Best Practice Autism

Autism Litigation Under IDEA

2012-01-22T09:21:00.000-05:00

There has been adramatic worldwide increase in reported cases of autism over the past decade.Autism is much more prevalent than previously thought, especially when viewedas a spectrum of disorders (ASD).According to the CDC, approximately 1 in 110 children in the United States havean autism spectrum disorder (ASD) or an estimated prevalence of about 1%. The occurrence of autism is also evident in the numberof students with ASD receiving special educational services. Data collectedfor the Department of Education indicate that the number of children ages 6through 21 identified with autism served under the Individuals With Disabilities Act (IDEA) has increased by more than 600 percent, from 42,000 in1997 to over 250,000 in 2007.

The increase in autism is also reflected in thefrequency of autism-related litigation and court decisions. A recent articleappearing in the Journal of Special Education Leadership (AutismLitigation Under the IDEA: A New Meaning of “Disproportionality?’) by LehighUniversity professor of education and law, Dr. Perry Zirkel,explored whether the litigation concerning students with autism isdisproportional to their enrollment in special education programs under IDEA.Zirkel analyzed 201 court decisions under IDEA that appeared in West’sEducation Law Reporter. He limited the analysis to the overlapping FAPE(Free Appropriate Public Education) and LRE (Least Restrictive Environment)categories as previous studies showed them to be the major part of IDEAlitigation. The FAPE category consisted of decisions where the parentchallenged the appropriateness of the child’s individual program or placement.This category also included cases where the court decided the appropriatenessof the proposed placement as the first step in the tuition reimbursementanalysis. The LRE category consisted of cases where the parents and districtsought different placements, and the court used the test, or set of criteria,applicable in its federal appellate jurisdiction for determining the LRE.

The study found that the child’s disabilityclassification was identified as autism in 64 (32%) of 201 FAPE/LRE decisionsanalyzed between 1993 and 2008. Autism litigation accounted for an average of37% from 1997 to 2008, ranging from 6% in the period closest to the 1990addition of autism to the list of IDEA disability classifications to 39% in themost recent four year period 2005-2008. Most importantly, Zirkel found thatwhen comparing the litigation percentage with the autism percentage in thespecial education population for the period 1993 to 2006, the ratio wasapproximately 10:1. Overall, the FAPE/LRE court cases are over 10 times morelikely to concern a child with autism than the proportion of children with thisdisability in the special education population.

The study suggests that the reasons for thisdisproportionality (or overrepresentation) of children with autism in FAPE/LRElitigation are multifaceted. An initial explanation concerns the severity ofthe disability and the resulting emotional stress placed on parents/caregiversand families. Another explanation may involve “cost.” For example, childrenwith ASD typically receive a significantly higher number of different specialeducation and related services than students with other disabilities. As aresult, the average per-pupil expenditure for special education services forschool-age children with autism is often more than for other IDEA disability classifications.This relative cost represents high stakes for both parents and districts andmay contribute significantly to the motivation for litigation (e.g., the numberof tuition reimbursement cases in the FAPE/LRE cases for autism). A thirdcontributing factor may be the recent attention given to autism compared toother IDEA disability classifications together with the complexity of thedisorder itself. The media attention given to autism and emergence of advocacygroups have also increased parents’ knowledge, but often popularize treatmentsthat are not supported in the scientific literature and/or viable ineducational contexts. As Zirkel comments, “…with the underlying mutual motivesof high costs and methodological controversy, it is not surprising that theparents of children with autism would be more prone to litigation than theparents of children with other disabilities.”

This investigation has several important (and practical)implications. For example, school district administrators should pay particularattention to providing effective evidence-based interventions and programs forchildren with autism and to establishing effective communications with theirparents. Parent-professional communication and collaboration are key componentsfor making educational and treatment decisions. On-going training and educationin autism are also important for both parents and professionals. Educators andsupport professionals who are trained in specific methodology and techniqueswill be most effective in providing the appropriate services and in modifyingcurriculum based upon the unique needs of the individual child. Given thelimited success of many school districts in addressing this complex disability,school officials must also be prepared to address the expected complaints andgrievances from parents of children with autism. At this point, specialeducation leaders should investigate the use of various alternate disputeresolution mechanisms such as mediation and IEP facilitation. As Zirkel concludes,“Although such steps are appropriate with all parents, especially with those ofchildren with disabilities, these results suggest that, without such priorityextra efforts, the likelihood of the parents of students with autism filing foran impartial hearing to challenge the IEP and persisting through this costlyand cumbersome adversarial process to a court decision will remaindisproportionally high.”

Zirkel, P. (2011). Autismlitigation under the IDEA: A new meaning of “disproportionality?” Journal ofSpecial Education Leadership, 24, 92-103.

The full text article isavailable at

http://blogs.edweek.org/edweek/speced/Zirkel%20Article%20on%20Autism%20Litigation%20Disproportional.PDF

Autism Assessment: An Interview with Author Dr. Lee A. Wilkinson

2012-01-17T20:40:00.000-05:00

Ever wonder why your child received anAutism diagnosis? Dr. Lee A. Wilkinson, Palm Beach County schoolpsychologist, autism expert, and author discusses his award-winning book, A Best Practice Guide toAssessment and Intervention for Autism and Aspergers Syndrome,with autism specialist and educational advocate Andrea Richardson at Thriving with Autism. Don't missthis chance to hear why psychologists ask the questions they do and how theyuse assessments to determine supports for your kids.

Listen to the interview on Blogtalk radio.

Dr. Wilkinson is an award winningauthor. His work was honored with a gold medal in the 2011 NextGeneration Book Awards Education/Academy Category and finalist awards for the2011 National Association for Special Educational Needs(NASEN) Educational Needs/Academic Book of the Year and 2010 National BestBook Awards. He can be reached at http:bestpracticeautism.com

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

2012-01-15T18:02:00.000-05:00

One of the most widelyused observation instruments for the assessment of autism is the AutismDiagnostic 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 mayhave autism or other autism spectrum disorder (ASD), also referred to aspervasive developmental disorder (PDD). The goal of the ADOS is to provide ahierarchy of “presses” (social structures) that elicit behaviors instandardized contexts relevant to ASD.

Use of the ADOS requiresclinical training and practice in observation and scoring, as well asadministering the standard activities. Clinical experience related to ASD andskill in working with children is recommended. It should be noted that the ADOSclassification system does not assign a diagnosis. The ADOS has thresholds forsocial interaction, communication and communication-social interaction (total).An individual may reach the threshold on all three scales but not receive aclinical diagnosis of ASD, because of late presentation of difficulties or norestricted/repetitive behaviors or interests. The authors stress the importanceof using the ADOS in conjunction with a developmental history, corroboratinginformation from other sources, and the use of clinical judgment (Lord et al,2008).

Administration and Scoring

The ADOS is standardizedin terms of the materials used, the activities presented, the examiner’sintroduction of activities, the hierarchical sequence of social pressesprovided by the examiner, and the way behaviors are coded or scored. The ADOSconsists of four “modules,” each of which can be administered in 30-45 minutes.The appropriate module is selected and administered depending on theindividual’s verbal ability. Module 1 is used for children who are preverbal orhave single-word language. Module 2 is appropriate for individuals with phrasespeech abilities. Module 3 is used for children and adolescents who areverbally fluent. Verbally fluent adolescents and adults are assessed withModule 4. More than one module can be administered if the examiner determinesthat a more or less advanced module is appropriate. The manual provides guidelinesfor selecting the most appropriate module and general instructions foradministration and scoring and interpreting an individual’s results.

ADOS classifications arebased on specific coded behaviors that are included in a scoring algorithmusing the DSM-IV diagnostic criteria, resulting in a Communication score, aReciprocal Social Interaction score, and a Total score (a sum of theCommunication and Reciprocal Social Interactions scores). ADOS items regardingplay and stereotyped behaviors are also coded but are not included in thediagnostic algorithm due to the difficulty in accurately assessing thesecharacteristics in a limited period of time (Lord et al., 2008). Behaviors arecoded using a 0- to 3-point coding system, with a 0 indicating that the behavioris not abnormal in the way specified in the coding description, 2 indicating adefinite difference, and a 3 indicating that a behavior is abnormal andinterferes in some way with the child’s functioning. Scores are compared withan algorithm cut-off score for autism or the more broadly defined ASD in eachof these areas. If the child’s score meets or exceeds cut-offs in all threeareas, they are considered to meet criteria for that classification on themeasure. An ADOS autism classification requires meeting or exceeding each ofthe three thresholds (social, communication, social-communication total) forautism. If thresholds for autism are not met, an ADOS classification of ASD isappropriate 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).

Psychometric Properties

The psychometric data usedin the derivation of the diagnostic algorithms were obtained from individualsdiagnosed with autism, pervasive developmental disorder not otherwise specified(PDD-NOS), and non-spectrum disorders in order to maximize diagnosticagreement. Individuals with a diagnosis of Asperger’s Disorder were notincluded in the validation sample (Lord et al., 2008). The manual provides arange of sensitivity and specificity data across modules for Autism and ASD vs.non-spectrum disorders. The instrument has sensitivity in the upper 90% rangeand specificity in the upper 80% to lower 90% range (Lord et al., 2008). TheADOS was very effective in discriminating individuals with either autism or ASDfrom those with non-spectrum disorders, while differentiation of autism and ASDresulted in specificities of .68 to .79. Agreement between raters fordiagnostic 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. Thelower results were found for stereotyped behaviors and restricted interests inmodule 3. Test-retest reliability indicates excellent stability for the “SocialInteraction” and “Communication” domains, and for their combined total,together with good stability for the “Stereotyped Behaviors and RestrictedInterests” over an average period of nine months. In total, there seems to besignificant evidence for sensitivity and specificity for the ADOS indifferentiating children with autism and ASD from children with non-spectrumdisorders (Lord et al., 2001, 2008).

Research

Various studies haveexamined the effectiveness of ADOS as it is used in clinical practice. Forexample, Mazefsky and Oswald (2006) examined the diagnostic utility anddiscriminative ability of the ADOS using a clinical population of 75 childrenreferred to a specialty diagnostic clinic over a 3 year time span. Theyreported 77% agreement between ADOS classification and team diagnosis, withmost discrepancies being in autism versus ASD. The authors note that theirresults (lower sensitivity) likely reflect the participation of children whopresent for assessments in common clinical practice. In contrast, the symptompresentation of the children used in the original studies to develop thepsychometric properties of the ADOS included “prototypical” representations ofthe disorders and excluded those with questionable diagnoses. This suggeststhat clinical expertise and experience with children with ASD is an essentialsupplement to the ADOS and other assessment instruments for the less“‘clear-cut” cases often seen in typical practice.

A current study alsoinvestigated the diagnostic validity of the ADOS in a clinical sample (Molloy,Murray, Akers, Mitchell, & Manning-Courtney, 2011). ADOS classificationswere compared to final diagnoses given to 584 children referred for evaluationfor a possible ASD in a children’s medical center. Sensitivities were moderateto high on the algorithms, while specificities were substantially lower thanreported in the original ADOS validity sample. The authors concluded that thehigher number of false positives was likely attributable to the composition oftheir clinical sample which included many children with a broad range ofdevelopmental and behavioral disorders. The results of this study also suggestthat clinical populations for which the ADOS is regularly used may besubstantially different from the research samples on which it was normed. As aresult, it is especially important that the ADOS not be used as a “stand-alone”assessment so as to minimize misclassification in clinical settings where thereare children with many other developmental or behavioral disorders.

The role of the ADOS inthe assessment of ASD in school and community settings has received attentionas well. The perceived advantages and disadvantages of the ADOS were examinedvia a national survey of practicing school and clinical psychologists(Akshoomoff, Corsello, & Schmidt, 2006). Perceived advantages of the ADOSincluded its strength in capturing ASD-specific behaviors and the standardizedstructure provided for observation, while diagnostic discrimination andrequired resources were the most commonly identified disadvantages. Respondentslisting advantages of the ADOS indicated that it captured ASD behaviors, bothgenerally and specifically, and that it was a good measure for identifyingbehaviors that are difficult to observe or probe in other situations.Respondents indicated that a disadvantage of the ADOS is that it tends to overclassify other diagnostic groups as ASD and does not discriminate well withinASD subgroups. Of those that indicated resources as a disadvantage, nearly allindicated time of administration as a disadvantage.

Conclusion

The Autism DiagnosticObservation Schedule (ADOS) is one of the few standardized diagnostic measuresthat involves scoring direct observations of the child’s interactions andaccounts for the developmental level and age of the child. It has the mostempirical support among observation-based diagnostic assessment procedures forautism and is recommended in several best practice guidelines as an appropriatestandardized diagnostic observation tool (National Research Council, 2001;Wilkinson, 2010). The ADOS offers the practitioner a standardized observationof current social-communicative behavior with excellent interrater reliability,internal consistency and test–retest reliability on the item, domain andclassification levels for autism and non-spectrum disorders. Psychometricproperties reflect consistent differentiation of autism and ASD from non-spectrumindividuals, with less reliable differentiation of autism from ASD (Lord etal., 2001, 2008).

Practitioners shouldconsider the following points when using of the ADOS in clinical and schoolsettings.

1. It is important to distinguish between an ADOS classification and anoverall diagnosis of autism. The ADOS is intended to be but “one source” ofinformation used in making a diagnosis of ASD. Because coding is made from asingle observation, it does not include information about onset or early developmentalhistory. ADOS algorithms include items coding social behaviors andcommunication but do not offer an adequate opportunity to measure restrictedand repetitive behaviors (though such behaviors are coded if they occur). Thismeans that the ADOS alone cannot be used to make complete standard diagnoses.

2. Thegoal of the ADOS is to provide standardized contexts in which to observe thesocial-communicative behaviors of individuals across the life-span in order toassist in the diagnosis of autism and other ASD. It provides information onlyon current behavior and was not developed to measure changes over time.Therefore, the ADOS domain or total scores are not a good measure of responseto treatment or of developmental gains, especially in the later modules (Lordet al., 2008).

3. The usefulness of the ADOSis related to the examiner’s clinical skills and experience with theinstrument. Training and practice in administering the activities, scoring, andobservation is required. The ADOS should be administered by an experiencedclinician with appropriate training who can use both quantitative andqualitative information to form a clinical impression from the standardactivities.

4. Studies suggest thatclinical populations for which the ADOS is used may be substantially differentfrom the research samples on which it was normed. As the authors caution, theinstrument is not meant to be used as a “stand-alone” assessment. Supportinginformation from a developmental history, additional observational informationor a detailed parent interview are needed for a comprehensive diagnosis. Thisis especially important in any clinical and school settings where children withvarious other developmental or behavioral disorders are referred and evaluated.

5. Agreement between clinicaldiagnostic decisions and standardized diagnostic measures is difficult forchildren with less typical presentations than classic autism. As a result,diagnostic measures are likely to have difficulty with specificity andsensitivity for children with ASD who do not present with classic features ofautism. Further research on the ADOS is needed with children who have an ASDother than autism and with a broader range of children typically seen inclinical and school settings.

References

Akshoomoff, N, Corsello,C., & Schmidt, H. (2006). The role of the Autism Diagnostic ObservationSchedule in the assessment of autism spectrum disorders in school and communitysettings. 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). TheAutism Diagnostic Observation Schedule-Generic: A standard measure of socialand communication deficits associated with the spectrum of autism. Journal ofAutism and Developmental Disorders, 30, 205-223.

Lord, C., Rutter, M.,DiLavore, P. C., & Risi, S. (2008). Autism Diagnostic Observation ScheduleManual. Los Angeles: Western Psychological Services.

Mazefsky, C.A., &Oswald, D.P. (2006). The discriminative ability and diagnostic utility of theADOS-G, ADI-R, and GARS for children in a clinical Setting. Autism, 10, 533–49.

Molloy, C. A., Murray, D.S., Akers, R., Mitchell, T., & Manning-Courtney, P. (2011). Use of theAutism 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). Abest practice guide to assessment and intervention for autism and Aspergersyndrome in schools. London: Jessica Kingsley Publishers.

Autism Speaks: Top 10 Research Achievements of 2011

2012-01-03T13:10:00.000-05:00

Autism Speaks, the world's largest autismscience and advocacy organization, has released its annual list of the 10 mostsignificant science achievements to have impacted autism during the previousyear. Every year, Autism Speaks documents the progress made toward its missionto discover the causes and treatment for autism spectrum disorders (ASD), andidentifies the Top 10 Autism Research Achievements of the year. Autism Speaks’Top Ten list includes discoveries on how frequently autism recurs in families andthe extent to which “environmental,” or non-genetic, influences, increase therisk of autism in those who are genetically predisposed to this developmentaldisorder. These important results continue to shape the future of autismresearch for 2012 and beyond.

The 2011 list reflects the exponentialrate of discovery in autism research, supported by the joint commitment ofgovernment health agencies and private organizations such as Autism Speaks insupporting this vital work. With input from Autism Speaks' Scientific AdvisoryCommittee (SAC), Autism Speaks science staff culled through thousands ofpublications to arrive at these choices. “These outstanding scientific advancesare changing the way we think about autism and its causes,” said SAC member GaryGoldstein, M.D., president and chief executive officer of the Kennedy KriegerInstitute. “From the game-changing twin study to the emerging clues onenvironmental risk factors, these studies highlight the important role ofgene-environmental interactions in autism.”

“Not only has the research communitycontinued to make significant progress towards effective treatments, 2011offered some game-changing discoveries that help us understand underlyingcauses of ASD,” says our Chief Science Officer Geraldine Dawson, Ph.D. “Some ofthese discoveries will have direct and immediate impact on quality of life ofpeople with autism.”

Read the list at http://www.autismspeaks.org/science/science-news/top-ten-autism-research-achievements-2011

Free Preview: Award-Winning Book on Autism Spectrum Disorders in Schools

2011-12-19T17:37:00.001-05:00

A free preview of theaward-winning book A Best Practice Guide to Assessment and Intervention forAutism and Asperger Syndrome in schools is now available. Filling acritical void in the autism literature, this authoritative yet accessible bookprovides psychologists, educators, support professionals, advocates, andparents with a best practice guide to screening, assessment, and interventionfor school-age children with autism spectrum disorders (ASD). Grounded in thelatest research, special features include illustrative case examples and anindex to 50 evidence-based best practice recommendations. This book also makesan ideal text for graduate-level training courses in psychology and specialeducation, and is certain to become a widely used resource that will meet theneeds of both experienced practitioners and those new to the field.

