Wednesday, December 21, 2016

A Multi-Tiered Approach to Screening for Autism in Schools

 
There has been a dramatic worldwide increase in reported cases of autism over the past decade. Yet, compared to population estimates, identification rates have not kept pace in our schools. It is not unusual for children with less severe symptoms of ASD to go unidentified until well after entering school. As a result, it is critical that school-based educational support personnel (e.g., school psychologists, speech/language pathologists, special educators, counselors, and social workers) give greater priority to case finding and screening to ensure that children with ASD are identified and have access to the appropriate intervention services. 
   
Screening and Identification

Until recently, there were few validated screening measures available to assist school professionals in the identification of students with the core ASD-related behaviors. However, our knowledge base is expanding rapidly and we now have reliable and valid tools to screen and evaluate children more efficiently and with greater accuracy. The following tools have demonstrated utility in screening for ASD in educational settings and can be used to determine which children are likely to require further assessment and/or who might benefit from additional support. All measures have sound psychometric properties (e.g., discriminative validity), are appropriate for school-age children, and time efficient (10 to 20 minutes to complete). Training needs are minimal and require little or no professional instruction to complete. However, interpretation of results requires familiarity with ASD and experience in administering, scoring, and interpreting psychological tests.
The Autism Spectrum Rating Scales (ASRS; Goldstein & Naglieri, 2009) is a norm-referenced tool designed to effectively identify symptoms, behaviors, and associated features of ASD in children and adolescents from 2 to 18 years of age. The ASRS can be completed by teachers and/or parents and has both long and short forms. The Short form was developed for screening purposes and contains 15 items from the full-length form that have been shown to differentiate children diagnosed with ASD from children in the general population. High scores indicate that many behaviors associated with ASD have been observed and follow-up recommended.
The Social Communication Questionnaire (SCQ; Rutter, Bailey, & Lord, 2003), previously known as the Autism Screening Questionnaire (ASQ), is a parent/caregiver dimensional measure of ASD symptomatology appropriate for children of any chronological age older than four years. It is available in two forms, Lifetime and Current, each with 40 questions. Scores on the questionnaire provide a reasonable index of symptom severity in the reciprocal social interaction, communication, and restricted/repetitive behavior domains and indicate the likelihood that a child has an ASD.
The Social Responsiveness Scale, Second Edition (SRS-2; Constantino & Gruber, 2012) is a brief quantitative measure of autistic behaviors in 4 to 18 year old children and youth. This 65-item rating scale was designed to be completed by an adult (teacher and/or parent) who is familiar with the child’s current behavior and developmental history. The SRS items measure the ASD symptoms in the domains of social awareness, social information processing, reciprocal social communication, social anxiety/avoidance, and stereotypic behavior/restricted interests. The scale provides a Total Score that reflects the level of severity across the entire autism spectrum.
A Multi-Tier Screening Strategy
The ASRS, SCQ, and SRS-2 can be used confidently as efficient first-level screening tools for identifying the presence of the more broadly defined and subtle symptoms of higher-functioning ASD in school settings. School-based professionals should consider the following multi-step strategy for identifying at-risk students who are in need of an in-depth assessment.
Tier  one. The initial step is case finding. This involves the ability to recognize the risk factors and/or warning signs of ASD. All school professionals should be engaged in case finding and be alert to those students who display atypical social and/or communication behaviors that might be associated with ASD. Parent and/or teacher reports of social impairment combined with communication and behavioral concerns constitute a “red flag” and indicate the need for screening. Students who are identified with risk factors during the case finding phase should be referred for formal screening.
Tier two. Scores on the ASRS, SCQ, and SRS-2 may be used as an indication of the approximate severity of ASD symptomatology for students who present with elevated developmental risk factors and/or warning signs of ASD. Screening results are shared with parents and school-based teams with a focus on intervention planning and ongoing observation. Scores can also be used for progress monitoring and to measure change over time. Students with a positive screen who continue to show minimal progress at this level are then considered for a more comprehensive assessment and intensive interventions as part of Tier 3.  However, as with all screening tools, there will be some false negatives (children with ASD who are not identified). Thus, children who screen negative, but who have a high level of risk and/or where parent and/or teacher concerns indicate developmental variations and behaviors consistent with an autism-related disorder should continue to be monitored, regardless of screening results.
Tier three. Students who meet the threshold criteria in step two may then referred for an in-depth assessment. Because the ASRS, SCQ, and SRS-2 are strongly related to well-established and researched gold standard measures and report high levels of sensitivity (ability to correctly identify cases in a population), the results from these screening measures can be used in combination with a comprehensive developmental assessment of social behavior, language and communication, adaptive behavior, motor skills, sensory issues, and cognitive functioning to aid in determining eligibility for special education services and as a guide to intervention planning.
Concluding Comments
Compared with general population estimates, children with mild autistic traits appear to be an underidentified and underserved population in our schools. There are likely a substantial number of children with equivalent profiles to those with a clinical diagnosis of ASD who are not receiving services. Research indicates that outcomes for children on the autism spectrum can be significantly enhanced with the delivery of intensive intervention services. However, intervention services can only be implemented if students are identified. Screening is the initial step in this process. School professionals should be prepared to recognize the presence of risk factors and/or early warning signs of ASD, engage in case finding, and be familiar with screening tools in order to ensure children with ASD are being identified and provided with the appropriate programs and services. 

