatic language. It is most important to consider whether/how the child applies language skills in daily life. When presentation and/or assessment data is unclear, or there are possible alternative diagnoses, TC recommends looking deeply at the child’s desire to communicate. Example: severe apraxia with behavior problems can look like ASD, however, looking for an effort to communicate, even it can’t use words and has aversive behaviors as communication, can help tease out whether ASD. Look for overtures and ability to enjoy engagement. Second language influence: TC notes that kids without ASD should still respond to nonverbal communication and social reciprocity. Be sure to carefully watch and consider how they play with toys. Ideally should have interpreter during assessment.

Special Considerations When second language influence: Use an interpreter Carefully consider response to non-verbal communication and play Observe with caregivers and siblings TC cautions against ruling out ASD just because a child scores average on standardized tests of language, including pragmatic language. It is most important to consider whether/how the child applies language skills in daily life. When presentation and/or assessment data is unclear, or there are possible alternative diagnoses, TC recommends looking deeply at the child’s desire to communicate. Example: severe apraxia with behavior problems can look like ASD, however, looking for an effort to communicate, even it can’t use words and has aversive behaviors as communication, can help tease out whether ASD. Look for overtures and ability to enjoy engagement. Second language influence: TC notes that kids without ASD should still respond to nonverbal communication and social reciprocity. Be sure to carefully watch and consider how they play with toys. Ideally should have interpreter during assessment.

Questions for consideration: Preferred mode of communication? Idiosyncratic speech patterns? Receptive language ability? Expressive language ability? Level of independence in communication? Idiosyncratic: the lady with the clay (instead of art teacher), referring to self by name

“Of the Type Specified” ASD May have impaired nonverbal communication Gestures Eye contact Body language Facial expressions May have odd intonation - Robotic - Flat - Sing-song - Volume modulation - Sound as if giving lecture TC cautions against ruling out ASD just because a child scores average on standardized tests of language, including pragmatic language. It is most important to consider whether/how the child applies language skills in daily life. When presentation and/or assessment data is unclear, or there are possible alternative diagnoses, TC recommends looking deeply at the child’s desire to communicate. Example: severe apraxia with behavior problems can look like ASD, however, looking for an effort to communicate, even it can’t use words and has aversive behaviors as communication, can help tease out whether ASD. Look for overtures and ability to enjoy engagement. Second language influence: TC notes that kids without ASD should still respond to nonverbal communication and social reciprocity. Be sure to carefully watch and consider how they play with toys. Ideally should have interpreter during assessment.

“Of the Type Specified” ASD May have idiosyncratic/peculiar speech - Repetitive utterances - Scripting - Neologisms - Referring to one’s self by name - Pronoun errors (ex: he to mean I) - Echolalia TC cautions against ruling out ASD just because a child scores average on standardized tests of language, including pragmatic language. It is most important to consider whether/how the child applies language skills in daily life. When presentation and/or assessment data is unclear, or there are possible alternative diagnoses, TC recommends looking deeply at the child’s desire to communicate. Example: severe apraxia with behavior problems can look like ASD, however, looking for an effort to communicate, even it can’t use words and has aversive behaviors as communication, can help tease out whether ASD. Look for overtures and ability to enjoy engagement. Second language influence: TC notes that kids without ASD should still respond to nonverbal communication and social reciprocity. Be sure to carefully watch and consider how they play with toys. Ideally should have interpreter during assessment.

“Of the Type Specified” ASD Individuals with ASD may: talk excessively about their own special interests have perseveration (“stuck” on one idea) have decreased abstract language make inappropriate social remarks have difficulty understanding humor have difficulty with conversational skills TC cautions against ruling out ASD just because a child scores average on standardized tests of language, including pragmatic language. It is most important to consider whether/how the child applies language skills in daily life. When presentation and/or assessment data is unclear, or there are possible alternative diagnoses, TC recommends looking deeply at the child’s desire to communicate. Example: severe apraxia with behavior problems can look like ASD, however, looking for an effort to communicate, even it can’t use words and has aversive behaviors as communication, can help tease out whether ASD. Look for overtures and ability to enjoy engagement. Second language influence: TC notes that kids without ASD should still respond to nonverbal communication and social reciprocity. Be sure to carefully watch and consider how they play with toys. Ideally should have interpreter during assessment.

