Monday, September 26, 2016

Best Practice Review: The Autism Diagnostic Observation Schedule (ADOS)

One of the most widely used observation instruments for the assessment of autism is the Autism Diagnostic Observation Schedule (ADOS) (Lord, Rutter, DiLavore, & Risi, 2008). The ADOS is a semistructured assessment of social interaction, communication, play, and imaginative use of materials for individuals who may have autism or an autism spectrum disorder (ASD). The goal of the ADOS is to provide a hierarchy of “presses” (social structures) that elicit behaviors in standardized contexts relevant to ASD.
The ADOS requires clinical training and practice in observation and scoring, as well as administering the standard activities. Clinical experience related to ASD and skill in working with children is recommended. It should be noted that the ADOS classification system does not assign a diagnosis. The ADOS has thresholds for social interaction, communication and communication-social interaction (total). An individual may reach the threshold on all three scales but not receive a clinical diagnosis of ASD, because of late presentation of difficulties or no restricted/repetitive behaviors or interests. The authors stress the importance of using the ADOS in conjunction with a developmental history, corroborating information from other sources, and the use of clinical judgment (Lord et al, 2008).
Administration and Scoring
The ADOS is standardized in terms of the materials used, the activities presented, the examiner’s introduction of activities, the hierarchical sequence of social presses provided by the examiner, and the way behaviors are coded or scored. The ADOS consists of four “modules,” each of which can be administered in 30-45 minutes. The appropriate module is selected and administered depending on the individual’s verbal ability. Module 1 is used for children who are preverbal or have single-word language. Module 2 is appropriate for individuals with phrase speech abilities. Module 3 is used for children and adolescents who are verbally fluent. Verbally fluent adolescents and adults are assessed with Module 4. More than one module can be administered if the examiner determines that a more or less advanced module is appropriate. The manual provides guidelines for selecting the most appropriate module and general instructions for administration and scoring and interpreting an individual’s results.
ADOS classifications are based on specific coded behaviors that are included in a scoring algorithm using the DSM-IV diagnostic criteria, resulting in a Communication score, a Reciprocal Social Interaction score, and a Total score (a sum of the Communication and Reciprocal Social Interactions scores). ADOS items regarding play and stereotyped behaviors are also coded but are not included in the diagnostic algorithm due to the difficulty in accurately assessing these characteristics in a limited period of time (Lord et al., 2008). Behaviors are coded using a 0- to 3-point coding system, with a 0 indicating that the behavior is not abnormal in the way specified in the coding description, 2 indicating a definite difference, and a 3 indicating that a behavior is abnormal and interferes in some way with the child’s functioning. Scores are compared with an algorithm cut-off score for autism or the more broadly defined ASD in each of these areas. If the child’s score meets or exceeds cut-offs in all three areas, they are considered to meet criteria for that classification on the measure. An ADOS autism classification requires meeting or exceeding each of the three thresholds (social, communication, social-communication total) for autism. If thresholds for autism are not met, an ADOS classification of ASD is appropriate when the three ASD thresholds are met or exceeded. In all cases, the ASD thresholds are lower for ASD than those of autism (Lord et al., 2001, 2008).

