Wednesday, December 7, 2016

Assessment Tools for ASD: Sensitivity Matters



Evidence-based assessment requires using instruments with strong reliability and validity for the accurate identification of children’s problems and disorders, for ongoing monitoring of children’s response to interventions, and for evaluation of the outcomes of intervention. These procedures must also have demonstrated effectiveness in diagnosis, clinical formulation, intervention planning, and outcome assessment. 

Professionals should have an understanding of the basic psychometrics properties that underlie test use and development when assessing children and youth for autism spectrum disorder (ASD). For example, diagnostic validity is an especially important psychometric characteristic to consider when evaluating the quality and usefulness of a screening instrument or more comprehensive measure. It refers to a test’s accuracy in predicting group membership (e.g., ASD versus non-ASD) and 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 screens 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 screens negative. A highly specific test means that there are few false positive results (e.g., individuals without a disorder who screen positive). False negatives decrease sensitivity, whereas false positives decrease specificity. An efficient screening 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 screened negative that are truly without the disorder. The higher the PPV and NPV values, the more efficient the instrument at correctly identifying cases. It is important to recognize that PPV is influenced by the sensitivity and specificity of the test as well as the prevalence of the disorder in the sample under study. 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.
© Lee A. Wilkinson, PhD
Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, chartered psychologist, and certified cognitive-behavioral therapist. He provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorders. Dr. Wilkinson is author of the award-winning books,  A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a best-selling text in the APA School Psychology Book Series,  Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Saturday, November 19, 2016

Award-Winning Finalist in the Psychology/Mental Health category of the 2016 Best Book Awards



Overcoming Anxiety and Depression on the Autism Spectrum is available from Jessica Kingsley Publishers, AmazonBarnes & Noble, Book DepositoryBooks-A-Million and other online book retailers.

Get the lowest price on Overcoming Anxiety and Depression on the Autism Spectrum: A Self-help Guide Using CBT from AllBookstores.com.

Lee A. Wilkinson, PhD is a licensed and nationally certified school psychologist, registered psychologist, and certified cognitive-behavioral therapist. He provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorder. Dr. Wilkinson is author of the award-winning books,  A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).



Wednesday, November 16, 2016

Best Practice Review: The Social Communication Questionnaire (SCQ)

Best Practice Review: The Social Communication Questionnaire (SCQ)

The Social Communication Questionnaire (SCQ; Rutter, Bailey, & Lord, 2003), previously known as the Autism Screening Questionnaire (ASQ), was initially designed as a companion screening measure for the Autism Diagnostic Interview-Revised (ADI-R; Rutter, Le Couteur & Lord). The SCQ is a parent/caregiver dimensional measure of ASD symptomatology appropriate for children of any chronological age older than fours years. It can be completed by the informant in less than 10 minutes. The primary standardization data were obtained from a sample of 200 individuals who had participated in previous studies of ASD. 

The SCQ is available in two forms, Lifetime and Current, each with 40 questions presented in a yes or no format. Scores on the questionnaire provide an index of symptom severity and indicate the likelihood that a child has an ASD. Questions include items in the reciprocal social interaction domain (e.g., “Does she/he have any particular friends or best friend?”), the communication domain (e.g., “Can you have a to and fro ‘conversation’ with him/her that involves taking turns or building on what you have said?”) and the restricted, repetitive, and stereotyped patterns of behavior domain (e.g., Has she/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 has received significant scrutiny and has consistently demonstrated its effectiveness in predicting ASD versus non-ASD status in multiple studies. A meta-analysis examining the previous research on the utility of the SCQ as a screening instrument found it to be an acceptable screening tool for ASD (area under the curve = 0.885) (Chesnut et al., 2017). The scale has been found to have good discriminant validity and utility as an efficient screener for at-risk groups of school-age children. The lifetime version is recommended for screening purposes as it demonstrates the highest sensitivity value. A threshold raw score of >15 is recommended to minimize the risk of false negatives and indicate the need for a comprehensive evaluation. Comparing autism to other diagnoses, this threshold score resulted in a sensitivity value of .96 and a specificity value of .80 in a large population of children with autism and other developmental disorders. The positive predictive value was .93 with this cutoff. The authors recommend using different cut-off scores for different purposes and populations. Several studies (Allen et al., 2007; Eaves et al, 2006) have suggested that a cut-off of 11 may be more clinically useful (Norris & Lecavalier, 2010).
The SCQ is one of the most researched of the ASD-specific evaluation tools and can be recommended for screening and as part of comprehensive developmental assessment for ASD (Chestnut et al., 2017; Norris & Lecavalier, 2010; Wilkinson, 2010, 2016). The SCQ (Lifetime form) is an efficient screening instrument for identifying children with possible ASD for a more in-depth assessment. For clinical purposes, practitioners might consider a multistage assessment beginning with the SCQ, followed by a comprehensive developmental evaluation (Wilkinson, 2011, 2016). However, cut-off scores may need to be adjusted depending on the population in which it is used. The evidence also indicates that although the SCQ is appropriate for a wide age range, it is less effective when used with younger populations (e.g., children two to three years). It was designed for individuals above the age of four years, and seems to perform best with individuals over seven years of age.

