Monday, December 19, 2011

Free Preview: Award-Winning Book on Autism Spectrum Disorders in Schools


A free preview of the award-winning book A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in schools is now available. Filling a critical void in the autism literature, this authoritative yet accessible book provides psychologists, educators, support professionals, advocates, and parents with a best practice guide to screening, assessment, and intervention for school-age children with autism spectrum disorders (ASD). Grounded in the latest research, special features include illustrative case examples and an index to 50 evidence-based best practice recommendations. This book also makes an ideal text for graduate-level training courses in psychology and special education, and is certain to become a widely used resource that will meet the needs of both experienced practitioners and those new to the field.
Diane Adreon, Associate Director of the University of Miami-Nova Southeastern University Center for Autism and Related Disabilities (UM-NSU CARD) and co-author of  Asperger Syndrome and Adolescence: Practical Solutions for School Success, comments that “Dr. Lee Wilkinson has produced a well-written, user-friendly, comprehensive guide to the assessment and intervention of students with ASD. School district administrators, attorneys, educators and psychologists will want to have this guide available to them as a resource on ‘best practice’ in the field of ASD.” Diane Twachtman-Cullen, Editor-in-Chief of Autism Spectrum Quarterly, calls the book “a landmark contribution destined to become a classic in the field of autism spectrum disorders (ASDs)” and writes, “Dr. Wilkinson has made an enormous contribution to the field by comprehensively and systematically illuminating not only what needs to be done, but also how to go about doing it.”
A Best Practice Guide was honored with a gold medal in the 2011 Next Generation Book Awards Education/Academic Category and finalist awards for the 2011 National Association for Special Educational Needs (NASEN) Educational Needs/Academic Book of the Year and 2010 National Best Book Awards. It is available in print and e-book editions.
The free preview is available at:

Saturday, December 3, 2011

DSM-5: Rethinking Asperger's Disorder

The American Psychiatric Association’s recommendation to delete (remove) Asperger’s disorder as a separate diagnostic category from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has been widely publicized.  Specifically, DSM-5 Work Group members propose a new category of “autism spectrum disorder,” which subsumes the current diagnoses of autistic disorder (autism), Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS). This new category reflects members’ conclusion that “a single spectrum disorder” better describes our current understanding of the neurodevelopmental disorders.
An important feature of the proposed criteria for autism spectrum disorder (ASD) is a change from three (autistic triad) to two domains; “social/communication deficits” and “fixated and repetitive pattern of behaviors.” Several social/communication criteria were merged to clarify diagnostic requirements and reflect research indicating that deficits in communication are “inseparable and more accurately considered as a single set of symptoms...”  Work Group members commented that language deficits are neither universal in ASD, nor should they be considered as a defining feature of the diagnosis.
DSM-IV Criteria in Practice
Problems in applying the current DSM criteria were a key consideration in the Work Group’s recommendation to delete Asperger’s disorder as a separate diagnostic entity. Numerous studies indicate that it is difficult to reliably distinguish between Asperger syndrome, autism, and other disorders on the spectrum in clinical practice (Attwood, 2006; Macintosh & Dissanayake, 2006; Leekam, Libby, Wing, Gould & Gillberg, 2000; Mayes & Calhoun, 2003; Mayes, Calhoun, & Crites, 2001; Miller & Ozonoff, 2000; Ozonoff, Dawson, & McPartland, 2002; Witwer & Lecavalier, 2008). For example, children with autism who develop proficient language have very similar trajectories and later outcomes as children with Asperger disorder (Bennett et al., 2008; Howlin, 2003; Szatmari et al., 2000) and the two are indistinguishable by school-age (Macintosh & Dissanayake, 2004), adolescence (Eisenmajer, Prior, Leekam, Wing, Ong, Gould & Welham 1998; Ozonoff, South and Miller 2000) and adulthood (Howlin, 2003). Individuals with Asperger disorder also typically meet the Communication criterion of autism, “marked impairment in the ability to initiate or sustain a conversation with others,” making it is possible for someone who meets the DSM-IV-TR criteria for Asperger’s disorder to also meet the criteria for autistic disorder.
Treatment and Outcome
Another important consider in the DSM proposal was response to treatment. Intervention research cannot predict, at the present time, which particular intervention approach works best with which individual. Likewise, data is not available on the differential responsiveness of children with Asperger’s disorder and high-functioning autism (HFA) to specific interventions (Carpenter, Soorya, & Halpern, 2009). There are no empirical studies demonstrating the need for different treatments or different responses to the same treatment, and in clinical practice the same interventions are typically offered for both autism and Asperger’s disorder (Wilkinson, 2010). Treatments for impairments in pragmatic (social) language and social skills are the same for both groups.
Application of the New Criteria
It’s important to remember that in the DSM, a mental disorder is conceptualized as a clinically important collection of behavioral and psychological symptoms that causes an individual distress, disability or impairment. The objective of the draft criteria is that every individual who has significant “impairment” in social-communication and restricted and repetitive behavior or interests (RRBI) should meet the diagnostic criteria for autism spectrum disorder. Language impairment/delay is not a necessary criterion for diagnosis of ASD. Therefore anyone who demonstrates severe and sustained impairments in social skills and restricted, repetitive patterns of behavior, interests, or activities in the presence of generally age-appropriate language acquisition and cognitive functioning, who might previously have been given a diagnosis of Asperger’s disorder, would now meet the criteria for the new category of ASD. The draft criteria would also feature dimensions of severity that include current levels of language and intellectual functioning. Additionally, the Work Group intends to provide detailed symptom examples suitable for all ages and language levels, so that ASD will not be overlooked in persons of average or superior IQ who are experiencing “clinical” levels of difficulty.
Conclusion
In conclusion, the DSM-V Work Group members’ proposal of a new category, “autism spectrum disorder,” which subsumes the current diagnoses of autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS), better describes our current understanding about the clinical presentation and course of the neurodevelopmental disorders. Conceptualizing autism as a spectrum condition rather than a categorical diagnostic entity is in keeping with the extant research suggesting that there is no clear evidence that Asperger’s disorder and high-functioning autism are different disorders. As Gillberg (2001) notes, the terms Asperger syndrome and high-functioning autism are more likely “synonyms” than labels for different disorders. Lord (2011) also comments that although there has been much controversy about whether there should be separate diagnoses, "Most of the research has suggested that Asperger syndrome really isn't different from other autism spectrum disorders." "The take-home message is that there really should be just a general category of autism spectrum disorder, and then clinicians should be able to describe a child's severity on these separate dimensions." Unfortunately, many individuals may have been advised (or assumed) that a diagnosis of Asperger’s disorder was separate and distinct from Autistic disorder and that intervention/treatment, course, and outcome were clinically different for each disorder. While including Asperger’s Disorder under the proposed category of “autism spectrum disorder” may well require a period of transition and adjustment, the proposed “dimensional” approach to diagnosis will likely result in more effective identification, treatment, and research for individuals on the spectrum.
The complete article and list of references are available at <On the Road to DSM-5: Rethinking Asperger’s Disorder>
A more detailed summary and discussion of the proposed draft revisions to DSM disorders and criteria are available at <http://www.dsm5.org>

Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also the editor of a new Volume in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools.
© Lee A. Wilkinson, PhD

Thursday, November 10, 2011

What's in a name? Autism or Asperger's


To diagnose autism spectrum disorders (ASD), clinicians typically administer a variety of tests or scales and use information from observations and parent interviews to classify individuals into subcategories listed in standard psychiatric diagnostic manuals. This process of forming "best-estimate clinical diagnoses" has long been considered the gold standard, but a new study demonstrates that these diagnoses are widely variable across centers, suggesting that this may not be the best method for making diagnoses.
The study, A Multisite Study of the Clinical Diagnosis of Different Autism Spectrum Disorders, published on Nov. 7 in the journal Archives of General Psychiatry, adds to previous evidence that standardized diagnostic instruments accurately identify individuals who have autism. It is also consistent with recent skepticism about the value of categorical groupings of autism spectrum disorders in standard diagnostic manuals, such as the Diagnostic and Statistical Manual of Mental Disorders-IV-text revision (DSM-IV-TR) and the International Statistical Classification of Diseases. According to the study’s lead investigator Dr. Catherine Lord, head of the Institute for Brain Development at Weill Cornell Medical College and New York Presbyterian Hospital, “There has been a lot of controversy about whether there should be separate diagnoses for autism spectrum disorder, especially Asperger syndrome," "Most of the research has suggested that Asperger syndrome really isn't different from other autism spectrum disorders."
The study, funded by the Simons Foundation and the National Institute of Mental Health, involved 12 North American university-based centers. About 2,100 children and youth between ages four and 18, who were known to have an autism spectrum disorder, were given a specific diagnosis based on tests of communication, behavior and intelligence as well as psychologists' observations and discussions with parents. On average, diagnostic test scores were similar across all sites. However, the researchers found that diagnoses of specific categories of autism spectrum disorder varied dramatically from site to site across the country. For example, clinicians at one site gave participants only a diagnosis of autistic disorder, while clinicians at other sites gave a diagnosis of autism to less than half of the participants. The proportion of individuals receiving a diagnosis of Asperger syndrome ranged from zero to nearly 21 percent across sites. 
These findings are important both for parents and for organizations that provide services to children and youth with autism spectrum disorders, the researchers said. According to Lord, parents should “not get too caught up in the difference between autism, PDD-NOS and Asperger's,” “The labels are pretty meaningless, because people are using the same general terms as if they mean the same thing, when they really don’t,” “Because clinicians may not be using labels appropriately or diagnosing accurately, they may not be getting a sense of children’s strengths and weaknesses and what therapy is best for them.” she said. “What's important is: How much trouble does your child have with language? How much is your child hyperactive as well as autistic? Are repetitive behaviors a major feature of your child's life?" Researchers also note that the findings support a move toward a general diagnosis of autism spectrum disorder, rather than drawing the line between more specific disorders.  As Lord concludes, “The take-home message is that there really should be just a general category of autism spectrum disorder, and then clinicians should be able to describe a child’s severity on these separate dimensions.”
SOURCE: bit.ly/spSpt2 Archives of General Psychiatry, online November 7, 2011
© Lee A. Wilkinson, PhD


Thursday, September 29, 2011

How Many Doctors Does It Take to Diagnosis an Autism Spectrum Disorder (ASD)?