ADOS-2

The ADOS-2 is a revision of the original ADOS and like its predecessor is a semi-structured, standardized observational assessment tool designed to assess autism spectrum disorders in children, adolescents, and adults (Lord, Rutter, DiLavore, Risi, Gotham, & Bishop, 2012). The second edition includes updated protocols, revised algorithms, a new Comparison Score, and a Toddler Module. Administration and coding procedures for the ADOS-2 are functionally the same as those for the ADOS. One of five different modules (Modules 1, 2, 3, 4 or the Toddler Module) is chosen based upon expressive language level and chronological age. In Modules 1 through 4, algorithm scores are compared with cutoff scores to yield one of three classifications: autism, autism spectrum (ASD), or non-spectrum. In the Toddler Module, algorithms yield "ranges of concern" rather than classification scores. A new Comparison Score or severity metric for Modules 1 through 3 allows the examiner to compare a child's overall level of autism spectrum-related symptoms to that of children diagnosed with ASD who are the same age and have similar expressive language skills. 
Psychometric Properties
The psychometric data used in the derivation of the diagnostic algorithms were obtained from individuals diagnosed with autism, pervasive developmental disorder not otherwise specified (PDD-NOS), and non-spectrum disorders in order to maximize diagnostic agreement. Individuals with a diagnosis of Asperger’s Disorder were not included in the validation sample (Lord et al., 2008). The manual provides a range of sensitivity and specificity data across modules for Autism and ASD vs. non-spectrum disorders. The instrument has sensitivity in the upper 90% range and specificity in the upper 80% to lower 90% range (Lord et al., 2008). The ADOS was very effective in discriminating individuals with either autism or ASD from those with non-spectrum disorders, while differentiation of autism and ASD resulted in specificities of .68 to .79. Agreement between raters for diagnostic classification when assessing individuals with autistic disorder, ASD, and non-spectrum disorders ranged from 81% to 93% for the four modules. Internal consistency for all domains and modules ranged from .47 to .94. The lower results were found for stereotyped behaviors and restricted interests in module 3. Test-retest reliability indicates excellent stability for the “Social Interaction” and “Communication” domains, and for their combined total, together with good stability for the “Stereotyped Behaviors and Restricted Interests” over an average period of nine months. In total, there seems to be significant evidence for sensitivity and specificity for the ADOS in differentiating children with autism and ASD from children with non-spectrum disorders (Lord et al., 2001, 2008). When comparing the ADOS to the ADOS-2, sensitivity and specificity values appear largely comparable or improved with the new algorithms.

Research
Various studies have examined the effectiveness of ADOS as it is used in clinical practice. For example, Mazefsky and Oswald (2006) examined the diagnostic utility and discriminative ability of the ADOS using a clinical population of 75 children referred to a specialty diagnostic clinic over a 3 year time span. They reported 77% agreement between ADOS classification and team diagnosis, with most discrepancies being in autism versus ASD. The authors note that their results (lower sensitivity) likely reflect the participation of children who present for assessments in common clinical practice. In contrast, the symptom presentation of the children used in the original studies to develop the psychometric properties of the ADOS included “prototypical” representations of the disorders and excluded those with questionable diagnoses. This suggests that clinical expertise and experience with children with ASD is an essential supplement to the ADOS and other assessment instruments for the less “‘clear-cut” cases often seen in typical practice.
A current study also investigated the diagnostic validity of the ADOS in a clinical sample (Molloy, Murray, Akers, Mitchell, & Manning-Courtney, 2011). ADOS classifications were compared to final diagnoses given to 584 children referred for evaluation for a possible ASD in a children’s medical center. Sensitivities were moderate to high on the algorithms, while specificities were substantially lower than reported in the original ADOS validity sample. The authors concluded that the higher number of false positives was likely attributable to the composition of their clinical sample which included many children with a broad range of developmental and behavioral disorders. The results of this study also suggest that clinical populations for which the ADOS is regularly used may be substantially different from the research samples on which it was normed. As a result, it is especially important that the ADOS not be used as a “stand-alone” assessment so as to minimize misclassification in clinical settings where there are children with many other developmental or behavioral disorders.