References

Allen CW, Silove N, Williams K, et al. (2007). Validity of the Social Communication Questionnaire in Assessing Risk of Autism in Preschool Children with Developmental Problems. J Autism Dev Disord37, 1272–8.

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

Chesnut, S. R., Wei,T., Barnard-Brak, L., & Richman, D. M. (2017). A meta-analysis of the social communication questionnaire: Screening for autism spectrum disorder. Autism, 21, 920-928. https://doi.org/10.1177/1362361316660065
Eaves L, Wingert H, Ho H, et al. (2006). Screening for Autism Spectrum Disorders with the Social Communication Questionnaire. Developmental and Behavioral Pediatrics, 27, 95–103.
Mash, E. J., & Hunsley, J. (2005). Evidence-based assessment of child and adolescent disorders: Issues and challenges. Journal of Clinical Child and Adolescent Psychology, 34, 362-379.
Norris, M., & Lecavalier, L. (2010). Screening accuracy of level 2 autism spectrum disorder rating scales: A review of selected instruments. Autism, 14, 263–284.
Rutter, M., Bailey, A., & Lord, C. (2003). Social Communication Questionnaire. Los Angeles: Western Psychological Services.
Wilkinson, L. A. (2010).  A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London and Philadelphia: Jessica Kingsley Publishers.
Wilkinson, L. A. (2011). Identifying students with autism spectrum disorders: A review of selected screening tools. Communiqué, 40, pp. 1, 31-33.

Wilkinson, L. A. (2017).  A best practice guide to assessment and intervention for autism spectrum disorder in schools (2nd Edition). London and Philadelphia: Jessica Kingsley Publishers.

Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, registered psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools, and author of the book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. Dr. Wilkinson's latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

© Lee A. Wilkinson, PhD

Monday, November 7, 2016

Healthcare Providers Unprepared to Treat Adults with Autism


Healthcare Providers Unprepared to Treat Autistic Adults

It is estimated that nearly a half million youth with autism will enter adulthood over the next decade. As children with autism become adults their primary medical care will move from pediatrics to adult medicine. A survey by the Autism Research Program at Kaiser Permanente Northern California found that many healthcare providers are ill prepared to treat adults on the autism spectrum. The findings were reported at the International Meeting for Autism Research in Salt Lake CityUtah.
Researchers polled providers of adult primary care, mental health, and obstetrics and gynecology services through the insurer’s network. Practitioners were asked about their ability to recognize autism, their knowledge of the disorder, their comfort level in treating those with the condition and their need for training and resources.
Of 922 providers surveyed, 77 percent rated their ability to treat patients on the spectrum as poor or fair. While more that 90 percent of the providers said they would investigate the possibility of autism in patients with limited eye contact, most under-reported the number of people on the autism spectrum who were actually under their care. In addition, only 13 percent of providers indicated that they had adequate tools or referral resources to appropriately accommodate those with autism.
To better understand the providers’ responses, follow-up interviews were conducted with nine primary care physicians. The researchers found that the majority had received limited or no autism training in medical school or during their residencies. All of the providers indicated a need for more education and improvements in the transition from pediatric care providers to adult medicine for those on the autism spectrum.
The preparation of healthcare providers is a pressing issue as an increasing number of individuals with autism are expected to enter adulthood in the coming years. Further research is urgently needed to study the transition from pediatric to adult healthcare and identify strategies that will lead to better medical care for adults on the autism spectrum.

Tuesday, November 1, 2016

Inclusive Education for Students with Autism


Inclusive Education for Students with Autism

The Individuals with Disabilities Education Improvement Act of 2004 (IDEA) (P.L. 108-446) (http://idea.ed.gov/) guarantees a free and appropriate public education (FAPE) in the least restrictive environment (LRE) for every student with a disability. The LRE provision mandates that “to the maximum extent appropriate, children with disabilities, including children in public or private institutions or other care facilities, are educated with children who are not disabled, and special classes, separate schooling, or other removal of children with disabilities from the regular educational environment occurs only when the nature or severity of the disability of a child is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily.”  In general, inclusion (or inclusive education) with typical peers is considered to be the best placement option for students with disabilities. It should also be noted that while 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 and intensive level of service.