How many doctors does it take to diagnose an autism spectrum disorder (ASD)? This is a question that many parents continue to ask in response to their frustration with the diagnostic process. For example, a survey of more than 1,200 families in the United Kingdom found that only 8 percent of families received a diagnosis for their children upon their first clinical visit; 40 percent received a diagnosis by the second clinical visit; and 63 percent finally received a firm diagnosis by their third clinical visit. In many instances, parents waited more than 5 years before a diagnosis was confirmed.
A recent survey of parents of school-age children with ASD across five countries (including the US) found an average diagnosis age of 7.5 years and a consistent concern with the timeliness of identification and frustration with the delay in accessing services. Parents reported visiting, on average, between four and five clinicians en route to an ASD diagnosis. Some participants responded to our question with comments such as “too many to count.” The number of professionals visited did not differ significantly based on child’s gender, race, or type of ASD diagnosis. Child diagnostic age was positively correlated with the number of professionals seen during the process of obtaining a diagnosis. In effect, the more professionals a child saw during the process, the older he or she was when finally receiving the diagnosis. Despite the fact that the diagnostic age is decreasing, just over 40 percent of parents reported that they were not satisfied with the diagnostic process. In fact, the more professionals that families saw on their journey to a diagnosis, the more negatively parents viewed the experience. Parents were more satisfied with the diagnostic process when they saw fewer professionals to get the diagnosis and when the children received diagnoses at younger ages.
So, what are the implications? A late diagnosis postpones the timely implementation of intervention services and may contribute to parental distress in coping with an ASD. It is well established that early interventions for children with developmental disabilities are important in increasing cognitive, linguistic, social, and self-help skills. Assisting parents to develop effective management techniques is also likely to avoid or minimize the potential for secondary behavioral and emotional problems. Importantly, because more capable children with ASD are likely to be educated in general education classrooms, delayed recognition of their problems can result in the implementation of ineffective or inappropriate teaching methods that fail to address the core social-communication deficits of ASD. Delays in diagnosis and identification also have wide implications for families. It is now accepted that autism is most likely among the most heritable of all childhood disorders and that for any family with a child with ASD, there is considerable risk that other children in the family may have social, language, or other neurocognitive problems. Family histories of autism or autistic-like behavior or having an older sibling with autism are known risk factors. A delay in identification may result in siblings with the ‘broader phenotype’ being overlooked and as a result, not receive the help needed to address their problems.
Although further research is necessary to identify what additional factors make the diagnostic experience a negative one for so many families, it is clear that better screening and identification practices are needed. Parents are frequently faced with a slow and frustrating period of uncertainty and worry and find themselves in the position of trying to convince their children’s doctors that there is a need for a specialist assessment. Several studies that have qualitatively examined parents’ views on the diagnostic process have noted a tendency for some physicians to minimize or dismiss parents’ concerns about their children’s development and, instead, to encourage them to wait for their children to “out grow” their problems. Although the average age at which autism is diagnosed has decreased in recent years, families have continued to describe a significant struggle during the process of obtaining an autism diagnosis.
Unfortunately, many pediatricians, clinicians, and educators take a “wait-and-watch” approach and may not recognize the early red flags. Although no two children are alike in terms of their development and behavior, best practice requires that a standardized screening tool be administered at any point when concerns (red flags) about ASD are raised by a parent or teacher or as a result of school observations or questions about developmentally appropriate social, communicative, and play behaviors, or where there is a family history of autism or related disabilities. Parents should also continue to be vigilant and keep an ongoing record of behavior that appears atypical or concerning. This information can be very useful in any future assessments.
Recommended Resources:
Stone, W. L. (2006). Does my child have autism? A parent’s guide to early detection and intervention in autism spectrum disorders. San Francisco, CA: Jossey Bass.
Wilkinson, L. A. (2010).  ABest Practice Guide to Assessment and Intervention for Autism and AspergerSyndrome in Schools. London: Jessica Kingsley Publishers.
© Lee A. Wilkinson, PhD


Wednesday, September 21, 2011

Florida Association of School Psychologists (FASP): 38th Annual Conference

Palm Beach County school psychologist, Lee A. Wilkinson, PhD, will present a skill-building workshop adapted from his award-winning book,  Autism and Asperger Syndrome in Schools: A Best Practice Guide to Assessment and Intervention, at the 38th Annual Conference of the Florida Association of school Psychologists (FASP). The Conference will take place from November 1st through the 5th at the Omni Orlando Resort at ChampionsGate, 1500 Masters Blvd, ChampionsGate, Florida 33896. Breakout sessions begin on Tuesday, November 1st thru Wednesday, November 2nd, with Featured Presentations to follow on Thursday, November 3rd. Continuing education credits (CEUs) will offered for Dr. Wilkinson’s workshop as well as a number of other presentations. Join FASP for the BEST professional development offering for school psychologists in Florida...Register Today!

For more information on the author and his book, please visit http://bestpracticeautism.com

Thursday, September 15, 2011

On the Radio: Author Discusses Award Winning Book


Dr. Lee A. Wilkinson, Palm Beach County school psychologist and award winning author will discuss his book, “A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools,” on WJTW radio’s “Book Corner” with host Sharon Dunn airing Friday, September 16th through Sunday, September 18th at 8:20am, 2:20pm and 5:20pm at 100.3 FM, or online at wjtwfm.com. Tune in to hear the Dr. Wilkinson discuss the prevalence of autism spectrum disorders in our schools, educational planning for students with ASD, and practical and useful resources for both parents and professionals.

Dr. Wilkinson is the author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, from Jessica Kingsley Publishers. His work was honored with a gold medal in the 2011 Next Generation Book Awards Education/Academic Category and finalist awards for the 2011 National Association for Special Educational Needs (NASEN) Educational Needs/Academic Book of the Year and 2010 National Best Book Awards.