The role of the ADOS in the assessment of ASD in school and community settings has received attention as well. The perceived advantages and disadvantages of the ADOS were examined via a national survey of practicing school and clinical psychologists (Akshoomoff, Corsello, & Schmidt, 2006). Perceived advantages of the ADOS included its strength in capturing ASD-specific behaviors and the standardized structure provided for observation, while diagnostic discrimination and required resources were the most commonly identified disadvantages. Respondents listing advantages of the ADOS indicated that it captured ASD behaviors, both generally and specifically, and that it was a good measure for identifying behaviors that are difficult to observe or probe in other situations. Respondents indicated that a disadvantage of the ADOS is that it tends to over classify other diagnostic groups as ASD and does not discriminate well within ASD subgroups. Of those that indicated resources as a disadvantage, nearly all indicated time of administration as a disadvantage.
Conclusion
The Autism Diagnostic Observation Schedule (ADOS) is one of the few standardized diagnostic measures that involves scoring direct observations of the child’s interactions and accounts for the developmental level and age of the child. It has the most empirical support among observation-based diagnostic assessment procedures for autism and is recommended in several best practice guidelines as an appropriate standardized diagnostic observation tool (National Research Council, 2001; Wilkinson, 2010). The ADOS offers the practitioner a standardized observation of current social-communicative behavior with excellent interrater reliability, internal consistency and test–retest reliability on the item, domain and classification levels for autism and non-spectrum disorders. Psychometric properties reflect consistent differentiation of autism and ASD from non-spectrum individuals, with less reliable differentiation of autism from ASD (Lord et al., 2001, 2008).
Practitioners should consider the following points when using of the ADOS in clinical and school settings.
1. It is important to distinguish between an ADOS classification and an overall diagnosis of autism. The ADOS is intended to be but “one source” of information used in making a diagnosis of ASD. Because coding is made from a single observation, it does not include information about onset or early developmental history. ADOS algorithms include items coding social behaviors and communication but do not offer an adequate opportunity to measure restricted and repetitive behaviors (though such behaviors are coded if they occur). This means that the ADOS alone cannot be used to make complete standard diagnoses (see Wilkinson for a description of assessment domains and recommended measures).
2. The goal of the ADOS is to provide standardized contexts in which to observe the social-communicative behaviors of individuals across the life-span in order to assist in the diagnosis of autism and other ASD. It provides information only on current behavior and was not developed to measure changes over time. Therefore, the ADOS domain or total scores are not a good measure of response to treatment or of developmental gains, especially in the later modules (Lord et al., 2008).
3. The usefulness of the ADOS is related to the examiner’s clinical skills and experience with the instrument. Training and practice in administering the activities, scoring, and observation is required. The ADOS should be administered by an experienced clinician with appropriate training who can use both quantitative and qualitative information to form a clinical impression from the standard activities.
4. Studies suggest that clinical populations for which the ADOS is used may be substantially different from the research samples on which it was normed. As the authors caution, the instrument is not meant to be used as a “stand-alone” assessment. Supporting information from a developmental history, additional observational information or a detailed parent interview are needed for a comprehensive diagnosis. This is especially important in any clinical and school settings where children with various other developmental or behavioral disorders are referred and evaluated.
5. Agreement between clinical diagnostic decisions and standardized diagnostic measures is difficult for children with less typical presentations than classic autism. As a result, diagnostic measures are likely to have difficulty with specificity and sensitivity for children with ASD who do not present with classic features of autism. Further research on the ADOS is needed with children who have an ASD other than autism and with a broader range of children typically seen in clinical and school settings.