Best practice screening and assessment guidelines are available from: A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition). 

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. Dr. Wilkinson 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. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Wednesday, December 7, 2016

Assessment Tools for ASD: Sensitivity Matters


Professionals should have an understanding of the basic psychometrics properties that underlie test use and development when assessing children and youth for autism spectrum disorder (ASD). For example, diagnostic validity is an especially important psychometric characteristic to consider when evaluating the quality and usefulness of a screening instrument or more comprehensive measure. It refers to a test’s accuracy in predicting group membership (e.g., ASD versus non-ASD) and 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 screens 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 screens negative. A highly specific test means that there are few false positive results (e.g., individuals without a disorder who screen positive). False negatives decrease sensitivity, whereas false positives decrease specificity. An efficient screening 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 screened negative that are truly without the disorder. The higher the PPV and NPV values, the more efficient the instrument at correctly identifying cases. It is important to recognize that PPV is influenced by the sensitivity and specificity of the test as well as the prevalence of the disorder in the sample under study. 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.
© Lee A. Wilkinson, PhD
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 books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTboth published by Jessica Kingsley PublishersHe 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. Dr. Wilkinson's latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Friday, December 2, 2016

Holiday Tips for Parents of Kids on the Autism Spectrum


The holiday season can be a stressful time of year for everyone, especially for parents of children on the autism spectrum. The sights and sounds of the holidays can be stressful and over-stimulating. There are many changes in routine, family events, parties, and vacations that need to be planned. Sometimes the stress of these changes can become overwhelming and the joy and happiness of the holidays might be lost. Here are some helpful tips to lessen your child’s anxiety and increase your family’s enjoyment of the holiday season: 