Diane Adreon, AssociateDirector of the University of Miami-Nova Southeastern University Center forAutism and Related Disabilities (UM-NSU CARD) and co-author of Asperger Syndrome and Adolescence:Practical Solutions for School Success, comments that “Dr. Lee Wilkinsonhas produced a well-written, user-friendly, comprehensive guide to theassessment and intervention of students with ASD. School districtadministrators, attorneys, educators and psychologists will want to have thisguide available to them as a resource on ‘best practice’ in the field of ASD.”Diane Twachtman-Cullen, Editor-in-Chief of Autism Spectrum Quarterly,calls the book “a landmark contribution destined to become a classic in thefield of autism spectrum disorders (ASDs)” and writes, “Dr. Wilkinson has madean enormous contribution to the field by comprehensively and systematicallyilluminating not only what needs to be done, but also how to go about doingit.”

A Best Practice Guide was honored with a gold medal in the 2011 NextGeneration Book Awards Education/Academic Category and finalist awards for the2011 National Association for Special Educational Needs (NASEN) EducationalNeeds/Academic Book of the Year and 2010 National Best Book Awards. It isavailable in print and e-book editions.

The free preview isavailable at:

http://books.google.com/books?printsec=frontcover&id=cwyGUFkMFDoC#v=onepage&q&f=false

DSM-5: Rethinking Asperger's Disorder

2011-12-03T15:44:00.001-05:00

The American PsychiatricAssociation’s recommendation to delete (remove) Asperger’s disorder as aseparate diagnostic category from the fifth edition of the Diagnostic andStatistical Manual of Mental Disorders (DSM-5) has been widely publicized. Specifically, DSM-5 Work Group memberspropose a new category of “autism spectrum disorder,” which subsumesthe current diagnoses of autistic disorder (autism), Asperger’s disorder,childhood disintegrative disorder, and pervasive developmental disorder nototherwise specified (PDD-NOS). This new category reflects members’ conclusionthat “a single spectrum disorder” better describes our current understanding of the neurodevelopmentaldisorders.

An important feature ofthe proposed criteria for autism spectrum disorder (ASD) is a change fromthree (autistic triad) to two domains; “social/communication deficits” and“fixated and repetitive pattern of behaviors.” Several social/communicationcriteria were merged to clarify diagnostic requirements and reflect researchindicating that deficits in communication are “inseparable and more accuratelyconsidered as a single set of symptoms...” Work Group members commentedthat language deficits are neither universal in ASD, nor should they beconsidered as a defining feature of the diagnosis.

DSM-IV Criteria inPractice

Problems in applying thecurrent DSM criteria were a key consideration in the Work Group’s recommendationto delete Asperger’s disorder as a separate diagnostic entity. Numerous studiesindicate that it is difficult to reliably distinguish between Aspergersyndrome, autism, and other disorders on the spectrum in clinical practice (Attwood,2006; Macintosh & Dissanayake, 2006; Leekam, Libby, Wing, Gould &Gillberg, 2000; Mayes & Calhoun, 2003; Mayes, Calhoun, & Crites, 2001; Miller& Ozonoff, 2000; Ozonoff, Dawson, & McPartland, 2002; Witwer &Lecavalier, 2008). For example, children with autism who develop proficientlanguage have very similar trajectories and later outcomes as children withAsperger disorder (Bennett et al., 2008; Howlin, 2003; Szatmari et al., 2000)and the two are indistinguishable by school-age (Macintosh & Dissanayake,2004), adolescence (Eisenmajer, Prior, Leekam, Wing, Ong, Gould & Welham1998; Ozonoff, South and Miller 2000) and adulthood (Howlin, 2003). Individualswith Asperger disorder also typically meet the Communication criterion ofautism, “marked impairment in the ability to initiate or sustain a conversationwith others,” making it is possible for someone who meets the DSM-IV-TR criteriafor Asperger’s disorder to also meet the criteria for autistic disorder.

Treatment and Outcome

Another important considerin the DSM proposal was response to treatment. Intervention research cannotpredict, at the present time, which particular intervention approach works bestwith which individual. Likewise, data is not available on the differentialresponsiveness of children with Asperger’s disorder and high-functioning autism(HFA) to specific interventions (Carpenter, Soorya, & Halpern, 2009). Thereare no empirical studies demonstrating the need for different treatments ordifferent responses to the same treatment, and in clinical practice the sameinterventions are typically offered for both autism and Asperger’s disorder (Wilkinson,2010). Treatments for impairments in pragmatic (social) language andsocial skills are the same for both groups.

Application of the NewCriteria

It’s important to rememberthat in the DSM, a mental disorder is conceptualized as a clinically importantcollection of behavioral and psychological symptoms that causes an individualdistress, disability or impairment. The objective of the draft criteria is thatevery individual who has significant “impairment” in social-communication and restrictedand repetitive behavior or interests (RRBI) should meet the diagnostic criteriafor autism spectrum disorder. Language impairment/delay is not a necessary criterionfor diagnosis of ASD. Therefore anyone who demonstrates severe and sustainedimpairments in social skills and restricted, repetitive patterns of behavior,interests, or activities in the presence of generally age-appropriate languageacquisition and cognitive functioning, who might previously have been given adiagnosis of Asperger’s disorder, would now meet the criteria for the newcategory of ASD. The draft criteria would also feature dimensions of severitythat include current levels of language and intellectual functioning. Additionally,the Work Group intends to provide detailed symptom examples suitable for allages and language levels, so that ASD will not be overlooked in persons ofaverage or superior IQ who are experiencing “clinical” levels of difficulty.

Conclusion

In conclusion, the DSM-VWork Group members’ proposal of a new category, “autism spectrum disorder,”which subsumes the current diagnoses of autistic disorder, Asperger’s disorder,childhood disintegrative disorder, and pervasive developmental disorder nototherwise specified (PDD-NOS), better describes our current understanding aboutthe clinical presentation and course of the neurodevelopmental disorders. Conceptualizingautism as a spectrum condition rather than a categorical diagnostic entity is inkeeping with the extant research suggesting that there is no clear evidencethat Asperger’s disorder and high-functioning autism are different disorders. AsGillberg (2001) notes, the terms Asperger syndrome and high-functioning autismare more likely “synonyms” than labels for different disorders. Lord (2011)also comments that although there has been much controversy about whether thereshould be separate diagnoses, "Most of the research has suggested thatAsperger syndrome really isn't different from other autism spectrumdisorders." "The take-home message is that there really should bejust a general category of autism spectrum disorder, and then clinicians shouldbe able to describe a child's severity on these separate dimensions." Unfortunately,many individuals may have been advised (or assumed) that a diagnosis ofAsperger’s disorder was separate and distinct from Autistic disorder and thatintervention/treatment, course, and outcome were clinically different for eachdisorder. While including Asperger’s Disorder under the proposed category of“autism spectrum disorder” may well require a period of transition andadjustment, the proposed “dimensional” approach to diagnosis will likely resultin more effective identification, treatment, and research for individuals onthe spectrum.

The complete article andlist of references are available at <On the Road to DSM-5: Rethinking Asperger’s Disorder>

A more detailed summaryand discussion of the proposed draft revisions to DSM disorders and criteriaare available at <http://www.dsm5.org>

What's in a name? Autism or Asperger's

2011-11-10T18:51:00.001-05:00

To diagnose autismspectrum disorders (ASD), clinicians typically administer a variety of tests orscales and use information from observations and parent interviews to classifyindividuals into subcategories listed in standard psychiatric diagnostic manuals.This process of forming "best-estimate clinical diagnoses" has longbeen considered the gold standard, but a new study demonstrates that thesediagnoses are widely variable across centers, suggesting that this may not bethe best method for making diagnoses.

The study, A MultisiteStudy of the Clinical Diagnosis of Different Autism Spectrum Disorders, publishedon Nov. 7 in the journal Archives of General Psychiatry, adds to previousevidence that standardized diagnostic instruments accurately identifyindividuals who have autism. It is also consistent with recent skepticism aboutthe value of categorical groupings of autism spectrum disorders in standarddiagnostic manuals, such as the Diagnostic and Statistical Manual of MentalDisorders-IV-text revision (DSM-IV-TR) and the International StatisticalClassification of Diseases. According to the study’s lead investigator Dr.Catherine Lord, head of the Institute for Brain Development at Weill CornellMedical College and New York Presbyterian Hospital, “There has been a lot ofcontroversy about whether there should be separate diagnoses for autismspectrum disorder, especially Asperger syndrome," "Most of theresearch has suggested that Asperger syndrome really isn't different from otherautism spectrum disorders."

The study, fundedby the Simons Foundation and the National Institute of Mental Health, involved12 North American university-based centers. About 2,100 children and youthbetween ages four and 18, who were known to have an autism spectrum disorder,were given a specific diagnosis based on tests of communication, behavior andintelligence as well as psychologists' observations and discussions withparents. On average, diagnostic test scores were similar across all sites.However, the researchers found that diagnoses of specific categories of autismspectrum disorder varied dramatically from site to site across the country. Forexample, clinicians at one site gave participants only a diagnosis of autisticdisorder, while clinicians at other sites gave a diagnosis of autism to lessthan half of the participants. The proportion of individuals receiving adiagnosis of Asperger syndrome ranged from zero to nearly 21 percent acrosssites.

These findings areimportant both for parents and for organizations that provide services tochildren and youth with autism spectrum disorders, the researchers said. Accordingto Lord, parents should “not get too caught up in the difference between autism,PDD-NOS and Asperger's,” “The labels are pretty meaningless, because people areusing the same general terms as if they mean the same thing, when they reallydon’t,” “Because clinicians may not be using labels appropriately or diagnosingaccurately, they may not be getting a sense of children’s strengths andweaknesses and what therapy is best for them.” she said. “What's important is:How much trouble does your child have with language? How much is your childhyperactive as well as autistic? Are repetitive behaviors a major feature ofyour child's life?" Researchers also note that the findings support a movetoward a general diagnosis of autism spectrum disorder, rather than drawing theline between more specific disorders. AsLord concludes, “The take-home message is that there really should be just a generalcategory of autism spectrum disorder, and then clinicians should be able todescribe a child’s severity on these separate dimensions.”

SOURCE: bit.ly/spSpt2 Archives of General Psychiatry,online November 7, 2011

http://www.newswise.com/articles/diagnoses-of-autism-spectrum-disorders-vary-widely-across-clinics

Social Stories: An Emerging and Effective Intervention for Students with Autism Spectrum Disorders (ASD)

2011-10-16T20:23:00.000-04:00

Over the past decadesocial stories have shown promise as a positive and proactive classroomstrategy for teaching social skills to children with autism spectrum disorders(ASD). They continue to be widely discussed, reviewed, and recommended as aneffective and user-friendly behavioral intervention. Social stories allow thechild to receive direct instruction in learning the appropriate socialbehaviors that are needed for success in the classroom setting. The simplicityand utility of social stories make them a popular choice for use in bothgeneral and special education settings.

What is a Social Story?

A social story is a shortstory that is written in a child specific format describing a social situation,person, skill, experience, or concept in terms of relevant cues and appropriatesocial behavior. The objective of this intervention strategy is to enhance achild’s understanding of social situations and teach an appropriate behavioralresponse that can be practiced. Each story is designed to teach the child howto manage his or her own behavior during a specific social situation bydescribing where the activity will take place, when it will occur, what willhappen, who is involved, and why the child should behave in a certain way. Inessence, social stories seek to answer the who, what, when, where, and whyaspects of a social situation in order to improve the child’s perspectivetaking. Subsequent social interactions allow for the frequent practice of thedescribed behavioral response cue and the learning of new social behavior.Although a number of commercial publications offer generic social stories forcommon social situations, it is best to individualize the content of the storyaccording to the child’s unique behavioral needs.

Writing a Social Story

Social stories follow anexplicit format of approximately 5 to 10 sentences describing the social skill,the appropriate behavior, and others’ viewpoint (perspective) of the behavior.These sentences are written according to comprehension level of the child andinclude the following basic sentence types.

Descriptive sentenceswhich provide statements of fact and objectively define the “wh” question ofthe social situation.
Directive sentences thatdescribe the desired behavior and generally begin with “I will work on” or “Iwill try.”
Perspective sentenceswhich describe other individual’s reaction and feelings associated with thetarget situation.
Affirmative sentenceswhich stress a rule or directive in the story.
Control sentences thathelp the child to remember the directive.
Cooperative sentences thatdescribe who will help and how help will be given.

The social story should bewritten in a way that ensures accuracy of interpretation, using vocabulary andprint size appropriate for the child’s ability. Pictures illustrating theconcept can be included for children who have difficulty reading text withoutcues. They can be simple line drawings, clip art, books, or actual photographs.An example of a social story (text only) is provided at the end of thisarticle.

Implementing a SocialStory

Social stories should notbe used in isolation and are not intended to address all of the behavioralchallenges of the child with ASD. Rather, they should be integrated into thestudent’s IEP or behavior support plan on a daily basis to complement otherinterventions and strategies. When the social story is first implemented, theteacher must be certain that the child understands the story and social skillbeing taught. The child can then read the story independently, read it aloud toan adult, or listen as the adult reads the story. The most appropriate methodis dependent upon the individual abilities and needs of the child. Regardlessof how the story is implemented, it is necessary for comprehension of the storyto be assessed. Two approaches are recommended. The first is to have thestudent complete a checklist or answer questions in at the end of the story.The other is to have the student role play and demonstrate what he or she willdo the next time the situation occurs. Once comprehension has been assessed, adaily implementation schedule should be created. It should be noted that thereare no limitations on how long a student can use a social story. Some studentswill learn a new social behavior quickly while others will need to read theirstories for several weeks. A criticalfeature of implementing a social story is monitoring student progress andcollecting data to evaluate improved social outcomes. The following steps arerecommended when developing and implementing a social story intervention.

Identify the need forbehavioral intervention
Define the inappropriatebehavior.
Define an alternativepositive behavior.
Write the story using thesocial story format.
Include the social storyin the child’s behavior plan.
Implement the socialstory.
Practice the social skillused in the social story.
Evaluatecomprehension.
Remind the child where thesocial skill should be used.
Prompt the child to use thesocial skill at appropriate times during the day.
Affirm the child when theyuse the appropriate social behavior.
Monitor Progress.
Evaluateoutcome.

Effectiveness of SocialStories

As we know, there are nointerventions or treatments that can cure autism. In fact, there are very fewthat have been scientifically shown to produce significant, long-term benefitsfor children with ASD. Although the published research on social storiesprovides preliminary support for their effectiveness in reducing challengingbehavior and increasing social interaction for children with ASD, it isuncertain whether they alone are responsible for long-lasting changes in socialbehaviors. Other strategies (e.g., reinforcement schedules, social skillstraining) implemented together with social stories may be required to producedesired changes in social behavior. As a result, social stories should beincluded as part of a multicomponent intervention in the classroom setting.While further outcome research is needed, social stories may be considered anemerging and potentially effective approach for facilitating social skills inchildren with ASD.

Example of a Social Story

David, a second graderwith ASD, has a difficult time waiting to talk with his teacher, repeatedlyspeaks out of turn and interrupts other students. When told to wait, hefrequently experiences a “meltdown” and refuses to cooperate. His teacherdeveloped a social story called “Waiting My Turn to Talk.”

Waiting My Turn to Talk

At school I like to talkto the teacher and other students. (descriptive sentence)
Many times other studentswant to talk with the teacher too. (descriptive sentence)
Students cannot talk tothe teacher at the same time. (descriptive sentence)
I will wait my turn totalk (directive sentence )
When it is not my turn, Iwill try to listen to what others are saying and not interrupt.(directivesentence)
These are good rules tofollow (affirmative sentence)
The teacher will help meby calling my name when it is my turn to talk (cooperative sentence)
My teacher is happy when Iam a good listener and wait for my turn to talk. (perspective sentence)
The other kids will likeme when I wait my turn and don’t interrupt them. (perspective sentence)
I will try to remember tobe a good listener and wait for my turn to talk. (control sentence)

David’s ComprehensionQuestions

When should I talk to myteacher?
What should I do whenother students are talking?
Will my teacher and theother kids be happy if I wait my turn to talk?

Recommended Readings and Resources:

http://www.thegraycenter.org/

http://www.thegraycenter.org/social-stories

Crozier, S., & Sileo,N. M. (2005). Encouraging positive behavior with social stories: Anintervention for children with autism spectrum disorders. TEACHING ExceptionalChildren, 37, 26-31.

Gray, C. A. (2000).Writing social stories with Carol Gray [Videotape and workbook]. Arlington, TX:Future Horizons.

Gray, C. A. (2000). Thenew social story book. Arlington, TX: Future Horizons.

Gray, C. A. (2002). MySocial Stories Book. London: Jessica Kingsley Publishers.

Sansosti, F. J., &Powell-Smith, K. A. (2006). Using social stories to improve the social behaviorof children with Asperger syndrome. Journal of Positive Behavior Interventions,8(1), 43–57.

Spencer, V. G., Simpson,C. G., & Lynch, S. A. (2008). Using social stories to increase positivebehaviors for children with autism spectrum disorders. Intervention in Schooland Clinic, 44, 58-61.

How many doctors does it take to diagnose an autism spectrum disorder (ASD)?

2011-09-29T20:30:00.000-04:00

How many doctors does ittake to diagnose an autism spectrum disorder (ASD)? This is a question thatmany parents continue to ask in response to their frustration with thediagnostic process. For example, a survey of more than 1,200 families in theUnited Kingdom found that autism was diagnosed on average at 5.5 years andhigher functioning ASD such as Asperger syndrome at 11 years. Only 8 percent offamilies received a diagnosis for their children upon their first clinicalvisit; 40 percent received a diagnosis by the second clinical visit; and 63percent finally received a firm diagnosis by their third clinical visit. Inmany instances, parents waited more than 5 years before a diagnosis wasconfirmed (Howlin & Moore, 1997; Howlin & Asgharian, 1999).