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

References
Akshoomoff, N, Corsello, C., & Schmidt, H. (2006). The role of the Autism Diagnostic Observation Schedule in the assessment of autism spectrum disorders in school and community settings. The California School Psychologist, 11, 7-19.
Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P C, et al. (2000). The Autism Diagnostic Observation Schedule-Generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205-223.
Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2008). Autism Diagnostic Observation Schedule Manual. Los Angeles: Western Psychological Services.

Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule, second edition. Torrance, CA: Western Psychological Services.
Mazefsky, C.A., & Oswald, D.P. (2006). The discriminative ability and diagnostic utility of the ADOS-G, ADI-R, and GARS for children in a clinical Setting. Autism, 10, 533–49.

McCrimmon, A. & Kristin Rostad, K. (2014). Test Review: Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) Manual (Part II): Toddler Module. Journal of Psychoeducational Assessment, 32, 88–92.
Molloy, C. A., Murray, D. S., Akers, R., Mitchell, T., & Manning-Courtney, P. (2011). Use of the Autism Diagnostic Observation Schedule (ADOS) in a clinical setting. Autism, 15, 143-162.
National Research Council. (2001). Educating children with autism. Washington, DC: National Academy Press.
Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London & Philadelphia: Jessica Kingsley Publishers.

Wilkinson, L.A. (2016). A best practice guide to assessment and intervention for autism spectrum disorder in schools, Second Edition. London & 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 provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorders. Dr. Wilkinson 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 CBTHe 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. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

© Lee A. Wilkinson, PhD

Tuesday, September 20, 2016

Self-Help for Young Adults on the Autism Spectrum


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

Friday, September 9, 2016

The IEP: Educating Children with Autism


Education has been shown to be among the most effective intervention/treatment for children with autism spectrum disorder (ASD). The most recent reauthorization of the Individuals with Disabilities Education Act (IDEA 2004) entitles all students with disabilities to a free appropriate public education (FAPE). In fact, the National Research Council (2001) recommends that all children identified with ASD, regardless of severity, be made eligible for special educational services under the IDEA category of autism. FAPE encompasses both procedural safeguards and the student’s individual education program (IEP). The IEP is the cornerstone for the education of a child with ASD. When a student is determined eligible for special education services, an IEP planning team is formed to develop the IEP and subsequently determine placement. Parents, teachers and support professionals play a key role in the development, implementation, and evaluation of the child’s IEP. All share the responsibility for monitoring the student’s progress toward meeting the plan's specific academic, social, and behavioral goals and objectives. 
Although the type and intensity of services will vary, depending on the student’s age, cognitive and language levels, behavioral needs and family priorities, the IEP should address all areas in which a child needs educational assistance. These include academic and non-academic goals if the services will provide an educational benefit for the student. All areas of projected need are incorporated in the IEP, together with the specific setting in which the services will be provided and the professionals who will provide the service. School districts should ensure that the IEP process follows the procedural requirements of IDEA. This includes actively involving parents in the IEP process and adhering to the time frame requirements for assessment and developing and implementing the student’s IEP.  Moreover, parents must be notified of their due process rights. It’s important to recognize that parent-professional communication and collaboration are key components for making educational and program decisions.
The content of an IEP should include the following (Individuals with Disabilities Education Improvement Act, 2004):
  • The IEP should be based on the child’s unique pattern of strengths and weaknesses. Goals for a child with ASD commonly include the areas of communication, social behavior, adaptive skills, challenging behavior, and academic and functional skills. The IEP must address appropriate instructional and curricular accommodations and modifications, together with related services such as counseling, occupational therapy, speech/language therapy, physical therapy and transportation needs. Evidence-based instructional strategies should also be adopted to ensure that the IEP is implemented appropriately.
  • A statement of the child's present level of educational performance (both academic and nonacademic aspects of his or her performance). 
  • Specific goals and objectives designed to provide the appropriate educational services. This includes a statement of annual goals that the student may be expected to reasonably meet during the coming academic year, together with a series of measurable, intermediate objectives for each goal. 
  • Appropriate objective criteria, evaluation procedures and schedules for determining, at least annually, whether the child is achieving the specific objectives detailed in the IEP. 
  • A description of all specific special education and related services, including individualized instruction and related supports and services to be provided (e.g., counseling, occupational, physical, and speech/language therapy; transportation) and the extent to which the child will participate in regular educational programs with typical peers. 
  • Accommodations should be specifically documented in the IEP. Accommodations refer to the adjustments made to ensure that the student has equal access to educational programming by removing, to the extent, possible, barriers to successful classroom performance. Adjustments may be made to (a) instructional methods, teaching style, and curricular materials; (b) classroom and homework assignments; (c) assessment tools and ways of responding; (d) time requirements; and (e) environmental setting. Once accommodations are made, the student with special needs is expected to meet the standards of all students.
  • The initiation date and duration of each of the services to be provided (including extended school year services). 
  • If the student is 16 years of age or older, the IEP must include a description of transitional services (coordinated set of activities designed to assist the student in movement from school to post-school activities).
School districts should assure that progress monitoring of students with ASD is completed at specified intervals by an interdisciplinary team of professionals who have a knowledge base and experience in autism. This includes collecting evidence-based data to document progress towards achieving IEP goals and to assess program effectiveness. School districts should also provide on-going training and education in ASD for both parents and professionals. Professionals who are trained in specific methodology and techniques will be most effective in providing the appropriate services and in modifying curriculum based upon the unique needs of the child.

Adapted from Wilkinson, L. A. (2016). Best practice in special education. In L. A. Wilkinson, A best practice guide to assessment and intervention for autism spectrum disorder in schools (pp. 157-200). London: Jessica Kingsley Publishers.


