EDUCATION-BASED EVALUATIONS FOR ASD KELLY DUNLAP, PSY. S STEPHANIE DYER, ED. S.
AGENDA • The New Evaluation Reality • The Three Prongs of Educational Eligibility • Process Components • REED • Evaluation Components • Determination of Eligibility (Results Review Process) • Evaluation Report • IEP • Differential Eligibility Considerations
New Reality: MORE KIDS
Number of Michigan Students with ASD by Age * Based on 2012 MDE, OSE Eligibility Count 1600 1400 1354 1279 1241 1231 1200 1171 1134 1117 1065 1038 955 1000 900 818 800 630 553 600 395 400 339 280 236 200 4 189 193 153 124 128 51 13 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Age 15 16 17 18 19 20 21 22 23 24 25 26
NEW REALITY: MORE PLAYERS • Autism Insurance Legislation • http: //www. michigan. gov/autism • http: //autismallianceofmichigan. org/news-info/autismlegislation/ • The Autism State Plan • http: //michigan. gov/autism • The Autism Council
MICHIGAN AUTISM COUNCIL • Purpose: Implementation of the Autism State Plan • Autism State Plan: http: //michigan. gov/autism • Subcommittee Work • Early identification and intervention • Adults services and supports • Education
AUTISM COUNCIL SUBCOMITTEES Early Intervention Adult Services Workgroups Screening and Assessment / ASD Eligibility Determination Education
CURRENT PLAYERS AT THE TABLE Special Ed Autism Insurance Benefit (AIB) Private Insurance Medicaid / MIChild Criteria ASD / MARSE ASD = Autistic Disorder, AS, PDD-NOS (DSM IV) Plan for Evaluation REED / Timeline ------------------- Who Evaluates Psych, SSW, SLP Licensed Psych or Physician CMHP Using What Tools Prescriptive for Child / Purpose Must include an “Autism Diagnostic Observation Schedule” (e. g. ADOS-2) Must include ADOS-2 and Developmental Family History (e. g. ADI-R) Diagnosis of Condition Determination of Impairment / Diagnosis IFSP / IEP Team Determines Impairment Eligibility for Services IFSP / IEP Team determines adverse impact Treatment prescribed or ordered by evaluator CMHP + Medicaid Agency final approval Service Plan IFSP / IEP Treatment Plan developed by board certified or licensed provider IPOS developed through PCP process Types of Services IFSP=Early Intervention services; IEP=SE, RS, and SAS Behavioral Health, Pharmacy, Psychiatric, Psychological, Therapeutic ABA (EIBI and ABI)
ACRONYM DECIPHERING TOOL • SE = Special Education • ASD = Autism Spectrum Disorder • MARSE = Michigan Administrative Rules for Special Education • REED = Review of Existing Evaluation Data • MET = Multidisciplinary Evaluation Team • IFSP = Individual Family Service Plan • IEP = Individualized Educational Program • SAS = Supplementary Aids and Services • P&S = Programs & Services • FAPE = Free and Appropriate Public Education • LRE = Least Restrictive Environment • AIB = Autism Insurance Benefit • DSM = Diagnostic and Statistical Manual of Mental Disorders • PDD-NOS = Pervasive Developmental Disorder – Not Otherwise Specified • ADOS = Autism Diagnostic Observation Schedule • ADI = Autism Diagnostic Interview • CMHP = Child Mental Health Professional • PCP = Person-Centered Plan • IPOS = Individual Plan of Service • ABA = Applied Behavioral Analysis • EIBI = Early Intensive Behavioral Intervention • ABI = Applied Behavioral Intervention • ABLLS = Assessment of Basic Language and Learning Skills • VB-MAPP = Verbal Behavioral Milestones Assessment and Placement Program
NEW REALITY IN EVALUATIONS FOR ASD • Potential increase in referrals • Potential increase in pressure to accept clinical diagnoses • Increased need for collaboration across systems
So, where do we start? Ensure quality special education eligibility evaluations for ASD (i. e. Clean up our own backyard!)
NEW REALITY: MORE COMPLEXITY • Common Comorbid Conditions: • • • Seizures and epilepsy Anxiety Depression Attention difficulties Bipolar Disorder Obsessive Compulsive • Some are considered part of ASD, so when is condition at a level that warrants an different or additional dx?