Special Considerations Children with a language delay or disorder may or may not have nonverbal communication skills typical for their age Their entire concept of language is impaired, nonverbal communication skills may be impaired along with verbal communication For example: eye contact may be impaired but these students will tend to use it when requesting better than children with ASD

Evaluating Language Language (& speech) Samples
Go beyond mean length and sentence structure use of syntax, semantics, morphology, pragmatics, speech atypicalities communicative intent and response to others How they attempt to get needs met Gain multiple informal samples Conversation Descriptive tasks Play (have cause and effect, functional, and make believe toys) Look for pragmatic language during speech and language sample (reciprocity, picking up on social cues, responding to questions, appropriate gestures) Tip: Include play in speech and language sample

Evaluating Language Delay in Language/Communication
(at or below 48 month developmental level) Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) Comprehensive language and communication profile Developed considering children with autism and verbal behavior approach to teaching Tool for progress monitoring and program planning Examination of barriers to communication Does not require specialized training, but need to familiarize yourself with it

Evaluating Language Verbally Fluent-Typical Elementary Age
Clinical Evaluation of Language Fundamentals-5 Speech and language sample Test of Language Competence Comprehensive Assessment of Spoken Language Children’s Communication Checklist-2 Oral and Written Language Scales Thompson Center prefers CELF & Speech language sample Look for pragmatic language during speech and language sample (reciprocity, picking up on social cues, responding to questions, appropriate gestures) Tip: Include play in speech and language sample TLC is good for assessing abstract language and social language CASL is long, but has a subtest for pragmatic language assessment

Evaluating Language Very Young Children
Clinical Evaluation of Language Fundamentals-Preschool – 2 Preschool Language Scale-5th edition Speech and Language Sample Peabody Picture Vocabulary Test-4 Expressive One Word Vocabulary Test -4 MacArthur-Bates Communicative Development-3 Reynell Developmental Language Scales-3 Sequenced Inventory of Communicative Development-Revised Test of Early Language Development-3 TC Prefers CELF or PLS & Speech and Language Sample - PLS is good for young children and those with lower abilities because it assesses down to birth & provides scores for nonverbal communication Test of early language development is similar to Preschool Language Scale

Include Assistive Technology specialist
Evaluating Language Students with Limited Verbal Abilities Speech and Language Sample Parent Report Augmentative Communication Assessment Profile Matching Assistive Technology and Child Developmental Assessment for Individuals with Severe Disabilities-2 Picture Exchange Trial Include Assistive Technology specialist TC recommends a good Speech and Language sample and in depth parent interview/report of communication at home. Criterion-referenced tools, observations and reports from those familiar can be more instructive for IEP planning than standardized assessment with this population TC encourages an informal communication sample with nonverbal children, looking for whether the child can point, how they make requests (if they do), how use any words they might have to communicate, and at the communicative intent of the child’s communication. TC uses parent report tool called “REEL” that goes from birth to age 3 Also look for social skills of joint attention, referencing , and turn taking. Use of play is effective in these samples, and TC recommends providing opportunities for pretend and symbolic play. In speech language sample, include trial with word sound approximations, PECS, and/or signing to help determine what interventions might be appropriate by watching what the child is capable of learning.

Speech Special Consideration
Articulation deficits can impact communication and social skills TC recommends keeping in mind how articulation impacts communication and social skills, which are already areas of difficulty for kids with ASD

Social, Emotional and Behavioral

Social, Emotional, Behavioral
Assessment of pragmatic language is important, even for those students with appropriate expressive and receptive language Obtain information from multiple sources

Need to Evaluate: Topography of social behaviors Contexts of social behaviors Overall level of social emotional functioning Functional communication skills Pragmatic language

Gain Pragmatic Information Does the student: Show awareness and interest in others? Initiate/respond social interaction? Interact differently based on context? Display appropriate emotions for the environment? Pragmatic/social language (reciprocal interactions, facial expression, nonliteral language, conversations)? Make two slide or pare down

Indirect Assessments for Pragmatics Interviews, informal Structured interviews Diagnostic Interview Schedule for Children Autism Comorbidity Interview-Present and Lifetime versions Rating Scales Behavior Assessment System for Children-2 Achenbach Scales; Child Behavior Checklist Social Responsiveness Scale Social Skills Improvement System Anxiety, depression, and attention-related