References and Further Reading
Information and tips on writing and developing measurable IEP goals for learners with ASD are available from the following:
Kabot, S., & Reeve, C. (2014). Curriculum and Program Structure. In L. A. Wilkinson (Ed.), Autism spectrum disorder in children and adolescents:  Evidence-based assessment and intervention in schools (pp. 195-218). Washington, DC: American Psychological Association.
Myles, B. S., Adreon, D. A., Hagen, K., Holverstott, J., Hubbard, A., Smith, S. M., et al. (2005). Life journey through autism: An educator’s guide to Asperger syndrome. Arlington, VA: Organization for Autism Research.
National Research Council (2001). Educating children with autism. Committee on Educational Interventions for Children with Autism. C. Lord & J. P. McGee (Eds). Division of Behavioral and Social Sciences and Education. Washington, DC: National Academy Press.
Twachtman-Cullen, D., & Twachtman-Bassett, J. (2011). The IEP from A to Z: How to create meaningful and measurable goals and objectives. San Francisco, CA: Jossey-Bass.
Wagner, S. (2014). Continuum of Services and Individualized Education Plan Process. In L. A. Wilkinson (Ed.). Autism spectrum disorder in children and adolescents:  Evidence-based assessment and intervention in schools (pp. 173-193). Washington, DC: American Psychological Association.
Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.
Wilkinson, L. A. (Ed.). (2014). Autism spectrum disorder in children and adolescents:  Evidence-based assessment and intervention in schools. Washington, DC: American Psychological Association.

Wilkinson, L. A. (2016). A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd edition). London: Jessica Kingsley Publishers.
Wilmshurst, L. & Brue, A. (2010). The complete guide to special education: Expert advice on evaluations, IEPs, and helping kids succeed (2nd edition). San Francisco, CA: Jossey-Bass.
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 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. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Tuesday, September 6, 2016

Pragmatic Language Skills and the Autism Spectrum

The diagnostic criteria for autism spectrum disorder (ASD) include persistent deficits in social communication and social interaction across multiple contexts. Problems with the pragmatic/social use of language or impairment in the ability to understand and use language in social-communicative contexts is a core feature of ASD. Pragmatic skills involve: (a) using language for different purposes; (b) changing language according to the needs of a listener or situation; (c) understanding non-literal language; and (d) following rules for conversations.  

There are many unwritten rules in society that govern our behavior. While most of us intuitively understand these rules, individuals with ASD have not automatically learned the conventions and nuances that make up their social environment. These unspoken or “hidden” social standards can make the world a confusing place and result in life-long challenges. For example, social expectations such as “it is not polite to interrupt others while they are talking,” “take turns in conversation” and “discuss other topics besides only those you are interested in” are not taught and are assumed to be known and understood. We seem to have an “unconscious” navigator that allows us to make intuitive sense of the unspoken rules in society and adjust to the social demands of our everyday lives.
The unspoken rules of social engagement involve the use of the pragmatic, social communicative functions of language (e.g., turn taking, understanding of inferences and figurative expressions) as well as nonverbal skills needed to communicate and regulate interaction (e.g., eye contact, gesture, facial expression). This includes body language and idioms, metaphors, or slang – phrases and meanings that we intuitively assimilate or learn through observation or subtle cues. Individuals with ASD tend to interpret language literally and may be puzzled by the common everyday expressions used by a typical peer or adult. They may fail to use appropriate nonverbal communication skills, such as eye contact and have impairments in comprehension, or generally have difficulty communicating with others. As a result, peers often feel ineffective when engaged in social exchanges with a child on the autism spectrum and may avoid that person and/or react in a negative way (e.g., teasing or bullying), further impacting the development of appropriate social skills. 
Consider how idioms or figurative speech such as “how the cookie crumbles,” “curiosity killed the cat,” "kill two birds with one stone," "everything but the kitchen sink," and “when it rains, it pours” will have a totally different meaning and result in confusion if taken literally. In order to understand language, we must understand what the idioms in that language mean (there are well over 3,000 idioms in the English language). If you try to figure out the meaning of an idiom literally (word by word), you will be bewildered. While the typical individual might understand that the phrase “that’s the way the cookie crumbles,” and accompanying body language (e.g., voice, body) communicates to the listener that something unfortunate has happened, to someone with a pragmatic social-communication problem, this idiom will have a completely different meaning and be confusing.