 Decorating and Shopping  
  • If your child has difficulty with change, you may want to gradually decorate the house. Decorate in stages, rather than all at once. It may also be helpful to develop a visual  schedule or calendar that shows what will be done on each day.
  • Allow your child to interact with the decorations and help put them in place.
  • Flashing lights or musical decorations can disturb some children. To see how your child will respond, provide an opportunity experience these items in a store or at elsewhere first. 
  • Last minute holiday shopping can be stressful for children who rely on routines. If you do take your child shopping, allow enough time to gradually adapt to the intense holiday stimuli that stores exhibit this time of year.
 Family Routines and Travel
  • Meet as a family to discuss how to minimize disruptions to established routines and how to  support positive behavior when disruptions are inevitable. 
  • Continue using behavior support strategies during the holidays. For example, use social stories to help your child cope with changes in routine and visual supports to help prepare for more complicated days.
  •  Use a visual schedule if you are celebrating the holidays on more than one day to show when there will be parties/gifts and when there will not. 
  • Use rehearsal and role play to give children practice ahead of time in dealing with new social situations, or work together to prepare a social story that incorporates all the elements of an upcoming event or visit to better prepare them for that situation 
  • If you are traveling for the holidays, make sure you have child’s favorite foods, books or toys available. Having familiar items readily available can help to calm stressful situations. 
  • If you are going to visit family or friends, make sure there is a quiet, calm place to go to if needed. Teach your child to leave a situation and/or how to access support when a situation becomes overwhelming. For example, if you are having visitors, have a space set aside for the child as his/her safe/calm space. He or she should be taught ahead of time that they should go to their space when feeling overwhelmed. This self- management strategy will also be helpful in future situations.
 Gifts and Play Time
  • If you put gifts under the Christmas tree, prepare well ahead of time by teaching that gifts are not to be opened without the family there. Give your child a wrapped and a reward for keeping it intact. 
  • Practice unwrapping gifts, taking turns and waiting for others, and giving gifts. Role play scenarios with your child in preparation for him/her getting a gift they may not want 
  • Take toys and other gifts out of the box before wrapping them. It can be more fun and less frustrating if your child can open the gift and play with it immediately. 
  • When opening gifts as a family, try passing around an ornament to signal whose turn it is to open the next gift. This helps alleviate disorganization and the frustration of waiting. 
  • Prepare siblings and young relatives to share their new gifts with others. 
  • If necessary, consider giving your child a quiet space to play with his/her own gifts, away from the temptation of grabbing at other children’s toys 
  • Prepare family members for strategies to use to minimize anxiety or behavioral incidents, and to enhance participation. Provide suggestions ahead of time that will make for a less stressful holiday season. 
  • Keep an eye out for signs of anxiety or distress, including an increase in behavior such as humming or rocking - this may indicate it's time to take a break from the activity.
  •  Understand how much noise and other sensory input your child can manage. Know their level of anxiety and the amount of preparation it may require. 
  • Try to relax and have a good time. Do everything possible to help reduce the stress level for your child and family during the holidays. If you are tense your child may sense that something is wrong. Don’t forget to prepare yourself! A calm and collected parent is better able to help their family enjoy this wonderful time of year.

Lee A. Wilkinson, PhD, has published widely on the topic of autism spectrum disorders both in the US and internationally. Dr. Wilkinson 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 latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Monday, November 21, 2016

Best Practice Guidelines for Assessment of Autism Spectrum Disorder (ASD) in Schools


The number of children identified with autism has more than doubled over the last decade. School-based professionals are now being asked to participate in the screening, assessment, and educational planning for children and youth on the spectrum more than at any other time in the recent past. Moreover, the call for greater use of evidence-based practice has increased demands that school personnel be prepared to recognize the presence of risk factors, engage in case finding, and be knowledgeable about “best practice” guidelines in assessment and intervention for autism spectrum disorder (ASD) to ensure that students are being identified and provided with the appropriate programs and services.


Best practice guidelines are developed using the best available research evidence in order to provide professionals with evidence-informed recommendations that support practice and guide practitioner decisions regarding assessment and intervention. Best practice requires the integration of professional expertise, each student’s unique strengths and needs, family values and preferences, and the best research evidence (rigorous peer-review) into the delivery of services. Professionals and families collaborate and work together as partners to prioritize domains of functioning for assessment and intervention planning. Best practices for school-based practitioners are best practices for students and their families.               
                                           Comprehensive Developmental Assessment

