Sunday, October 16, 2016

What Do School Personnel Know About Autism?

School Personnel Knowledge of 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?
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).
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.
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 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

Friday, October 14, 2016

Suicide Risk in Children & Youth on the Autism Spectrum

Suicide and suicidal ideation are serious public health problems among youth in the United States. Suicide is the third leading cause of death among individuals between the ages of 10 and 14, and the second leading cause of death among individuals between the ages of 15 and 24. More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease, combined. It is estimated that 1 in 12 high school students may attempt suicide each year and that more than 2 million adolescents aged 12 to 17 suffered a major depressive episode in the past year. Moreover, estimates for suicide deaths in younger age groups tend to be conservative because suicide deaths may be misclassified as accidental or undetermined. The extant research indicates a strong relationship between depression and suicidal ideation or attempts.
Children and youth on the autism spectrum (ASD) frequently have co-occurring (comorbid) psychiatric conditions, with rates significantly higher than would be expected from the general population. In fact, depression is one of the most common comorbid conditions observed in individuals with ASD, particularly higher functioning youth. Studies of psychiatric comorbidity in young adults with ASD revealed that a majority had experienced at least one episode of major depression and reported recurrent major depression. Although depression is frequent in autism, there is little research available on suicidal ideation and attempts in children and youth with ASD. This knowledge is critical to help identify at-risk children and target risk factors for intervention in order to reduce and prevent suicide ideation and attempts.
Experts agree that much needs to be learned about suicide ideation and attempts, depression, and other psychiatric comorbidities in ASD. A study published in Research in Autism Spectrum Disorders examined the frequency of suicide ideation and attempts, as well as risk factors in 791 children with autism (1–16 years), 35 depressed children without ASD, and 186 typical children. Mothers rated their children on a 4-point scale from “not at all a problem” to “very often a problem” on a 165-item pediatric behavior scale (PBS). Dependent variables were two items assessing suicide ideation (“talks about harming or killing self”) and attempts (“deliberately harms self or attempts suicide”). Co-occurring problems scores on the PBS included teased by peers; behavior problems (e.g., disobedient, defiant, and aggressive); mood dysregulation (e.g., explosive, irritable, and temper tantrums); attention deficit, impulsive; hyperactive, anxious, depressed, poor peer relationship (e.g., difficulty making friends); psychotic features (e.g., hallucinations and confusing fantasy and reality); underaroused (e.g., drowsy and sluggish), eating disturbance (e.g., poor appetite, over eating, binging, and purging); excessive sleep, sleeping less than normal and difficulty falling and staying asleep; and somatic complaints (e.g., headaches and stomachaches).
Data analyses compared scores between the children with autism, depression, and typical development. Age, IQ, gender, race, socio-economic status (SES), autism severity, teased, and comorbid psychological problem scores also analyzed to predict children whose mothers rated suicide ideation or attempts as sometimes to very often a problem versus never a problem. The results indicated that the percentage of children with autism who had ideation or attempts was 28 times greater than that for typical children, but less than for depressed children. For children with autism, four demographic variables (age 10 or older, minority status, lower SES, and male) were significant risk factors of suicide ideation or attempts. The majority of children (71%) who had all four demographic risk factors had ideation or attempts. Comorbid psychological problems most highly predictive of ideation or attempts were depression, behavior problems, and being teased or bullied. Almost half of children with these problems had suicide ideation or attempts. Depression was the strongest single predictor of suicide ideation or attempts in children with autism with 77% of children with ideation or attempts considered by their mothers to be depressed. A significant finding was that there was no difference in the frequency of suicide ideation or attempts between higher functioning children with ASD and those children with more severe impairment (e.g.., intellectual disability).
This study provides important information regarding the risk factors related to suicide in children and youth with ASD. A major finding is that many of the predictors of and variables associated with suicide behavior in adolescent and adult psychiatric and nonpsychiatric samples are also found in children with ASD. For example, ideation or attempts were associated with behavior problems (disobedient, defiant, and aggressive), impulsivity, and mood dysregulation (explosive, irritable, and temper tantrums). Children with these externalizing problems combined with the internalizing problem of depression are at high risk for suicide ideation and attempts. Teasing and bullying by peers is a common problem for children on the spectrum and was reported by a majority of mothers in the study. Suicide ideation or attempts were three times more frequent in children who were teased than in those not teased. The finding that the frequency of suicide ideation and attempts did not differ as a function of severity or IQ also suggests that many of the correlates of suicide behavior apply across the entire autism spectrum.
The authors recommend that all children with ASD be screened for suicide ideation or attempts because the frequency of ideation and attempts is significantly higher than in typical children and does not differ as a function of autism severity or IQ. This is especially important for children who have demographic and comorbid risk factors, including age 10 or older, male, minority status, lower SES, teased, depressed, impulsive, behavior problems, and mood dysregulation. Practitioners must fully be aware of the risk of suicide along with preventative and treatment methods. Addressing suicide in youth relies on prevention techniques and modification of risk factors, along with therapeutic intervention once children are identified as at-risk. Evidence-based techniques to reduce depression and prevent suicide should be incorporated into programs and services for children with ASD who present with risk factors. This should include interventions aimed at addressing co-occurring problems that may contribute to suicidal ideation and attempts, such as teasing, depression, behavior problems, impulsivity, and mood dysregulation. Lastly, future research should investigate other predictors (e.g., previous attempts, negative life events, family history of suicide, and biologic and neurochemical variables), which may improve identification of children at risk for suicide ideation and attempts.
Mayes, S. D., Gorman, A. A., Hillwig-Garcia, J., & Syed, E. (2013). Suicide ideation and attempts in children with autism. Research in Autism Spectrum Disorders, 7, 109-119.
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).