Direct Assessments for Pragmatics Clinical Evaluation of Language Fundamentals-5th (pragmatics) Clinical Evaluation of Language Fundamentals- Preschool-2 (pragmatic profile) Speech and Language Sample Social Language Development Test Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP, social/play profile) Test of Pragmatic language The Pragmatic Rating Scale Test of Problem Solving (elementary and adolescent) Language use is social Caution standardized pragmatic language assessments can have misleading results because kids with ASD can’t apply the knowledge but may be able to explain aspects of social language Social communication assessment should involve observation, information gathering, formal, and informal evaluation. Importance of direct interaction with client that are unstructured. (Wilkinson, 2014, p. 116)

Social, Emotional, and Behavioral
Limitations to Assessing Pragmatic Language PL assessments are not as well developed as tests of language fundamentals Only a few standard assessments available for higher functioning children with ASD PL assessments have limited valid norms for pragmatic development and objective criteria performance (Young et al. 2005). Any instruments should not be used in isolation to make decisions regarding classification and intervention planning.

Social Functioning/ Pragmatic Skills Do not rule out autism if student scores average on standardized measures of pragmatic language Many students with autism can label the correct answer or convention but cannot apply this into everyday interactions and appropriate context Most important to consider whether/how the child applies language skills in daily life

Special Considerations for Pragmatic Observations Observe across multiple settings Settings need to be social May need to structure or arrange interactions

Special Considerations for Pragmatic Observations Often observe for presence and not absence of behaviors Unstructured observations are impacted by what is emphasized in the write up Importance of: Comparison to typical peers Emphasis on social-pragmatics and not just disruptive behaviors

Structured Observation Form
University of Missouri Thompson Center –TEAM social-communication observation form

“Of the Type Specified” Behaviors
Repetitive Motor Movements Hand/finger, complex body, posturing Ritualized patterns of behavior Echoing, scripting Repetitive use of objects Highly Restricted, Fixated Interests Rigidly held routines and distress when interrupted Limited range of interests or odd interest Hyper or Hypo-Reactivity to Sensory Stimuli

Gain Behavioral Information Does the student: Have any coping or self-advocacy skills? Behaviors that interfere with functioning (externalizing, internalizing, inappropriate)? Environmental factors that contribute to, motivate or alleviate problem behaviors?

Functional Behavior Assessments Essential information for program planning for ANY disruptive behaviors (not just for aggressive behaviors) Process includes: Records review Teacher interview Student interview Observations SYSTEMATIC DATA COLLECTION on antecedents, behaviors, and consequences Consideration of results in relation to development across domains of functioning (language, pragmatic, executive functioning, etc.) Before going into this slide, refer back to the rating scales of behavior functioning (BASC) Plug for TEAM

Special Considerations for Behavior Observations Observe across multiple settings Observe both when behaviors are most and least likely to occur Report environmental characteristics, as well as the antecedents and consequences to any behaviors observed

Adaptive Behavior

Importance of Adaptive Behavior
Should be assessed for all students evaluated for autism Students with Autism have poor outcomes after high school Post secondary outcomes 24.5% have any post-secondary training (not necessarily full-time or until completion) 79.5% have had some post-secondary employment 26.7% were employed full-time 73.3% were employed part-time 19.9% held a job for more than 36 months 39.3% received accommodations 5.8% living independently (National Longitudinal Transition Study, 2009) AT TOP: FRAME WHY IMPORTANT TO ADDRESSS

Adaptive Behavior Questions to Consider:
Is the student independent in self-care, such as feeding, dressing, hygiene, and toileting? Level of participation in home activities, such as chores and preparing meals? Level of community skills, like managing money, transportation, navigating community services, and self-advocacy? Appropriate safety? How well developed are skills necessary for the next environment? What supports are needed to plan for any foreseeable transitions? Talking point: how much are parents doing to support the child at home, what would happen if those supports weren’t there?

Adaptive Behavior Special Considerations:
Obtain information on how much support is being provided to the student at home and in classroom on adaptive skills What would happen if those supports weren’t there? Adaptive behavior rating scales don’t differentiate ASD from other disabilities But do give broad scope look at independence in this area Can narrow down to which area to target Talking point: how much are parents doing to support the child at home, what would happen if those supports weren’t there?