The primary goals of conducting an autism spectrum assessment are to determine the presence and severity of an autism spectrum disorder (ASD), develop interventions for intervention/treatment planning, and collect data that will help with progress monitoring. Professionals must also determine whether an ASD has been overlooked or misclassified, describe coexisting (comorbid) disorders, or identify an alternative classification. There are several important considerations that should inform the assessment process. First, a developmental perspective is critically important. While the core symptoms of are present during early childhood, ASD is a lifelong disability that affects the individual’s adaptive functioning from childhood through adulthood. Utilizing a developmental assessment framework provides a yardstick for understanding the severity and quality of delays or atypicality. Because ASD affects multiple developmental domains, the use of an interdisciplinary team constitutes best practice for assessment and diagnosis of ASD. A team approach is essential for establishing a developmental and psychosocial profile of the child in order to guide intervention planning. The following principles should guide the assessment process.
  • Children who screen positive for ASD should be referred for a comprehensive assessment.  Although screening tools have utility in broadly identifying children who are at-risk for an autism spectrum condition, they are not recommended as stand alone diagnostic instruments or as a substitute for a more inclusive assessment.
  • Assessment should involve careful attention to the signs and symptoms consistent with ASD as well as other coexisting childhood disorders.
  • When a student is suspected of having an ASD, a review of his or her developmental history in areas such as speech, communication, social and play skills is an important first step in the assessment process.
  • A family medical history and review of psychosocial factors that may play a role in the child’s development is a significant component of the assessment process. 
  • The integration of information from multiple sources will strengthen the reliability of the assessment results.
  • Evaluation of academic achievement should be included in assessment and intervention planning to address learning and behavioral concerns in the child’s overall school functioning.
  • Assessment procedures should be designed to assist in the development of  instructional objectives and intervention strategies based on the student’s unique pattern of strengths and weaknesses.
  • Because impairment in communication and social reciprocity are core features of ASD, a comprehensive developmental assessment should include both domains
  • Restricted, repetitive patterns of behavior, interests, or activities (RRB) are a defining feature of ASD and should be a focus of assessment.
A comprehensive developmental assessment approach requires the use of multiple measures including, but not limited to, verbal reports, direct observation, direct interaction and evaluation, and third-party reports. Assessment is a continuous process, rather than a series of separate actions, and procedures may overlap and take place in tandem. While specific activities of the assessment process will vary and depend on the child’s age, history, referral questions, and any previous evaluations and assessments, the following components should be included in a best practice assessment and evaluation of ASD in school-age children.
  •  Record review
  •  Developmental and medical history
  •  Medical screening and/or evaluation
  • Parent/caregiver interview
  • Parent/teacher ratings of social competence/interaction
  • Direct child observation
  • Cognitive assessment
  • Academic assessment
  • Adaptive behavior assessment
  • Social communication and language assessment
  • Assessment of RRB (including sensory issues)
Children with ASD often demonstrate additional problems beyond those associated with the core domains. Therefore, other areas should be included in the assessment battery depending on the referral question, history, and core evaluation results. These may include:
  • Sensory processing
  • Executive function, memory, and attention
  •  Motor skills
  • Family system 
  • Co-occurring (comorbid) behavioral/emotional problems   
The above referenced principles and procedures for the assessment of school-age children with ASD are reflected in recommendations of the American Academy of Neurology, the American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, and a consensus panel with representation from multiple professional societies. A detailed description of the comprehensive developmental assessment model and specific assessment tools recommended for each domain can be found in A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).
© Lee A. Wilkinson, PhD
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 books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT, both published by Jessica Kingsley PublishersHe 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. Dr. Wilkinson's latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Positive Behavior Support (PBS) for Learners on the Autism Spectrum