A recent survey of parentsof school-age children with ASD across five countries (including the US) foundan average diagnosis age of 7.5 years for Asperger syndrome and a consistentconcern with the timeliness of identification and frustration with the delay inaccessing services. Parents reported visiting, on average, between four andfive clinicians en route to an ASD diagnosis. Some participants responded toour question with comments such as “too many to count.” The number ofprofessionals visited did not differ significantly based on child’s gender,race, or type of ASD diagnosis. Child diagnostic age was positively correlatedwith the number of professionals seen during the process of obtaining adiagnosis. In effect, the more professionals a child saw during the process,the older he or she was when finally receiving the diagnosis. Despite the factthat the diagnostic age is decreasing, just over 40 percent of parents reportedthat they were not satisfied with the diagnostic process. In fact, the more professionalsthat families saw on their journey to a diagnosis, the more negatively parentsviewed the experience. Parents were more satisfied with the diagnostic processwhen they saw fewer professionals to get the diagnosis and when the childrenreceived diagnoses at younger ages.

So, what are theimplications? A late diagnosis postpones the timely implementation ofintervention services and may contribute to parental distress in coping with anASD. It is well established that early interventions for children withdevelopmental disabilities are important in increasing cognitive, linguistic,social, and self-help skills. Assisting parents to develop effective managementtechniques is also likely to avoid or minimize the potential for secondarybehavioral and emotional problems. Importantly, because more capable childrenwith ASD are likely to be educated in general education classrooms, delayedrecognition of their problems can result in the implementation of ineffectiveor inappropriate teaching methods that fail to address the coresocial-communication deficits of ASD. Delays in diagnosis and identificationalso have wide implications for families. It is now accepted that autism ismost likely among the most heritable of all childhood disorders and that forany family with a child with ASD, there is considerable risk that otherchildren in the family may have social, language, or other neurocognitiveproblems. Family histories of autism or autistic-like behavior or having anolder sibling with autism are known risk factors. A delay in identification mayresult in siblings with the ‘broader phenotype’ being overlooked and as aresult, not receive the help needed to address their problems.

Although further researchis necessary to identify what additional factors make the diagnostic experiencea negative one for so many families, it is clear that better screening andidentification practices are needed. Parents are frequently faced with a slowand frustrating period of uncertainty and worry and find themselves in theposition of trying to convince their children’s doctors that there is a needfor a specialist assessment. Several studies that have qualitatively examinedparents’ views on the diagnostic process have noted a tendency for somephysicians to minimize or dismiss parents’ concerns about their children’sdevelopment and, instead, to encourage them to wait for their children to “outgrow” their problems. Although the average age at which autism is diagnosed hasdecreased in recent years, families have continued to describe a significantstruggle during the process of obtaining an autism diagnosis.

Unfortunately, manypediatricians, clinicians, and educators take a “wait-and-watch” approach andmay not recognize the early red flags. Although no two children are alike interms of their development and behavior, best practice requires that astandardized screening tool be administered at any point when concerns (redflags) about ASD are raised by a parent or teacher or as a result of schoolobservations or questions about developmentally appropriate social,communicative, and play behaviors, or where there is a family history of autismor related disabilities. Parents should also continue to be vigilant and keepan ongoing record of behavior that appears atypical or concerning. Thisinformation can be very useful in any future assessments.

Recommended Resources:

American Academy of Pediatrics. Understanding Autism Spectrum Disorders [pamphlet]

Autism Society of America

Center for Disease Control and Prevention (CDC)

First Signs

Life Journey through Autism: A Parent’s Guide to Assessment

National Institute of Child Health and Human Development Autism Site

Stone, W. L. (2006). Doesmy child have autism? A parent’s guide to early detection and intervention inautism spectrum disorders. San Francisco, CA: Jossey Bass.

Wilkinson, L. A. (2010). ABest Practice Guide to Assessment and Intervention for Autism and AspergerSyndrome in Schools. London: Jessica Kingsley Publishers.

Florida Association of School Psychologists (FASP): 38th Annual Conference

2011-09-21T16:20:00.000-04:00

Palm Beach County school psychologist,Lee A. Wilkinson, PhD, will present a skill-building workshop adapted from hisaward-winning book, Autism and Asperger Syndrome in Schools: A Best Practice Guide to Assessment andIntervention, at the 38th AnnualConference of the Florida Association of school Psychologists (FASP). TheConference will take place from November 1st through the 5th at the Omni OrlandoResort at ChampionsGate, 1500 Masters Blvd, ChampionsGate, Florida 33896. Breakoutsessions begin on Tuesday, November 1st thru Wednesday, November 2nd, with Featured Presentations to follow on Thursday, November 3rd. Continuingeducation credits (CEUs) will offered for Dr. Wilkinson’s workshop as well as anumber of other presentations. Join FASP for the BEST professionaldevelopment offering for school psychologists in Florida...Register Today!

http://www.fasp.org/Relations/FASP_Annual_Conference.html

For more information onthe author and his book, please visit http://bestpracticeautism.com

On the Radio: Author Discusses Award Winning Book

2011-09-15T20:27:00.000-04:00

Dr. Lee A. Wilkinson, PalmBeach County school psychologist and award winning author will discuss his book,“A Best Practice Guide to Assessment and Intervention for Autism and AspergerSyndrome in Schools,” on WJTW radio’s “Book Corner” with host Sharon Dunn airingFriday, September 16th through Sunday, September 18th at 8:20am, 2:20pm and5:20pm at 100.3 FM, or online at wjtwfm.com.Tune in to hear the Dr. Wilkinson discuss the prevalence of autism spectrumdisorders in our schools, educational planning for students with ASD, and practicaland useful resources for both parents and professionals.

Dr. Wilkinson is the author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, from Jessica Kingsley Publishers. His work was honored with a gold medal in the 2011 Next Generation Book Awards Education/Academic Category and finalist awards for the 2011 National Association for Special Educational Needs (NASEN) Educational Needs/Academic Book of the Year and 2010 National Best Book Awards.

Assessment Tools for ASD: Diagnostic Validity

2011-08-27T20:13:00.001-04:00

Diagnostic validity is an especially important psychometric characteristic to consider when evaluating the quality and usefulness of a test or screening instrument. It refers to an instrument’s accuracy in predicting group membership (e.g., ASD versus non-ASD). Diagnostic validity 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 screen 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 screen negative. A highly specific test means that there are few false positive results (individuals without a disorder who screen positive). False negatives decrease sensitivity, while false positives decrease specificity. An efficient assessment 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 that screened negative that are truly without the disorder. The higher the PPV and NPV values, the better the instrument at correctly identifying cases. It is important to recognize that PPV is determined by the sensitivity and specificity of the test and the prevalence of disorder in the population being tested. 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.

Practitioners should carefully review the psychometric properties of assessment tools and select those with high sensitivity and PPV values. For example, rating scales such as the Autism Spectrum Rating Scales (ASRS) and Social Communication Questionnaire (SCQ) have, on average, high sensitivity and PPV, while instruments such as the Gilliam Autism Rating Scale (GARS) underestimate the likelihood of children with autism being classified as having autism, indicating poor sensitivity.

Lecavalier L. (2005). An evaluation of the Gilliam Autism Rating Scale. Journal of Autism and Developmental Disorders, 35, 795-805.

Norris, M. & Lecavalier, L. (2010). Screening accuracy of level 2 autism spectrum disorder rating scales: A review of selected instruments. Autism, 14, 263-284.

Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.

Autism Advocacy Workshop

2011-08-25T15:30:00.000-04:00

Palm Beach County School District psychologist, Lee A. Wilkinson, PhD, will be present a workshop, Autism Spectrum in Schools: Assessment and Advocacy, at the fifth annual STatewide Advocacy Network on Disabilities (STAND) Pinellas Accessing Resources Conference (SPARC) on September 24th, in Largo, FL. The SPARC 2011 Conference brings together exhibitors from across the nation to showcase the best resources available to special education advocates. Professional educators, therapists, psychologists, and parents alike will have an opportunity to learn about resources beneficial to special needs students as well as all children. Attendees can choose from 60 different breakout sessions, browse more than 150 different exhibitors, earn credit toward professional license recertification, and meet representatives from state, regional and local organizations.

Dr. Wilkinson is the author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, from Jessica Kingsley Publishers. His work was honored with a gold medal in the 2011 Next Generation Book Awards Education/Academic Category and finalist awards for the 2011 National Association for Special Educational Needs (NASEN) Educational Needs/Academic Book of the Year and 2010 National Best Book Awards.

Best Practice Research: New Study Indicates High Recurrence Risk for Autism

2011-08-15T12:13:00.000-04:00

A recent research study suggests that nearly 1 in 5 children who have an older sibling with autism will also develop the disorder at a rate much higher than previously thought. Earlier estimates put the risk at between 3 and 10%, but a new study found a substantially higher risk rate of 18.7%, on average.

Researchers in the U.S., Canada and Israel followed 664 infants from 12 US and Canadian sites who had at least one older brother or sister with an autism spectrum disorder. Overall, 132 infants or approximately 19% received an autism diagnosis by their third birthday.

The highest rates were in infants who had at least two older siblings with autism – 32% also developed the disorder. Boys were nearly three times as likely to develop autism as girls, with a recurrence rate of 26.2% versus 9.1%.

The study’s lead author Sally Ozonoff, a psychiatry and behavioral sciences professor with the Mind Institute at the University of California at Davis, noted that 80% of siblings studied did not develop autism, and that the prevalence rate was an “average.” According to Ozonoff, “It’s important to recognize that these are estimates that are averaged across all of the families. So, for some families, the risk will be greater than 18 per cent, and for other families it would be less than 18 per cent.” “At the present time, unfortunately, we do not know how to estimate an individual family’s actual risk.”

The study has important implications for both parents and professionals. Families and primary care professionals should be especially observant with infants whose older siblings have been diagnosed with an autism spectrum disorder. Early identification and intervention are critically important to outcome. Ozonoff and her colleagues comment, “The red flags identified should be followed by immediate referral for infant intervention rather than adopting a 'wait-and-see' attitude because early specialized intervention is considered best practice for ASD and may represent the best hope for reducing symptoms and overall disability in high-risk infants who are developing ASD."

Reference:

Ozonoff S, et al. Recurrence risk for autism spectrum disorders: a baby siblings researchconsortium study. Pediatrics 2011; DOI: 10.1542/peds.2010-2825.

Best Practice Conference: STAND-Pinellas Accessing Resources Conference (SPARC)

2011-08-12T18:37:00.023-04:00

September 24th, 2011

Saturday, 8:00am - 4:30pm

Fitzgerald Middle School

6410 118th Ave N, Largo, FL

The fifth annual STatewide Advocacy Network on Disabilities (STAND) Pinellas Accessing Resources Conference (SPARC) brings together exhibitors from across the nation to showcase the best resources available to special education advocates. Professional educators, therapists, psychologists, counselors and parents alike will have an opportunity to learn about resources beneficial to special needs students as well as all children.

Choose from 60 different breakout sessions
Earn credit toward professional license sessions.
Browse more than 150 different exhibitors.
Earn credit toward professional license recertification.
Meet representatives from state, regional and local organizations to answer your questions.

Register online now!

http://www.standadvocates.org/sparkconferenceregistration20

Because every child deserves a voice!

Educationally and Legally Appropriate Programs for Students with ASD

2011-08-04T17:08:00.001-04:00

Since Congress added autism as a disability category to the Individuals with Disabilities Education Act (IDEA) in 1990, the number of students receiving special education services in this category has increased over 900 percent nationally. It’s critically important that educators understand the provisions for providing legally and educationally appropriate programs and services for students identified with ASD.

Research indicates that education is the most effective treatment/intervention for children with ASD. The most recent reauthorization of the Individuals with Disabilities Education Act (IDEA 2004) <http://idea.ed.gov/explore/home >entitles all students with disabilities to a free, appropriate public education (FAPE). 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.

Although clinical diagnoses, psychiatric reports, and treatment recommendations can be helpful in determining eligibility and educational planning, the provisions of IDEA are the controlling authority with regard to decisions for special education. While clinical information is professionally helpful, it is neither legally required nor sufficient for determining educational placement. Therefore, it’s especially important for administrators, parents, advocates, teachers and non-school professionals to keep in mind that when it comes to special education, it is state and federal education codes and regulations (not clinical criteria) that determine eligibility and IEP planning decisions. Legal and special education experts recommend the following guidelines to help school districts meet the requirements for providing legally and educationally appropriate programs and services to students with ASD.

1. 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.

2. School districts should make certain that comprehensive, individualized evaluations are completed by school professionals who have knowledge, experience, and expertise in ASD. If qualified personnel are not available, school districts should provide the appropriate training or retain the services of a consultant.

3. School districts should develop IEPs 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 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.

4. 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.

5. School districts should make every effort to place students in integrated settings to maximize interaction with non-disabled peers. Inclusion with typically developing students is important for a child with ASD as peers provide the best models for language and social skills. However, inclusive education alone is insufficient, evidence-based intervention and training is also necessary to address specific skill deficits. Although the least restrictive environment (LRE) provision of IDEA requires that efforts be made to educate students with special needs in less restrictive settings, IDEA also recognizes that some students may require a more comprehensive program to provide FAPE.

6. School districts should 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 individual child.

References and further reading:

Individuals with Disabilities Education Improvement Act of 2004. Pub. L. No. 108-446, 108th Congress, 2nd Session. (2004).

Mandlawitz, M. R. (2002). The impact of the legal system on educational programming for young children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 32, 495-508.

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-Reilly, J. (2003). How Well Does Your Child's IEP Measure Up? Quality Indicators for Effective Service Delivery. London: Jessica Kingsley Publishers.

Wilkinson, L. A. (2010). Best practice in special needs education. In L. A. Wilkinson, A best practice guide to assessment and intervention for autism and Asperger syndrome in schools (pp. 127-146). London: Jessica Kingsley Publishers.

Wrightslaw: Special Education Law, 2ndEdition (2007).

Yell, M. L., Katsiyannis, A, Drasgow, E, & Herbst, M. (2003). Developing legally correct and educationally appropriate programs for students with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 18, 182-191.

©Lee A. Wilkinson, PhD

Best Practice Book Review: Social Literacy: A Social Skills Seminar for Young Adults with ASDs, NLDs, and Social Anxiety

2011-07-22T10:35:00.006-04:00

Although there has been a significant increase in research and clinical studies related to children and with autism spectrum disorders (ASD), we have only recently begun to appreciate the complex challenges faced by adults who were not identified in childhood and are presently an underserved population. Social Literacy: A Social Skills Seminar for Young Adults with ASDs, NLDs, and Social Anxiety by Mary Riggs Cohen is a book and CD set that provide an evidence-based social skills curriculum for more capable young adults with social learning needs and life transition issues (e.g., college, work, interpersonal relationships).

The Social Skills Seminar incorporates the basic principles of cognitive behavioral therapy (CBT) with the overarching goal of developing social and communicative competency through direct teaching, modeling, coaching, role-playing, and practice activities. The book covers the background and structure for conducting a social skills training course over a 12-week period, meeting once each week for 3-hour class sessions. Beginning with an introduction, the author takes the reader through a discussion of the neurobiology of social learning disorders and the theoretical foundations of program design. Subsequent chapters include the selection, training, and use of social coaches, understanding of nonverbal communication, improving conversational skills, interpersonal relationships and dating, and employment issues and interviewing skills. A template is provided for each class and includes objectives, exercises, and applicable handouts. The final chapters describe efficacy studies of social skills training and practical applications. Perhaps the most impressive feature of the seminar is the use of social coaches to enhance generalization to real world situations by engaging participants in experiential opportunities. Each participant is assigned an individual coach who provides feedback and support during the 12-week course. Chapter 3 of the book provides a description of the social coach selection process, a critical step that takes place prior to initiation of the program with participants.

The accompanying CD-ROM contains PowerPoint slides that provide a sequential format to the instructional portion of the class. Photocopiable handouts used in the class lessons are also included. As noted in the text, social coaches are an integral part of the seminar. Slides for preparing social coaches are included on the CD and provide essential training on social learning disorders, outcome measures, curriculum topics, and coaching activities.

At present, there is a paucity of information about the educational and employment outcomes for more capable adults on the autism spectrum. This includes those in the general population who do not meet the threshold for a diagnosis but whose social problems impact their personal and social lives. However, it is clear that outcome depends to a large degree on the level and appropriateness of support provided to the individual. Social Literacy is the most comprehensive and evidence-based framework currently available for planning and executing a meaningful and effective social skills training program for young adults with social learning challenges. The program is designed to be flexible and can be adapted and modified to accommodate the specific needs of the participants. The publication of Social Literacy also provides an opportunity for researchers to investigate the effectiveness of social skills training in adult populations. I highly recommend this social learning course to professionals in private practice, secondary schools, colleges and universities, and community settings who work with young adults to help them navigate the social environment and achieve a successful transition to this stage of life.

Cohen, Mary Riggs (2011). Social literacy: A social skills seminar for young adults with ASDs, NLDs, and social anxiety. Baltimore, MD: Paul H. Brookes Publishing Co.

©lee A. Wilkinson

Best Practice Book Review: Does My Child Have Autism?

2011-07-17T16:20:00.000-04:00

Does My Child Have Autism? authored by Wendy Stone emphasizes the critical importance of early identification and intervention for young children with autism spectrum disorders (ASD). This comprehensive and accessible book provides much needed assistance to parents in identifying the early warning signs of autism, understanding the diagnostic process, and identifying scientifically validated interventions and treatments. The author also provides practical suggestions, activities, and teaching techniques that can be used to improve social, communication, and play skills at home. Frequently asked questions are included at the end of each chapter to address common issues and questions often asked by parents. An Appendix provides a listing of resources for further information. Although the author suggests that the book was written primarily for parents, clinicians, and educators, experienced autism professionals will find it to be a valuable resource as well. This book will also make a welcome addition to one's professional and lending library. Despite significant changes in the field of autism over the past several years, Does My Child Have Autism? continues to be an important text and one I highly recommend to both parents and professionals.

Stone, W. L. (2006). Does my child have autism: A parent’s guide to early detection and intervention in autism spectrum disorders. San Francisco, CA: Jossey-Bass.

©Lee A. Wilkinson

Autism: Disorder or Condition?

2011-07-13T19:03:00.002-04:00

Autism is variously viewed as a psychiatric disorder, mental disorder, and mental disability by the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association [APA], 1994) and International Classification of Diseases (World Health Organization, 1993). The requirements for all disorders in the DSM-IV are "evidence" of personal distress, functional impairment, or contribution to personal risk of loss. The boundary between normality (or typicality) and pathology is conceptualized as a “clinically” significant behavioral or psychological syndrome that occurs within an individual and is associated with a disability (or impairment in one or more areas of functioning). The clinician’s task in using the DSM classification system is to determine whether the problems presented by the individual can be reasonably conceptualized as a mental "disorder" within this context.