Saturday, August 27, 2011

Assessment Tools for ASD: Diagnostic Validity


Diagnostic validity is an especially important psychometric characteristic to consider when evaluating the quality and usefulness of a test or screening instrument. It refers to an instrument’s accuracy in predicting group membership (e.g., ASD versus non-ASD). Diagnostic validity can be expressed through metrics such as sensitivity and specificity, and positive predictive value (PPV) and negative predictive value (NPV).  Sensitivity and specificity are measures of a test's ability to correctly identify someone as having a given disorder or not having the disorder. Sensitivity refers to the percentage of cases with a disorder that screen positive. A highly sensitive test means that there are few false negative results (individuals with a disorder who screen negative), and thus fewer cases of the disorder are missed. Specificity is the percentage of cases without a disorder that screen negative. A highly specific test means that there are few false positive results (individuals without a disorder who screen positive). False negatives decrease sensitivity, while false positives decrease specificity.  An efficient assessment tool should minimize false negatives as these are individuals with a likely disorder who remain unidentified.  Sensitivity and specificity levels of .80 or higher are generally recommended.
Positive Predictive Value (PPV) and Negative Predictive Value (NPV) are also important validity statistics that describe how well a screening tool or test performs. The probability of having a given disorder, given the results of a test, is called the predictive value. PPV is interpreted as the percentage of all positive cases that truly have the disorder. PPV is a critical measure of the performance of a diagnostic or screening measure, as it reflects the probability that a positive test or screen identifies the disorder for which the individual is being evaluated or screened. NPV is the percentage of all cases that screened negative that are truly without the disorder. The higher the PPV and NPV values, the better the instrument at correctly identifying cases. It is important to recognize that PPV is determined by the sensitivity and specificity of the test and the prevalence of disorder in the population being tested. For example, an ASD-specific screening measure may be expected to have a higher PPV when utilized with a known group of high-risk children who exhibit signs or symptoms of developmental delay, social skills deficits, or language impairment. In fact, for any diagnostic test, when the prevalence of the disorder is low, the positive PPV will also be low, even using a test with high sensitivity and specificity.
Practitioners should carefully review the psychometric properties of assessment tools and select those with high sensitivity and PPV values. For example, rating scales such as the Autism Spectrum Rating Scales (ASRS) and Social Communication Questionnaire (SCQ) have, on average, high sensitivity and PPV, while instruments such as the Gilliam Autism Rating Scale (GARS) underestimate the likelihood of children with autism being classified as having autism, indicating poor sensitivity.
Lecavalier L. (2005). An evaluation of the Gilliam Autism Rating Scale. Journal of Autism and Developmental Disorders, 35, 795-805.
Norris, M. & Lecavalier, L. (2010). Screening accuracy of level 2 autism spectrum disorder rating scales: A review of selected instruments. Autism, 14, 263-284.

© Lee A. Wilkinson, PhD

Thursday, August 25, 2011

Autism Advocacy Workshop


Palm Beach County School District psychologist, Lee A. Wilkinson, PhD, will be present a workshop, Autism Spectrum in Schools: Assessment and Advocacy, at the fifth annual STatewide Advocacy Network on Disabilities (STAND) Pinellas Accessing Resources Conference (SPARC) on September 24th, in Largo, FL. The SPARC 2011 Conference brings together exhibitors from across the nation to showcase the best resources available to special education advocates. Professional educators, therapists, psychologists, and parents alike will have an opportunity to learn about resources beneficial to special needs students as well as all children. Attendees can choose from 60 different breakout sessions, browse more than 150 different exhibitors, earn credit toward professional license recertification, and meet representatives from state, regional and local organizations.
Dr. Wilkinson is the author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, from Jessica Kingsley Publishers. His work was honored with a gold medal in the 2011 Next Generation Book Awards Education/Academic Category and finalist awards for the 2011 National Association for Special Educational Needs (NASEN) Educational Needs/Academic Book of the Year and 2010 National Best Book Awards.


Monday, August 15, 2011

High Recurrence Risk for Autism in Siblings

A research study published in the journal Pediatrics suggests that nearly 1 in 5 children who have an older sibling with autism will also develop the disorder at a rate much higher than previously thought. Earlier estimates put the risk at between 3 and 10%, but a new study found a substantially higher risk rate of 18.7%, on average.
Researchers in the U.S., Canada and Israel followed 664 infants from 12 US and Canadian sites who had at least one older brother or sister with an autism spectrum disorder. Overall, 132 infants or approximately 19% received an autism diagnosis by their third birthday.
The highest rates were in infants who had at least two older siblings with autism – 32% also developed the disorder. Boys were nearly three times as likely to develop autism as girls, with a recurrence rate of 26.2% versus 9.1%.
The study’s lead author Sally Ozonoff, a psychiatry and behavioral sciences professor with the Mind Institute at the University of California at Davis, noted that 80% of siblings studied did not develop autism, and that the prevalence rate was an “average.” According to Ozonoff, “It’s important to recognize that these are estimates that are averaged across all of the families. So, for some families, the risk will be greater than 18 per cent, and for other families it would be less than 18 per cent.”  “At the present time, unfortunately, we do not know how to estimate an individual family’s actual risk.”
The study has important implications for both parents and professionals.  Families and primary care professionals should be especially observant with infants whose older siblings have been diagnosed with an autism spectrum disorder. Early identification and intervention are critically important to outcome. Ozonoff and her colleagues comment, “The red flags identified should be followed by immediate referral for infant intervention rather than adopting a 'wait-and-see' attitude because early specialized intervention is considered best practice for ASD and may represent the best hope for reducing symptoms and overall disability in high-risk infants who are developing ASD."
Reference:
Ozonoff S, et al. Recurrence risk for autism spectrum disorders: a baby siblings research consortium study. Pediatrics 2011; DOI: 10.1542/peds.2010-2825.

