Saturday, June 29, 2013

Dog Makes a Difference for Boy with Autism

Months after being abandoned and left for dead, a dog is now making a difference in the life of a young boy with autism.
 Last year, animal rescuers found a maltreated puppy on the side of a road in Georgia. They nursed her back to health and named her “Xena” the Warrior Puppy. Xena’s recovery won fans and her story helped raise thousands of dollars for the care of abused animals.
However, it’s Xena’s relationship with her new owner that’s creating the largest impact. Now healthy, Xena was adopted by Jonny Hickey, who has autism, and his family. Once shy and withdrawn, Jonny’s family says Xena has made a major difference in his life, inspiring him to make a video to promote April’s status as both Autism Awareness Month and Prevention of Cruelty to Animals Month.
“My name is Jonny,” starts the video that aired on WXIA-TV, the Atlanta NBC affiliate, “and this is my puppy, Xena. Well, my Xena was hurt really bad. By some not-so-nice people. And I have autism. So I think we make a pretty perfect team to spread the word to be nice to animals, and nice to kids like me.”

Courtesy of

Lee A. Wilkinson, PhD is the 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 recent volume in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools and author of the new book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT.

Sunday, June 16, 2013

Best Practice Autism Expert Interview

I recently had the privilege of connecting on Linkedin with Dr. Lee Wilkinson, a seasoned expert on the topic of autism spectrum disorders (ASD). Dr. Wilkinson holds credentials as a nationally certified school psychologist, registered psychologist, chartered scientist, and certified cognitive-behavioral therapist. His numerous publications revolve around the topics of behavioral consultation, therapy, and individuals with autism spectrum disorders. After learning about his award-winning text, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, I hoped that he might agree to share his insight and expertise with Preschoology readers. And he graciously did! The information he shares here will be particularly helpful to parents with concerns that their young child displays signs of autism.
Q: If a parent has concerns that their child displays signs of autism, what first steps would you recommend towards finding help?
A: My best practice recommendation is that a child who shows signs (red flags) of autism spectrum disorder (ASD) be immediately referred to a health care provider (pediatrician, family practitioner) for screening. If parents are worried about their child’s development, they should actively voice these concerns to the child’s pediatrician and not feel as if they are an alarmist. It is especially important that a standardized screening tool be administered at any point when parents express concerns or have questions about their child’s social, communicative, and play behaviors. In fact, the American Academy of Pediatrics (AAP) recommends that all children be screened with a standardized broadband screening tool at the 9-, 18-, 24- and 30-month visits, and an ASD-specific screening tool at the 18- and 24-month visits. When a screening indicates a possible delay, the child should be referred to an Early Intervention (EI) program (statewide interagency system providing comprehensive services to infants and toddlers with disabilities) and directly for a comprehensive assessment by an “experienced” multidisciplinary team that includes, but not limited to a developmental pediatrician, pediatric neurologist, speech/language pathologist, child/clinical psychologist, special educator, audiologist, and occupational therapist. Depending on where a parent lives, there might be a university-based autism clinic or research facility that provides diagnostic evaluations and intervention services. For children age three and older, evaluations and special services can be provided through local school districts. Finally, it is especially important that parents seek services from professionals with training and experience in assessing and treating young children with ASD.