Today’s Guiding Principle • NO OPINIONS • ALL DECISIONS INFORMED BY…. • THE LAW • THE RESEARCH • THE DATA
WARNING • I heard that…. • I was told…. PRACTICE IS NOT NECESSARILY LAW, POLICY, or RULE
WE MUST ENSURE QUALITY EVALUATIONS • All staff need to be competent at ASD screening / evaluation • Current Issues: – Not recognizing there are THREE required eligibility areas – Not recognizing that “educational impact” can be in one of THREE areas (e. g. academic, behavior, social) – Use of tools with no observational data – Not understanding terms: • Marked • Qualitative • Adverse Impact
AGENDA • The New Evaluation Reality • The Three Prongs of Educational Eligibility • Process Components • • • REED Evaluation Components Determination of Eligibility Evaluation Report IEP • Differential Eligibility Considerations
THE THREE PRONGS OF ELIGIBILITY • CRITERIA • IMPACT • NEED
GUIDING PRINCIPLE “There is no single behavior that is always typical of Autism and no behavior that would automatically exclude an individual child from a diagnosis of Autism. ” (NRC) PREPONDERANCE OF EVIDENCE (Dave Schoemer)
AUTISM SPECTRUM DISORDER TRIAD s nt me air Imp cal o tive lita Recipr ction a ra Qu in nte l. I ocia S Qua litat In C ive Im om mu pairme nica n tion ts ASD Restrictive, Repetitive & Stereotyped Behavior
DSM-V CHANGE: ASD Persistent Deficits in Social Communication & Social Interaction Restricted & Repetitive Patterns of Behavior SEVERITY RATING LEVELS 1 -3: 3 = Requiring very substantial support 1 = Requiring support
ELIGIBILITY VS DIAGNOSIS
MICHIGAN DEFINITION OF ASD
MICHIGAN DEFINITION OF AUTISM SPECTRUM DISORDER Characterized by qualitative impairments in: a. Reciprocal Social Interactions b. Communication c. Restricted Range of Interests / Repetitive Behavior
“QUALITATIVE” • Markedly Atypical • Significantly different from other students at the same age and developmental level • Outside the typical sequence of development • Across all environments. • Presence and Absence • Unique to each Student
MICHIGAN DEFINITION OF AUTISM SPECTRUM DISORDER Characterized by qualitative impairments in: Reciprocal Social Interactions Communication Restricted Range of Interests / Repetitive Behavior
RECIPROCAL SOCIAL INTERACTION A mutual exchange (e. g. of words, actions, or feelings).
RECIPROCAL SOCIAL INTERACTION AT LEAST 2 OF THE FOLLOWING 4 (i) Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction. • • Marked = Substantial & Sustained; Clearly Evident; Distinctive and noticeably different from same-aged peers PURPOSE of Nonverbal Behavior • EXAMPLES: • Seems to look “through” a person, lacks eye contact to initiate or sustain interaction, has fleeting or inconsistent eye contact • Lacks emotion or appropriate facial affect for the social situation, lacks accurate facial expression to reflect internal feelings, facial expressions seem rehearsed or mechanical (i) Difficulty maintaining appropriate body space, awkward/stiff response or movement, gait challenges (ii)Lacks understanding of the use of nonverbal cues (e. g. pointing, head nod, waving), does not respond to communication partner signals to start or end a conversation
RECIPROCAL SOCIAL INTERACTION AT LEAST 2 OF THE FOLLOWING 4 (ii) Failure to develop peer relationships appropriate to developmental level. ---NOTE: that results from deficits in social reciprocity and inability to understand the perspectives of others, another’s point of view, or predict another’s behavior. • Examples: • • • Lack of understanding of age-appropriate humor and jokes Disruption of ongoing activities when entering play or social circles Lack of initiation or sustained interactions with others Preference to play alone Continuous failure in trying to understand the social nuances and follow the social rules Desire for friendships but with multiple failed attempts Misinterpretation of social cues or communication intent of others Tolerance of peers but no engagement in conversation or activity Confusion with the telling of lies Policing peers (e. g. reporting rule infractions on the playground)
THEORY OF MIND (To. M) means the ability to recognize and understand thoughts, beliefs, desires and intentions of other people in order to make sense of their behavior and predict what they are going to do. (Atwood, 2007) TOM—ability to understand the feelings, intentions and perspectives of others and recognize that they are different from our own.