The problem behaviors of children on the autism spectrum (ASD) are among the most challenging and stressful issues faced by schools and parents. The current best practice in treating and preventing undesirable or challenging behaviors utilizes the principles and practices of positive behavior support (PBS). PBS is not a specific intervention per se, but rather a set of research-based strategies that are intended to decrease problem behaviors by designing effective environments and teaching students appropriate social and communication skills. PBS utilizes primary (school-wide), secondary (targeted group), and tertiary (individual) levels or tiers of intervention, with each tier providing an increasing level of intensity and support. 
Other than families, teachers are the most influential resource for students with and without special needs. Although functional behavior assessment (FBA) and intensive individual support is recommended for students with serious and persistent challenging behaviors, teachers may prevent the possibility of problematic behavior through the implementation of class-wide and targeted group PBS strategies. For example, effective prevention of challenging social behavior can be addressed through arranging the classroom environment and/or by adapting instruction and the curriculum. Changing the classroom environment or instruction may lessen the triggers or events that set off the challenging behavior. Teaching effective social interaction and communication as replacements for challenging behavior is also a preventive strategy for improving little used student social interaction and communication skills. Teachers can model, demonstrate, coach, or role-play the appropriate interaction skills. They can teach students to ask for help during difficult activities or negotiate alternative times to finish work. Encouraging positive social interactions such as conversational skills will help students with challenging behavior to effectively obtain positive peer attention. The following are examples of PBS strategies for improving social skills and prosocial behaviors in the classroom (Vaughn, Duchnowski, Sheffield, & Kutash, 2005; Wilkinson, 2016). 
Initiating interactions. Teachers might notice that when a student with ASD enters the classroom, group activity, or other social interaction, he or she may have particular difficulty greeting others students or starting a conversation. For example, they may joke, call another student a name, laugh, or say something inappropriate. In this situation, the student may have trouble ini­tiating interactions or conversations. The teacher might talk to the student individually and offer suggestions for ways he or she can provide an appropriate greeting or introduce a topic of conversation. The student might then be asked to practice or role-play the desired behavior.
Example: “why don’t you ask students what they did last night, tell them about a TV show you watched, or ask if they finished their homework, rather than shouting or saying ‘Hey, Stupid.’ Other students in the class want to be your friend, but you make it difficult for them to talk with you. Let’s practice the next time the class begins a new group activity.”
Maintaining interactions. Many students with ASD struggle to maintain a conversation (e.g.., turn taking). Some may dominate the conversation and make others feel that they have nothing to contribute, while other students may experience difficulty keeping up with the flow of conversation and asking questions. Students may also have lim­ited topics of interest and discuss these topics repetitively.
Example: “I’ve noticed that other students cannot share their thoughts and ideas with you when you start a conversation because you do all the talking. It may seem to them that you don’t care what they have to say. Other students will be more willing to talk if you stop once you’ve stated your idea or opinion and allow them a turn to talk. When you stop, they know you are listening. You can say to them, “What do you think?” or “Has this ever happened to you?’”
Terminating interactions. Some students with ASD may not know how to appropriately end a conversation. They may abruptly walk away, start talking with another student, or bluntly tell a student they don’t know what they’re talking about. Other students may interpret this as rude and impolite behavior. Teachers might point out to the student some ac­ceptable ways of ending a conversation.
Example: “You just walked away from that student when they were talking. Rather than walk away, you might say “‘I have to go now,’ ‘It’s time for my next class,’ ‘Or ‘I’ll see you later and we can finish our talk.’”
Recognizing body language. The recognition of body language or nonverbal cues is critical to suc­cessful social interactions. Students with ASD typically have difficulty interpreting these cues from teachers or other students. Body language tells students when they violate a person’s personal space, a person needs to leave, or they need to change behavior. Teachers can incorporate these skills into their class time or school day.
Example: Before leaving the classroom, demonstrate  nonverbal cues by holding a finger to your lips and telling students that means “quiet,” a hand held up with palm fac­ing outward means “wait” or “stop,” and both hands pushing downward means “slow down.” You may need to demonstrate facial expressions you use to “deliver messages” and what they mean. Other students can demonstrate nonverbal cues they use. When students move through the halls, you may want to teach them the “arms length” rule for personal space.
Transitions. Many students with ASD have significant problems changing from one activity to the next or moving from one location to another. They may be easily upset by abrupt changes in routine and unable to estimate how much time is left to finish an activity and begin the next one. Poor executive function skills such as disorganization may also prevent them from putting materials away from the last activity or getting ready for the next activity. They may also need closure and preparation time for the transition. Problems arise if the teacher tries to push them to transition at the last minute.
Example: About 10 minutes prior to the transition, refer to the classroom schedule and announce when the bell will ring or when the next activity will begin. Provide a 5-minute and then a 1-minute warning. This countdown helps students finish assignments or end favorite activities. For students that have difficulty getting started after a transition, place assign­ment folders on their desks so that they have their assignments and don’t have to wait for instructions or materials. They can use the same folder to submit assignments (the folders can be left on their desks at the end of the period).
Conclusion 
Students on the autism spectrum often lack the social skills to communicate and interact effectively with peers and adults. They may use challenging or disruptive behavior to communicate their needs. These examples illustrate how PBS provides a proactive framework for assessing social interaction and communication needs and for teaching new, effective skills that replace the challenging behavior. When used consistently, these strategies fit within the framework of the classroom and can help promote positive student behavior.