The pervasive developmental disorders (PDD) have traditionally been viewed as categorical rather than dimensional systems of classification (diagnoses). With a categorical or dichotomous scheme, disorders are either present or absent (e.g., an individual meets or does not meet criteria). For example, the DSM-IV-TR and ICD-10 list specific criteria for each disorder that must be met to receive a diagnostic classification. They both focus on a description of behavior rather than its function.

Researchers and practitioners now posit that autism falls on a continuum and that there is no clear distinction between “mild autism” and the boundaries of neurotypicality (or normalcy). In fact, we now recognize that autism-related traits are normally distributed throughout the general population and that autism is best conceptualized as a spectrum of severity. As Lorna Wing comments, “All of the features that characterize Asperger syndrome can be found in varying degrees in the normal population.” According to the extant literature, the accepted terminology is to use autism spectrum disorder or the acronym ASD as an umbrella term to describe individuals with Asperger’s Disorder (Syndrome), high-functioning autism (HFA), and PDD-NOS.

Nevertheless, experts such as Baron-Cohen (2008) contend that the term autism spectrum condition (ASC) is preferable to ASD as this term concurrently recognizes both the disabling aspects of autism and a profile of strengths (e.g., non-social skills). As with any “condition,” an autism spectrum condition may or may not be disabling. This includes groups of more successful individuals in the general population who present with sub-clinical (or sub-threshold) features of ASD. While individuals who have autistic traits certainly think and perceive differently than typical individuals, they may not be significantly impaired. An individual may demonstrate mild qualitative differences in social skills, yet not meet the clinical criteria for an autism-related condition such as high-functioning autism or Asperger’s disorder (syndrome). While a person’s social skills might be below average relative to his or her age group, these differences may not result in what might be considered to be a “global” disability or impairment. Moreover, there are individuals without a diagnosis who have marked difficulties, while others with a diagnosis have only mild problems. Despite the considerable variation in the profiles of individuals with autism, it is when these “differences” in social functioning lead to an impairment in adaptability (e.g., personal, occupational) and the need for clinical services, that we describe the individual as having a disorder. This includes the commonly co-occurring (or comorbid) disorders such as anxiety and depression.

So, we return to the question, Disorder or Condition? It would seem that the term “condition” is more compatible with the dimensional view of autism. It reflects the assumption that autistic traits exist on a continuum and that they are normally distributed throughout the general population (e.g., we all have some autistic traits). Using the term autism spectrum condition (ASC) also communicates a “value-free” or neutral perception as opposed to the negative impression associated with disorder or disability. Lastly, the term condition acknowledges that individuals with ASC may also possess positive traits, thus encouraging a strength-based perspective.

©Lee A. Wilkinson

Best Practice Research: Autism and Joint Attention

2011-06-28T14:27:00.000-04:00

Although there are no “absolute” clinical indicators of autism, some of the early “red flags” include: • Does not smile by the age of six months • Does not respond to his or her name • Does not cry • Does not babble or use gestures by 12 months and • Does not point to objects by 12 months. Children with autism typically experience delays in speech and communication skills. Not only will they often develop spoken language later, but they are less likely to develop non-verbal communication skills such as “joint attention,” pointing, or gesturing.

Children seek to share attention with others spontaneously during the first year of life. “Joint attention” is an early-developing social-communicative skill in which two people (usually a young child and an adult) use gestures and gaze to share attention with respect to interesting objects or events. Before infants have developed social cognition and language, they communicate and learn new information by following the gaze of others and by using their own eye contact and gestures to show or direct the attention of the people around them. Impairment in joint attention is considered an important “red flag” of autism.

Researchers in Melbourne Australia, working on a long-term study of 1900 eight month old children, found that those with autism used fewer gestures to communicate than other kids. Speech pathologist Carly Veness, who led the research, said there was a pattern of low gesture use among autistic children between the ages of eight months and two years. "We found that there was a decreased use of gestures like pointing, showing and giving,” she commented. Children who were diagnosed with autism by age seven were compared with others who had language and developmental problems as well as those who had typical communication skills. Examining the data over the seven-year period, researchers found that the children with autism produced fewer communicative gestures at age two compared to other children. Some of these children had also demonstrated problems with their hand gestures as early as eight months. Future research is needed to determine how well the low use of gestures is at predicting a diagnosis of autism and whether certain gestures differentiate typical children from those with the disorder.

http://news.theage.com.au/breaking-news-national/gestures-may-play-role-in-autism-diagnosis-20110626-1gl62.html

The Autism Bookshelf

2011-06-24T17:44:00.001-04:00

I’m pleased to announce the creation of a new Linkedin group, The AUTISM BOOKSHELF. The objective of this group is to advocate, educate, and inform by providing a selective, comprehensive, and objective review of books and articles dealing with autism spectrum disorders (ASD) that will meet members’ informational needs. This includes a guide to the books we think are most deserving of your attention, links to relevant sites, including book review and publishers' sites from around the world and our own recommended list of ASD “best practice” resources. This group also provides a forum to discuss up-to-date information on scientifically validated assessment and treatment options for children with ASD. Created to be a practical and useful resource, autism bookshelf offers essential information for psychologists, speech/language pathologists, teachers, counselors, advocates, attorneys, special education professionals, and parents. We hope you will join us in sharing publications, resources, and information that present evidence-based strategies and tools for assessing and supporting children with ASD, and for connecting and partnering with families and other autism professionals.

Please visit: http://www.linkedin.com/groups/Autism-Bookshelf-3793173?trk=myg_ugrp_ovr

Best Practice Book Review: Pivotal response treatments for autism: Communication, social, and academic development.

2011-06-24T15:02:00.001-04:00

This comprehensive text describes intervention strategies and outcome data related to Pivotal Response Treatments (PRT) for autism. The PRT approach focuses on normalizing child development for children with autism via a delivery model that uses both a developmental approach and applied behavior analysis (ABA). It has demonstrated empirical support in the literature. The chapters are well written and cover a range of topics related to interventions in the general education classroom, parent education programs, communication, social development, and strategies for addressing disruptive behavior. Case examples are also included. The chapter on combining functional assessment and self-management procedures to reduce disruptive behavior should appeal to school-based professionals such as school psychologists, special educators, and other support personnel. Overall, the text succeeds in describing an integrated and comprehensive approach to the treatment of autism. Those without experience or background in autism related research and practice might find some portions of the text to be a challenging read.

Koegel, R. L., & Koegel, L. K. (2006). Pivotal response treatments for autism: Communication, social, and academic development. Baltimore, MD: Paul H. Brookes Publishing.

Best Practice Autism: Read it on Kindle!

2011-06-20T16:17:00.000-04:00

“A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools” by Palm Beach school psychologist Dr. Lee A. Wilkinson is now available as an Amazon Kindle e-book.

This award-winning book provides a step-by-step guide to screening, assessment, and intervention for school-age children with autism spectrum disorders. Published by Jessica Kingsley Publishers Ltd, the leading international publisher of books focusing on the autism spectrum, this comprehensive resource combines the best of a user-friendly handbook and the depth of an academically oriented text book. With illustrative case studies, FAQs, quick reference boxes, best practice index, and glossary of terms, this concise and well researched guidebook will be widely used by psychologists, advocates, teachers, speech/language therapists, counselors, and parents.

Lee A. Wilkinson, EdD, PhD, NCSP is an author, behavioral scientist, and practitioner. Dr. Wilkinson is currently a school psychologist in the Palm Beach County, Florida public school system where he provides diagnostic and consultation services for children with autism spectrum disorders and their families. He has published widely on the topic of autism spectrum disorders.

“A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools” is available from Jessica Kingsley Publishers, ISBN: 978-1-84905-811-7 and can be ordered directly from the publisher at http://www.jkp.com/ and all major booksellers, including http://www.amazon.com/ and http://www.barnesandnoble.com/

Seizure Treatments for Children with Autism

2011-06-16T14:31:00.000-04:00

Although the association between autism and seizure disorder is not as yet firmly established, there appears to be a higher incidence of febrile seizures in children with autism compared to the general population. Although a majority of children will have only one febrile seizure in their lifetime, many children will progress to 'status epilepticus' (epilepsy). In fact, 15-20% of children with epilepsy have a history of a previous febrile seizure. Approximately 25 to 35 percent of people with autism will eventually experience full-scale seizures. Many others will have seizure-like brain activity, in which there is no obvious effect on muscles but potential effects on brain functioning, such as temporary loss of attention.

Until recently, little has been known about which traditional treatments for epileptic seizures and commonly used non-traditional alternative treatments are most effective for treating seizures or epilepsy specifically in children and adults with autism. A new study provides insight into which treatments are most beneficial in such cases. James Adams, a professor at Arizona State University conducted the research, together with Richard E. Frye, a physician specializing in child and behavioral neurology in the Department of Pediatrics at University of Texas-Houston. The complete study is published in the medical journal BMC Pediatrics.

The researchers surveyed 733 parents whose children with autism experience seizures, epilepsy and/or seizure-like brain activity. They asked parents to rate the effectiveness of 25 traditional and 20 non-traditional medical treatments for seizures. The survey also assessed the effects and side-effects of those treatments. Overall, antiepileptic drugs were reported by parents to reduce the occurrence and severity of seizures but worsened problems with sleep, communication, behavior, attention and mood. Non-antiepileptic drugs were perceived to improve other symptoms but did not reduce occurrence of seizures or make them less severe to the same extent as the anti-epileptic drugs. Four anti-epileptic drugs: valproic acid, lamotrigine, levetiracetam and ethosuximide were reported to most often reduce the number or lessen the severity of seizures, with little positive or negative effect on other symptoms of autism. Certain traditional non-anti-epileptic drug treatments, particularly the ketogenic diet, were perceived to both lessen the number and reduce the severity of seizures and other symptoms. The results of this study should provide physicians with a guide for more effectively managing the treatment of children experiencing seizures related to autism.

Article URL: http://www.medicalnewstoday.com/releases/227355.php

Toddlers At Risk For Autism

2011-06-14T11:37:00.000-04:00

Researchers and practitioners advise that children identified with autism begin intensive behavioral treatment and receive educational services as early as possible in order to achieve the best possible outcomes. There is clear evidence that the early initiation of services is associated with a greater response to intervention and positive changes in language, social, or cognitive outcomes. In fact, the American Academy of Pediatrics (AAP) recommends that all children be screened for autism at 18 and 24 months of age.

A new research study from the University of Utah suggests that a significant portion of at-risk children between 14-24 months can be identified through systematic screening by autism experts and providers working together. The study, published in Pediatrics, was designed to see whether a partnership between pediatricians and autism experts could identify at-risk children in a real-life, clinical setting. According to lead author, Judith S. Miller, Ph.D., formerly of the U Department of Psychiatry and now at the Children's Hospital of Philadelphia, "There has been limited research into how screening might occur in a real-life situation," "Our study demonstrated how collaboration between pediatricians and autism experts facilitates screening."

Miller and her colleagues used two widely accepted questionnaires to screen 796 toddlers between 14 and 24 months of age at a large medical practice. The questionnaires included a 23-item checklist for parents called the Modified Checklist for Autism in Toddlers (M-CHAT), and the Infant Toddler Checklist (ITC), a 24-item broad-based screener of language and communication. The questionnaires were completed by caregivers (typically parents) and pediatricians for each child during all types of patient visits (well-child, follow-up, sick visits, and immunizations).

Miller and her colleagues evaluated each questionnaire. If either the M-CHAT or ITC indicated a child had signs of ASD, the researchers then conducted a follow-up interview on the phone to verify the parent's responses. If the follow-up interview verified the potential signs of autism, the child was evaluated in person. Using both screening tests, 13 children were identified with early signs of ASD, 10 of who had not previously been evaluated for ASD.

The study not only showed that a partnership between autism experts and providers can identify at-risk children at a much younger age, but also provided immediate help to 10 toddlers who may have otherwise been overlooked and lost critical time for intervention. "It was great to help parents see their child's strengths as well as areas of concern, and to try to help them access intervention before the signs of ASD had become severe." Miller said. "I hope it leads to a better outcome."

J. S. Miller, T. Gabrielsen, M. Villalobos, R. Alleman, N. Wahmhoff, P. S. Carbone, B. Segura. The Each Child Study: Systematic Screening for Autism Spectrum Disorders in a Pediatric Setting. Pediatrics, 2011; DOI: 10.1542/peds.2010-0136

Article URL: http://www.medicalnewstoday.com/releases/227375.php

Continue reading on Examiner.com Toddlers At Risk For Autism - West Palm Beach Asperger & Education | Examiner.com http://www.examiner.com/asperger-education-in-west-palm-beach/toddlers-at-risk-for-autism#ixzz1PGTRck47

Best Practice Review: The Social Communication Questionnaire (SCQ)

2011-06-05T20:40:00.001-04:00

The Social Communication Questionnaire (SCQ; Rutter, Bailey, &Lord, 2003), previously known as the Autism Screening Questionnaire (ASQ), wasinitially designed as a companion screening measure for the Autism DiagnosticInterview-Revised (ADI-R; Rutter, Le Couteur & Lord). The SCQ is aparent/caregiver dimensional measure of ASD symptomatology appropriate forchildren of any chronological age older than fours years. It can be completedby the informant in less than 10 minutes. The primary standardization data wereobtained from a sample of 200 individuals who had participated in previousstudies of ASD. The SCQ is available in two forms, Lifetime and Current, eachwith 40 questions presented in a yes or no format. Scores on the questionnaireprovide an index of symptom severity and indicate the likelihood that a childhas an ASD. Questions include items in the reciprocal social interaction domain(e.g., “Does she/he have any particular friends or best friend?”), thecommunication domain (e.g., “Can you have a to and fro ‘conversation’ withhim/her that involves taking turns or building on what you have said?”) and therestricted, repetitive, and stereotyped patterns of behaviour domain (e.g., Hasshe/he ever seemed to be more interested in parts of a toy or an object [e.g.,spinning the wheels of a car], rather than using the object as intended?”).

Compared to other screening measures, the SCQ hasreceived significant scrutiny and has consistently demonstrated itseffectiveness in predicting ASD versus non-ASD status in multiple studies. Thescale has been found to have good discriminant validity and utility as anefficient screener for at-risk groups of school-age children. A threshold rawscore of >15 is recommended to minimize the risk of false negatives andindicate the need for a comprehensive evaluation. Comparing autism to otherdiagnoses (excluding mental retardation), this threshold score resulted in asensitivity value of .96 and a specificity value of .80 in a large populationof children with autism and other developmental disorders. The positivepredictive value was .93 with this cutoff. The authors recommend usingdifferent cut-off scores for different purposes and populations (e.g., acut-off of 22 when differentiating autism from other ASDs and a cut-off of 15when differentiating ASD from non-ASD). Several studies (Allen et al., 2007;Eaves et al, 2006) have suggested that a cut-off of 11 may be more clinicallyuseful (Norris & Lecavalier, 2010).

The SCQ is one of the most researched of theASD-specific evaluation tools and can be recommended for screening and as partof comprehensive developmental assessment for ASD (Norris &Lecavalier, 2010; Wilkinson, 2010, 2011). The SCQ is an efficient screeninginstrument for identifying children with possible ASD for a more in-depthassessment. For clinical purposes, practitioners might consider a multistageassessment beginning with the SCQ, followed by a comprehensive developmentalevaluation (Wilkinson, 2011). However, cut-off scores may need to be adjusteddepending on the population in which it is used. The evidence also indicatesthat although the SCQ is appropriate for a wide age range, it is less effectivewhen used with younger populations (e.g., children two to three years). It wasdesigned for individuals above the age of four years, and seems to perform bestwith individuals over seven years of age.

References:

Chandler, S., Charman, T., Baird, G., Simonoff, E.,Loucas, T., Meldrum, D., & Pickles, A. (2007). Validation of the SocialCommunication Questionnaire in a population cohort of children with autismspectrum disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1324–1332.

Mash, E. J., & Hunsley, J. (2005).Evidence-based assessment of child and adolescent disorders: Issues andchallenges. Journal of Clinical Child and Adolescent Psychology, 34,362-379.

Norris, M., & Lecavalier, L. (2010). Screeningaccuracy of level 2 autism spectrum disorder rating scales: A review ofselected instruments. Autism, 14, 263–284.

Rutter, M., Bailey, A.,& Lord, C. (2003). Social Communication Questionnaire. LosAngeles: Western Psychological Services.

Wilkinson, L. A. (2010). A best practice guideto assessment and intervention for autism and Asperger syndrome in schools.London: Jessica Kingsley Publishers.

Wilkinson, L. A. (2011). Identifying students withautism spectrum disorders: A review of selected screening tools. Communiqué, 40, pp.1, 31-33.

Meet Author and Psychologist Dr. Lee A. Wilkinson

2011-06-01T18:47:00.000-04:00

WHAT: Author talk and book-signing with Lee A. Wilkinson, PhD

WHEN: Thursday, June 23, 2011, 6:30 p.m.

Admission to Meet the Author is free and open to the public.

WHERE: West Boynton Branch of the Palm Beach County Library System 9451 Jog Road Boynton Beach, FL 33437 (561) 734-5556

Meet local author and school psychologist Lee A. Wilkinson June 23rd at the West Boynton Branch of the Palm Beach County Library System. Dr. Wilkinson will discuss his award winning book “A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools.” A book signing will follow. (60 min.) Preregister by calling 561-734-5556.

Written by a practicing school psychologist with extensive experience in the field of neurodevelopmental disorders, this authoritative, yet accessible book provides educators, support professionals, and parents with a best practice guide to screening, assessment, and intervention for school-age children with autism spectrum disorders.

Autism Spectrum Quarterly calls the book “a landmark contribution destined to become a classic in the field of autism spectrum disorders” and comments, “Dr. Wilkinson has made an enormous contribution to the field by comprehensively and systematically illuminating not only what needs to be done, but also how to go about doing it.”

The Journal of Autism and Developmental Disorders said of the book, "This book provides a complete source for parents, educators, researchers and clinicians seeking information related to assessment and interventions available for individuals (mostly children) diagnosed with Autism Spectrum Disorders (ASD). Parents will benefit from reading this book as it exposes variety of issues to consider when seeking assessment and treatment for their children."