Wednesday, October 5, 2016

Approved Online Continuing Education Course for School Psychologists

This 3-hour online continuing education course, Autism Spectrum Disorder: Evidence-Based Screening & Assessment, is APA-approved and available for credit for school psychologists. Epidemiological studies indicate a progressively rising prevalence trend for autism spectrum disorders (ASD) over the past decade. School professionals and clinicians must be prepared to recognize the presence of risk factors and/or early warning signs of ASD and be familiar with screening and assessment tools in order to ensure that students are being identified and provided with the appropriate programs and services. The objectives of this course are to identify DSM-5 diagnostic changes in the ASD diagnostic criteria, summarize the empirically-based screening and assessment methodology in ASD, and describe a comprehensive developmental approach for assessing children, adolescents, and young adults with ASD. Course #30-69 | 44 pages | 40 posttest questions. CE Credit: 3 Hours
              Learning Objectives 
  1. Identify the changes in the new DSM-5 criteria for ASD 
  2. Distinguish between DSM diagnosis and IDEA classification schemes 
  3. Identify the three levels of a multi-tier assessment strategy to screen for ASD 
  4. List the components of a comprehensive developmental assessment for ASD 
  5. Name co-occurring conditions commonly found in ASD 
  6. Name key components of programs and services for ASD.
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.

CE Information  

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; by the Continuing Education Board of the American Speech-Language-Hearing Association (ASHA Provider #AAUM) to provide continuing education activities in speech-language pathology and audiology; by the National Board of Certified Counselors (NBCC) to offer home study continuing education for NCCs (Provider #5590); by the Association of Social Work Boards (ASWB Provider #1046, ACE Program); by the National Association of Alcoholism & Drug Abuse Counselors (NAADAC Provider #000279); by the American Occupational Therapy Association (AOTA Provider #3159); by the Commission on Dietetic Registration (CDR Provider #PR001); by the California Board of Behavioral Sciences (#PCE1625); by the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635), Dietetics & Nutrition (#50-1635), and Occupational Therapy Practice (#34); by the Illinois DPR for Social Work (#159-00531); by the Ohio Counselor, Social Worker & MFT Board (#RCST100501); by the South Carolina Board of Professional Counselors & MFTs (#193); and by the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).
 About the Author
Lee A. Wilkinson, EdD, PhD, NCSP, is a licensed and nationally certified school psychologist, registered psychologist, and certified cognitive-behavioral therapist. Dr. Wilkinson is also a university educator and teaches graduate courses in psychological assessment, clinical intervention, and child and adolescent psychopathology. His research and professional writing has focused on behavioral consultation and therapy, and children and adults with autism spectrum disorders. He has published numerous journal articles on these topics both in the United States 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 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 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, October 4, 2016

Book Review - "THE LOVING PUSH"

The LovingPush: ​How parents and professionals can help spectrum kids become successful adults 
by Temple Grandin, PhD and Debra Moore, PhD

