Friday, May 25, 2012

Evidence-Based Practice and Autism in the Schools


School professionals are now expected to participate in the identification and treatment of children with autism spectrum disorders (ASD) more than at any other time in the recent past. Practitioners must be prepared to recognize the presence of risk factors and/or early warning signs of ASD, engage in case finding, and be familiar with assessment tools and interventions in order to ensure that students are being identified and provided with the appropriate programs and services.
There continues to be a pressing need for evidence-based guidance on providing treatment to children with autism spectrum disorders (ASD). Schools today face the challenge of providing appropriate services to a diverse and increasingly numerous student population diagnosed with ASD. In order to achieve this goal, evidence-based practice is essential in the schools. To assist school professionals as they strive to help these students reach their potential, the National Autism Center has produced a comprehensive 245-page manual, Evidence-Based Practice and Autism in the Schools. The manual outlines relevant topics, including the current state of research findings, professional judgment and data-based clinical decision making, values and preferences of families, and capacity building. Each chapter sets a course for advancing the efforts of school systems to engage in evidence-based practice for their students on the autism spectrum.
The National Autism Center has distributed 3,000 printed copies of this manual to school systems around the country. The Educator Manual is also available to individuals on the Center’s website as a pdf at http://www.nationalautismcenter.org/learning/practitioner.php
The National Autism Center is May Institute’s center for the promotion of evidence-based practice. It is a nonprofit organization dedicated to serving children and adolescents with Autism Spectrum Disorders (ASD) by providing reliable information, promoting best practices, and offering comprehensive resources for families, practitioners, and communities.

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.

Thursday, May 17, 2012

Early Intensive Behavioral Intervention (EIBI) for Autism

Early intensive behavioral intervention (EIBI) is considered a central feature of intervention programming for children with autism. EIBI programs are among the most and best researched of the psychoeducational interventions. Several research publications and meta-analysis indicate that early intensive behavioral intervention (EIBI) may improve the quality of life and level of functioning for children with autism spectrum disorders (ASD). EIBI programs are based on applied behavior analysis (ABA), a behavioral approach that is well supported in the research literature. ABA can be thought of as an inclusive term that encompasses a number of concepts and techniques used in the assessment, treatment, and prevention of behavioral problems in children with ASD. Perhaps the best known technique within EIBI is called discrete trial training. This method 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. The principles of ABA are also incorporated within other interventions and programs such as incidental teaching and pivotal response training.
EIBI programs have typically focused on preschool and young children. Research now suggests that school-age children with ASD may benefit as much as younger children from this approach and that EIBI programs can be successfully adapted to school settings. Although there is little professional disagreement that EIBI is an effective treatment, on average, for children with autism, we should be mindful that it does not produce significant changes in all areas of children’s functioning or result in similar gains for all children. Moreover, EIBI may not be appropriate for all children. While EIBI is an important and effective intervention approach, there is a need for further research documenting the maintenance of gains of EIBI and long-term outcomes.

Further information on evidence-based treatment/intervention for autism is available from the National Autism 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 editor of a text in the American Psychological Association (APA) School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools, and author of the book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools, (2nd Edition).

© Lee A. Wilkinson, PhD

Sunday, May 6, 2012

Book Review: Autism and Asperger Syndrome in Schools


Book Review: A Best Practice Guide to Assessment and Intervention For Autism and Asperger Syndrome in Schools 