DEVELOPMENTAL TRAJECTORIES Experts on people Normal birth ASD Experts on things
RECIPROCAL SOCIAL INTERACTION AT LEAST 2 OF THE FOLLOWING 4 (iii) Marked impairment in spontaneous (i. e. without prompting) seeking to share enjoyment, interests, or achievements with other people, for example, by a lack of showing, bringing, or pointing out objects of interest. (i. e. Joint / Shared Attention) • Examples: • Deficits in the use of pointing to orient another to an object or event • Bringing objects or items to others for the purposes of getting needs met, but not for a shared experience • Shifting conversations to one’s own interest rather than responding to the interests of others
RECIPROCAL SOCIAL INTERACTION AT LEAST 2 OF THE FOLLOWING 4 (iv) Marked impairment in the areas of social or emotional reciprocity (i. e. Identifying and responding appropriately to other’s emotional states (e. g. , comfort a crying person)) • EXAMPLES: • Lack of social smiling; Lack of interest in the ideas of others • Aloofness and indifference toward others • Seemingly rude statements to others without filter or negative intent Difficulty explaining their own behaviors in context of impact on others • Difficulty predicting how others feel or think • Problems inferring the intentions or feelings of others • Failure to understand how their behavior impacts how others think or feel • Problems with social conventions (e. g. turn-taking / personal space) • Lack of appropriate responding to someone else’s pain or distress • Creating arbitrary social rules to make sense of ambiguous social norms
MICHIGAN DEFINITION OF AUTISM SPECTRUM DISORDER Characterized by qualitative impairments in: Reciprocal Social Interactions Communication Restricted Range of Interests / Repetitive Behavior
COMMUNICATION AT LEAST 1 OF THE FOLLOWING 4 (i) Delay in, or total lack of, the development of spoken language not accompanied by an attempt to compensate • Failure to understand that words have a communicative intent • About 40% of children with an ASD do not talk at all. • About 25%– 30% of children with an ASD have some words at 12 to 18 months of age and then lose them. • Remaining children speak, but sometimes not until later in childhood and/or nonfunctional speech. http: //www. cdc. gov/ncbddd/autism/signs. html
COMMUNICATION (ii) Impairment in Pragmatics: The ability to initiate, sustain, or engage in reciprocal conversation with others a. Using language for varying purposes (e. g. greeting, informing, promising, requesting, etc. ) b. Changing language according to the needs of the listener or situation (e. g. , giving background information to an unfamiliar listener, speaking differently in a classroom than on a playground) c. Following rules of conversations and storytelling (e. g. , taking turns in conversation, staying on topic, rephrasing when misunderstood, proximity, use of eye contact
EXAMPLES • Difficulty with the social aspects of language (e. g. understanding non-literal language used in conversation) • Issues with prosody (e. g. flat and emotionless or high and pitchy with atypical rhythm or rate) • Difficulty initiating, sustaining, or ending conversations with others • Difficulty using repair strategies when communication breaks down • Talking for extended periods of time about a subject of the student’s liking, regardless of the listener’s interest • Talking at someone in a monologue rather than conversing
RECEPTIVE & EXPRESSIVE LANGUAGE ARE NOT EQUAL • • I didn’t say she stole my money.
COMMUNICATION (iii) Stereotyped / repetitive use of language / idiosyncratic • Idiosyncratic = contextually irrelevant or not understandable to the listener; may have private meaning / be understood by the speaker or to those familiar to the situation (e. g. movie lines) • Can include: • Echolalia • Repeat videos / scripts • Nonsense language • Verbal Fascinations
(IV) LACK OF VARIED, SPONTANEOUS MAKEBELIEVE PLAY OR SOCIAL IMITATIVE PLAY APPROPRIATE TO DEVELOPMENTAL LEVEL. • Compared to Developmental Level • Extremely Stilted • Embracing Play
MICHIGAN DEFINITION OF AUTISM SPECTRUM DISORDER Characterized by qualitative impairments in: Reciprocal Social Interactions Communication Restricted Range of Interests / Repetitive Behavior
RESTRICTIVE, REPETITIVE, STEREOTYPED BEHAVIORS AT LEAST 1 OF THE FOLLOWING 4 (i) Encompassing preoccupation with 1 or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus. • Intrusive; frequent, interfere with participation in daily activities • DISTRESS OVER DISRUPTION (ii) Apparently inflexible adherence to specific, nonfunctional (e. g. no purpose) routines or rituals. • Eat only one type, color, texture of food • Self imposed rules (must touch 3 doors before opening) (iii) Stereotyped and repetitive motor mannerisms, for example, hand or finger flapping or twisting, or complex whole-body movements. (iv) Persistent preoccupation with parts of objects.
(III) STEREOTYPED AND REPETITIVE MOTOR MANNERISMS, FOR EXAMPLE, HAND OR FINGER FLAPPING OR TWISTING, OR COMPLEX WHOLEBODY MOVEMENTS. • Cautions – Prioritize Criteria • Comprehensive Evidence of ASD
(IV) PERSISTENT PREOCCUPATION WITH PARTS OF OBJECTS. • Observations and Interactions Over Time • Dave – Air Conditioner Parts
THE THREE PRONGS OF ELIGIBILITY üCRITERIA • IMPACT • NEED
MICHIGAN DEFINITION OF ASD IMPACT
MICHIGAN DEFINITION OF AUTISM SPECTRUM DISORDER #1. Considered a lifelong developmental disability that adversely affects a student’s educational performance in 1 or more of the following areas: a) Academic (e. g. ability to meaningfully participate and progress in the general curriculum including lack of initiation, impaired quality of participation, low grades, etc. ) (b) Behavioral (e. g. disruption, aggression, lack of appropriate engagement, eloping, tantrums, etc. ) (c) Social (e. g. ability to develop and maintain relationships/friendships, responses to social situations that alienates others and diminishes acceptance, etc. )
ESTABLISHING NEED IDEA § 300. 306 • To be eligible for special education services, the educational impact of the student’s ASD must necessitate special education or related services. • Special education is defined as specially designed instruction which means “adapting, as appropriate to the needs of an eligible child…” • Specialized instruction must be needed for the student to make progress in school and benefit from general education instruction to be eligible for services. • Effectiveness of previously implemented interventions is one way to determine the need for specialized instruction.