Friday, August 12, 2011

Best Practice Conference: STAND-Pinellas Accessing Resources Conference (SPARC)


September 24th, 2011 
Saturday, 8:00am - 4:30pm
Fitzgerald Middle School 
6410 118th Ave N, Largo, FL
The fifth annual STatewide Advocacy Network on Disabilities (STAND) Pinellas Accessing Resources Conference (SPARC) brings together exhibitors from across the nation to showcase the best resources available to special education advocates. Professional educators, therapists, psychologists, counselors and parents alike will have an opportunity to learn about resources beneficial to special needs students as well as all children.
  •  Choose from 60 different breakout sessions     
  •  Earn credit toward professional license sessions. 
  •   Browse more than 150 different exhibitors. 
  •  Earn credit toward professional license recertification.               
  •  Meet representatives from state, regional and local organizations to answer your  questions. 

                     Register online now!

          Because every child deserves a voice!


Thursday, August 4, 2011

Legally Appropriate Educational Services for Students with ASD

Since Congress added autism as a disability category to the Individuals with Disabilities Education Act (IDEA) in 1990, the number of students receiving special education services in this category has increased over 900 percent nationally. It’s critically important that educators understand the provisions for providing legally and educationally appropriate programs and services for students identified with ASD.
 Research indicates that education is the most effective treatment/intervention for children with ASD. The most recent reauthorization of the Individuals with Disabilities Education Act (IDEA 2004) <http://idea.ed.gov/explore/home >entitles all students with disabilities to a free, appropriate public education (FAPE). FAPE encompasses both procedural safeguards and the student’s individual education program (IEP). The IEP is the cornerstone for the education of a child with ASD. When a student is determined eligible for special education services, an IEP planning team is formed to develop the IEP and subsequently determine placement.
Although clinical diagnoses, psychiatric reports, and treatment recommendations can be helpful in determining eligibility and educational planning, the provisions of IDEA are the controlling authority with regard to decisions for special education. While clinical information is professionally helpful, it is neither legally required nor sufficient for determining educational placement. Therefore, it’s especially important for administrators, parents, advocates, teachers and non-school professionals to keep in mind that when it comes to special education, it is state and federal education codes and regulations (not clinical criteria) that determine eligibility and IEP planning decisions. Legal and special education experts recommend the following guidelines to help school districts meet the requirements for providing legally and educationally appropriate programs and services to students with ASD.
1. School districts should ensure that the IEP process follows the procedural requirements of IDEA. This includes actively involving parents in the IEP process and adhering to the time frame requirements for assessment and developing and implementing the student’s IEP.  Moreover, parents must be notified of their due process rights. It’s important to recognize that parent-professional communication and collaboration are key components for making educational and program decisions.
2. School districts should make certain that comprehensive, individualized evaluations are completed by school professionals who have knowledge, experience, and expertise in ASD. If qualified personnel are not available, school districts should provide the appropriate training or retain the services of a consultant.
3. School districts should develop IEPs based on the child’s unique pattern of strengths and weaknesses. Goals for a child with ASD commonly include the areas of communication, social behavior, adaptive skills, challenging behavior, and academic and functional skills. The IEP must address appropriate instructional and curricular modifications, together with related services such as counseling, occupational therapy, speech/language therapy, physical therapy and transportation needs. Evidence-based instructional strategies should also be adopted to ensure that the IEP is implemented appropriately.
4. School districts should assure that progress monitoring of students with ASD is completed at specified intervals by an interdisciplinary team of professionals who have a knowledge base and experience in autism. This includes collecting evidence-based data to document progress towards achieving IEP goals and to assess program effectiveness.
5. School districts should make every effort to place students in integrated settings to maximize interaction with non-disabled peers. Inclusion with typically developing students is important for a child with ASD as peers provide the best models for language and social skills. However, inclusive education alone is insufficient, evidence-based intervention and training is also necessary to address specific skill deficits. Although the least restrictive environment (LRE) provision of IDEA requires that efforts be made to educate students with special needs in less restrictive settings, IDEA also recognizes that some students may require a more comprehensive program to provide FAPE. 
6. School districts should provide on-going training and education in ASD for both parents and professionals. Professionals who are trained in specific methodology and techniques will be most effective in providing the appropriate services and in modifying curriculum based upon the unique needs of the individual child.
References and further reading:
Individuals with Disabilities Education Improvement Act of 2004. Pub. L. No. 108-446, 108th Congress, 2nd Session. (2004). 
Mandlawitz, M. R. (2002). The impact of the legal system on educational programming for young children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 32, 495-508.
National Research Council (2001). Educating children with autism. Committee on Educational Interventions for Children with Autism. C. Lord & J. P. McGee (Eds). Division of Behavioral and Social Sciences and Education. Washington, DC: National Academy Press.
Twachtman-Cullen, D., & Twachtman-Reilly, J. (2003). How Well Does Your Child's IEP Measure Up? Quality Indicators for Effective Service Delivery. London: Jessica Kingsley Publishers.
Wilkinson, L. A. (2010). Best practice in special needs education. In L. A. Wilkinson, A best practice guide to assessment and intervention for autism and Asperger syndrome in schools (pp. 127-146). London: Jessica Kingsley Publishers. 
Yell, M. L., Katsiyannis, A, Drasgow, E, & Herbst, M. (2003). Developing legally correct and educationally appropriate programs for students with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 18, 182-191.
©Lee A. Wilkinson, PhD

Friday, July 22, 2011

Best Practice Book Review: Social Literacy: A Social Skills Seminar for Young Adults with ASDs, NLDs, and Social Anxiety

Although there has been a significant increase in research and clinical studies related to children and with autism spectrum disorders (ASD), we have only recently begun to appreciate the complex challenges faced by adults who were not identified in childhood and are presently an underserved population. Social Literacy: A Social Skills Seminar for Young Adults with ASDs, NLDs, and Social Anxiety  by Mary Riggs Cohen is a book and CD set that provide an evidence-based social skills curriculum for more capable young adults with social learning needs and life transition issues (e.g., college, work, interpersonal relationships). 