L. A. Wilkinson  A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools. Philadelphia, PA: Jessica Kingsley, 2010.
Reviewed by: Adam W. McCrimmon, University of Calgary, Calgary, Alberta, Canada DOI: 10.1177/0829573510393154
Brief Introduction
A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools is a new book providing comprehensive and detailed information pertaining to school-based assessment and treatment of Pervasive Developmental Disorders (also commonly referred to as autism spectrum disorders). Written by Dr. Lee A. Wilkinson, a practicing school psychologist, professor, and established researcher in the field of autism spectrum disorders, the book contains seven chapters, each focusing on a specific aspect of working with and supporting individuals in this population (e.g., screening, assessment, interventions). In line with its title, the focus of the book is on the implications for practice and the implementation of best-practice approaches by mental health professionals working in a school setting. It serves as a resource for parents and mental health professionals who work with individuals with autism or Asperger syndrome within a school setting (e.g., school psychologists, educational psychologists, clinical psychologists, counseling psychologists, social workers).
Content and Structure
The initial chapter contains an overview and description of the pervasive developmental disorders, the common presenting symptomatology (the “autistic triad”), and the prevalence rates of each disorder. This initial description is thorough and provides the reader with explicit and relevant information on the common characteristics of each disorder as well as the important clinical and behavioral differences among them. Many readers will appreciate the detail taken in these descriptions and will likely be better informed about the specific features of each disorder and the broader category of pervasive developmental disorders as a whole.  
Following from this, the book focuses on autism and Asperger syndrome specifically, beginning with a systematic description of the best practices approach to assessment through the processes of initial screening and formal assessment. Specific measures related to each of these processes are described and compared, providing the reader with evidence-based information pertaining to the utility of specific screening and diagnostic measures/tools as well as effective and efficient diagnostic process. The author then progresses on to a discussion of best practices in intervention and educational supports, including a description of the existing evidence base for a variety of commonly used approaches and strategies. The author concludes with a discussion of future research directions and specific areas in need of targeted investigation.
Critique
The focus of this book is on providing practitioners and caregivers more in depth information pertaining to autism and Asperger syndrome. The layout of the book is easy to read as it is written for a varied audience. The coverage of important and relevant topics is thorough and provides targeted information for individuals interested in learning more about this class of childhood disorders. Indeed, the chapters on screening and formal assessment provide information pertaining to specific measures and their utility. Similarly, the chapters on interventions and academic supports provide a succinct overview of current popular approaches and strategies. Furthermore, important information is highlighted through diligent use of text boxes (e.g., best practices processes and procedures within several chapters) that allow the reader to discern key information at a glance. This approach is best observed in the chapter pertaining to intervention and treatment in which the author presents information on the current empirical evidence for a variety of interventions, providing the reader with a quick overview of each and a summary of the supporting evidence, or lack thereof.
Another strength of the book is its focus on the screening process prior to formal assessment. The description of a best practices approach to quick and effective screening of individuals presented in this chapter is likely to be of particular benefit to educators and school psychologists. Indeed, if used, the measures and screening processes described in this chapter could reduce workload and increase the effectiveness of many such professionals by enabling them to provide the appropriate services (e.g., formal assessment, behavior management strategies, and/or consultation) efficiently.  
A noteworthy feature of the book is its use of two clinical case studies that are interwoven throughout several chapters. These cases provide the reader with insight regarding relevant background information, presenting symptomatology, assessment results and interpretation, and suggested intervention activities for individuals with autism or Asperger syndrome. Indeed, these case studies will likely afford greater understanding of the information provided in the book by parents, professionals, and individuals affected by autism or Asperger syndrome themselves.
A final strength of the book is its inclusion of recent research and clinical information. As such, much of the reviewed literature is up to date, providing the reader with appropriate information regarding the current state of affairs for each disorder. This inclusion of recent empirical evidence is especially important given the rapid pace of research and findings and the typical delay between development and publication of volumes such as this one.
Despite the many strengths of the book, two limitations are noted. First, the majority of information is psychological in nature, and classroom-based individuals will find little suited for their purposes. For example, the book contains very detailed and prescriptive information pertaining to psychological screening, formal assessment, and development of intervention planning. However, there is no information pertaining to specific “red flags,” behavioral indicators that teachers or other such school professionals should make note of. As many teachers, particularly those in the early elementary school years, keenly desire more information on how they can facilitate the identification of students with a possible pervasive developmental disorder, this book would seem to be an excellent resource to provide such important information. Moreover, as school psychologists are increasingly advocating for a larger consultative role in their work, and less of a role as a designated “tester,” providing such information that could then be passed along to teachers would afford greater consultative opportunities for school psychologists and enhance the working relationship with teachers. However, the lack of this information reinforces teachers’ continued reliance on psychologists or other mental health professionals to work with children in this population. 
Second, the two case studies provide an adequate picture of higher functioning aspects of individuals with a pervasive developmental disorder (e.g., “high-functioning autism” or Asperger syndrome) through the screening and formal assessment processes. However, no contextual examples of those individuals more typical of the autism population are provided. Specifically, the majority of individuals with autism demonstrate cognitive challenges and associated limitations in functioning across a variety of domains. As such, their behavioral presentation is typically much different that those described in the case studies. As well, only one of these case studies was integrated into the chapter on interventions, providing limited contextual information for the reader regarding this essential component to service delivery and support. Additional case studies may have resulted in a more inclusive and comprehensive presentation of this broad category of disorders. Thus, although the majority of the case studies provide enlightening and important information, these two specifically are more limited in scope and clinical usefulness.
Overall, this book presents readers with an excellent overview of autism and Asperger syndrome. The author has expertly formatted the book and each chapter so that the reader is provided with an excellent resource of recent and relevant information pertaining to screening, formal assessment, and interventions with individuals in this population. The use of two case studies helps to highlight some of the information presented throughout the book. Although the majority of information will be useful from a clinical or psychological perspective and is representative primarily of the higher functioning end of the autism spectrum, it is believed that many school-based professionals will be able to make use of this excellent resource.
Canadian Journal of School Psychology 2011 26: 257  DOI: 10.1177/0829573510393154
The online version of this article can be found at: http://cjs.sagepub.com/content/26/3/257.citation
Canadian Journal of School Psychology 26(3) 257–259
© 2011 SAGE Publications
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.


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