MICHIGAN DEFINITION OF ASD AGE SENSORY Not Primary EI TEAM
CET: CENTRALIZED EVALUATION TEAM • Objective 3 -person team • Sole purpose is ASD eligibility • Start with the child, not the characteristics (e. g. does the ASD dominate the child’s thinking? ) • Use the quadrants for observation and organizing information • Conduct a home visit with all 3 members • MET meeting to determine eligibility (Meeting Mechanics) • Preponderance of evidence • One combined report • Report follows the MARSE criteria • Meet with parents BEFORE the IEP meeting
TEAM CONFIGURATIONS
TEAM EVALUATION ☺ Collaboration ☺ One voice ☺ One contact ☺ One report
AGENDA • The New Evaluation Reality • The Three Prongs of Educational Eligibility • Process Components • • • REED Evaluation Components Determination of Eligibility Evaluation Report IEP • Differential Eligibility Considerations
PROCESS COMPONENTS • REED • Evaluation Components • Determination of Eligibility • Evaluation Report • IEP
REED (REVIEW OF EXISTING EVALUATION DATA) • Required at re-evaluations and at termination of eligibility. • Recommended at initial evaluation, especially if evaluation data from outside sources is available (e. g. diagnostic reports from a private clinic). (NOTE: COLLABORATION OPPORTUNITY) • Purpose of the REED is to: • Review available information and assessment data (e. g. ADOS, developmental history, rating scale results); • Determine if the information is sufficient to make a determination of eligibility (i. e. meets eligibility criteria that impacts academic, behavioral, or social progress in school that necessitates special education); • If not, determine what else is needed to make a determination of eligibility (e. g. observations to determine impact on educational performance); • Establish a plan for gathering the additional information.
Considerations • We still have obligation to address MARSE eligibility criteria (ex: ADHD) • What do we know from what they provided? Diagnostic information/rating scale scores Developmental history ADOS score • What do we still need to know? What does child look like across settings? Impact on social, behavioral, academic Additional parent/teacher info specific to triad Communicate with evaluator
OTHER CONSIDERATIONS • Consideration of ALL potential disabilities • Information to assist in differential eligibility • Gather information to assist in developing the IEP • Communication needs of the student including assistive technology • The student’s social needs including peer to peer support • The student’s behavioral needs including the need for a functional behavioral assessment, positive behavioral support plan, or an emergency crisis plan • Academic needs of the student (i. e. accommodations and differentiation)
PROCESS COMPONENTS • REED • Evaluation Components • Determination of Eligibility • Evaluation Report • IEP
EVALUATION COMPONENTS • Teacher / Building Staff Interviews • Parent / Family Interviews & Home Visit • Observations Across Settings • Standardized Assessment Domain Considerations
EVALUATION PLAN CHECKLIST
Clinton County RESA Example Attended by MET members (Psych, SSW, SLP) Critical for coordination of scheduling Discussion and assignments of evaluation components Allows time for training, questions, problem solving, etc.
INTERVIEWS; SURVEYS; HOME VISIT • School • Home • Facilitated Meeting Social Interaction Communication Behaviors Sensory • Face to Face • Surveys OTHER (e. g. academic, cognitive functioning) • In the home WHY? • Build Relationship • Pervasiveness of Characteristics • Describe Behaviors from another perspective What makes you think the child / student has ASD?
OTHER SURVEY QUESTIONS • Talking Points vs. Questions • Challenges with published tools: • Don’t match MARSE criteria • Don’t focus on impact and need • May not facilitate robust discussion AREAS TO CONSIDER • Reciprocal Social Interaction • Communication • Restrictive / Repetitive Behavior • Differential Eligibility: • • Developmental History Medical History Cognitive / Adaptive Skills Educational Skills
EVALUATION COMPONENTS • Teacher / Building Staff Interviews • Parent / Family Interviews & Home Visit • Observations Across Settings • Standardized Assessment Domain Considerations
OBSERVATIONS PUBLIC SCHOOL INVESTIGATOR • Evidence of presence / absence of behaviors across settings; Is the ASD dominating the child’s interaction with the environment? • “JUST THE FACTS”— examples / non-examples but NOT interpretation!!! <that meeting is coming!!> • The Importance of Context • INVESTIGATE: Dig down below the surface • PARTICIPATE to get more detailed information • CONDUCT mini experiments to see the impact or response
OBSERVATIONS • All team members need to conduct observations • Make sure all settings, times of day, contexts are covered • Allow room in schedule for additional observations • Powerful…allows for considering function of behavior (“eyes on kid, eyes on kid…”) • Dig down below the surface
DIRECT OBSERVATION “EYES ON KID” Qualitative Impairment in Communication Qualitative Impairment in Reciprocal Social Interaction Restrictive, Repetitive and Stereotyped Behaviors Sensory
CHAR-EM ELIGIBILITY GUIDELINES
Observations in Context The Tip of the Iceberg Analogy • The tip is the observable behavior; • The context cues us into what underlies the behavior (e. g. motivation, intent, function) • Function = Differential Eligibility
CAUTION: Attribution Theory ASD EI / SM ? ?