Because social communication deficits are among the core challenges of ASD, a best practice student assessment should include an evaluation of pragmatic competence and not be limited to the formal, structural aspects of language (i.e., articulation and receptive/ expressive language functioning). As a group, more capable students with ASD tend to demonstrate strength in formal language, but a weakness is pragmatic and social skills. As a result, they often fail to qualify for speech-language services because they present strong verbal skills and large vocabularies, and score well on formal language assessments. A variety of assessment strategies should be used, including direct assessment, naturalistic observation and interviewing significant others, including parents and educators, who are valuable sources of information. Students with pragmatic language deficits who do not meet the DSM-5 ASD criteria for restricted, repetitive patterns of behavior should be evaluated for social (pragmatic) communication disorder (SCD).  

It is imperative that speech/language services for children with ASD include particular attention to the pragmatic, social communicative functions of language (e.g., turn taking, understanding of inferences and figurative expressions) as well as to the nonverbal skills needed to communicate and regulate interaction (e.g., eye contact, gesture, facial expression, and body language). Significant and severe deficits in the ability to communicate and interact with others can limit participation in mainstream academic settings and community activities. Moreover, pragmatic deficits tend to become even more obvious and problematic as social and educational demands increase with age. 


Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, registered psychologist, and certified cognitive-behavioral therapist. He provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorders. Dr. Wilkinson 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 CBTHe 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. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

© 2016 Lee A. Wilkinson, PhD

Monday, September 5, 2016

Special Needs Students Bullied More than Others



Students with special needs face a number of challenges in our nations’ schools and communities. Although students in general and special education experience bullying, there is little research investigating bullying (i.e., as a bully, victim, or bully–victim) among students with disabilities. A study published in the Journal of School Psychology found that students receiving special education services for behavioral disorders and those with more noticeable disabilities are not only more likely to be bullied than their general education peers, but are more likely to engage in bullying behavior themselves.
Participants in the study were 816 students, 9 to 16 years of age, from nine Midwestern elementary and middle schools in one school district. From this total group, 686 were not receiving special education services (categorized as “no disability”), and 130 were receiving special education services (categorized as “observable disability,” “non-observable disability,” and “behavioral disability”). Data on students’ involvement in bullying, office referrals, and prosocial behavior were collected. Self-report measures were used to assess students’ experiences with bullying and victimization and how often students engaged in various aggressive and prosocial behaviors.
The results indicated that students with behavioral disorders reported the highest levels of bullying others and being bullied themselves. The study also found that students with observable disabilities (e.g.., language impairments, hearing impairments, and mild intellectual disability) were more likely to bully others and to be victimized compared with students in general education.  As the authors comment, “The observable nature of the disability makes it easy to identify those students as individuals with disabilities, which may place them at a greater risk for being the easy target of bullying. Being frustrated with the experience of victimization, those students might engage in bullying behavior as a form of revenge.”
The study also found that students with non-observable disabilities, such as a learning disability, reported similar levels of bullying and victimization as students without disabilities. They also reported significantly less victimization compared with students with more outward behavioral disabilities. While both boys and girls engaged in bullying, there was no significant gender difference in both general education and special education students when it came to the behavior. Although fifth grade students in general education reported much more victimization than sixth-, seventh-, eighth- and ninth-graders, there was no difference for students in special education.

What are the implications of this study? The authors offer several suggestions for school-based bullying prevention and intervention programming. For example, anti-bullying interventions emphasizing prosocial skills should be implemented for students, regardless of their ability. Students in general education could help the process by serving as prosocial role models for students with disabilities. Teachers may also provide reinforcement for prosocial behavior or assign students in general education with students in special education in small groups to work on class projects together to promote positive interaction. For students with both behavioral and observable disabilities, providing support and teaching strategies to cope with peer victimization are important. Helping students with observable disabilities become better integrated into general education classes may help prevent them from being bullied. "Programming should be consistently implemented across general and special education, should occur in each grade and should be part of an inclusive curriculum," the authors recommend. "A culture of respect, tolerance and acceptance is our only hope for reducing bullying among all school-aged youth."
© 2016 Lee A. Wilkinson, PhD

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