Adaptive Behavior-Assessment
Adaptive Behavior Assessment System-2 Vineland Adaptive Behavior Scales-2 Structured interview option Assess adaptive behavior for all ASD students , not just severely impaired because: (Goldstein 234) Help in diagnosis , particularly to determine if meets criteria for ID Determining strengths and weaknesses Planning interventions Measuring response to intervention (and no practice effects) Also important to assess for independence with transition in mind. ABAS has self-report option that could be appropriate for older students. Goldstein: how to choose which : consider how detailed the info is you need and format (checklist only vs interview option) ABAS is a checklist only but multiple reporter forms (care giver, teacher, and self) Vineland and SIBS both have interview option as well as rating scale p. 103 MAGI Thompson Center recommends ABAS recommended given ease of use and interpretation. Vineland can be confusing for parents to fill out and also because of standardized scores on vineland can be confusing (v-scale scores) However, the Vineland has a broader and lower range of abilities measured, so may be more appropriate for extremely impaired individuals because it can provide more accurate scores about their skill level. Also, sometimes the Vineland parent interview is a better way to get accurate information with parents who may struggle with reporting. The structured interview allows the examiner to ask questions and rate the child’s skill level instead of having a parent read and circle. Also beneficial to have the interview option for parents who may have limitations of their own that could impact their ability to complete a rating scale they read on their own (illiteracy, second language influence, cognitive impairment, limited education etc).

Cognitive Functioning

Cognitive Functioning
Types of Intelligent Tests: Comprehensive IQ – assesses verbal and nonverbal abilities to provide a complete picture of the child’s broad cognitive ability, strengths, and weaknesses Brief IQ- abbreviated IQ test that provides estimate of cognitive ability and is usually a quick assessment Nonverbal IQ- does not test verbal cognitive ability, and instead typically measures visual reasoning skills Comprehensive IQ means one that has both verbal and nonverbal components to it, this is to provide a complete picture of the child’s broad cognitive ability and strengths and weaknesses. - For kids with asd who may have limited verbal skills iq can be misleading and can impact placement decisions. In addition, kids with very high verbal skills can mislead into thinking IQ is intact. When records of previous standardized comprehensive IQ tests indicate stable cognitive abilities over time, an abbreviated measure may be sufficient, but not recommended as an initial IQ assessment. Knowing expressive and receptive language level can help in determining what test to give (may need to give a nonverbal) Attempt to get an iq score for most evaluations but look at it as a snap shot in time of how the child is functioning. The scores may be different once the child has more skills for imitation, joint attention, and sustained attention. But it is a good picture of that child’s daily learning ability at the time of testing, because those behaviors will also get in the way of learning in a classroom setting.

Special Considerations: Comprehensive IQ test is recommended for initial evaluation At minimum a brief IQ is recommended for follow-up evaluations Assess receptive and expressive language before administering IQ test to help determine tool Recommend obtaining IQ, for current representation of functioning (but interpret with caution as scores can be fluid, with scores changing after appropriate testing behaviors develop) Comprehensive IQ means one that has both verbal and nonverbal components to it, this is to provide a complete picture of the child’s broad cognitive ability and strengths and weaknesses. - For kids with asd who may have limited verbal skills iq can be misleading and can impact placement decisions. In addition, kids with very high verbal skills can mislead into thinking IQ is intact. When records of previous standardized comprehensive IQ tests indicate stable cognitive abilities over time, an abbreviated measure may be sufficient, but not recommended as an initial IQ assessment. Knowing expressive and receptive language level can help in determining what test to give (may need to give a nonverbal) Attempt to get an iq score for most evaluations but look at it as a snap shot in time of how the child is functioning. The scores may be different once the child has more skills for imitation, joint attention, and sustained attention. But it is a good picture of that child’s daily learning ability at the time of testing, because those behaviors will also get in the way of learning in a classroom setting.