Fundamental Attribution Error Jarod - Outcomes Told the teacher he liked her moustache ASD EXPLAIN BEHAVIOR EI / SM EXPLAIN BEHAVIOR?
Identifying Underlying Issue Antecedents Behavior Context Underlying ASD: --Deficits in Social Reciprocity --Deficits in Theory of Mind --Communication Deficits --Restrictive / Repetitive Behavior Consequence Context Underlying EI / SM: --Emotional Dysfunction --Abuse / Trauma --Mental Health Dx --Risk Factors (e. g. SES)
Identifying Underlying Issue Antecedents Behavior Consequence Teacher instructs “time to get in line” Ss tries to be first in line and yells and screams when prevented Teacher re-states who the line-leader is Underlying ASD: --Deficits in Social Reciprocity --Deficits in Theory of Mind Underlying EI: --Difficulty regulating emotion --low self-esteem / worth
THINK IN FUNCTION / PURPOSE • Marci was observed grabbing toys and objects from others and appeared unaware that the other child was using or playing with the object. Marci was observed tickling peers under the chin while giggling, moving from one peer to the next. None of the children appeared to be enjoying this, but Marci did not seem to recognize their displeasure. • Marci was observed pulling at girls’ ponytails and accessories; Marci has not been noted to pull hair other than in pony/pigtails or when there accessories present. Marci was noted to state, “I want to poke her in the eye” and “I want to kick her” in a very unemotional manner not directed at anyone. Despite her statement, Marci has not attempted to do the things that she says.
THE IMPORTANCE OF CONTEXT Marci was observed grabbing toys and objects from others and appeared unaware that the other child was using or playing with the object. Marci was observed tickling peers under the chin while giggling, moving from one peer to the next. None of the children appeared to be enjoying this, but Marci did not seem to recognize their displeasure. Marci was observed pulling at girls’ ponytails and accessories; Marci has not been noted to pull hair other than in pony/pigtails or when there accessories present. Marci was noted to state, “I want to poke her in the eye” and “I want to kick her” in a very unemotional manner not directed at anyone. Despite her statement, Marci has not attempted to do the things that she says.
THE IMPORTANCE OF CONTEXT Marci was observed grabbing toys and objects from others, while yelling, “I had it first!” and pushing peers away. Marci was observed tickling peers under the chin while giggling, moving from one peer to the next. None of the children appeared to be enjoying this, but Marci kept saying, “Am I bugging you yet? ” and “Isn’t this so funny? ” Marci was observed pulling at girls’ ponytails and accessories; she will say, “I don’t like your hair like that-it looks stupid. ” Marci was noted to state, “I want to poke her in the eye” and “I want to kick her” while being redirected from an argument with a peer. Marci has previously shoved, kicked and poked this girl when she doesn’t do what Marci wants her to do.
OBSERVATIONS
EVALUATION COMPONENTS • Teacher / Building Staff Interviews • Parent / Family Interviews & Home Visit • Observations Across Settings • Standardized Assessment Domain Considerations
OTHER SUPPORTING EVIDENCE • Checklists • Interview Forms • Direct Assessment Tools
EVALUATION METHODS/TOOLS • Predominantly OBSERVATION and INTERVIEW • Not YES/NO, Black/White…Qualitative Evaluation • Autism Diagnostic Observation Schedule (ADOS): Not score, but observation opportunity • Specific diagnostic tests (communication, cognitive, social, sensory, adaptive) • Caution: Questionnaires? CARS?
