Sunday, April 15, 2012

Autism Primer (Part 2): Q & A with Dr. Lee A. Wilkinson

In Part 2 of this Autism Primer, Dr. Wilkinson offers introductory answers to frequently asked questions about identification and educational planning for autism spectrum disorder (ASD). Resources are also provided that will guide you to further information. The content is intended to be informational only and does not constitute professional advice.
Question: What is the difference between DSM-5 and IDEA?
Answer: It is important to recognize that there is a difference between the clinical and the educational definitions of autism. The Individuals with Disabilities Education Act of 2004 (IDEA) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are the two primary systems of classification. The DSM-5 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 in our schools. The Individuals with Disabilities Education Act (IDEA) entitles all students with special needs to a free appropriate public education (FAPE). According to the 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.
Question: What is an IEP (Individualized Education Program)?
Answer: The IEP is a planning, teaching and progress monitoring tool and a working document for all children with special educational needs. The Individual with Disabilities Act (IDEA) requires that when a child is identified as having special educational needs, he or she is provided with an individualized education program (or plan) that specifies the services the student will receive during the school year.  In addition to outlining academic objectives and goals, the IEP includes interventions, modifications, behavioral supports, related services, and learning opportunities designed to assist the child throughout school and with transition to adulthood. Goals for a student with ASD usually include the areas of communication, social behavior, challenging behavior, and academic and functional skills.
Question: What is the difference between a 504 plan and IEP? 

Answer: There continues to be considerable misunderstanding among educators regarding the salient differences in purpose, eligibility, and type of plan (IEP versus Accommodation Plan) between IDEA and Section 504. While both have the same mandate to provide a free appropriate public education (FAPE), they have very different ways of meeting this requirement. Section 504 is civil rights legislation (not a federal grant program like IDEA) and the FAPE requirement is met for 504-only students via an accommodation plan (504 Plan), not the direct, specially designed instructional services of an individualized education program (IEP). The definition of a person with a disability under Section 504 is quite broad and includes “Any person who has a physical or mental impairment which substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such impairment.” In contrast, IDEA defines a "child with a disability" as a child: "with mental retardation, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments, or specific learning disabilities; and who, by reason thereof, needs special education and related services."
Question: Do all children with ASD need special education?
Answer: All children and youth with ASD will benefit from individualized and specialized interventions and programs.  According to the National Research Council (2001), a child who receives a diagnosis of any ASD should be eligible for special educational programming under the educational category of “autism,” regardless of the specific diagnostic category within the autism spectrum (autistic disorder, Asperger’s disorder, atypical autism, PDDNOS). Research supports the importance of initiating educational service as soon as a child is suspected of having an ASD. 

Question: Why do more boys than girls receive a diagnosis of ASD?
Answer: Boys are at greater risk for nearly all developmental, behavioral, and learning disorders and are at least four times more likely than girls to receive a diagnosis of autism. The ratio increases to 10:1 with Asperger syndrome and higher functioning autism (HFA). Although there are no documented reasons for this gender difference, some researchers have hypothesized that a genetic mechanism or gender bias might play a role. It has been hypothesized that differences in brain organization might provide a protective factor for girls and lowers the risk for developing the disorder. There is also some conjecture that expression of the behavioral phenotype might be different for girls than boys. Since females are socialized differently, ASD may not be manifest in the same way as typical male behavioral signs and patterns. There may also be a gender bias associated with a reliance on male criteria with respect to the diagnostic criteria for ASD.
Question: What is ABA?
Answer: Applied Behavior Analysis (ABA) is perhaps the most popular approach to the treatment of autism and other pervasive developmental disorders. This method uses positive reinforcement, repetition and prompting to teach language, play and social skills. Discrete trial training (DTT) is the most common teaching technique incorporated into the ABA method. This approach involves breaking behaviors down into subcategories and teaching each subcategory through repetition, positive reinforcement and prompts that are gradually removed from the program as the child progresses. During this teaching, each subcategory is taught intensely and exclusively until the behavior is learned to help to ensure success for the child. Discrete trial training is a technique that can be an important element of a comprehensive educational program for the child with ASD.
Question: What is Positive Behavior Support (PBS)?
Answer: Positive Behavior Support (PBS) is a systematic approach to preventing or reducing challenging behaviors, and, eventually, to enhancing the quality of life for individuals with autism and support providers. A central concept in PBS is the significance of the "function" of behavior. All behavior is considered to be meaningful, purposeful, and functional for the individual. The key objective of PBS is to determine the function of the problem behavior, and then to teach socially acceptable alternative/replacement skills and behaviors that are effective and efficient in accomplishing the function of the problem behavior. 

Resources for Further Information
 A Parent’s Guide to Evidence-Based Practice and Autism
Autism Society of America <> <>
Individuals with Disabilities Education Improvement Act of 2004. Pub. L. No. 108-446, 108th Congress, 2nd Session. (2004).
Life Journey through Autism: A Parent’s Guide to Assessment. Arlington, VA: Organization for Autism Research.
National Autism Center <>
National Institute of Child Health and Human Development Autism Site <>
National Research Council (2001). Educating Children with Autism. Washington, DC: National Academy Press.
Organization for Autism Research (OAR) <>
Twachtman-Cullen, D., & Twachtman-Bassett, J. (2011). The IEP from A to Z: How to create meaningful and measurable goals and objectives. San Francisco, CA: Jossey-Bass. 
Yale Child Study Center

Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also the editor of a recent volume in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools and author of the new book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT.

© Lee A. Wilkinson PhD

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