Wilkinson’s book was named the Winner in the Education/Academic category of the 2011 Next Generation Indie Book Awards and honored as an Award-Winning Finalist in the Education/Academic category of the "Best Books 2010 Awards” sponsored by USA Book News.

Lee A. Wilkinson, PhD is an author, school psychologist and university educator with a practice and research interest in autism spectrum disorders (ASD). He resides in South Florida where his practice involves providing diagnostic and consultation services for children with autism spectrum disorders and their families. He is also a university educator and trainer, and teaches graduate courses in psychological assessment, clinical intervention, and developmental psychopathology. He has published widely on the topic of autism spectrum disorders.

For more information about the book and its author go to author's website: http://bestpractice.com.

A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools” is available from Jessica Kingsley Publishers, ISBN: 978-1-84905-811-7 and can be ordered directly from the publisher at http://www.jkp.com/ and all major booksellers, including http://www.amazon.com/ and http://www.barnesandnoble.com/.

Best Practice News: School Psychologist Wins Book Award

2011-05-13T18:35:00.000-04:00

West Palm Beach, FL: May 11, 2011

“A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools” by school psychologist Dr. Lee A. Wilkinson has been named a Winner in the Education/Academic category of the 2011 Next Generation Indie Book Awards. The Next Generation Indie Book Awards “was established to recognize and honor the most exceptional independently published books in 60 different categories, for the year, and is presented by Independent Book Publishing Professionals Group.” The winners and finalists will be highlighted in a special 2011 Next Generation Indie Book Awards catalog which will be distributed at Book Expo America ("BEA") in New York later this month to attendees including book buyers, library representatives, media, industry professionals, and others. Wilkinson’s book was also recently short-listed by the National Association for Special Educational Needs (NASEN) in the UK for their2011 Special Educational Needs Academic Book of the year award. Previously, “A Best Practice Guide…” was honored as an Award-Winning Finalist in the Education/Academic category of the "Best Books 2010 Awards” sponsored by USA Book News.

This authoritative, yet accessible book provides a step-by-step guide to screening, assessment, and intervention for school-age children with autism spectrum disorders. Published by Jessica Kingsley Publishers Ltd, the leading international publisher of books focusing on the autism spectrum, this comprehensive resource combines the best of a user-friendly handbook and the depth of an academically oriented text book. With illustrative case studies, FAQs, quick reference boxes, best practice index, and glossary of terms, this concise and well researched guidebook will be widely used by psychologists, advocates, teachers, speech/language therapists, counselors, and parents.

Diane Adreon, Associate Director of the University of Miami-Nova Southeastern University Center for Autism and Related Disabilities (UM-NSU CARD) and co-author of “Asperger Syndrome and Adolescence: Practical Solutions for School Success,” comments that “Dr. Lee Wilkinson has produced a well-written, user-friendly, comprehensive guide to the assessment and intervention of students with ASD. School district administrators, attorneys, educators and psychologists will want to have this guide available to them as a resource on ‘best practice’ in the field of ASD.”

Diane Twachtman-Cullen, Editor-in-Chief of Autism Spectrum Quarterly, calls the book “a landmark contribution destined to become a classic in the field of autism spectrum disorders (ASDs)” and writes, “Dr. Wilkinson has made an enormous contribution to the field by comprehensively and systematically illuminating not only what needs to be done, but also how to go about doing it.”

Lee A. Wilkinson, PhD, is an applied researcher, behavioral scientist, and practitioner. He is a nationally certified school psychologist, chartered psychologist, and certified cognitive-behavioral therapist. He is also a university educator and trainer, and teaches graduate courses in psychological assessment, clinical intervention, and developmental psychopathology. He has published widely on the topic of autism spectrum disorders.

“A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools” is available from Jessica Kingsley Publishers, ISBN: 978-1-84905-811-7 and can be ordered directly from the publisher at http://www.jkp.com/ and all major booksellers, including http://www.amazon.com/ and
http://www.barnesandnoble.com/.

Media Contact: Lee A. Wilkinson, PhD
Phone: (561) 686-2549
7708 Red River Road
West Palm Beach, Fl 33411
http://bestpracticeautism.com
http://www.indiebookawards.com
Review Copies and Interviews are Available.

# # #

Best Practice Autism Report: Complementary and Alternative Treatments

2011-04-30T15:33:00.000-04:00

Autism is a disorder with no known cause or cure. Parents and advocates of children with ASD will understandably pursue interventions and treatments that offer the possibility of helping the student, particularly if they are perceived as unlikely to have any adverse effects. Unfortunately, families are often exposed to unsubstantiated, pseudoscientific theories, and related clinical practices that are ineffective and compete with validated treatments, or that have the potential to result in physical, emotional, or financial harm. The time, effort, and financial resources spent on ineffective treatments can create an additional burden on families. Professionals and parents should use caution with treatments that (a) are based on overly simplified scientific theories; (b) make claims of recovery and/or cure; (c) use case reports or anecdotal data rather than scientific studies; (d) lack peer-reviewed references or deny the need for controlled research studies; or (e) are advertised to have no potential or reported adverse effects (Myers, Johnson et al., 2007). School professionals play an important role in helping parents and other caregivers to differentiate empirically validated treatment approaches from treatments that are unproven and potentially ineffective and/or harmful.

Often referred to as CAM, or complementary and alternative medicine, these treatments commonly lack scientific evidence supporting their safety or effectiveness in treating the symptoms of ASD. Although growing in popularity, CAM treatments such as elimination diets, dietary supplements, and biological agents can have negative side effects and are not generally supported by scientific research. Several nutritional interventions are widely used by parents, most notably restriction of food allergens (e.g., yeast-free diet, gluten-and casin-free (GF-CF) diet) and dietary supplements such as vitamins (e.g., A, C, B-6 and magnesium, fatty acids, and DMG). There is a lack of objective scientific evidence to indicate that these CAM therapies improve the symptoms of ASD (Myers, Johnson, et al., 2007; Ozonoff et al., 2002; Stone, 2006, Baron-Cohen, 2008). Because CAM therapies have not been adequately evaluated, evidence-based recommendations for their use are not feasible (Myers, Johnson, et al., 2007).

Questions to Ask About ASD Treatments:

1. Is there reliable evidence to support the effectiveness of the intervention?

2. Has it been scientifically validated?

3. What is the rationale or underlying purpose of the intervention or treatment?

4. Does the intervention/treatment focus on one particular aspect or is it a general comprehensive approach?

5. Is there excessive media publicity surrounding the intervention or treatment?

6. How successful has the intervention been for children in the general classroom?

7. How will the treatment/intervention be integrated into the child’s educational program?

8. Is there a risk that the treatment will result in harm to the child?

9. What assessment procedures are involved?

10. Do school personnel have experience with the intervention? What training is required?

Best Practice Review: The Social Responsiveness Scale (SRS)

2011-04-27T19:26:00.000-04:00

The Social Responsive Scale (SRS; Constantino & Gruber, 2005) is abrief quantitative measure of autistic behaviors in 4 to 18 year old childrenand 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 anddevelopmental history. The SRS can be completed in approximately 15 minutes andfocuses on the child’s reciprocal social interactions, a core impairment in allpervasive developmental disorders. Standardization is based on a sample of1,636 children drawn from the general population.

The SRS items measure the ASD symptoms in the domains ofsocial awareness, social information processing, reciprocal socialcommunication, social anxiety/avoidance, and stereotypic behavior/restrictedinterests. Each item is scored from 1 (not true) to 4 (almost alwaystrue). Scores are obtained for five treatment subscales: Social Awareness(e.g., “Is aware of what others are thinking or feeling”), Social Cognition(e.g., Doesn’t recognize when others are trying to take advantage of him orher”), Social Communication (e.g., Avoids eye contact or has unusual eyecontact”), Social Motivation (e.g., “Would rather be alone than with others”),and Autistic Mannerisms (e.g., Has an unusually narrow range ofinterests”).

Interpretation is based on a single score reflecting the sumof responses to all 65 SRS questions. Raw scores are converted to T-scores(with mean of 50 and standard deviation of 10) for gender and rater type. Atotal T-score of 76 or higher is considered severe and strongly associated witha clinical diagnosis of autistic disorder. A T-score of 60 through 75 isinterpreted as falling in the mild to moderate range and considered typical forchildren with mild or “high functioning” ASD, while a T-score of 59 or lesssuggests an absence of ASD symptoms. A total raw score of > 75 wasassociated with a sensitivity value of .85 and specificity value of .75 for ASD(Autistic Disorder, Asperger’s Disorder, or PDD-NOS). The AUC was .85 forrecommended screening and clinical cutoff scores and indicates good overalldiscrimination. In school settings, raw scores at or above 85 from two separateinformants provides very strong evidence of ASD. More impressive values have been noted whenusing lower parent or teacher scores. For example, T-scores of > 60 from both parent and teacher havebeen shown to result in a 96.8% likelihoodof a clinically identified ASD diagnosis (Constantino et al., 2003, 2007).

The SRS is an efficient tool for capturing the more subtleaspects of social impairment associated with ASD (e.g., PDD-NOS) and reflectsthe level of severity across the autism spectrum. The scale demonstrates strongreliability across informants, acceptable internal consistency, and correlateshighly with the Autism Diagnostic Interview-Revised (ADI-R). Brief,quantitative, and based on naturalistic observations of parents and teachers,the SRS can be used as an effective screener in clinical or educationalsettings, an aid to clinical diagnosis, or a measure of response tointervention (Wilkinson, 2010, 2011). The SRS compares favorably to moretime-intensive measures and can help school and clinical psychologists identifythe type of social impairment characteristic of autism spectrum disorders (ASD)in children as young as 4 years of age and guide development ofintervention/treatment programs. Of course, the results of questionnairemeasures should not replace clinical assessment and must be integrated withinformation from different sources. The SRS should be used within the contextof a comprehensive evaluation, including developmental history and assessmentof intellectual, language, and adaptive behavior functioning (Wilkinson, 2010).Further research is needed to assess how the SRS performs when differentiating childrenwith ASD from other childhood disorders (e.g., ADHD) and those withintellectual disability.

References:

Chandler, S., Charman, T., Baird, G., Simonoff, E., Loucas,T., Meldrum, D., & Pickles, A. (2007). Validation of the SocialCommunication Questionnaire in a population cohort of children with autismspectrum disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 1324–1332.

Constantino et al. (2003). Validation of a brief measure of autistic traits: Comparison of thesocial responsiveness scale with the autism diagnostic interview-revised.Journal of Autism and Developmental Disorders, 33, 427-433.

Constantino, J. N., & Gruber, C. P. (2005). SocialResponsiveness Scale. Los Angeles: Western Psychological Services.

Constantino et al. (2007). Rapid quantitative assessment ofautistic social impairment by classroom teachers. Journal of the AmericanAcademy of Child and Adolescent Psychiatry, 46, 1668-1676.

Mash, E. J., & Hunsley, J. (2005). Evidence-basedassessment of child and adolescent disorders: Issues and challenges. Journal ofClinical Child and Adolescent Psychology, 34, 362-379.

Norris, M., & Lecavalier, L. (2010). Screening accuracyof level 2 autism spectrum disorder rating scales: A review of selectedinstruments. Autism, 14, 263–284.

Wilkinson, L. A. (2010). A best practice guide to assessmentand intervention for autism and Asperger syndrome in schools. London: JessicaKingsley Publishers.

Wilkinson, L. A. (2011). Identifying students with autismspectrum disorders: A review of selected screening tools. Communiqué, 40, pp.1, 31-33.

New ASHA Approved Online Continuing Education Course

2011-04-11T18:58:00.001-04:00

This new 3-hour online continuing education course, Autism Spectrum Disorders in Schools: Evidence-Based Screening & Assessment, is now ASHA-approved and available for credit by Speech-Language Pathologists and Audiologists.

Please visit:

http://pdresources.wordpress.com/2011/04/11/asd in-schools-is-now-asha-approved/

Best Practice Report: Evidence-Based Interventions/Treatments

2011-04-10T19:03:00.002-04:00

Supporting children with ASD requires individualized and effective intervention strategies. With few exceptions, the evidence base for interventions for students with ASD is in the formative stage. Robust, impartial research is needed to determine which interventions are most effective and with which students. While children with ASD share a number of similar behavioral and other characteristics, every child is unique. Intervention approaches must be sensitive to their uniqueness and individuality. The following effectiveness ratings for selected interventions and treatments should be considered a “snapshot” in time and are intended to reflect the scientific evidence published in peer-reviewed journals. Each intervention is rated for effectiveness, both positive and negative, providing a classification which identifies the level of scientific evidence which supports or does not support its use. For example, interventions that are “well established” have strong empirical support in the scientific literature. Interventions having an “emerging and effective” level of support are considered promising and have become or are emerging as important features of many programs. However, they require additional objective verification. Those with a lack of empirical data (no evidence) do not infer that the intervention or treatment is ineffective, but rather that efficacy has not been objectively demonstrated or validated. Lastly, those rated as having “negative evidence,” may cause harm and are not recommended for use.

Well Established:

Early Intensive Behavioral Intervention (EIBI)

Effective Evidence:

Positive Behavior Support (PBS)

Picture Exchange Communication System (PECS)

Cognitive Behavioral Therapy (CBT)

Peer-Mediated Strategies

Emerging and Effective Evidence:

Social Stories

TEACCH

Visual Schedule/Support

Incidental Teaching

Pivotal Response Training (PRT)

Social Skills Training

No Evidence:

Sensory Integration Therapy (SI)

Negative Evidence/Not Recommended:

Auditory Integration Training (AIT)

Facilitated Communication (FC)

It is important to note that there is considerable overlap between the many different treatment approaches. For example, strategies based on applied behavioral analysis (ABA) are an integral part of many interventions, such as early intensive behavioral intervention (EIBI), picture exchange communication system (PECS), and pivotal response treatment (PRT). The success of the intervention depends on the interaction between the age of the child, his or her developmental level and individual characteristics, the strength of the treatment and competency of the interventionalist. These ratings are not intended as an endorsement or a recommendation as to whether or not a specific intervention is suitable for a particular child with ASD. Each child is different and what works for one may not work for another. Different approaches to intervention have been found to be effective for children with autism, and no comparative research has been conducted that demonstrates one approach is superior to another. The selection of a specific intervention should be based on goals developed from a comprehensive assessment. A description of the aforementioned interventions and treatments are available from Wilkinson (2010). A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools.

Special Educational Needs Book Awards

2011-04-07T17:43:00.000-04:00

“A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools” has been short-listed by the National Association for Special Educational Needs (NASEN) for their 2011 Special Educational Needs Academic Book of the year award. The awards are widely recognized as representing excellence and best practice in books and resources for special educational needs. They will be presented to the winners in each category at an informal ceremony to be held at NASEN Live 2011 at the Reebok Stadium, Bolton, Lancashire, UK on Tuesday 24th May 2011. NASEN is the leading organization in the UK which aims to promote the education, training, advancement and development of all those with special and additional support needs. Please visit the NASEN website for further details about the awards.

Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.

PediaStaff Resources - Book Review: A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools - featured March 23, 2011

2011-04-02T16:58:00.000-04:00

PediaStaff Resources - Book Review: A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools - featured March 23, 2011

Autism Awareness Month: Recognize the Signs

2011-04-02T10:11:00.000-04:00

April has been designated national Autism Awareness Month and provides a special opportunity for individuals across our country to educate and raise awareness in their neighborhoods, workplaces, schools and local communities. Recent studies indicate that rates for both autism spectrum disorders (ASD) and autistic disorder are 3 to 4 times higher than 30 years ago. The pervasive developmental disorder (PDD) category, also commonly referred to as ASD, represents one of the fastest growing disability categories in the world. In the United States, ASD is more prevalent in the pediatric population than cancer, diabetes, spina bifida, and Down syndrome. The U.S. Centers for Disease Control now estimates that 1 in 110 8-year-old children have an autism spectrum disorder. In fact, prevalence and incidence figures suggest that over 1.5 million Americans are affected by autism.

Research indicates that the outcomes for children with ASD can be significantly improved by early identification and intensive intervention. It is critically important to identify those children who are at-risk in order to reduce the time between symptom appearance and formal diagnosis and treatment. An important goal of Autism Awareness is to alert new parents and others of the early behavioral signs of autism. The signs and symptoms typically appear during the first three years of life and relate to language, social behavior, and behaviors concerning objects and routines. "Red flags" or key warning signs of autism include:

Does not smile by the age of six months
• Does not respond to his name
• Does not cry
• Does not babble or use gestures by 12 months
• Does not point to objects by 12 months
• Does not use words by 16 months
• Does not use two-word phrases by 24 months
• Regresses after mastering skills/loses previously mastered skills
• Delays in milestones like crawling and walking.

Children with ASD (but not always) experience delays in speech and communication skills. Not only will they often develop spoken language later, but they are less likely to develop non-verbal communication skills such as pointing, joint attention, or gesturing. I always recommend that a standardized screening tool be administered at any point when concerns about ASD are raised by a parent or teacher or as a result of school observations or questions about developmentally appropriate social, communicative, play behaviors, or where there is a family history of autism or related disabilities. Because ASDs continue to grow at such a dramatic rate, it is an issue that deserves our attention not only in April, but throughout the year.

Intellectual Functioning in ASD

2011-03-30T18:01:00.001-04:00

A critical domain of a core assessment battery for ASD is intellectual or cognitive functioning. Establishing the level of cognitive ability is important for both classification and intervention planning purposes. For example, the level of intellectual functioning is associated with the severity of autistic symptoms, skill acquisition and learning ability, and level of adaptive functioning, and is one of the best predictors of long-term outcome (Harris & Handleman, 2000; Stevens et al., 2000; Venter, Lord, & Schopler, 1992). Because the IQs of children with ASD have the same properties as those obtained by other children age 5 years and older, they are reasonable predictors of future educational performance and (Klinger, O’Kelley, & Mussey, 2009; Sattler & Hoge, 2006). Thus, an appropriate measure of IQ is considered to be an essential component of the core assessment battery.