BE INTENTIONAL WITH STANDARDIZED TOOLS • Remember: Tools were not designed to align with the MARSE criteria or measure impact / need. • ASD characteristics that may negate results: • Difficulty establishing rapport • Lack of motivation to please • Challenges with attention, engagement, and persistence in task demands • Difficulty transitioning • Language deficits • Interfering and challenging behaviors • Tools are only as good as their technical adequacy
Technical Adequacy • Sample • Reliability • Validity • EXAMPLE: ADOS-2: • Test / Re-test Reliability— 2 Weeks: • Classification changed for 9 of the 39 children (23%)
ASIEP-3 (AUTISM SCREENING INSTRUMENT FOR EDUCATIONAL PLANNING) • Consists of 5 Separate Measures • The Autism Behavior Checklist (ABC) = 47 item checklist • Results indicate the probability of the student having ASD • Content Validity: Items were developed based on an extensive review of the literature describing the characteristics of autism • “The ability of the ABC to discriminate among different diagnostic groups needs to be examined further”
ASSESSMENT TOOLS CENTRAL ASSESSMENT LENDING LIBRARY (CALL) HTTPS: //WWW. CMICH. EDU/COLLEGES/CHSBS/PSYCHOLOGY/CALL/PAGES/DEFAULT. ASPX/ • ASIEP-3: Autism Screening Instrument for Educational Planning • ADOS-2 (Autism Diagnostic Observation Schedule) • ADI-R: Autism Diagnostic Interview • CARS-2: Childhood Autism Rating Scale • GARS-2: Gilliam Autism Rating Scale • GADS: Gilliam Asperger Disorder Scale • KADI: Krug Asperger Disorder Index • PEP-3: Psycho. Educational Profile • ABLLS-R: Assessment of Basic Language and Learning Skills • VB-MAPP: Verbal Behavior – Milestones Assessment and Placement Program
QUESTIONS TO GUIDE THE USE OF STANDARDIZED TOOLS • Does the tool have adequate technical adequacy? • What is the purpose or intended outcomes? • What questions are you attempting to answer and will the tool provide that information? • What are the language requirements and do they match the ability level and communication modality of the student? • Given the student’s behavioral challenges, will the tool likely produce reliable and valid results? • How current is the tool (e. g. when was it published and standardized)? • What are the potential challenges in using the tool (e. g. results are not consistent with other information)?
CREATIVE USES OF STANDARDIZED TOOLS “BREAKING STANDARDIZATION” • Observe performance under various conditions (e. g. use of visuals supports) • Create conditions not easily observed in natural settings. • NOTE: Such expansions can be beneficial in capturing rich information on the student’s learning needs, strengths, and challenges, but invalidates obtained scores. Avoid by first administering under standardized conditions. • Some options for breaking standardization include the following: • Administer subscales or items within subscales in a different order so highly preferred tasks can follow less preferred ones to increase motivation; • Start at the beginning of a particular subscale (easiest item) rather than the age -suggested starting point to create behavioral momentum; • Take frequent breaks; Use tangible reinforcers; • Use a multiple-choice or fill-in-the-blank formats rather than an open-ended; • Paraphrase instructions and/or simplify language to match child’s level; • Use terms and phrases that are familiar to the child (e. g. , “match” vs. “find me another one just like this”);
PROCESS COMPONENTS • REED • Complete Evaluation Components • Determination of Eligibility • Evaluation Report • IEP
Clinton County RESA Example Meeting Mechanics Review Information / Data using 4 quadrants Differential Eligibility Note-taking / Beginning of Report Writing Any more information needed to make determination?
RESULTS REVIEW MEETING • Only Eval Team present (Psy, SSW, SLP) • List all 12 criteria on board • Color code information (teacher, parent, eval team) • Ask BIG question in each area: Is there a qualitative impairment in socialization? . . . • Discuss each criterion; check criterion that has been reached • Report writer (on computer)
GO TO THE BOARD! Communication Reciprocal Social Interaction Restrictive and Repetitive Behaviors Sensory
DETERMINING ELIGIBILITY • Start with the child, not the characteristics • Integrate quantitative & qualitative information • Within qualitative assessment, discover whether student meets criteria for Autism Spectrum Disorder • “Preponderance of the evidence”
TAKE NOTES
RESULTS REVIEW MEETING CONT… • Process • All data sources • Determine eligibility / DECISION • If eligible as ASD, determine how the ASD is impacting progress in gen ed in the areas of socialization, independence, communication, transition, self-regulation… • Feedback/recommendations provided to building team, parents, coach, sped rep
Of primary concern is Johnny’s level of independence. Due to difficulties in pragmatic language and communication, sensory modulation, and socialization, Johnny’s independence is limited. In order to participate with the routines and activities of the classroom, Johnny currently requires considerable physical and verbal prompting from adults. His independence is significantly impacted in the following areas: • Transition (task to task and place to place) • Group participation • Direction following • Self care • Interactions with peers • Outside play • Inside play with free choice time • Spontaneous conversation
PROCESS COMPONENTS • REED • Complete Evaluation Components • Determination of Eligibility • Evaluation Report • IEP
CRITICAL REPORT CONSIDERATIONS • Write ONE Report • Customize to the M. E. T. Form ( ASD Criteria) • Build a case for your conclusion (e. g. you shouldn’t get to end and question eligibility recommendation) • Avoid “cut and paste” process (makes it challenging to cohesively build a case) • Use Persuasive Writing Skills • Explain what does NOT align (e. g. standardized scores, parent reports of behaviors, etc. )
REPORT ORGANIZATION
CONTEXTUALIZED REPORT STRUCTURE
PROCESS COMPONENTS • REED • Complete Evaluation Components • Determination of Eligibility • Evaluation Report • IEP
FP PLAA INFORMING THE IEP Supplementary Aids & Services Goals a Object nd ives or Benchm arks
The PLAAFP Present Levels of Academic Achievement and Functional Performance What about the ASD impacts access and progress in: • The general education CURRICULUM • General education ENVIRONMENTS (including social skill development, independent skills, etc. )? • Further education, employment, and independent living
THE IMPACT STATEMENT IMPACT How does the ASD impact access and progress in general education curriculum and environments? Due to Sean’s lack of reciprocity and restricted range of interests, he does not independently engage in and navigate the daily schedule and requires 6 -7 verbal and visual prompts by adults before following simple tasks. He also does not independently get materials he needs to complete classroom activities and tasks, and requires up to 10 adult prompts to complete his classroom work. As many as 6 times an hour, Sean attempts to leave the classroom to seek out his preferred activity (basketball) and as a result, he misses instruction 3 -4 times per day for 5 -10 minutes. .