The Social Skills Seminar incorporates the basic principles of cognitive behavioral therapy (CBT) with the overarching goal of developing social and communicative competency through direct teaching, modeling, coaching, role-playing, and practice activities. The book covers the background and structure for conducting a social skills training course over a 12-week period, meeting once each week for 3-hour class sessions. Beginning with an introduction, the author takes the reader through a discussion of the neurobiology of social learning disorders and the theoretical foundations of program design. Subsequent chapters include the selection, training, and use of social coaches, understanding of nonverbal communication, improving conversational skills, interpersonal relationships and dating, and employment issues and interviewing skills. A template is provided for each class and includes objectives, exercises, and applicable handouts. The final chapters describe efficacy studies of social skills training and practical applications. Perhaps the most impressive feature of the seminar is the use of social coaches to enhance generalization to real world situations by engaging participants in experiential opportunities. Each participant is assigned an individual coach who provides feedback and support during the 12-week course. Chapter 3 of the book provides a description of the social coach selection process, a critical step that takes place prior to initiation of the program with participants.
The accompanying CD-ROM contains PowerPoint slides that provide a sequential format to the instructional portion of the class. Photocopiable handouts used in the class lessons are also included. As noted in the text, social coaches are an integral part of the seminar. Slides for preparing social coaches are included on the CD and provide essential training on social learning disorders, outcome measures, curriculum topics, and coaching activities. 
At present, there is a paucity of information about the educational and employment outcomes for more capable adults on the autism spectrum. This includes those in the general population who do not meet the threshold for a diagnosis but whose social problems impact their personal and social lives. However, it is clear that outcome depends to a large degree on the level and appropriateness of support provided to the individual. Social Literacy is the most comprehensive and evidence-based framework currently available for planning and executing a meaningful and effective social skills training program for young adults with social learning challenges. The program is designed to be flexible and can be adapted and modified to accommodate the specific needs of the participants. The publication of Social Literacy also provides an opportunity for researchers to investigate the effectiveness of social skills training in adult populations. I highly recommend this social learning course to professionals in private practice, secondary schools, colleges and universities, and community settings who work with young adults to help them navigate the social environment and achieve a successful transition to this stage of life.
Cohen, Mary Riggs (2011). Social literacy: A social skills seminar for young adults with ASDs, NLDs, and social anxiety. Baltimore, MD: Paul H. Brookes Publishing Co.

©lee A. Wilkinson

Sunday, July 17, 2011

Best Practice Book Review: Does My Child Have Autism?


Does My Child Have Autism? authored by Wendy Stone emphasizes the critical importance of early identification and intervention for young children with autism spectrum disorders (ASD). This comprehensive and accessible book provides much needed assistance to parents in identifying the early warning signs of autism, understanding the diagnostic process, and identifying scientifically validated interventions and treatments. The author also provides practical suggestions, activities, and teaching techniques that can be used to improve social, communication, and play skills at home. Frequently asked questions are included at the end of each chapter to address common issues and questions often asked by parents. An Appendix provides a listing of resources for further information. Although the author suggests that the book was written primarily for parents, clinicians, and educators, experienced autism professionals will find it to be a valuable resource as well. This book will also make a welcome addition to one's professional and lending library. Despite significant changes in the field of autism over the past several years, Does My Child Have Autism? continues to be an important text and one I highly recommend to both parents and professionals.
Stone, W. L. (2006). Does my child have autism: A parent’s guide to early detection and intervention in autism spectrum disorders. San Francisco, CA: Jossey-Bass.
©Lee A. Wilkinson

Wednesday, July 13, 2011

Autism: Disorder or Condition?




Autism is variously viewed as a psychiatric disorder, mental disorder, and mental disability by the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association [APA], 1994) and International Classification of Diseases (World Health Organization, 1993). The requirements for all disorders in the DSM-IV are "evidence" of personal distress, functional impairment, or contribution to personal risk of loss. The boundary between normality (or typicality) and pathology is conceptualized as a “clinically” significant behavioral or psychological syndrome that occurs within an individual and is associated with a disability (or impairment in one or more areas of functioning). The clinician’s task in using the DSM classification system is to determine whether the problems presented by the individual can be reasonably conceptualized as a mental "disorder" within this context.
The pervasive developmental disorders (PDD) have traditionally been viewed as categorical rather than dimensional systems of classification (diagnoses). With a categorical or dichotomous scheme, disorders are either present or absent (e.g., an individual meets or does not meet criteria). For example, the DSM-IV-TR and ICD-10 list specific criteria for each disorder that must be met to receive a diagnostic classification. They both focus on a description of behavior rather than its function. 
Researchers and practitioners now posit that autism falls on a continuum and that there is no clear distinction between “mild autism” and the boundaries of neurotypicality (or normalcy). In fact, we now recognize that autism-related traits are normally distributed throughout the general population and that autism is best conceptualized as a spectrum of severity. As Lorna Wing comments, “All of the features that characterize Asperger syndrome can be found in varying degrees in the normal population.” According to the extant literature, the accepted terminology is to use autism spectrum disorder or the acronym ASD as an umbrella term to describe individuals with Asperger’s Disorder (Syndrome), high-functioning autism (HFA), and PDD-NOS.  