 Resources for Further Information  
Alberto, P., & Troutman, A. (2006). Applied behavior analysis for teachers (7th edition). New York, NY: Prentice-Hall.
Crone, D. A., Horner, R. H., & Hawken, L. S. (2004). Responding to problem behavior in schools: The behavior education program. New York: Guilford Press.
Crone, D. A., & Horner, R. H. (2003). Building positive behavior support systems in schools: Functional behavioral assessment. New York: Guilford.
Dunlap, G., Iovannone, R., Kincaid, D., Wilson, K., Christiansen, K., Strain, P., & English, C., (2010). Prevent-Teach-Reinforce: A school-based model of positive behavior support. Baltimore: Brookes.
Horner, R. H., Sugai, G., Todd, A. W., & Lewis-Palmer, T. (2005). School-wide positive behavior support. In L. Bambara & L. Kern (Eds.), Individualized supports for students with problem behaviors: Designing positive behavior plans (pp. 359-390). New York: Guilford Press.
Martella, R. C., Nelson, J. R., & Marchand-Martella, N. E. (2003). Managing disruptive behaviors in the schools: A schoolwide, classroom, and individualized social learning approach. Boston, MA: Allyn and Bacon, Inc.
OSEP Technical Assistance Center on Positive Behavioral Interventions and Supports. http://www.pbis.org/default.aspx 
Sprague, J. R., & Walker, H. M. (2005). Safe and healthy schools: Practical prevention strategies. New York, NY: Guilford.
Sprick, R.S., & Garrison, M. (2008). Interventions: Evidence-based behavioral strategies for individual students. Eugene, OR: Pacific Northwest Publishing.
Vaughn, B., Duchnowski, A., Sheffield, S., & Kutash, K., (2005). Positive behavior support: A classroom-wide approach to successful student achievement and interactions. Department of Child and Family Studies, Louis de la Parte Florida Mental Health Institute. Tampa, FL: University of South Florida.
Wilkinson, L. A. (2016). A best practice guide to assessment and intervention for autism spectrum disorder in schools. London: Jessica Kingsley Publishers.

Learners on the Autism Spectrum: A Best Practice Guide to Assessment & Intervention in Schools


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 Publishers, Amazon.com, Barnes & Noble, Books-A-Million, Book 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 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. His previous book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT, was honored as an “Award-Winning Finalist in the “Health: Psychology/Mental Health” category of the 2016 Best Book Awards.”

    Saturday, November 19, 2016

    Award-Winning Finalist in the Psychology/Mental Health category of the 2016 Best Book Awards


    Overcoming Anxiety and Depression on the Autism Spectrum is available from Jessica Kingsley Publishers, AmazonBarnes & Noble, Book DepositoryBooks-A-Million and other online book retailers.