Cautions regarding interpretation: Be aware of threats to IQ score validity ASD symptoms can interfere with testing Ex: Lacking imitation and joint attention skills Ex: scripting on verbal questions Ex: repetitive behaviors with manipulatives Misinterpreting of scores low scores as lack of engagement and higher subtest scores as more capabilities Provide honest feedback, with compassion Interpret Overall IQ scores with caution (splinter skills, discrepant subdomain scores) Big idea: understanding profile and how this impacts programming p. 102 MAGI & Goldstein 215. Challenges can present with kids with ASD and nonverbal IQ because of issues with joint attention and imitation. It’s generally better to get some information through non-standardized format than abandoning attempts to get info when standardized procedure doesn’t work. Just be sure to note that in the verbal and written evaluation report. May be appropriate to break standardization. Certain ASD behaviors can impair a child’s performance on a standardized IQ test, though it may not be because they do have the intellectual ability to do the task. This can cause an invalid or underestimate of cognitive ability because ASD behavior interfered with testing. Examples of children lining up blocks instead of making the assigned pattern (repetitive behavior) or scripting during verbal items instead of answering the question. Goldstein – tests requiring skills specifically impaired in ASD (imitation, interpretation of social information, joint attention, understanding personal pronouns) may result in lower scores than those that require skills that are common areas of strength, especially in young children composites/overall average of IQ subtest performance (full scale IQ) misleading because may overestimate areas of weaknesses and underestimate strengths. common for strengths to be in nonverbal/visual reasoning; weakness in verbal reasoning (but this can vary, no single cognitive pattern is indicative of ASD) ex: Asperger type ASD strengths in verbal

Common Cognitive Patterns of ASD Tend to focus on details instead of big picture May have impaired: Theory of Mind Complex and abstract information processing Flexibility in thinking Implicit/intuitive learning Look for tendencies of these types in responses, can be informative about thinking patterns Goldstein – 218 When assessing cognitive abilities, looking for tendencies of these types in their reasoning and be informative

No “best test” for students with autism Common for strengths to be in nonverbal/visual reasoning and weaknesses in verbal reasoning Consider the purpose of the assessment in selecting the test: Overall abilities compared to same-age peers? Discrepancy between visual and verbal reasoning? Discrepancy between concrete and abstract reasoning? Theory of mind? Executive functioning? Nonverbal IQ may be used to consider ID and/or language impairment in the school setting Stress WHY obtaining IQ score: Placement How do we present materials (visual supports?) General ed teachers prepare for re-stating and presenting assignments Theory of mind- independent performance across settings, group work, initiate and sustain attention to task Executive functioning- effects performance across settings and demands - What data do you need if your team is unsure and considering multiple eligibilities?

Age-Appropriate Language Functioning Wechsler Scales (WISC-V; WPPSI-IV; WAIS-IV) Differential Ability Scales-2 Stanford Binet Intelligence Scale-5 Kauffman Ability Battery (version appropriate for age) Consider timing element for those with ASD Wechsler scales preferred by Thompson Center because of the psychometric properties, longstanding status as gold standard, and because they are typically more familiar to others so it is easier to discuss results and compare data with other measures. In addition, because it provides both verbal and nonverbal scores, as well as processing speed and working memory, the WISC can be useful for identifying cognitive strengths and weaknesses. The WISC-5 came out recently and so recommend making the switch from wisc 4 as soon as possible so have most current version and norms. Wechsler scales can be good for a comprehensive picture of skills that daily life in school requires, as compared to typical peers the child’s same age. However, may be less informative for tapping into greatest strengths and if needed to determine whether a discrepancy exists (such as between cognitive and language or cognitive and academic) in order to determine a need for services. Also, the wisc can be long and not as engaging as some other measures of iq. Noted in Wilkinson 2014 The timing element of the Wechsler scales can be problematic and stressful for some individuals with ASD, as well as some of the conceptual demands for younger kids. The general ability index of the WISC may be appropriate for some kids with ASD (because of associated weaknesses in processing speed and working memory).

Delayed Expressive Language but Functional Receptive Language Differential Ability Scales-2 (Special Nonverbal Composite) Wechsler Nonverbal Scale of Ability Kim’s comments: the DAS is a relatively quick comprehensive IQ and is often more engaging for kids than the WISC. The availability of the Special Nonverbal Composite is particularly useful for cases when a comprehensive IQ is desired but a language impairment is suspected. The SNC may be sufficient for identifying discrepancies in kids with language impairments. A caution though, that the DAS could underestimate nonverbal intelligence in kids who have impaired receptive language because there are verbal directions. The DAS is also a good option because it has out-of-range testing options and norms so can use items designed for younger children but have the norms available for the child’s chronological age. From Wilkinson: The Differential Abilities Scales (DAS-II; Elliott 2007) is also an option for evaluating cognitive ability in children with ASD. The DAS-II assesses both intellectual and academic skills. It can be administered to children across a wide chronological and mental age range (2.5 through 17 years), making it appropriate for repeat administrations, to track progress, and for research projects in which the developmental range of participants may vary considerably. Especially helpful for the ASD population is the option of out-of range testing (e.g. administration of tests usually given to children of a different age). Norms for school-age children are available for the preschool battery, permitting use of the test with older children with significant intellectual limitations. The DAS-II also provides a Special Nonverbal Composite (SNC) score which summarizes the nonverbal domains. The SNC is particularly useful when testing children with ASD who are verbal but may have a mild to moderate language impairment.