Nevertheless, experts such as Baron-Cohen (2008) contend that the term autism spectrum condition (ASC) is preferable to ASD as this term concurrently recognizes both the disabling aspects of autism and a profile of strengths (e.g., non-social skills). As with any “condition,” an autism spectrum condition may or may not be disabling. This includes groups of more successful individuals in the general population who present with sub-clinical (or sub-threshold) features of ASD. While individuals who have autistic traits certainly think and perceive differently than typical individuals, they may not be significantly impaired. An individual may demonstrate mild qualitative differences in social skills, yet not meet the clinical criteria for an autism-related condition such as high-functioning autism or Asperger’s disorder (syndrome). While a person’s social skills might be below average relative to his or her age group, these differences may not result in what might be considered to be a “global” disability or impairment. Moreover, there are individuals without a diagnosis who have marked difficulties, while others with a diagnosis have only mild problems. Despite the considerable variation in the profiles of individuals with autism, it is when these “differences” in social functioning lead to an impairment in adaptability (e.g., personal, occupational) and the need for clinical services, that we describe the individual as having a disorder. This includes the commonly co-occurring (or comorbid) disorders such as anxiety and depression.
So, we return to the question, Disorder or Condition? It would seem that the term “condition” is more compatible with the dimensional view of autism. It reflects the assumption that autistic traits exist on a continuum and that they are normally distributed throughout the general population (e.g., we all have some autistic traits). Using the term autism spectrum condition (ASC) also communicates a “value-free” or neutral perception as opposed to the negative impression associated with disorder or disability. Lastly, the term condition acknowledges that individuals with ASC may also possess positive traits, thus encouraging a strength-based perspective.

Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers.

©Lee A. Wilkinson

Tuesday, June 28, 2011

Best Practice Research: Autism and Joint Attention

Although there are no “absolute” clinical indicators of autism, some of the early “red flags” include: • Does not smile by the age of six months • Does not respond to his or her name • Does not cry • Does not babble or use gestures by 12 months and • Does not point to objects by 12 months. Children with autism typically experience delays in speech and communication skills. Not only will they often develop spoken language later, but they are less likely to develop non-verbal communication skills such as “joint attention,” pointing, or gesturing. 
Children seek to share attention with others spontaneously during the first year of life. “Joint attention” is an early-developing social-communicative skill in which two people (usually a young child and an adult) use gestures and gaze to share attention with respect to interesting objects or events. Before infants have developed social cognition and language, they communicate and learn new information by following the gaze of others and by using their own eye contact and gestures to show or direct the attention of the people around them. Impairment in joint attention is considered an important “red flag” of autism.
Researchers in Melbourne Australia, working on a long-term study of 1900 eight month old children, found that those with autism used fewer gestures to communicate than other kids. Speech pathologist Carly Veness, who led the research, said there was a pattern of low gesture use among autistic children between the ages of eight months and two years. "We found that there was a decreased use of gestures like pointing, showing and giving,” she commented. Children who were diagnosed with autism by age seven were compared with others who had language and developmental problems as well as those who had typical communication skills. Examining the data over the seven-year period, researchers found that the children with autism produced fewer communicative gestures at age two compared to other children. Some of these children had also demonstrated problems with their hand gestures as early as eight months. Future research is needed to determine how well the low use of gestures is at predicting a diagnosis of autism and whether certain gestures differentiate typical children from those with the disorder.
http://news.theage.com.au/breaking-news-national/gestures-may-play-role-in-autism-diagnosis-20110626-1gl62.html

Friday, June 24, 2011

The Autism Bookshelf


I’m pleased to announce the creation of a new Linkedin group, The AUTISM BOOKSHELF. The objective of this group is to advocate, educate, and inform by providing a selective, comprehensive, and objective review of books and articles dealing with autism spectrum disorders (ASD) that will meet members’ informational needs. This includes a guide to the books we think are most deserving of your attention, links to relevant sites, including book review and publishers' sites from around the world and our own recommended list of ASD “best practice” resources. This group also provides a forum to discuss up-to-date information on scientifically validated assessment and treatment options for children with ASD. Created to be a practical and useful resource, autism bookshelf offers essential information for psychologists, speech/language pathologists, teachers, counselors, advocates, attorneys, special education professionals, and parents. We hope you will join us in sharing publications, resources, and information that present evidence-based strategies and tools for assessing and supporting children with ASD, and for connecting and partnering with families and other autism professionals.
© Lee A. Wilkinson
    

Best Practice Book Review: Pivotal response treatments for autism: Communication, social, and academic development.


This comprehensive text describes intervention strategies and outcome data related to Pivotal Response Treatments (PRT) for autism. The PRT approach focuses on normalizing child development for children with autism via a delivery model that uses both a developmental approach and applied behavior analysis (ABA). It has demonstrated empirical support in the literature. The chapters are well written and cover a range of topics related to interventions in the general education classroom, parent education programs, communication, social development, and strategies for addressing disruptive behavior. Case examples are also included. The chapter on combining functional assessment and self-management procedures to reduce disruptive behavior should appeal to school-based professionals such as school psychologists, special educators, and other support personnel. Overall, the text succeeds in describing an integrated and comprehensive approach to the treatment of autism. Those without experience or background in autism related research and practice might find some portions of the text to be a challenging read.