    Get the lowest price on Overcoming Anxiety and Depression on the Autism Spectrum: A Self-help Guide Using CBT from AllBookstores.com.


    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 recent volume in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools.

    Tuesday, November 1, 2016

    Sensory Sensitivity in Adults on the Autism Spectrum

    Anecdotal reports and empirical evidence suggest that atypical or unusual sensory responses are a common feature of autism spectrum conditions. Sensory issues are now included in the DSM-5 symptom criteria for restricted, repetitive patterns of behavior, interests, or activities (RRB). This includes hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment; such as apparent indifference to pain/heat/cold and adverse response to specific sounds or textures.  When present, sensory problems can interfere with adaptability in many areas of life (communication, daily living, socialization, occupational). Understanding sensory issues in adults on the autism spectrum is critical to the identification and prescription of appropriate interventions.

    A study published in Autism investigated sensory over-responsivity in adults compared to control participants and the extent to which daily life experiences were endorsed as uncomfortable or distressing by those on the spectrum. The researcher’s hypothesized that adults with autism would report more sensory over-responsivity than controls. A second objective was to test whether sensory over-responsivity is linked to autistic traits in adults with and without autism.
    Adults with (n = 221) and without (n = 181) autism spectrum conditions participated in an online survey. The Autism Spectrum Quotient (AQ), the Raven Progressive Matrices and the Sensory Processing Scale were used to characterize the sample. Adults with autism spectrum conditions reported more sensory over-responsivity than control participants across various sensory domains (visual, auditory, tactile, olfactory, gustatory and proprioceptive). Notable in this study was the association between sensory over-responsivity and autistic traits. Increased sensory sensitivity was associated with more self-reported autistic traits, both across and within groups. These results indicate that adults on the autism spectrum experience sensory over-responsivity to daily sensory stimuli to a high degree and that a positive relationship exists between sensory over-responsivity and autistic traits.
    Despite its limitations, this study shows that adults on the spectrum self-report over-responsivity across multiple sensory domains that affect their daily life routines and thus quality of life. Evaluating and attending to over-responsivity have implications for understanding and addressing the sensory components of their daily life routines and roles. Appropriate intervention should be directed towards sensory issues that may be contributing to emotional and psychological challenges and towards designing sensory friendly domestic and work environments.
    Tavassoli T., Miller, L. J., Schoen, S. A., Nielsen, D. M., & Baron-Cohen, S. (2014). Sensory over-responsivity in adults with autism spectrum conditions. Autism, 18, 428–432.  
    doi: 10.1177/1362361313477246

    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 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 CBTHis latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd edition).

    Sunday, October 16, 2016

    What Do School Personnel Know About Autism?


    Autism spectrum disorder (ASD) affects approximately 1 to 2 % of the school-age population.  The majority of children with autism are educated within the public school system, most often in general education classes, either full- or part-time. Thus, teachers (regular and special education) and other school personnel must be familiar with current best practices for identifying and treating children with ASD. However, many do not have formal training in educating and intervening with this group of children. To address the increased need for services in school settings, it has been recommended that school personnel participate in trainings to develop the skills and competencies necessary to provide effective services to students with ASD. 

