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).
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. 
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,, 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

    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).

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