Koegel, R. L., & Koegel, L. K. (2006). Pivotal response treatments for autism: Communication, social, and academic development. Baltimore, MD: Paul H. Brookes Publishing.




Monday, June 20, 2011

Autism in Schools: Read it on Kindle!

Fully updated to reflect DSM-5 and current assessment tools, procedures and research, this second edition of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools provides a practical and scientifically-based approach to identifying, assessing, and treating children and adolescents with an Autism Spectrum Disorder (ASD) in school settings. Integrating current research evidence with theory and best practice, this book will support school-based professionals in a number of key areas including:
  • Screening and assessing children and youth on the autism spectrum.
  • Identifying evidence-based interventions and practices.
  • Developing and implementing comprehensive educational programs and providing family support.

      Each chapter features a consolidated and integrative description of best practice assessment and intervention/treatment approaches for children and youth with ASD. It brings the topics of assessment and intervention together in a single authoritative resource guide consistent with recent advances in evidence-based practice.  Illustrative case examples, glossary of terms, and helpful checklists and forms make this the definitive resource for identifying and implementing interventions for school-age children and youth with ASD.
      This Guide is intended to meet the needs of school-based professionals such as school psychologists, counselors, speech/language pathologists, occupational therapists, counselors, social workers, administrators, and both general and special education teachers. Parents, advocates, and community-based professionals will also find this guide a valuable and informative resource.
      Editorial Reviews  
      “It is rare that one book can pack so many resources and easy to digest information into a single volume!  Families, school personnel, and professionals all need the extensive, and up-to-date tips, guides, and ‘must-knows’ provided here. It’s obvious the author is both a seasoned researcher and practitioner – a winning combination.” — Dr. Debra Moore, psychologist and co-author with Dr. Temple Grandin, of The Loving Push: How Parents & Professionals Can Help Spectrum Kids Become Successful Adults

      “Dr Wilkinson has done it again. This updated and scholarly Second Edition reflects important recent changes regarding diagnosis and services for students with Autism Spectrum Disorder. With its numerous best-practice suggestions, it is a must-read for school psychologists, school social workers, and those who teach in general and special education.” — Dr Steven Landau, Professor of School Psychology in the Department of Psychology, Illinois State University
      “This book is an essential resource for every educator that works with students with ASD! The easy-to-read format is complete with up to date research on evidence-based practices for this population, sample observation and assessment worksheets and case studies that allow the reader to apply the information presented.” — Gena P. Barnhill, PhD, NCSP, BCBA-D, LBA, Director of Special Education Programs at Lynchburg College, Lynchburg, VA  

      A Best practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Ed.) is available from Jessica Kingsley PublishersAmazon.comBarnes & NobleBooks-A-MillionBook Depository, and other booksellers. The book is available in both print and eBook formats.

      Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book,  A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and editor of the text in the APA School Psychology Book Series,  Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His previous book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT, was recently honored as an “Award-Winning Finalist in the “Health: Psychology/Mental Health” category of the 2016 Best Book Awards.”




      Thursday, June 16, 2011

      Seizure Treatments for Children with Autism

      Although the association between autism and seizure disorder is not as yet firmly established, there appears to be a higher incidence of febrile seizures in children with autism compared to the general population. Although a majority of children will have only one febrile seizure in their lifetime, many children will progress to 'status epilepticus' (epilepsy). In fact, 15-20% of children with epilepsy have a history of a previous febrile seizure. Approximately 25 to 35 percent of people with autism will eventually experience full-scale seizures. Many others will have seizure-like brain activity, in which there is no obvious effect on muscles but potential effects on brain functioning, such as temporary loss of attention.

      Until recently, little has been known about which traditional treatments for epileptic seizures and commonly used non-traditional alternative treatments are most effective for treating seizures or epilepsy specifically in children and adults with autism. A study provides insight into which treatments are most beneficial in such cases. James Adams, a professor at Arizona State University conducted the research, together with Richard E. Frye, a physician specializing in child and behavioral neurology in the Department of Pediatrics at University of Texas-Houston. The complete study is published in the medical journal BMC Pediatrics.

      The researchers surveyed 733 parents whose children with autism experience seizures, epilepsy and/or seizure-like brain activity. They asked parents to rate the effectiveness of 25 traditional and 20 non-traditional medical treatments for seizures. The survey also assessed the effects and side-effects of those treatments. Overall, antiepileptic drugs were reported by parents to reduce the occurrence and severity of seizures but worsened problems with sleep, communication, behavior, attention and mood. Non-antiepileptic drugs were perceived to improve other symptoms but did not reduce occurrence of seizures or make them less severe to the same extent as the anti-epileptic drugs. Four anti-epileptic drugs: valproic acid, lamotrigine, levetiracetam and ethosuximide were reported to most often reduce the number or lessen the severity of seizures, with little positive or negative effect on other symptoms of autism. Certain traditional non-anti-epileptic drug treatments, particularly the ketogenic diet, were perceived to both lessen the number and reduce the severity of seizures and other symptoms. The results of this study should provide physicians with a guide for more effectively managing the treatment of children experiencing seizures related to autism. 


      Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also editor of a new Volume in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools.

      © Lee A. Wilkinson, PhD






      Follow by Email

      Top 10 Most Popular Best Practice Posts

      Search BestPracticeAutism.com

      Blog Archive

      Best Practice Books

      Total Pageviews