Research

Child characteristics such as severity of autism symptoms are thought to determine educational placement. However, where a child lives may significantly impact whether they are placed in an inclusive or segregated classroom, a national analysis suggests. The study published online in the journal Focus on Autism and Other Developmental Disabilities examined external factors, including state of residence and state funding formulas, to determine their potential influence on placement outcomes. On average, about 37 percent of students identified with autism spectrum disorder (ASD) spent at least 80 percent of their school day in inclusive environments. But the numbers varied considerably from one state to the next, ranging from just 8 percent in Washington, D.C. to 62 percent in Iowa. 

There was considerable variation among states in placing students with autism in inclusive, mainstreaming, self-contained, and separate schools. Specifically, states varied substantially in the percentage of students with autism educated in each setting, with some states consistently favoring inclusion (Colorado, Connecticut, Idaho, Iowa, Minnesota, Nebraska, North Dakota, West Virginia, and Wisconsin). Other states, however, generally leaned toward more restrictive settings (Alaska, Delaware, Florida, Hawaii, Louisiana, New Hampshire, New Jersey, New York, South Carolina, and Washington, D.C.). States in the Eastern United States tended to have more restrictive placement rates than states in the Western United States. State special education funding was found to have a minimal impact on placement outcomes.
These findings suggest that factors that are external to child characteristics (e.g., severity of ASD symptoms) influence educational placement decisions for students with ASD. “If child-specific factors were solely responsible for education placement decisions, one would expect states to have similar rates of inclusive, self-contained, mainstreaming and separate school placements for students with ASDs,” the author commented. “Instead, … results indicate that educational placement varies by state.” 

Implications

Overall, it is unlikely that child characteristics alone determine placement outcomes. Although School districts should make every effort to place students in integrated settings to maximize interaction with typical peers, analysis of the public data presented in this study suggests that many states are still falling short of including autistic students in general education settings for significant portions of the day. Inclusion with typically developing students is important for a child with autism 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. The argument must shift from should we include autistic students in general education to understanding how to include them successfully. It is critical to identify how practices that benefit students with autism, including structure (visual, communication, and social supports), positive behavior supports, and systematic instruction, can be implemented effectively in general education settings. 
Jennifer A. Kurth,  Educational Placement of Students With Autism: The Impact of State of Residence, Focus on Autism and Other Developmental Disabilities, first published on September 3, 2014 doi:10.1177/1088357614547891.
Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, chartered psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books,  A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Wednesday, October 12, 2016

Risk Factors Associated with Self-Injury in Autism

Risk Factors Associated Self-Injurious behavior in Autism

Children with autism spectrum disorder (ASD) frequently engage in maladaptive behaviors such as aggression and rituals. The most distressing to caregivers and challenging for health care providers are self-injurious behaviors (SIB). These behaviors are classified as any type of action directed towards the self, resulting in physical injury. The most common types of SIB in children and adults with autism spectrum disorder include hand biting, head banging and scratching. This might be head banging on floors, walls or other surfaces, hand or arm biting, hair pulling, eye gouging, face or head slapping, skin picking, scratching or pinching, forceful head shaking. SIB varies from case to case can be understood as existing on a continuum in relation to frequency and intensity, ranging from mild and infrequent to severe and chronic. An increased understanding of the incidence and risk factors associated with SIB in autism is needed to develop treatment options.

A study in the Journal of Autism and Developmental Disorders assessed 7 factors that may influence self injury in a large group of 250 children and adolescents with ASD: (a) atypical sensory processing; (b) impaired cognitive ability; (c) impaired functional communication; (d) deficits in social interaction; (e) age; (f) the need for sameness; and (g) ) compulsive or ritualistic behavior. Other factors that may influence SIB incidence such as gender and ASD severity were also assessed. A series of diagnostic tests were administered either directly to the children and adolescents or to their parents to assess: (a) autism severity; (b) cognitive and adaptive ability; (c) and receptive and expressive language; (d) repetitive behaviors; and (e) self-injury.
The results indicated that half of the children and adolescents demonstrated SIB. Atypical sensory processing was the strongest single predictor of self-injury followed by sameness, impaired cognitive ability and social functioning. Age, impaired functional communication, and ritualized behavior did not contribute significantly to self-injury. No significant effects of gender or severity of autistic symptoms were found in the study.
Implications

Self-injury is highly prevalent in children, teens, and adults with ASD. Atypical sensory processing and the need for sameness were contributors to SIB in this study, indicating that clinicians may want to focus on these two risk factors to develop function-based treatment options for self-injury. Research has also found significant associations between SIB and behavioral (aggression, hyperactivity, anxiety) developmental (adaptive behaviors, IQ), and somatic (sleep problems) factors. It is critical that interventions that target the risk factors associated SIB be identified and implemented in clinical practice. Providing empirically supported behavioral interventions to autistic individuals with SIB will not only impact directly on the problem behavior, but will enhance their social, educational, and adaptive functioning as well. Further research is clearly needed to better understand additional contributing factors that may influence these complex behaviors in children with ASD. For example, temperament, ability to self-regulate emotions, and medication usage might contribute to increased self injury.
Key References 