Q: How would you advise a parent who has concerns that their very young child displays signs of autism, but who is instructed by specialists to hold off on evaluations and wait until the child is older?
A: The signs and symptoms of autism do not generally appear suddenly, but rather develop gradually during the first three years of life. The earlier the child is identified and intensive intervention can begin, the better the outcomes tend to be for children with ASD. It is important to note that there are no “absolute” clinical indicators of autism in very young children and that there is wide variability in the course and timing of typical development and personalities of infants and children. Although there is some research evidence that the cardinal features of autism can be identified very early in life, the most reliable diagnosis is generally made by trained professionals when a child reaches approximately 2 years of age. Because very young children are difficult to evaluate and diagnostic tests and procedures tend to be less reliable than those with older children, many specialists are hesitant to refer or evaluate a child before age 3 or 4. Although ASD is a complex disorder and often difficult to diagnose in young children, it is my opinion that it is best to err on the side of caution which means screening and providing services for young children who show atypical development which may be characteristics of ASD. I recommend that parents remain clear, positive, and persistent when discussing their concerns with their health care provider or specialist. This includes being proactive and indicating that they want to move forward now (and not wait) with a screening or evaluation. Even if a health care professional or specialist continues to be reluctant, parents can contact their local early intervention (EI) program themselves. The Autism Society of America has local chapters which may also be of help in locating clinicians and services. Finally, I always recommend that parents 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.
Q: I’ve observed that young children might receive multiple labels before specialists determine a diagnosis of autism. For parents, this can be an emotional roller coaster and very frustrating. How do you explain this phenomenon and help ease parents through the process?
A: It is not unusual for many children to receive multiples labels before being diagnosed with ASD. The delays or atypicality in social development, communication, neurocognition, and behavior will vary in severity of symptoms, age of onset, and association with other childhood disorders. The challenge for practitioners is to determine if the symptoms observed in ASD are part of the same dimension (e.g., the autism spectrum) or whether they represent another developmental disorder. Consequently, it can be difficult to “rule out” other developmental disorders whose symptoms are often observed in ASD. Moreover, differences in professional opinions are particularly evident for young children with atypical developmental concerns. A child might present with a delay in language development and be later diagnosed with a receptive or expressive language disorder but not demonstrate the social impairment characteristic of ASD. A global developmental delay might also be diagnosed. Many children identified with ASD receive an initial diagnosis of attention-deficit hyperactivity disorder (ADHD) or a sensory processing disorder. If a child does not receive a diagnosis of ASD, I recommend that parents ask for an explanation as to why their child does not currently meet the diagnostic criteria. Because ASD is a behaviorally-based diagnosis, I suggest that parents continue to observe and carefully monitor their child’s social and communication development. If a parent continues to have concerns about ASD, they should seek a second opinion or ask for a reevaluation in 6 months or a year.
For more information regarding Dr. Wilkinson’s featured text, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in School, visit: 
Dr. Wilkinson also hosts the website
This wonderful resource features up-to-date information on scientifically validated treatment options for children with ASD and a list of best practice books, articles, and links to relevant organizations.
Interview courtesy of