AGENDA • The New Evaluation Reality • The Three Prongs of Educational Eligibility • Process Components • • • REED Evaluation Components Determination of Eligibility Evaluation Report IEP • Differential Eligibility Considerations
DIFFERENTIAL ELIGIBILITY ECDD…SLI…CI…EI • Don’t you think its __________?
CONSIDERATIONS FOR YOUNG CHILDREN • Given complexities and range of developmental changes, we need solid understanding of typical development and disorders that mirror ASD in young children • Higher threshold for determining communication, social, and behavior impairment may need to be considered
CONSIDERATIONS FOR YOUNG CHILDREN • Not appropriate to recommend alternative eligibility (such as SLI or ECDD) in order to prolong or avoid the ASD eligibility • According to MARSE, ECDD eligibility should be used only when: “primary delays cannot be differentiated through existing criteria within [other eligibility categories]. ” • Policies that indicate age cutoffs for finding a student eligible under the ASD classification should also be eliminated.
EI (Emotional Impairment) Criteria (1) Emotional impairment shall be determined through manifestation of behavioral problems— • Primarily in the affective domain---The affective domain involves the influence of emotion on behavior and may include areas such as emotional stability and control, interaction with, response to, and ability to work with others, and self-control. This item implies that emotional and behavioral functioning departs from generally accepted and developmentally appropriate norms. • Over an extended period of time—Implies the student exhibits these behavioral problems for at least ninety (90) school days. Selected period allows time for resolution of situational responses as well as time for targeted interventions to be attempted. For severe or dangerous behaviors, an abbreviated timeline may be needed (give rationale that problem will continue without special education support). • Which adversely affect the student’s education (implies pervasive and marked impact (frequency, duration or intensity) in academic performance or social functioning) to the extent that the student cannot profit from learning experiences without special education support. .
EI (Emotional Impairment) Criteria, cont. The problems result in behaviors manifested by 1 or more of the following characteristics: a. Inability to build or maintain satisfactory interpersonal relationships within the school environment. Interpersonal relationships refer to developmentally appropriate actions and reactions to peers and adults. To meet this criteria, a student should demonstrate pervasive (generally all teachers and peers) aberrant behaviors that occur at a greater frequency, intensity and duration for others at that developmental level. b. Inappropriate types of behavior or feelings under normal circumstances. This criterion implies atypical behaviors for which no observable reason exists. Mere misconduct or refusal to comply does not qualify a student in this category. The pervasiveness and frequency, intensity, and duration should also be considered.
EI (Emotional Impairment) Criteria, cont. c. General pervasive mood of unhappiness or depression. This criterion means a student must exhibit depressive symptomatology which typically involves changes in all four major areas: (1) affective (emotions), (2) motivation (loss of interest), (3) physical/motor functioning (e. g. weight / appearance), and (4) cognition. Pervasiveness implies impact in almost all aspects of a person’s life. NOTE: Aggression and non-compliance can mask depression. d. Tendency to develop physical symptoms or fears associated with personal or school problems. First consider a student’s medical condition before considering eligibility under this criterion. This criterion is related to conditions like school phobia and other intense anxiety disorders that result in physical symptomology and somatic complaints (e. g. headache, tics, stomachache).