Young adults on the autism spectrum face significant challenges as they transition to adulthood, with many being socially isolated, unemployed, and lacking services. Unfortunately, research suggests that the vast majority of these young adults will be residing in the parental or guardian home during the period of emerging adulthood. It is clear that more needs to be done to help them thrive to the best of their abilities and attain a high quality of life. "The Loving Push” by Drs. Grandin and Moore addresses these issues with a direct, yet empathetic and positive discussion of ways in which parents and professionals can enhance the potential of "spectrum kids" of any age and help them achieve productive and meaningful adult lives.
The authors convey a critical message that, more than other children and youth, those on the autism spectrum must overcome "learned helplessness" and move beyond their comfort zone in order to reach their full, unique potential. Pushing is necessary,” the authors write, “because those on the spectrum are unlikely to automatically pick up the mundane but necessary tasks of daily life without us intentionally nudging them and providing them with information, encouragement, and persistence.”
"The Loving Push" consists of Three Parts: Part I -The Path to Success Starts Here: Restoring Hope; Part –II: Stretching Your Child & Avoiding Pitfalls; and Part III: Preparing Your Child for Adulthood. Each part features Chapters containing important information, lessons, tips, and advice on how to “Lovingly Push” youth on the spectrum to reach their potential and achieve a successful transition to adulthood. The book begins by sharing 8 inspiring profiles of persons on the spectrum and using their real-life stories to illustrate the three essential components of success: “Avoiding Learned Helplessness, Learning Optimism/Resisting Habitual Negative Thinking, and The Critical Impact of Mentors.” The section on “Getting Families and Schools to Work Together” is especially important, given that transition planning is a critical part of preparing students for life after high school and producing the best outcomes. Young adults on the spectrum are particularly vulnerable during the initial years in the transition to adulthood when there is a shift in service provision after leaving high school. The authors recommend that teachers, parents, and professionals “lovingly” guide, push, and mentor our children and youth as early as possible, and for as long as possible.
The book also addresses the issue of co-occurring anxiety and depression. The authors discuss counseling and evidence-based psychotherapy approaches such as cognitive-behavioral therapy (CBT) and “mindfulness” techniques to reduce stress, and improve mood and psychological well-being. Group support for children, teens, and parents is referenced, as well as important commentary on “Psychotherapy Approaches Not Recommended.” Tips and cautions about medication use for anxiety and depression are also discussed.
“The Loving Push” devotes considerable attention to the problem of compulsive electronic gaming and how it can turn kids on the spectrum into “media recluses” and social isolates. Since children and youth on the spectrum tend to engage in restricted and repetitive behaviors, they are at higher risk for developing addictive game play patterns. Preoccupation with video games and trouble disengaging from them limits the opportunity for learning critical social and problem-solving skills. This Chapter warns parents and educators about the dangers of video games and screen-based media and lists steps they can take to minimize the negative effects of compulsive gaming.
Far too often, parents and teachers of kids on the autism spectrum focus more attention on teaching academic and behavior management skills than on daily living skills. Parents are often surprised to learn that daily living skills are more important than autism symptoms, language or IQ when it comes to employment and life satisfaction. Part III (Preparing Your Child for Adulthood) discusses the building blocks for independent living such as household skills (i.e., cooking, cleaning), driving or using public transportation, educational/vocational preparation, and social/community connection. Explicit teaching of these life skills prior to the transition to adulthood is crucial if we expect kids on the spectrum to have the necessary skills to live independently and negotiate adult life.
The central theme of “The Loving Push” is that the focus of intervention/treatment for spectrum kids must shift to promoting the adaptive behaviors and basic life skills that can facilitate and enhance ultimate functional independence and quality of life in adulthood. This includes helping them learn the skills needed to meet new developmental challenges such as independent living, vocational engagement, post-secondary education, and self-supporting employment. Drs. Grandin and Moore provide a much needed “push” in this direction. As the authors’ note, “With more and more young adults on the spectrum entering adulthood everyday, we don’t have time to lose.”
"The Loving Push” is a valuable resource and must read guide to preparing spectrum kids for a successful transition to self-reliance and independence in adult life. The book is not only highly recommended for parents, caregivers, and families, but also for professionals in private practice, schools, colleges/universities, and community settings who work with children, teens, and adults on the spectrum.

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