The primary goal of conducting an intellectual evaluation includes establishing a profile of the child's cognitive strengths and weaknesses in order to facilitate educational planning and to help determine the presence of any cognitive limitations. Assessment of cognitive strengths and weaknesses is particularly important because of the characteristically uneven profile of skills demonstrated by children with ASD. It is important that the individual test chosen (a) be appropriate for both the chronological and the mental age of the child, (b) provides a full range of standard scores, and (c) measures both verbal and nonverbal skills (Filipek et al., 1999). Of course, the use of any single score to describe the intellectual abilities of a child with ASD is clearly inappropriate and should never be used for diagnostic confirmation or differential diagnosis of ASD. It also needs to be emphasized that there are no specific cognitive profiles that can “reliably” differentiate children with ASD from children with other disorders (Klinger et al., 2009; Sattler & Hoge, 2006; Volkmar et al., 1999). However, when a specific intellectual profile is evident, this can have an important implication for how the child learns best and what intervention activities may be most effective.

A detailed description and application of a core assessment battery can be found in Wilkinson, L. A. (2010). “A best practice guide to assessment and intervention for autism and Asperger syndrome in schools.”

Best Practice Review: The Gilliam Autism Rating Scale: Second Edition (GARS-2)

2011-03-16T18:50:00.002-04:00

The GARS-2 is a revision of the widely used Gilliam Autism Rating Scale (1995). It was designed to assist psychologists, teachers, parents, and clinicians in identifying and diagnosing autism in individuals aged 3 through 22 and in estimating the severity of the disorder. The GARS-2 can be individually administered in 5 to 10 minutes and consists of 42 items describing the characteristic behaviors of persons with autism. The items are grouped into three subscales based on two definitions of autism, one from the Autism Society of America and the other from the diagnostic criteria for autistic disorder published in the DSM-IV-TR (American Psychiatric Association, 2000):

Stereotyped Behaviors
Communication
Social Interaction

The subscale standard scores are summed to produce an Autism Index (mean = 100, SD = 15). Higher standard scores and Autism Indices are indicative of more problematic behavior. Scoring also includes a Probability of Autism classification (Very Likely, Possibly, Unlikely).

According to the test manual, the second edition reflects several positive changes such as: (a) updated, more clearly described norms; (b) rewriting of some items and the scoring guidelines to improve clarity; and (c) a section that provides specific item definitions and examples for applied behavior analysis and research projects. New to the second edition is a structured interview form for gathering diagnostically important information from the child's parents that replaces the Early Development subscale found in the original version. The GARS-2 was normed on a representative sample of 1,107 persons with autism from 48 states within the United States. Demographic characteristics of the normative sample are keyed to the 2000 U.S. Census data. Few changes were made to GARS test items in developing the GARS-2. The difference between versions exists mostly on the fourth subscale, labeled ‘Developmental Disturbance’ on the GARS and ‘Parent Interview’ on the GARS-2.

Independent studies on the first version of the instrument have indicated less than optimal psychometric properties. For example, research examining the validity of the GARS (1995) consistently found that the scale underestimated the likelihood of children with autism being classified as having autism, indicating low sensitivity, with values ranging from .38 to .53 (Norris and Lecavalier, 2010). Sensitivity is the percentage of true cases correctly identified by a screen; a sensitivity value of .80 is the accepted standard.

A recent study of the validity of the GARS-2 three subscales did not support the subscale structure (Pandolfi, Magyar, & Dill, 2010). The findings suggest that the clinical utility of the scales is limited by factors related to item content and test development procedures and that the Autism Index be interpreted with caution. The Probability of Autism classification also lacks a sound empirical basis and may be subject to misinterpretation. A previous review also notes that although the names of the subscales correspond to the main DSM-IV criteria for Autistic Disorder, the items do not correspond entirely to the behavioral characteristics listed under these criteria or to the traits listed on the website of the Autism Society of America (Garro, 2006).

There are also questions regarding the normative sample (Norris & Lecavalier, 2010). Group membership was determined via caregiver report of diagnosis and/or school classification. A number of participants (27%) were recruited from the Asperger Syndrome Information and Support website, suggesting that a portion of the sample may have included individuals with other pervasive developmental disorders (PDD/ASD). Although the sample participants should have been diagnosed with autism, there is no information about the specific diagnostic criteria that were in fact used. Diagnosis of participants was not confirmed by the ADI-R, ADOS, or a clinical evaluation. Although the norms are not based upon age, the underrepresentation of older children and young adults also suggests that practitioners need to use caution when using the instrument with individuals from these age groups (Garro, 2006). From a more positive perspective, there is some preliminary support for the validity of the broad-based Autism Index. The content of the GARS-2 also reflects a number of behavioral characteristics that apply to individuals with ASD and may help guide the user in understanding the “autistic triad.” The manual also includes several cautions for the interpretation of results.

According to the manual, the GARS-2 should be administered by professionals who have training and experience in working with individuals with autism such as school psychologists, educational diagnosticians, and autism specialists. Practitioners who are currently using or considering using the GARS/GARS-2 for making an autism diagnosis or assessing symptom severity should exercise caution due to significant weaknesses, including the underidentification of higher‐functioning ASD and questions concerning standardization and norming procedures. Although the GARS-2 may have utility as a general screening or supplementary tool for ASD, it is not recommended it for inclusion as the primary phenotypic instrument in a comprehensive developmental assessment battery for autism (Norris & Lecavalier, 2010; Wilkinson, 2010).

Garro, A. (2006). Review of the Gilliam Autism Rating Scale-Second Edition. Seventeenth mental measurements yearbook with Tests in Print, Buros Institute of Mental Measurement. Lincoln: University of Nebraska Press.

Gilliam, J. (2006). GARS-2: Gilliam Autism Rating Scale-Second Edition. Austin, TX: PRO-ED.

Lecavalier L. (2005). An evaluation of the Gilliam Autism Rating Scale. Journal of Autism and Developmental Disorders, 35, 795-805.

Norris, M., & Lecavalier, L. (2010). Screening accuracy of level 2 autism spectrum disorder rating scales: A review of selected instruments. Autism, 14, 263-284.

Pandolfi V., Magyar C. I., & Dill C. A. (2010). Constructs assessed by the GARS-2: factor analysis of data from the standardization sample. Journal of Autism & Developmental Disorders, 40, 1118-30.

Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.

Update: Proposed Changes in Criteria for Asperger syndrome

2011-03-07T21:00:00.001-05:00

The American Psychiatric Association has updated the proposed draft diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Work Group members have proposed a new category of “autism spectrum disorder,” which incorporates the current diagnoses of autistic disorder (autism), Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS). This category reflects members’ conclusion that “a single spectrum disorder” better describes our current understanding about pathology and clinical presentation of the pervasive developmental disorders. The “autistic triad” will now become two:

1) Social/communication deficits

2) Fixated interests and repetitive behaviors

The proposed criteria for Autism Spectrum Disorder are:

Must meet criteria 1, 2, and 3:

1. Clinically significant, persistent deficits in social communication and interactions, as manifest by ALL of the following:

a. Marked deficits in nonverbal and verbal communication used for social interaction:

b. Lack of social reciprocity;

c. Failure to develop and maintain peer relationships appropriate to developmental level

2. Restricted, repetitive patterns of behavior, interests, and activities, as manifested by at least TWO of the following:

a. Stereotyped motor or verbal behaviors, or unusual sensory behaviors

b. Excessive adherence to routines and ritualized patterns of behavior

c. Restricted, fixated interests

3. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)

The rationale for this proposal includes the following.

Differentiation of autism spectrum disorder from typical development and other "nonspectrum" disorders is done reliably and with validity; while distinctions among disorders have been found to be inconsistent over time, variable across sites and often associated with severity, language level or intelligence rather than features of the disorder.
Deficits in communication and social behaviors are inseparable and more accurately considered as a single set of symptoms with contextual and environmental specificities
Delays in language are not unique nor universal in ASD and are more accurately considered as a factor that influences the clinical symptoms of ASD, rather than defining the ASD diagnosis
Requiring both criteria to be completely fulfilled improves specificity of diagnosis without impairing sensitivity
Providing examples for subdomains for a range of chronological ages and language levels increases sensitivity across severity levels from mild to more severe, while maintaining specificity with just two domains
Requiring two symptom manifestations for repetitive behavior and fixated interests improves specificity of the criterion without significant decrements in sensitivity.
Unusual sensory behaviors are explicitly included within a sudomain of stereotyped motor and verbal behaviors, expanding the specification of different behaviors that can be coded within this domain, with examples particularly relevant for younger children.
The presence, via clinical observation and caregiver report, of a history of fixated interests, routines or rituals and repetitive behaviors considerably increases the stability of autism spectrum diagnoses over time and the differentiation between ASD and other disorders.
Reorganization of subdomains increases clarity and continues to provide adequate sensitivity while improving specificity through provision of examples from different age ranges and language levels.

Autism Spectrum Disorders Continuing Education: Earn 3 CEU Credits Online!

2011-02-01T19:15:00.004-05:00

A new online continuingeducation course, Autism Spectrum Disorders in Schools: Evidence-BasedScreening and Assessment (3 CEUs) is available from Professional DevelopmentResources. The objective of this course is to summarize theempirically-based screening and assessment methodology in ASD and to describe acomprehensive developmental approach for assessing students with ASD. Thecourse was developed to help you:

1. Recognize thecharacteristics of the most prevalent types of ASD

2. Distinguish between DSMdiagnosis and IDEA classification

3. Learn the differencesbetween a dimensional and categorical view of ASD

4. Differentiate amongscreening, assessment, and diagnosis

5. Use a multi-stepassessment strategy to screen students withASD

6. Identify components ofa comprehensive developmental assessment forAS

7. Select evidence-basedassessment tools

8. Analyze coexistingconditions commonly found in students withASD

Professional DevelopmentResources is approved by the American Psychological Association (APA) and theFlorida Board of Psychology and Office of School Psychology (CE Broker Provider#50-1635) to sponsor continuing education for psychologists and schoolpsychologists. PDR is also approved by the National Board of Certified Counselors(NBCC) to offer home study continuing education for NCCs (Provider #5590); bythe Association of Social Work Boards (ASWB Provider #1046, ACE Program); andby the American Occupational Therapy Association for continuing education(#3159).

Please view a descriptionof the course at:

http://www.pdresources.org/CourseDetail.aspx?Category=Online&PageNumber=3&Profession=Psychology&Sort=CourseName&Text=&courseid=1077

Early Intervention for Toddlers With Autism Yields Improved Social Skills - West Palm Beach Asperger & Education | Examiner.com

2011-01-25T17:55:00.000-05:00

Early Intervention for Toddlers With Autism Yields Improved Social Skills - West Palm Beach Asperger & Education | Examiner.com

Best Practice Review: The Autism Spectrum Rating Scales (ASRS)

2011-01-21T18:20:00.004-05:00

The Autism Spectrum Rating Scales™ (ASRS™; Goldstein & Naglieri, 2009) are designed to measure behaviors, symptoms, and features associated with the Autism Spectrum Disorders (ASD) for children and adolescents aged 2 through 18 years. This standardized, norm-referenced instrument covers a wide range of behaviors associated with Autistic Disorder, Asperger’s Disorder (syndrome), and PDD-NOS, and incorporates symptom criteria from the DSM-IV-TR. The ASRS was standardized and normed on a large sample of 2,560 participants approximating the U.S. general population. Clinical samples were also created by collecting ratings from children and youth with clinical diagnoses (ASD, ADHD, Mood Disorders, Anxiety Disorders, Developmental Delay, and Communication Disorders).

The ASRS has full-length and short forms for young children aged 2 to 5 years, and for older children and adolescents aged 6 to 18 years. The full-length ASRS (2−5 Years) consists of 70 items, and the full-length ASRS (6−18 Years) contains 71 items. Separate parent (ASRS Parent Ratings) and teacher (ASRS Teacher Ratings) rating forms are available for each age group. The full-length form provides the most comprehensive assessment information, including the Total Score, ASRS Scales, and DSM-IV-TR Scale.

The ASRS Short Form contains items that best differentiated the nonclinical group from those diagnosed with ASD. The ASRS Short Form (2–5 Years) and ASRS Short Form (6–18 Years) both have 15 items, with parents and teachers completing the same form. This form provides a single total score, and can be used as a screening measure to determine which children and youth are likely to require a more comprehensive assessment for an ASD. The ASRS Short Form is also suitable for monitoring response to treatment/intervention.

The ASRS can be scored via paper-and-pencil and electronically. The ASRS Scoring Software and ASRS Online Assessment Center offer three report options: (1) an Interpretive Report with detailed results from one administration, (2) a Comparative Report providing a multi-rater perspective by combining results from up to five different raters, and (3) a Progress Monitoring Report that provides an overview of change over time by combining results of up to four administrations from the same rater. The ASRS Technical Manual provides step-by-step interpretation guidelines and an illustrative case study. An especially useful feature of the ASRS is the ability to compare results across raters. This can help determine if there is consistency across home and school contexts. Discrepancies can provide insight into differential responses and determine which symptoms are more prevalent in a particular setting.

The ASRS has strong psychometric qualities. Reliability data indicate high levels of internal consistency, good inter-rater agreement, and excellent test-retest reliability. Discriminative validity (classification accuracy) of both the ASRS full-length and ASRS Short Form indicate that the scales were able to accurately predict group membership with a mean overall correct classification rate of 90.4% on the ASRS (2-5) and 90.1% on the ASRS (6-18). Although the ASRS Technical Manual reports a moderate relationship between the ASRS Total Score and the Gilliam Autism Rating Scale, Second Edition (GARS-2) and the Gilliam Asperger’s Disorder Scale (GADS), criterion-related validity would have been enhanced by examining the consistency of the ASRS with a gold standard instrument such as the ADOS or ratings scales such as the Social Communication Questionnaire (SCQ) and Social Responsiveness Scale (SRS). The GARS and GADS are not currently recommended and should be used with caution due to significant weaknesses, including the underidentification of higher-functioning ASD and questions concerning standardization and norming procedures (Campbell, 2005; Norris & Lecavalier, 2010; Wilkinson, 2010).

In summary, the ASRS is a valuable tool that can help guide diagnostic and educational eligibility decisions, as well as for use in monitoring response to intervention and evaluating treatment outcomes. It is a reliable and valid instrument for assessing symptom severity across home and school contexts. Consistent with best practice, the ASRS should be used only as part of a more comprehensive developmental assessment that includes interviews and direct observation, together with a multidisciplinary assessment of social behavior, language and communication, adaptive behavior, motor skills, sensory issues, atypical behaviors, and cognitive functioning. An example of a comprehensive assessment battery can be found in A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools.

Campbell, J. M. (2005). Diagnostic Assessment of Asperger’s Disorder: A Review of Five Third-Party Rating Scales. Journal of Autism and Developmental Disorders, 35, 25-35

Goldstein, S., & Naglieri, J. A. (2009). Autism Spectrum Rating Scales (ASRS) Technical Manual. Tonawanda, NY: Multi-Health Systems, Inc.

Norris, M., & Lecavalier, L. (2010). Screening accuracy of level 2 autism spectrum disorder rating scales: A review of selected instruments. Autism, 14, 263-284.

Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.

Study Linking Vaccine to Autism a Fraud

2011-01-06T17:41:00.000-05:00

The first study to link a childhood vaccine to autism was based on falsified information about the children involved, according to a new report on the widely discredited research. In a recent editorial, the British Medical Journal (BMJ), an international peer reviewed medical journal, concluded that Dr. Andrew Wakefield misrepresented or altered the medical histories of all the patients whose cases formed the basis of the discredited 1998 study and that there was "no doubt" Wakefield was responsible.

A new examination found, by comparing the reported diagnoses in the study to hospital records, that the authors had altered facts about patients in their study. In an accompanying editorial, BMJ editor Fiona Godlee and colleagues called Wakefield's study "an elaborate fraud."

The conclusions of the 1998 paper by Andrew Wakefield and colleagues linking autism to childhood vaccines was previously renounced by 10 of its 13 authors and later retracted by the medical journal Lancet, where it was published. Numerous other published studies have found no link between MMR vaccine and autism. Unfortunately, there has been a dramatic increase in measles since Wakefield's original paper was published and there are sporadic outbreaks in Europe and the United States.

Executive Dysfunction and ASD

2010-12-09T20:16:00.005-05:00

Research evidence suggeststhat deficits in executive function are an important feature of ASD. Executivefunction is a broad term used to describe the higher-order cognitive processessuch as response initiation and selection, working memory, planning andstrategy formation, cognitive flexibility, inhibition of response,self-monitoring and self-regulation. It is generally acknowledged that thefrontal brain system (including frontal lobes) is responsible for thesefunctions. Executive functions include the many of the skills required toprepare for and execute complex behavior, such as planning, inhibition,organization, self-monitoring, cognitive flexibility, and set-shifting. Markersof executive dysfunction in include difficulty in initiating action, planningahead, inhibiting inappropriate responses, transitioning, and poorself-monitoring. Poor performance monitoring and self-regulation may beassociated with the core features of ASD such as a lack of social reciprocityand intense emotional responses to change (e.g., meltdowns).

We should note, however,that executive function deficits are not experienced by all individuals on theautism spectrum nor are they specific to ASD. Several childhood disorders suchas Attention-Deficit/Hyperactivity Disorder (ADHD) and Obsessive-CompulsiveDisorder share deficits in executive function. Nevertheless, executivedysfunction is likely to have an adverse impact on many areas of everyday lifeand affect adaptability in several domains (personal, social and communication).An assessment of executive function can add important information about thechild’s strengths and weaknesses and assist with intervention planning. Forexample, the Behavioral Rating Inventory of Executive Function (BRIEF; Gioia,Isquith, Guy, & Kenworthy, 2000), a parent- or teacher-ratedquestionnaire for children ages 5 to 18 years of age, can be used to assessexecutive functioning in children with ASD and may be included in acomprehensive assessment battery.

Further information onassessment and intervention is available from

A Best PracticeGuide to assessment and intervention for Autism and Asperger Syndrome inSchools.

Gioia, G. A., Isquith, P. K.,Guy, S. C, & Kenworthy, L. (2000). Behavior rating inventory ofexecutive function. Lutz, FL: Psychological Assessment Resources.