Delayed Expressive and Receptive Language (Non-verbal IQ) Leiter International Performance Scale-3 Comprehensive Test of Nonverbal Intelligence These assessments do not require the use of verbal directions or verbal responses, therefore reducing the impact of language delay on performance. Also, the Leiter-3 is engaging and does not require the use of time demands, which can be beneficial for testing with kids that have ASD. Thompson Center prefers the Leiter for nonverbal IQ. Ctoni in magi, ravens in Wilkinson p 80

IQ/Cognitive Screening Abbreviated Wechsler Abbreviated Scale of Intelligence-2 Kaufman Brief Intelligence Test Reynolds Intelligence Assessment Scales Stanford Binet-5 screening TC uses WASI for abbreviated IQ: (for use on re-eval after stable comprehensive IQ scores have been obtained and no concerns for cognitive ability)

Very Young Child Should use an assessment that provides mental age equivalents for developmental level Mullen Scales of Early Learning Differential Ability Scales-2 Bayley Scales of Infant and Toddler Development-3 Observations and play-based assessment of development Goldstein – consider assessment that provides mental-age equivalent for very young children, so highlights developmental level. Also good given the instability of standard IQ scores for very young children. - While play based observations are valuable try to do something structured so can have better/harder data for placement decisions TC prefers Mullen for this population TC Recommends having parents observe developmental testing to see if think child is performing at best of ability, helps with interpretation and preparing parents for the feedback.

Severely Impaired Psychoeducational Profile-3 Developmental Profile Developmental Assessment for Individuals with Severe Disabilities-2 Early Learning Accomplishment Profile For those unable to complete standardized IQ test. Developmental alternatives for when valid iq can’t be obtained. These provide information on developmental level and specific skills. Strongly recommend doing one of these especially standardized cognitive testing is discontinued.

Executive Functioning Skills Executive functioning deficits may be misinterpreted as behavior concerns Understanding executive functioning deficits can inform programming to promote academic achievement

Executive Functioning Skills A Developmental Neuropsychological Assessment 2 (NEPSY-2) Behavior Rating Inventory of Executive Function Barkley Deficits in Executive Functioning Scale Observations (such as time on task, motor restlessness) Connor’s Continuous Performance Test-3 Especially for students in average range of cognitive ability that we suspect autism for it is important to assess for ef skills. This gives programming info for them and we often find that in classrooms where kids are having behavioral difficulties the eval profile may look like they have average iq but have autism but not assesse d for ef, the ef deficits are interpreted as behavior concerns. Want to see pattern of strengths and weaknesses so when we are looking at academics and behavioral concerns that we would know how to support the student and program for them. Particular difficulty with shifting – Goldstein CPT probably not available in schools, it is a computerized assessment of executive functioning

Health and Co-Morbid Considerations

Health Guiding Questions Past diagnoses and treatments?
Current diagnoses and treatments? Does the child have any co-morbid medical or mental health related issues that impact school functioning? GI, seizures, anxiety, sleep problems

Motor Skills

Fine Motor and Sensory Guiding Questions
Are motor difficulties related to muscular weakness, sensory processing, or motor planning issues? Are motor issues interfering with participation in daily life activities and school? Is there evidence of oral motor difficulties associated with mouthing objects, decreased tolerance of foods, drooling, speech problems, or gagging? Under- or over- react to typical sensory information? Is activity level appropriate to environmental demands? Sensory seeking or defensive behaviors that interfere with daily functioning? Many kids with ASD have fine motor and/or sensory concerns, so in those cases it is important to assess for current functioning and needs in these areas, while keeping in mind that these are not core areas of deficit for ASD, but can be symptoms and can further impact learning and participation in the school setting.