Example Characteristics Inability to Maintain Relationships In ability to maintain relationships due to: • Responding aggressively toward others • Short temper • Starts fights • Withdrawn • Has intense emotional responses to typical peer disagreements • Demonstrates inappropriate sexual behaviors • Seeks excessive approval from others Inappropriate Behaviors or Feelings • • • Over-reacts to everyday occurrences (i. e. rage, excessive laughter, hysterics) Exhibits catastrophic or panic reactions to everyday occurrences Demonstrates flat, distorted or excessive affect Exhibits selfabusive behaviors Exhibits delusions and/or hallucinations or thought disorders Demonstrates extreme mood swings Unhappiness or Depression • • • Decreased interest / pleasure in previously enjoyed activities Excessive guilt and/or self-criticism Expresses feelings of extreme sadness Predicts failure or refuses to attempt tasks (projects hopelessness) Demonstrates agitation or lethargy Difficulty concentrating and/or making decisions Physical Symptoms / Fears • • Chronic Somatic complaints (i. e. headaches, stomach aches) Intense anxiety not associates with a specific stimuli Extreme fear in response to a specific stimuli Panic reactions to everyday occurrences
EI (Emotional Impairment) Criteria, cont. (2) Emotional impairment also includes students who, in addition to the characteristics specified in subrule (1) of this rule, exhibit maladaptive behaviors related to schizophrenia or similar disorders. The term “emotional impairment” does not include persons who are socially maladjusted, unless it is determined that the persons have an emotional impairment. What is Social Maladjustment? • Not defined by federal or state departments or clinical literature • Understanding is derived from the educational literature and practice, administrative decisions and court interpretations • Often associated with clinical Dx of CD, ODD, or Antisocial • Definition Components: – – Pervasive intentional behaviors that violate socially acceptable rules and norms Accepting no responsibility for actions Demonstrating little to no remorse Blame and intimidate / charm others while manipulating the situation to meet own needs
ASD vs. EI / SM • BEHAVIORS: – Refusal to do academic work – Not following school expectations / rules – Aggression toward peers • DISTINGUISH BETWEEN: – I don’t care about your rule vs. I don’t understand the rules frequently change; – ODD vs. I already know how to do this and if I know, then you should know; – I don’t care about your thoughts or feelings vs. I don’t understand you have different thoughts or feelings from me.
Preponderance of Evidence Compare & Contrast The Results Review Meeting Social Communication Behavior Sensory OTHER
Preponderance of Evidence Compare & Contrast Developmental History ASD • Developmental delays (e. g. language, joint attention) • Uneven development • Unusual skills / interests (e. g. door hinges, refrigerator letters – making words) EI • Family history / concerns • Hyperactivity • Emotional extremes outside typical developmental norms • Ritualistic • Nuance in restricted nature / rituals • Sophistication above developmental level CAUTION: Wrong Dx
Compare & Contrast History of Interventions • Visual Supports • Social Facts • Self Management • Social Reinforcement • Counseling
Compare / Contrast Specific Behaviors Social Maladjustment vs. ASD Social Maladjustment – Pervasive intentional behaviors that violate socially acceptable rules and norms – Accepting no responsibility for actions – Demonstrating little to no remorse – Blame and intimidate / charm others while manipulating the situation to meet own needs • EXAMPLE: Jonathon
Preponderance of Evidence Compare & Contrast Characteristics
COGNITIVE IMPAIRMENT (1) Cognitive impairment shall be manifested during the developmental period and be determined through the demonstration of all of the following behavioral characteristics: (a) Development at a rate at or below approximately 2 standard deviations below the mean as determined through intellectual assessment. (b) Scores approximately within the lowest 6 percentiles on a standardized test in reading and arithmetic. This requirement will not apply if the student is not of an age, grade, or mental age appropriate formal or standardized achievement tests. (c) Lack of development primarily in the cognitive domain. (d) Impairment of adaptive behavior. (e) Adversely affects a student’s educational performance.
Making a Final Decision • Preponderance of Evidence • No one behavior includes or excludes any specific eligibility area: – There always going to be instances that don’t fit the criteria!! – MUST explain what does not align – MUST build a case for your conclusion – However & Despite • Intelligent People can Disagree!!
What if there is disagreement? (e. g. Medical says “yes” and School says “no”) • Remember, different purposes (diagnosis versus special education eligibility and IEP development) • Adherence to strong evaluation process, report is defendable • Commitment to communication • Make sure to meet student needs Implementation of Universal Supports Use of SW-PBIS practices
Selected References • MARSE Rules • ISD Guidelines for Determining Eligibility of Emotional Impairment – Macomb – Char-Em – Ottawa • OCALI Online Identification Module • Other State Guidelines • NATTAP (Network of Autism Training and Technical Assistance Providers) 2008 Conference Session “Compare and Contrast EBD & ASD”—Columbus, OH • Trammell, B. , et. al. (2013) Assessment and Differential Diagnosis of Comorbid Conditions in Adolescents and Adults with ASD. Psychology in the Schools, 5 (9).
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