Best Practice Quick Reference: No Single Test is Diagnostic of ASD

2010-12-05T17:05:00.005-05:00

There are no specific biological or test markers to determine ASD. Although ASD is a neurobiological disorder; the diagnosis is made by behavioral criteria. No single measure provides a definitive diagnosis: data from an instrument must be interpreted in context as a component of the diagnostic process. The risk of under- and overdiagnosing ASD is minimized by utilizing information from multiple sources. Caution must be used when using any cut-off score to indicate a diagnosis or disability because this determination is not solely dependent on an absolute score or scores but rather on whether the measured traits result in impairments in everyday functioning or adaptive behavior and the need for specialized services. Intellectual test profiles should never be used for diagnostic confirmation or differential diagnosis of ASD subtypes.

Source:

Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.

Best Practice Autism Review: The Childhood Autism Rating Scale, Second Edition (CARS 2) )

2010-11-23T19:05:00.004-05:00

The recently published Childhood Autism Rating Scale, second edition (CARS 2), consists of two 15-item rating scales completed by the practitioner and a Parent/Caregiver Questionnaire. The Standard Version Rating Booklet (CARS 2-ST) is equivalent to the original CARS and is used with children younger than 6 years of age and those with communication difficulties or below-average cognitive ability. The High-Functioning Version Rating Booklet (CARS 2-HF) is an alternative for assessing verbally fluent children and youth, 6 years of age and older, with average or above intellectual ability. The Questionnaire for Parents or Caregivers (CARS 2-QPC) is an unscored questionnaire designed to obtain pertinent developmental information from parents or caregivers. Both the CARS 2-ST and CARS 2-HF each include 15 items addressing the following functional areas:

Relating to People
Imitation (ST); Social-Emotional Understanding (HF)
Emotional Response (ST); Emotional Expression and Regulation of Emotions (HF)
Body Use
Object Use (ST); Object Use in Play (HF)
Adaptation to Change (ST); Adaptation to Change/Restricted Interests (HF)
Visual Response
Listening Response
Taste, Smell, and Touch Response and Use
Fear or Nervousness (ST); Fear or Anxiety (HF)
Verbal Communication
Nonverbal Communication
Activity Level (ST); Thinking/Cognitive Integration Skills (HF)
Level and Consistency of Intellectual Response
General Impressions

Items on the Standard form duplicate those on the original CARS, while items on the HF form have been modified to reflect current research on the characteristics of higher functioning children and youth with autism (HFA) or Asperger Syndrome. To complete the ratings on the CARS 2-HF, the professional must have convergent information from MULTIPLE sources such as direct observation, parent and teacher interviews, prior assessments of cognitive functioning and adaptive behavior, and information from the Questionnaire for Parents or Caregivers (CARS 2-QPC). Ratings are based not only on frequency of the behavior in question, but also on its intensity, atypicality, and duration. Rating values for all items are summed to produce a Total Raw Score. Each form includes a graph that allows the practitioner quickly convert the Total Raw Score to a standard score or percentile rank (based on a clinical sample of individuals diagnosed with autism spectrum disorders).

The psychometric properties of the CARS 2-HF indicate a high degree of internal consistency and good interrater reliability. Validity information reports an overall discrimination index value of .93, with sensitivity and specificity values of .81 and .87, respectively. The HF form also demonstrates a relatively strong relationship with the “gold standard” Autism Diagnostic Observation Schedule (ADOS).

The following are critical features of the CARS 2-HF.

1. Parents and teachers should NOT be asked to complete the CARS 2 forms. Only well-informed professionals should complete the ratings.

2. The CARS 2 should NOT be used for screening in the general school-age population.

3. The practitioner must have a good understanding of the criteria for making the ratings and be in a position to collect information from multiple sources (direct observation, parent and teacher reports, prior assessments and clinical impressions).

4. The ratings from the CARS 2 should be considered as only one part of a multimodal, multidisciplinary decision-making process in the identification of children with ASD.

5. Direct observation and a developmental history MUST always be included in the assessment process.

6. Scores on the CARS 2 are interpreted relative to the level (severity) of autism-related behaviors compared to a clinical sample of individuals diagnosed with autism, NOT the typical individual.

In summary, The CARS 2-HF represents an important alternative that will be welcomed by school-based professionals such as school psychologists and speech/language pathologists. It is a sensitive and reliable instrument that will find a place in the school-based professional’s assessment “Tool Box.” Given the dramatic increase in the numbers of students being referred for screening and assessment, the CARS 2-HF is a useful instrument that helps quantify the level of symptom severity and importantly, assist with intervention and program planning. The CARS 2-HF scores are particularly helpful in identifying Autism, Asperger's Disorder, Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). Of course, the CARS 2 is not intended to be and should not be used as the sole instrument in making diagnostic or classification decisions. An example of a comprehensive assessment battery can be found in A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools.

Schopler, E, Van Bourgondien, M. E., Wellman, G. J., & Love, S. R. (2010). Childhood autism rating scale, second edition. Los Angeles, CA: Western Psychological Services.

A New Approach to Teaching Youth With Autism

2010-11-23T17:25:00.002-05:00

Source: Medical News Today

As the number of children diagnosed with autism spectrum disorders continues to increase, the one thing that won’t change is the need for those children to develop social skills. Statistics show that if these students are able to communicate effectively, they can achieve success in the classroom, and later, in the workplace. In addition to the challenges facing each individual student, educators find themselves facing dwindling resources. Now, researchers at the University of Missouri are developing an effective social competence curriculum, with a virtual classroom component, that could help educators meet the demand of this growing population.

Janine Stichter, a professor of special education at the MU College of Education, and her team have developed a curriculum that has shown success in an after-school format and is now being tested during daily school activities, with help from two three-year grants from the Institute of Educational Sciences in the U.S. Department of Education. The key factors in Stichter’s curriculum focus on specific needs and behavioral traits within the autism spectrum. By doing this, the instructor is able to deliver a more individualized instruction within a small group format and optimize the response to intervention.

Read the Rest of This Article on Medical News Today

Regressive Autism

2010-11-21T14:48:00.002-05:00

The topic of regressive autism has attracted considerable research interest in last 15 years, in part due to the interest in the link to vaccines. Other terms used to describe regression in children with autism are autism with regression, autistic regression, late-onset autism, and acquired autistic syndrome. Studies suggest that nearly 25 % of children with autism have experienced some level of developmental regression. Unfortunately, there is no standard definition for regression, and the prevalence of regression varies depending on the definition used.

In general, regressive autism is evident when a child appears to develop typically but then begins to lose language and/or social skills, typically between the ages of 15 and 30 months, and is subsequently diagnosed with autism. Some children lose social development rather than language, while some lose both. Therefore, language might be preserved but social interaction significantly impaired. Skill loss may be quite rapid or slow and preceded by an extended period of minimal skill progression. The loss may be accompanied by markedly reduced social play and interaction, repetitive behaviors, or increased irritability. Following the onset of regression, the child follows the standard pattern of autistic neurological development.

There is some research to suggest that regressive autism is early-onset autism that was recognized at a later date and that if there is a regressive phenotype of ASD, it is not characterized by normal or near-normal pre-loss development. In fact, research suggests that many children identified with regressive autism had some delay in communication and social skills prior to onset. Likewise, there was is no evidence that the onset of autistic symptoms or regression is related to measles-mumps-rubella vaccination. However, there might be an early vulnerability in the development of the nervous system and that these children weren't developing normally. Although the phenomenon of regressive autism is poorly understood, best practice requires that any child who presents with the “red flags” of autism be screened and if indicated, provided with a comprehensive developmental assessment. A complete guide to screening and assessment for ASD is available from A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools.

Outstanding Autism Resource for the School Professional

2010-10-30T11:07:00.008-04:00

A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools

by Lee A. Wilkinson, PhD, NCSP, was recently honored as an Award-Winning Finalist in the Education/Academic category of the "Best Books 2010" Awards sponsored by USA Book News. USA Book News.com is the premiere online magazine and review website for mainstream and independent publishing houses. Over 500 winners and finalists were announced in over 140 categories covering print and audio books.
Filling a critical void in the autism literature, this authoritative yet accessible book provides school psychologists, educators, support professionals, and parents with a best practice guide to screening, assessment, and intervention for school-age children with autism spectrum disorders (ASD). Grounded in the latest research, special features include illustrative case examples and an index to 50 evidence-based best practice recommendations. This book makes an ideal text for graduate-level training courses in school psychology and is certain to become a widely used resource that will meet the needs of both experienced psychologists and those new to the profession.

ISBN: 978-1-84905-811-7

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The Extreme Male Brain

2010-10-18T17:12:00.002-04:00

The finding that there are clear sex differences in Empathizing (females) and Systemizing (males) has led to a proposal that autism and Asperger syndrome can be conceptualized as an “extreme” of the typical male brain. This Extreme Male Brain (EMB) theory is an extension of Baron-Cohen’s Empathizing–Systemizing (E-S) model. Briefly, the E–S model proposes that there are two psychological dimensions. Empathizing (E) is defined as the drive to identify emotions and thoughts in others and to respond to these appropriately (Baron-Cohen, 2008). This dimension provides us with a way of making sense of other peoples’ behavior and a natural way of responding to others. In contrast, Systemizing (S) is defined as the drive to analyze and construct systems, with the goal of identifying and understanding rules in order to predict systemic behavioral events (Baron-Cohen, 2008). Systems can be technical, abstract, motoric, taxonomic, or social. We don’t analyze these systems in terms of emotions and mental states. Rather, we examine relationships between components and correlations between events which then allow us to understand any relevant underlying rules.

It is the asymmetry of ability (E-S) present in ASD that provides the basis for the EMB theory of autism. For example, Baron-Cohen describes five different brain “types.”

Type E – Empathy is stronger than Systemizing (E>S)
Type S – Systemizing is stronger than Empathy (S>E)
Type B (balanced) – Empathy is the same as Systemizing (E=S)
Extreme Type E – Empathy is above average but challenged with Systemizing (E>>S)
Extreme Type S – Systemizing is above average but challenged with Empathy (S>>E)

General population measures of Empathy and Systemizing suggest that most males have a Type S brain and most females have a Type E brain. The majority of individuals with ASD have an extreme of the male brain (Extreme Type S). Of course, this theory has yet to be fully tested, but it does appear to explain many of the core features of ASD.

Baron-Cohen, S. (2008). Autism and Asperger syndrome: The facts. New York: Oxford University Press.

Please read my best practice review of Autism and Asperger Syndrome: The facts.

Girls with ASD: Suffering in Silence

2010-10-16T16:41:00.006-04:00

Although there has been a dramatic increase in the number of children diagnosed with autism spectrum disorders (ASD) over the past decade, statistics indicate that boys are being referred and identified in far greater numbers than girls (Attwood, 2006; Wagner, 2006). In fact, referrals for evaluation of boys are approximately ten times higher than for girls (Attwood, 2006). Girls are also diagnosed with autism spectrum disorders at later ages relative to boys (Goin-Kochel, Mackintosh, & Meyers, 2006). This gender “gap” raises serious questions because many female students with ASD are being overlooked and will not receive the appropriate educational supports and services (Wilkinson, 2008).

Why are fewer girls being identified? Why do parents of girls experience a delay in receiving a diagnosis? Are there gender differences in the expression of the disorder? Answers to these questions have practical implications in that gender specific variations may have a significant impact on identification practices and the provision of educational services. Although few studies have examined gender differences in the expression of autism spectrum disorders, we do have several tentative explanations for the underdiagnosis and late identification of girls with ASD. They include the following.

Social communication and pragmatic deficits may not be readily apparent in girls because of a non-externalizing behavioral profile, passivity, and lack of initiative. Girls who have difficulty making sustained eye contact and appear socially withdrawn may also be perceived as “shy,” “naive,” or “sweet” rather than having the social impairment associated with an autism spectrum disorder (Wagner, 2006).

The diagnosis of another disorder often diverts attention from autism-related symptomatology. In many cases, girls tend to receive unspecified diagnoses such as a learning disability, processing problem, or internalizing disorder. A recent survey of women with Asperger syndrome indicated that most received a diagnosis of anxiety or mood disorder prior being identified with an autism spectrum disorder (Bashe & Kirby, 2005).

The perseverative and circumscribed interests of girls with autism spectrum disorders may appear to be age-typical. Girls who are not successful in social relationships and developing friendships might create imaginary friends and elaborate doll play that superficially resembles the neurotypical girl (Attwood, 2006).

Although Students with ASD are more likely to be the target of bullying than typical peers, this may not be recognized in girls due to gender differences in preferred modes of aggression. For example, girls may use covert verbal, social, and psychological forms of aggression while boys tend to rely on confrontational and direct modes of bullying (Besag, 2006). As a result, the more subtle nature of relational and indirect aggression (social exclusion and rejection) used by girls may be taken less seriously than the more obvious, direct aggression exhibited by boys.

Although girls may appear less symptomatic than boys, the genders do share similar profiles. Research suggests that when IQ is controlled, the main gender difference is a higher frequency of idiosyncratic and unusual visual interests and lower levels of appropriate play in males compared to females (Lord, Schopler, & Nevicki, 1982). As a result, the behavior and educational needs of boys are much more difficult to ignore and are frequently seen by teachers and parents as being more urgent, further contributing to a referral bias (Wilkinson, 2010).

Over reliance on the male model with regard to diagnostic criteria might contribute to a gender “bias” and underdiagnosis of girls (Kopp & Gillberg, 1992; Nyden et al., 2000). Clinical instruments also tend to exclude symptoms and behaviors that may be more typical of females with ASD.

If girls do process language and social information differently than boys, then clinical and educational interventions based largely on research with boys may be inappropriate Wilkinson, 2008). If gender specific variations do exist, then the predictive validity of the diagnosis and developmental course may well differ between the sexes. Meanwhile, educators and school personnel should question the presence of an ASD in girls referred for internalizing disorders such as anxiety or depression. Best practice recommends that when a girl presents with a combination of social immaturity, restricted interests, limited eye gaze, repetitive behaviors, social isolation, and is viewed as “unusual” or “odd” by parents, teachers and peers, the possibility of an ASD should be given consideration (Wagner, 2006; Wilkinson, 2010).

Reference List is available and supplied upon request -

Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.

©Lee A. Wilkinson

Best Practice Research: Hyperbaric Oxygen Therapy (HBOT) for Autism

2010-10-15T17:28:00.004-04:00

Parents of children with autism spectrum disorders (ASDs) often use complementary and alternative medicine (CAM) treatments with their children as an alternative, or in addition to, conventional treatments. CAM treatments are controversial and, for most, their efficacy has not been scientifically established. Hyperbaric oxygen therapy (HBOT), a scientifically supported treatment for decompression sickness, is being increasingly recommended as a treatment for autism. Although anecdotal evidence may exist, there is a need for rigorous controlled scientific research to evaluate the treatment effects of HBOT on the core symptoms of ASD.

The journal Research in Autism Spectrum Disorders reports the results of a randomized double-blind placebo-controlled trial study comparing HBOT to placebo in children with autistic disorder who received 80 sessions of treatment over a 15-week period. Multiple standardized instruments and direct behavioral observations were used to evaluate treatment effects on ASD symptoms. The results indicated no significant differences between HBOT and placebo groups across any of the outcome measures (social reciprocity, communication, and repetitive behaviors). The study concludes that HBOT does not result in a clinically significant improvement of the symptoms of autism and that it is not recommended for the treatment of ASD symptoms.

Granpeesheh, D., Tarbox, J., Dixon, D. R., Wilke, A. E., Allen, M. S., & Bradstreet, J. J. (2010). Randomized trial of hyperbaric oxygen therapy for children with autism. Research in Autism Spectrum Disorders, 4, 268-275.

http://ees.elsevier.com/RASD/default.asp

Complementary & Alternative Therapies

2010-10-01T18:40:00.002-04:00

The gluten-free, casein-free diet (GF/CF diet) continues to be a popular and widely used treatment by parents of children with. The premise is that avoiding gluten and/or casein (proteins found in wheat, barley, rye and dairy) might directly affect brain function and produce improvements in the cognitive and behavioral symptoms associated with ASD. Surveys suggest that nearly a third of parents of children with mild autism have used an alternative diet in the treatment of their children. The use of alternative diets in the treatment of ASD has also been encouraged by anecdotal reports of effectiveness from parents, celebrities, and the popular media. Given that autism has no know cure, parents and advocates will understandably pursue interventions/treatments that offer the possibility to improving symptoms, especially if the treatment appears to do no harm and is generally accepted. However, there continues to be controversy and debate as to effectiveness and risks of diets as a treatment for ASD.

A recent study appearing in the peer-reviewed journal, Autism Research, examined 14 articles related to research on the effects of gluten-free and/or casein-free (GFCF) diets in the treatment of ASD. Each study was analyzed and summarized in terms of (a) participants, (b) methodological quality (c) specifics of the intervention, (d) dependent variables, (e) outcome, and (e) conclusive evidence. Based on their review, the researchers determined that the published studies do not support the use of GFCF diets in the treatment of ASD (Mulloy, Lang, O’Reilly, Sigafoos, Lancioni, & Rispoli, 2010). They recommend, “Until conclusive evidence is found in support of GFCF diets, restrictive diets should only be implemented in the event a food allergy or intolerance is detected” (p. 335) and “Adverse consequences potentially associated with GFCF diets (e.g., stigmatization, diversion of treatment resources, reduced bone cortical thickness) further the argument against the diet’s therapeutic use.” (p. 337). They also suggest that if future research supports the use of GFCF diets (beyond avoiding allergens), then controlled trials might be initiated to determine whether a GFCF diet has any further benefit for individuals with ASD (Mulloy et al., 2010).

Mulloy, A., Lang, R., O’Reilly, M., Sigafoos, J., Lancioni, G., & Rispoli, M. (2010). Gluten-free and casein-free diets in the treatment of autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders, 4, 328-339

Sensory Integration Therapy

2010-09-23T17:04:00.014-04:00

Unusual sensory responses are relatively common in children with ASD and often one of the earliest indicators of autism in childhood. Although considered a “nontriadic” feature, when present, sensory issues may interfere with performance in many developmental and functional domains across home and school contexts. Best practice guidelines indicate that when needed, educational programs for children with ASD should integrate an appropriately structured physical and sensory milieu in order to accommodate any unique sensory processing challenges.