Wednesday, June 12, 2013

College Students on the Autism Spectrum

The term Autism Spectrum Disorder (ASD) refers to a single diagnostic category that includes two core-defining features: impairments in (a) social communication and (b) restricted and repetitive behaviors or interests (American Psychiatric Association [APA], 2013). There is, however, marked variability in the severity of symptomatology and need for support across individuals with ASD.  Symptom expression falls on a continuum and will vary from the significant impairment to more capable individuals with higher cognitive and linguistic abilities.  For example, the level of intellectual functioning can range from persons with cognitive impairment to those who score in the superior range on traditional IQ tests, from those who are socially intrusive to those who are social isolates, and from those with limited communication skills to those with precocious and advanced vocabulary.
Despite having impaired social interaction skills and unusual, idiosyncratic and sometimes intense interests and a high degree of rigidity, many secondary school students diagnosed with ASD possess the cognitive ability and verbal skills necessary for higher education. Unfortunately, many capable adolescents and young adults either do not seek or gain entry into college, or drop out prematurely due to social isolation, difficulty with changing routines and new schedules, problems living independently, and lack of external supports and guidance. Although young adults on the autistic spectrum may qualify academically for college, they often have difficult managing other aspects of college life. Indeed, the rates of post-secondary educational participation for youth with an ASD are substantially lower than the general population, with previous studies indicating 40% or fewer ever attend college and very few receive a degree (Shattuck, et al., 2012)
The dramatic increase in the prevalence of ASD among children indicates that a correspondingly large number of youth will be transitioning into adulthood in the coming years. In fact, approximately 50,000 adolescents with autism will turn 18 years old this year in the U.S. As a result, colleges and universities can expect to enroll more students who have been diagnosed with ASD in the near future. As more young people are identified with ASD without co-occurring intellectual disability, it is imperative that we begin to study the needs of young adults as they transition into postsecondary employment and education.
A study published in the journal, Autism, examined the prevalence of higher functioning students with ASD at a single university both diagnostically and dimensionally, and surveyed students on the characteristics, problems, and risks associated with ASD. Researchers found that between .7% and 1.9% of a large sample of students (n = 667) could meet criteria for ASD depending on whether ASD is viewed categorically or continuously, and that the true prevalence likely falls somewhere between these two estimates. This suggests that symptoms of ASD are fairly common among college students in this sample and that upwards of 1 in 100 students may meet criteria for an ASD diagnosis. An important finding was that none of the students who met the formal criteria for receiving a diagnosis of ASD had been diagnosed previously. Thus, it is possible that some college students who would meet ASD diagnostic criteria begin their college careers unidentified. This is concerning given the degree to which ASD symptoms were found to correlate with other mental health problems, most notably social anxiety and dissatisfaction with college and life overall. For example, symptoms of ASD were fairly common among students surveyed. From a dimensional perspective, those students scoring above the clinical threshold for symptoms of autism self-reported more problems with social anxiety than a matched comparison group of students with lower autism severity scores. In addition, symptoms of ASD were significantly correlated with symptoms of social anxiety, as well as depression and aggression.
These results have implications for clinical and educational practice, and illustrate the importance of screening for autism-related impairment among university students. In the coming years, colleges and universities may expect to enroll more students who have been diagnosed with ASD, students who meet criteria for the disorder but who not been identified, and students who would fall into the category of the broad autism phenotype. University administrators, educators, and the personnel who serve students with disabilities must be attentive of this group of individuals and identify approaches to make college a successful and rewarding experience. Unfortunately, we know little about how best to facilitate success and ease transitions for these students. The evidence base informing strategies for helping this population is poorly developed. Their needs are diverse and include problems with time management and scheduling, self-advocacy, isolation, interpersonal difficulties, and study skills development. The presence of psychiatric comorbidities (e.g., depression) and academic/ life dissatisfaction must also be included among the list of potential concerns. Although the number of 2-year and 4-year college providing opportunities for young adults with autism has been growing in recent years, there is a need for wider adoption of programs and resources to support young adults with ASD as they transition into and from college. The focus of intervention/treatment must shift from remediating the core deficits in childhood to promoting adaptive behaviors that can facilitate and enhance ultimate functional independence and quality of life in adulthood. This includes new developmental challenges such as independent living, vocational engagement, postsecondary education, and family support. 
Shattuck, P. T., Narendorf, S. C., Cooper, B., Sterzing, P. R., Wagner, M., & Taylor, J. L (2012) Postsecondary education and employment among youth with an autism spectrum disorder. Pediatrics, 129(6), 1042-1049. doi:10.1542/peds.2011-2864
U.S. Centers for Disease Control and Prevention. (2012). Prevalence of autism spectrum disorders. Autism and developmental disabilities monitoring network, 14 sites, United States, 2008. Morbidity and Mortality Weekly Report Surveillance Summaries, 61(3), 1-19. Atlanta, GA: Author.
White, S. W., Ollendick, T. H., & Bray, B. C. (2011). College students on the autism spectrum : Prevalence and associated problems. Autism, 15(6), 683–701 doi: 10.1177/1362361310393363
The online version of this article can be found at 
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 best-selling text in the American Psychological Association (APA) School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools and author of the book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. Dr. Wilkinson's most recent book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools, (2nd Edition).

Wednesday, June 5, 2013

Best Practice Review: The Social Communication Questionnaire (SCQ)

The Social Communication Questionnaire (SCQ; Rutter, Bailey, & Lord, 2003), previously known as the Autism Screening Questionnaire (ASQ), was initially designed as a companion screening measure for the Autism Diagnostic Interview-Revised (ADI-R; Rutter, Le Couteur & Lord). The SCQ is a parent/caregiver dimensional measure of ASD symptomatology appropriate for children of any chronological age older than fours years. It can be completed by the informant in less than 10 minutes. The primary standardization data were obtained from a sample of 200 individuals who had participated in previous studies of ASD. 