Assessment Fine Motor: Berry-Buktenica Developmental Test of Visual Motor Integration, 5 Bruiniks-Oseretsky Test of Motor Proficiency-2 Structured Observation Play-based Assessment Sensory: Sensory Profile-2 Short form (caregiver report age 3-14 years) Sensory Processing Measure Multiple reporter options For Early Childhood, recommend fine motor observation and play-based assessment of fine motor skills because need communication skills for standardized tests that may not be developed in young kids with ASD Sensory: Short form recommended because quick and schools sometimes have limited time but is a caregiver only form. Multi reporter ideal measure because can get more complete picture of the child given multiple sources of input.

Motor Special Considerations
Sensory may be a characteristic of autism but is not a core area Administration and interpretation of scores concerns Poor functional communication Lacking skill to imitate Repetitive behaviors Look at what skills will be needed to transition and caution against too narrow of skills reviewed and served in IEP The same concerns raised about standardized testing in general and iq testing specifically also apply to standardized fine motor testing. Problems with standardized tests like VMI and Briunicks for the very young children and those these without functional communication and imitations skills (not valid because need to be able to understand directions and imitate to complete tasks with validity). in addition, repetitive behaviors common in ASD can make the standardized tests concerning because some students will perform the repetitive behavior instead of complete the tasks appropriately, (could give 0) . ex: child lining things up during standardized testing (test scores invalid, not score of 0) Inability to complete the direction might lead some to think that the child cannot do the motor skill when the repetitive behavior or lacking imitation skills are getting in the way of the accurate fine motor assessment Most important to collect data on whether the interventions are working, less about standardized test scores (only repeat standardized test if NEED the score and info from it) Type of data to collect is “assist level” (how independent is the student, what level of help/support does he/she require to complete a functional task) Look at what skills will be needed to transition and caution against IEP goals and services being too narrow Ex: IEP goal of doing laundry but student didn’t know how to determine what type of clothing to wear for the given weather Commonly needed but overlooked skills are daily living skills, making a needed phone call, planning time for the week, reality of what the student will need to do (type of payment and transportation will use)

Academic Achievement

Academic Achievement Special Considerations
Consider academic achievement as it relates to future employment Consider needs for accommodations vs. direct instruction to increase independence Caution against requiring below average standardized academic test scores for eligibility determination A child may have appropriate academic skills but be slower at completing tasks, or perhaps struggle with organization. In some such cases, the student may be able to complete academic tasks with accommodations or reg ed support strategies instead of needing direct special ed instruction for that academic area. It is common for schools to rule out disability if a child has average WIAT or WJ scores, because they take it as indication that the child is not adversely impacted, but remember that educational impact does not JUST mean academic impact.

Post-Secondary Transition

Post-Secondary Transition
Guiding Questions What skills does the student need to develop to increase independence? What skills does the student need to develop in order to be successful in employment? What are the student’s strengths and weaknesses as related to future employment? Consider adaptive behavior here when thinking of these areas

Post-Secondary Transition
Special Considerations Assessments should include both Interest and Ability Adaptive Behavior, Pragmatic Language, & Executive Functioning Information Applies to Transition Assessment Planning Consider the use of transition assessments early for the purpose of comprehensive program planning BECKER BWAP

Summary Best practice school based evaluations for autism are comprehensive across domains of functioning Due to wide range of strengths and weaknesses, comprehensive reevaluation is ESSENTIAL! Evaluation is not just for eligibility Social-communication should be continually revisited

References Goldstein, S., Naglieri, J.A., & Ozonoff, S. (Eds.). (2009). Assessment of Autism Spectrum Disorders. New York: The Guilford Press. Missouri Autism Guidelines Initiative. (2010). Autism Spectrum Disorders: Missouri best practice guidelines for screening, diagnosis, and assessment. Thompson Foundation for Autism and the Division of Developmental Disabilities, MO Department of Mental Health. Wilkinson, L.A. (2010). A best practice guide to assessment and intervention for Autism and Asperger syndrome in schools [electronic resource]. Wilkinson, L.A. (2014). Autism Spectrum Disorder in children and adolescents: Evidence-based assessment and intervention in schools. Washington, D.C.: American Psychological Association.

Contact Information Thompson Center TEAM Education Program Jena K. Randolph, Ph.D. Kimberly Selders, M.A., CSS-School Psychologist Karen O’Connor, Ph.D., BCBA, LBA Brooke Burnett, M.Ed., BCBA, LBA For questions or more information, please contact the Thompson Center TEAM Program: Louis Nevins, Staff Specialist (573)

Best Practice for School-Based Evaluations of Autism

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