    Although a review of the literature suggests that school personnel are receiving some specialized training related to autism, there continues to be a pressing need for more continuing education opportunities and improved preparation. It is vital that school personnel understand this complex disorder in order to help students achieve positive outcomes, especially since they share the responsibility of educating the increasing number of children being identified with ASD.
    Pilot Study
    Although there is a paucity of research focusing on school personnel's perceived and/or factual knowledge of autism, a pilot survey published in the School Psychologist provides us with an exploratory investigation of teacher, counselor, and paraprofessional knowledge of autism. The survey attempted to answer the following questions: (a) To what extent do school personnel (teachers, counselors, and paraprofessionals) perceive that they are competent in their understanding of autism?; (b) What is school personnel's factual knowledge of autism (definition, assessment/diagnosis, and treatments)?; and (c) To what extent do school personnel that work directly with students with autism differ in their perception and factual knowledge of autism in comparison to those who do not work with students with autism?
    Participants
    Fifty-four school personnel from a southwestern state participated in the pilot survey. Participants were school district employees enrolled in various graduate level majors who were attending a small university (within the college of education) in the Southwestern United States. The sample included 26 general education teachers, 14 special education teachers, 7 school counselors and 7 paraprofessionals. Seventy percent indicated that they worked directly with students diagnosed with autism (instructor, interventionist, care-provider, etc.), while approximately 30 percent indicated that they indirectly served students with autism (consultant, academic planning, multidisciplinary team member, etc.). A majority indicated that they had never participated in autism training(s) and when asked whether they would like to take part in future training(s), most indicated that they did not have a desire to participate.
    Participants completed two measures developed by the authors, a Perceptions Survey and a Knowledge Survey. Both measures contained items derived from empirically-supported findings in the research literature. The Perceptions Survey items were designed to assess the respondents' perceived competence of their knowledge and ability to implement research findings. The Knowledge Survey items were designed to assess the respondents' factual knowledge of research findings about autism (definition, assessment/diagnosis, and treatment).
    Results
    The results of the survey indicated that overall, the perceived competence of general and special education teachers, school counselors, and paraprofessional regarding their knowledge of autism was average. Although school personnel that work directly and indirectly with students both reported having average perceived competence, those providing direct service had a statistically significantly higher level of perceived competence. The results of the Knowledge Survey indicated that school personnel who work directly with students correctly defined the disorder, while those that do not demonstrated moderate knowledge with some errors. However, school personnel's factual knowledge about the assessment/diagnosis and treatment of autism was low, regardless of whether services were delivered directly or indirectly.
    Discussion
    The findings of this pilot survey raise several important questions about school personnel’s perceived and factual knowledge about autism. A majority of participants indicated they had no prior training and expressed little interest in receiving education related to autism in the future. This is concerning, given that all participants working with students with autism, either directly or indirectly, reported average perceived competence yet demonstrated a low level of factual knowledge. This divergence suggests that teachers, school counselors, and paraprofessionals may overestimate their factual knowledge about autism and as a result, fail to see a need for additional training.
    Despite the study’s limitations (e.g., small sample size) and need for further research relating to school personnel’s perceptions and knowledge, the results have significant implications for school-based practice. For example, administrators, supervisors, and support professionals such as school psychologists should exercise caution when assuming that school personnel have an adequate factual understanding and working knowledge of autism. It is also important to recognize that anecdotal reports are insufficient when determing the need for training and that direct assessment of factual knowledge is required. Failure to correctly identify training needs can have a negative effect on screening/assessment and intervention selection, planning, and implementation. The results also raise an important question as to what extent school personnel’s perceived knowledge about autism might limit their willingness to participate in training and contribute to resistance in consultation.
    Concluding Comments
    There is a critical need for more coordinated efforts among community and school professionals for the training of teachers in evidence-based instruction and behavioral management practices for children with ASD. Because the knowledge base in ASD is changing so rapidly, it is imperative that school personnel remain current with the research and up to date on scientifically supported approaches that have direct application to the educational setting. For example, some intervention and assessment procedures require a specific knowledge base and skills for successful implementation. It is vital that service providers understand best practice procedures across school, community, and home settings. School personnel can help to ensure that students with ASD receive an effective educational program by participating in training programs designed to increase their understanding and factual knowledge about assessment and intervention /treatment approaches.
    Williams, K., Schroeder, J. L., Carvalho, C., & Cervantes, A. (2011). School personnel knowledge of autism: A pilot survey. The School Psychologist, 65, 7-9.

    Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist and a certified cognitive-behavioral therapist. He 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 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

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