The SCQ is available in two forms, Lifetime and Current, each with 40 questions presented in a yes or no format. Scores on the questionnaire provide an index of symptom severity and indicate the likelihood that a child has an ASD. Questions include items in the reciprocal social interaction domain (e.g., “Does she/he have any particular friends or best friend?”), the communication domain (e.g., “Can you have a to and fro ‘conversation’ with him/her that involves taking turns or building on what you have said?”) and the restricted, repetitive, and stereotyped patterns of behavior domain (e.g., Has she/he ever seemed to be more interested in parts of a toy or an object [e.g., spinning the wheels of a car], rather than using the object as intended?”).
Compared to other screening measures, the SCQ has received significant scrutiny and has consistently demonstrated its effectiveness in predicting ASD versus non-ASD status in multiple studies. The scale has been found to have good discriminant validity and utility as an efficient screener for at-risk groups of school-age children. A threshold raw score of >15 is recommended to minimize the risk of false negatives and indicate the need for a comprehensive evaluation. Comparing autism to other diagnoses (excluding mental retardation), this threshold score resulted in a sensitivity value of .96 and a specificity value of .80 in a large population of children with autism and other developmental disorders. The positive predictive value was .93 with this cutoff. The authors recommend using different cut-off scores for different purposes and populations (e.g., a cut-off of 22 when differentiating autism from other ASDs and a cut-off of 15 when differentiating ASD from non-ASD). Several studies (Allen et al., 2007; Eaves et al, 2006) have suggested that a cut-off of 11 may be more clinically useful (Norris & Lecavalier, 2010).
The SCQ is one of the most researched of the ASD-specific evaluation tools and can be recommended for screening and as part of comprehensive developmental assessment for ASD (Norris & Lecavalier, 2010; Wilkinson, 2010, 2011). The SCQ is an efficient screening instrument for identifying children with possible ASD for a more in-depth assessment. For clinical purposes, practitioners might consider a multistage assessment beginning with the SCQ, followed by a comprehensive developmental evaluation (Wilkinson, 2011, 2016). However, cut-off scores may need to be adjusted depending on the population in which it is used. The evidence also indicates that although the SCQ is appropriate for a wide age range, it is less effective when used with younger populations (e.g., children two to three years). It was designed for individuals above the age of four years, and seems to perform best with individuals over seven years of age.

Chandler, S., Charman, T., Baird, G., Simonoff, E., Loucas, T., Meldrum, D., & Pickles, A. (2007). Validation of the Social Communication Questionnaire in a population cohort of children with autism spectrum disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1324–1332.
Mash, E. J., & Hunsley, J. (2005). Evidence-based assessment of child and adolescent disorders: Issues and challenges. Journal of Clinical Child and Adolescent Psychology, 34, 362-379.
Norris, M., & Lecavalier, L. (2010). Screening accuracy of level 2 autism spectrum disorder rating scales: A review of selected instruments. Autism, 14, 263–284.
Rutter, M., Bailey, A., & Lord, C. (2003). Social Communication Questionnaire. Los Angeles: Western Psychological Services.
Wilkinson, L. A. (2010).  A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London and Philadelphia: Jessica Kingsley Publishers.
Wilkinson, L. A. (2011). Identifying students with autism spectrum disorders: A review of selected screening tools. Communiqué, 40, pp. 1, 31-33.

Wilkinson, L. A. (2016).  A best practice guide to assessment and intervention for autism spectrum disorder in schools (2nd Edition). London and Philadelphia: Jessica Kingsley Publishers.

Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, registered psychologist, and certified cognitive-behavioral therapist. He 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 best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools, and author of the book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. Dr. Wilkinson's latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

© Lee A. Wilkinson, PhD

Follow by Email

Top 10 Most Popular Best Practice Posts


Blog Archive

Best Practice Books

Total Pageviews