Sensory integration (SI) therapy is often used individually or as a component of a broader program of occupational therapy for children with ASD. While sensory activities may be helpful as part of an overall educational program, we have no reliable and convincing empirical evidence that sensory-based treatments have specific effects. It should be noted, however, that a lack of empirical data does not infer that the intervention or treatment is ineffective, but rather that efficacy has not been objectively demonstrated or validated. Interventions to address sensory related problems, when utilized, should be integrated at various levels into the student’s individualized educational program (IEP). Comprehensive educational programming may also include consultation with knowledgeable professionals (e.g. occupational therapists, speech/language therapists, physical therapists, adaptive physical educators) to provide guidance about potential interventions for children whose sensory processing or motoric difficulties interfere with educational performance.

All interventions and treatments should be based on sound theoretical constructs, robust methodologies, and empirical studies of effectiveness. Different approaches to intervention have been found to be effective for children with autism, and no comparative research has been conducted that demonstrates one approach is superior to another. The selection of specific interventions should be based on goals developed from a comprehensive assessment of each child’s unique needs and family preferences. A more detailed discussion of assessment domains (e.g. communication, social, sensory, academic) can be found in “A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools.”

Evidence-Based Screening for Autism Spectrum Disorders

2010-08-31T20:00:00.005-04:00

Epidemiological studies indicate a progressively rising prevalence trend for ASD over the past decade. Yet, compared with general population estimates, children with mild to moderate autistic traits remain 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 and clinicians should be prepared to recognize the presence of risk factors and/or early warning signs of ASD and be familiar with screening tools in order to ensure children with ASD are being identified and provided with the appropriate programs and services.

The following evidence-based 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, 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 (Short Form) (ASRS; Goldstein & Naglieri, 2009).

The Autism Spectrum Screening Questionnaire (ASSQ; Posserud, Lundervold, & Gillberg, 2006).

The Childhood Autism Spectrum Test (CAST; Williams, Allison, Scott, Stott, Baron-Cohen, & Brayne, 2006).

The Social Communication Disorders Checklist (SCDC; Skuse, Mandy, & Scourfield, 2005).

The Social Communication Questionnaire (SCQ; Rutter, Bailey, & Lord, 2003).

The Social Responsive Scale (SRS; Constantino & Gruber, 2005).

Of course, none of these screening measures can differentiate between the autism spectrum subtypes. A screening tool’s efficiency will also be influenced by the practice setting in which it is used. Autism-specific tools are not currently recommended for the universal screening of typical school-age children. Focusing on case finding and children with identified risk-factors and/or developmental delays increases predictive values and results in more efficient screening.

A multi-tier screening algorithm and step-by-step assessment guidelines are available from:

Wilkinson, L. A. (2010). A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools. London: Jessica Kingsley Publishers.

Can School Professionals Diagnose Autism?

2010-08-01T20:49:00.006-04:00

As we prepare for the new school year, this question will be asked with ever increasing frequency. Yes. Professionals such as school psychologists and speech/language pathologists can diagnose or classify a child with an autism spectrum disorder (ASD) within the school context. The dramatic increase in the prevalence of children with ASD over the past decade, together with the clear benefits of early intervention, have created a need for schools to identify children who may have an autism spectrum condition. It is not unusual for children with milder forms of autism to go undiagnosed until well after entering school. In fact, research indicates that only three percent of children with ASD are identified solely by non-school resources. As a result, school professionals are now more likely to be asked to participate in the screening and identification of children with ASD than at any other time in the past.

The Individuals with Disabilities Education Act of 2004 (IDEA) and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV) are the two major systems used to diagnose and classify children with ASD. The DSM-IV is considered the primary authority in the fields of psychiatric and psychological (clinical) diagnoses, while IDEA is the authority with regard to eligibility decisions for special education. The DSM-IV was developed by clinicians as a diagnostic and classification system for both childhood and adult psychiatric disorders. The IDEA is not a diagnostic system per se, but rather federal legislation designed to ensure the appropriate education of children with special educational needs in our public schools. Unlike the DSM-IV, IDEA specifies categories of ‘‘disabilities’’ to determine eligibility for special educational services. The definitions of these categories (there are 13), including autism, are the most widely used classification system in our schools. According to IDEA regulations, the definition of autism is as follows:

(c)(1)(i) Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age 3, that adversely affects a child’s educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. The term does not apply if a child’s educational performance is adversely affected primarily because the child has an emotional disturbance, as defined in this section.

(ii) A child who manifests the characteristics of ‘‘autism’’ after age 3 could be diagnosed as having ‘‘autism’’ if the criteria in paragraph (c)(1)(i) of this section are satisfied.

This educational definition is considered sufficiently broad and operationally acceptable to accommodate both the clinical and educational descriptions of autism and related disorders. While the DSM-IV diagnostic criteria are professionally helpful, they are neither legally required nor sufficient for determining educational placement. It is state and federal education codes and regulations (not DSM IV-TR) that drive classification and eligibility decisions. Thus, school professionals must ensure that children meet the criteria for autism as outlined by IDEA and may use the DSM-IV to the extent that the diagnostic criteria include the same core behaviors (e.g., difficulties with social interaction, difficulties with communication, and the frequent exhibition of repetitive behaviors or circumscribed interests). Of course, all professionals, whether clinical or school, should have the appropriate training and background related to the diagnosis and treatment of neurodevelopmental disorders. The identification of autism should be made by a professional team using multiple sources of information, including, but not limited to an interdisciplinary assessment of social behavior, language and communication, adaptive behavior, motor skills, sensory issues, and cognitive functioning to help with intervention planning and determining eligibility for special educational services.

Life Journey through Autism: A Parent’s Guide to Assessment. Arlington, VA: Organization for Autism Research.

American Academy of Pediatrics. Understanding Autism Spectrum Disorders [pamphlet]. Elk Grove Village, IL: American Academy of Pediatrics; 2005.

National Institute of Child Health and Human Development Autism Site

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: Jessica Kingsley Publishers.

Back to School: Best Practice Recommendations

2010-07-30T17:47:00.004-04:00

As our scientific knowledge and thinking about ASD continues to develop, professionals such as school and clinical psychologists, speech/language pathologists, behavior interventionists, social workers, special educators, and occupational therapists will be expected to play an important role in the educational planning of children with ASD by providing support, information, and recommendations to teachers, other school personnel and administrators, and families.

“A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools” features 50 best practice recommendations for screening, assessment, and treatment/intervention. Each provides the guidance needed by school and clinical professionals to make informed and scientifically-based decisions regarding the assessment, identification, and treatment of school-age children with autistic spectrum disorders (ASD). The following “best practice” suggestions are adapted from the text.

A standardized screening tool should be administered at any point when concerns about ASD are raised by a parent or teacher or as a result of school observations or questions about developmentally appropriate social, communicative, and play behaviors.
A comprehensive assessment should include evaluation of multiple domains of functioning in order to differentiate ASD from other conditions and provide a complete profile of the child to facilitate intervention planning.
A thorough speech-language-communication evaluation should be conducted for all students referred for a comprehensive assessment. Deficits in pragmatic language functioning may not be detected on formal language tests and require nontraditional assessment procedures.
No one methodology is effective for all children with autism. Generally, it is best to integrate approaches according to a student’s individual needs and responses.
Advocacy should not interfere with being a scientist. School professionals should focus on empirically-based strategies and outcomes and not attempt to prove that one intervention is better than another.
Children with any identified ASD, regardless of severity, should be eligible for special educational services under the category of autism spectrum disorders, as opposed to other terminology used by school systems (e.g., other health impaired, developmentally delayed, neurologically impaired).

Adapted from Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.

Copyright 2010 Lee A. Wilkinson. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

The School Psychologist

2010-07-01T11:36:00.002-04:00

As we know, there has been a dramatic increase in the prevalence of autism spectrum disorders (ASD) over the past decade. Yet, compared to estimates, identification rates have not kept pace in our schools. It is not unusual for children with milder forms of autism (e.g., Asperger syndrome, pervasive developmental disorder-NOS, high-functioning autistic disorder) to go undiagnosed (if at all) until well after entering school. Likewise, despite a marked increase in the percentage of children receiving special educational services under the Individual with Disabilities Education Improvement Act (IDEA, 2004) definition of autism, there are substantial numbers of children who have not been identified, especially more capable students on the spectrum.

Our increased awareness of autism, together with the clear benefits of early intervention, have created an urgent need for school professionals to identify children who may have an autism spectrum condition. As a result, school psychologists are now more likely to be asked to participate in the screening and identification of children with ASD than at any other time in the past. School psychologists are especially well prepared to conduct behavioral screening of students who have risk factors and/or present with warning signs of a spectrum condition. They play a critical role in case finding and by contributing to diagnostic activities, conducting psychoeducational evaluations, and guiding educators and parents to empirically supported interventions. Therefore, it is critically important to remain current with the research and up to date on scientifically supported “best practice” approaches that have direct application to the educational setting. By being knowledgeable about assessment and intervention and treatment approaches, including their strengths and limitations, school psychologists can help to ensure that children with ASD are being identified and provided with the appropriate programs and services.

Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.

Brock, S. E., Jimerson, S. R., & Hansen, R. L. (2006). Identifying, assessing, and treating autism at school. New York: Springer.

National Research Council (2001). Educating Children with Autism. Washington, DC:
National Academy Press.

Best Practice Q & A

2010-06-12T10:53:00.003-04:00

Question:

I am interested to know about medications for children with autism. My son is nine years old and has been diagnosed with Asperger syndrome. He has a great deal of anxiety and obsessive and ritualistic behaviors that cause him considerable distress. Although he is very high functioning intellectually, these behavior issues interfere with his school performance. He will be starting CBT therapy soon and hope that this will be helpful. We have also discussed the possibility of medication such as Zoloft and wonder whether this might be helpful as well.

Answer:

Prescription medications do not address the core symptoms of autism and are not be considered to be "first-line" interventions for children with ASD. At present, psychoeducational intervention is the benchmark intervention for autism. However, related problems such as hyperactivity, inattention, aggression, repetitive or compulsive behaviors, self-injury, anxiety or depression, and sleep problems may respond to a medication regimen. Medication may also have the potential to improve the ability to benefit from other types of interventions, as well as relieve family stress and enhance adaptability. For example, medical management of hyperactivity and impulsivity can help improve school functioning. Similarly, managing social anxiety and depression may increase participation in a social skills group or structured teaching program.

The most commonly prescribed medications for ASD are selective serotonin reuptake inhibitors or SSRIs such as Prozac, Zoloft, and Paxil; stimulants such as Concerta, Metadate, Methylin, Ritalin, and Adderall, and atypical neuroleptics such as Risperdal and Abilify, both with FDA approved labeling for the symptomatic treatment of children and adolescents with ASD. As with all medications, professionals and parents must be aware of the potential side-effects and contraindications of autism medications. We are still in need of large scale methodologically sound trials to examine outcomes with ASD.

You also commented on cognitive-behavioral therapy (CBT). CBT has been shown to be of value in addressing many of the coexisting problems experienced by individuals with ASD. In fact, there is a strong evidence base for the use of CBT interventions for depression and anxiety in both ASD and non-ASD populations. It has applicability to children with ASD who typically have deficits and distortions in thinking about thoughts and feelings and therefore, may be considered an "autism spectrum-friendly" approach. You might consider consulting "Attwood, T. (2004). Exploring feelings: Cognitive behaviour therapy to manage anxiety. Arlington, TX: Future Horizons" as a resource. As with all complex interventions, professionals who implement CBT-related strategies should be appropriately trained and experienced. Some cognitive-behavioral approaches may also be too complex for many younger children with ASD.

Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.

Social Skills Training

2010-05-20T20:30:00.005-04:00

Severe impairment in social reciprocity is the core, underlying feature of ASD. Socialization deficits are a major source of impairment, regardless of cognitive or language ability and do not decrease with development. Indeed, distress often increases as children approach adolescence and the social milieu becomes more complex. Evidence accumulating in the empirical literature indicates that in general, social skills interventions are likely to be appropriate for some primary school age children with either high-functioning autism or Asperger’s disorder. Commonly used approaches include individual and group social skills training, providing experiences with typically developing peers, and peer-mediated social skills interventions, all targeting the core social and communication domains. Child-specific social skills interventions frequently include (a) general instruction to increase knowledge and develop social problem solving skills, (b) differential reinforcement to improve social responding,(c) structured social skills training programs, (d) adult-mediated prompting, modeling, and reinforcement, and (e) various behavior management techniques such as self-monitoring.

While interventions based on the principles of ABA have been shown to improve functional communication and reduce problematic behaviors in children with ASD, interventions that target social deficits have not received the same level of attention. However, there is some emerging evidence to support traditional and newer naturalistic behavioral strategies and other approaches to social skills programming for young children with ASD. For example, there is some objective evidence to suggest that group-based social skills training and peer-mediated (teaching typical children to engage their peers with ASDs) approaches hold promise and may be useful interventions. It should be noted, however, that a recent meta-analysis of single-subject designs examining the effectiveness of school-based social skills interventions for children and adolescents with ASD found that they produced low treatment and minimal generalization effects across participants and settings. The research database suggests, however, that social interactive training is an effective and promising technique for promoting communication and social skills when used as one component of an overall educational curriculum for children with ASD.

Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.

Copyright 2010 Lee A. Wilkinson. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

"Best Practice" Book Excerpt

2010-05-03T19:49:00.004-04:00

Behavioral screening:

The broader autism phenotype has shifted our attention away from a strict definition of autism to recognition of higher-functioning subtypes of ASD (Wing, 2005; Wing & Potter, 2002). Population estimates of prevalence may, in actuality, underestimate the importance of autistic characteristics of less severity (Skuse et al., 2009). For example, cases are usually determined from assessments based on the initial selection of children who have severe and obvious symptoms. Mild or even moderate deficits in social-communicative competence may be missed, especially if they are associated with coexisting (comorbid) conduct and attention problems.

Developing screening tools to identify the milder variants of autism has been especially difficult because of the varying degrees of symptomatology (Wing, 2005). Until recently, there were few validated screening measures available to assist professionals in the identification of students with characteristics of the broader autistic phenotype (Campbell, 2005; Lord & Corsello, 2005). However, our knowledge of ASD is expanding rapidly and we now have more reliable and valid tools to screen and evaluate children efficiently and with greater accuracy (Yeargin-Allsopp et. al., 2003). These instruments may be used with children who present with risk factors (e.g., sibling or family history of autism) and/or when parents and teachers, or health care professionals observe or identify the presence of “red flags” (e.g., social, communication and behavioral concerns) of a neurodevelopmental disorder. Both parent and teacher screening tools are especially ideal for identifying children who are in need of a more comprehensive evaluation. They yield important information from individuals who know the child the best and are relatively easy to administer and score (Wiggins, Bakeman, Adamson, & Robins, 2007).

Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.

Copyright 2010 Lee A. Wilkinson. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

Autism Awareness in School

2010-04-17T11:59:00.004-04:00

Autism awareness should extend beyond surveillance with very young children to school-age children as well. As we know, autism spectrum disorders (ASD) are the second most serious developmental disability after mental retardation/intellectual impairment and are more prevalent among children than cancer, diabetes, spina bifida, and Down syndrome. If current prevalence estimates are translated into the approximate number of school-age children with autism, then there are substantial numbers of children who have not been identified, especially more able students with ASD. Even though significant progress has been made in identifying young children with typical or classic (Kanner’s) autism, it is not unusual for the milder forms of autism (e.g., without intellectual disability or noticeable language delay) to go undiagnosed until the child enters the new and demanding setting of the classroom. In fact, most elementary school-age children with ASD are identified by school resources. Statistics indicate that the largest group of school-age children identified under the IDEA special education category of autism are 7 to 9 years of age. Therefore, it is essential that school professionals, particularly school-based educational support personnel (e.g., special educators, school counselors, speech/language pathologists, and school psychologists), 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 identify students in need of further evaluation.

A Dimensional Approach to Autism

2010-04-11T17:53:00.005-04:00

The pervasive developmental disorders (PDD) have traditionally been viewed as categorical diagnoses. With a categorical or dichotomous scheme, disorders are either present or absent. For example, the DSM-IV-TR and ICD-10 list specific criteria for each disorder that must be met to receive a diagnostic classification. Similarly, the Individuals with Disabilities Education Act (IDEA) specify categories of special education disability. Both are categorical rather than dimensional systems of classification (e.g., a child meets or does not meet criteria) and both focus on a description of behavior rather than function.
We now question whether autism should be conceptualized as a distinct clinical entity or as a continuum of severity. For example, children with the same diagnostic classification are likely to be heterogeneous and many childhood disorders, including autism, fall along a continuum in the general population. Categorical classification fails to account for these quantitative differences between children with the same core symptoms. In fact, there is a growing consensus among professionals who work with children with PDD that the differences between the higher functioning subtypes are not particularly useful in terms of either intervention or outcome and that autism is more appropriately conceptualized as a spectrum condition rather than an “all-or-nothing” diagnostic entity. We also recognize that traits similar to those observed in PDD are not restricted to children with a clinical diagnosis. This is especially important because even mild degrees of autistic symptomatology can have an adverse effect on a child’s adaptive and school functioning. Thus, while categories are much easier to conceptualize, they tend to be of minimal use in actual practice.
This dimensional perspective is reflected in the American Psychiatric Association’s recently released draft diagnostic criteria for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Specifically, the proposal for a new category of “autism spectrum disorder,” which incorporates the current diagnoses of autistic disorder (autism), Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS). This single “spectrum disorder” better describes our current understanding about the clinical presentation and course of the pervasive developmental disorders (PDDs), and should facilitate more effective identification and treatment going forward.

Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.

April is Autism Awareness Month: Recognize the Warning Signs

2010-04-02T16:18:00.003-04:00

Research indicates that the outcomes for children with ASD can be significantly improved by early identification and intensive intervention. It is critically important to identify those children who are at-risk in order to reduce the time between symptom appearance and formal diagnosis and treatment. An important goal of Autism Awareness is to alert new parents and others of the early behavioral signs of autism. The signs and symptoms typically appear during the first three years of life and relate to language, social behavior, and behaviors concerning objects and routines. Red flags or key warning signs of autistic disorder include:

• Does not smile by the age of six months

• Does not respond to his name

• Does not cry

• Does not babble or use gestures by 12 months

• Does not point to objects by 12 months

• Does not use words by 16 months

• Does not use two-word phrases by 24 months

• Regresses after mastering skills/loses previously mastered skills

• Delays in milestones like crawling and walking.

Because of the dramatic increase in ASD, it is an issue that deserves our attention not only in April, but throughout the year.