Christensen T, Ringdahl J, Bosch J, et al. (2009). Constipation associated with self-injurious and aggressive behavior exhibited by a child diagnosed with autism. Education & Treatment of Children, 32, 89–103

Devine D. Self-injurious behaviors in autistic children: a neuro-developmental theory of social and environment isolation. Psychopharmacology. 2014; 231:979–997. [PubMed: 24057764]

Duerden, E. G., Oatley, H. K., Mak-Fan, K. M., McGrath, P. A., Taylor, M. J., Szatmari, P., & Roberts, S. W. (2012). Risk factors associated with self-injurious behaviors in children and adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42:2460–2470. DOI 10.1007/s10803-012-1497-9

Mahatmya, D., Zobel, A., & Valdovinos, M. G. (2008). Treatment approaches for self-injurious behavior in individuals with autism: Behavioral and pharmacological methods. Journal of Early and Intensive Behavior Intervention, 5, 106-118.

Moseley, R. L., Gregory, N. J., Smith, P., Allison, C., & Baron-Cohen, S. (2019). A 'choice', an 'addiction', a way 'out of the lost': exploring self-injury in autistic people without intellectual disability. Molecular autism10, 18. doi:10.1186/s13229-019-0267-3

Soke, G. N., Rosenberg, S. A., Hamman, R. F., Fingerlin, T., Rosenberg, C. R., Carpenter, L., … DiGuiseppi, C. (2017). Factors associated with self-injurious behaviors in children with autism spectrum disorder: Findings from two large national samples. Journal of autism and developmental disorders47(2), 285–296. doi:10.1007/s10803-016-2951-x

Summers, J., Shahrami, A., Cali, S., D'Mello, C., Kako, M., Palikucin-Reljin, A., … Lunsky, Y. (2017). Self-injury in autism spectrum disorder and intellectual disability: Exploring the role of reactivity to pain and sensory input. Brain sciences7(11), 140. doi:10.3390/brainsci7110140

Waters, P., & Healy, O. (2012). Investigating the relationship between self-injurious behavior, social deficits, and co-occurring behaviors in children and adolescents with autism spectrum disorder. Autism research and treatment2012, 156481. doi:10.1155/2012/156481

Wilkinson, L. A. (2017). Best practice in special education. In L. A. Wilkinson, A best practice guide to assessment and intervention for autism spectrum disorder in schools (pp. 157-200). London and Philadelphia: Jessica Kingsley Publishers.

Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, chartered psychologist, and certified cognitive-behavioral therapist. He provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorders. Dr. Wilkinson is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Editio

Tuesday, October 11, 2016

Self-Injurious Behavior (SIB) in Autistic Children

Predictors of Self-Injurious behavior in Autism

Children with autism spectrum disorder (ASD) frequently engage in maladaptive behaviors such as aggression and rituals. The most distressing to caregivers and challenging for health care providers are self-injurious behaviors (SIB). These behaviors are classified as any type of action directed towards the self, resulting in physical injury. The most common types of SIB in children and adults with ASD include hand biting, head banging and scratching. This might be head banging on floors, walls or other surfaces, hand or arm biting, hair pulling, eye gouging, face or head slapping, skin picking, scratching or pinching, forceful head shaking. SIB varies from case to case can be understood as existing on a continuum in relation to frequency and intensity, ranging from mild and infrequent to severe and chronic. An increased understanding of the incidence and risk factors associated with SIB in autism is needed to develop treatment options.

A study in the Journal of Autism and Developmental Disorders assessed 7 factors that may influence self injury in a large group of 250 children and adolescents with ASD: (a) atypical sensory processing; (b) impaired cognitive ability; (c) impaired functional communication; (d) deficits in social interaction; (e) age; (f) the need for sameness; and (g) ) compulsive or ritualistic behavior. Other factors that may influence SIB incidence such as gender and ASD severity were also assessed. A series of diagnostic tests were administered either directly to the children and adolescents or to their parents to assess: (a) autism severity; (b) cognitive and adaptive ability; (c) and receptive and expressive language; (d) repetitive behaviors; and (e) self-injury.
The results indicated that half of the children and adolescents demonstrated SIB. Atypical sensory processing was the strongest single predictor of self-injury followed by sameness, impaired cognitive ability and social functioning. Age, impaired functional communication, and ritualized behavior did not contribute significantly to self-injury. No significant effects of gender or severity of autistic symptoms were found in the study.
Implications

Self-injurious behavior is an important public health problem in individuals with autism spectrum disorder (ASD). SIB is a debilitating behavior that occurs in a significant proportion of children, teens, and adults with ASD. Atypical sensory processing and the need for sameness were contributors to SIB in this study. Research has also found significant associations between SIB and behavioral (aggression, hyperactivity, anxiety) developmental (adaptive behaviors, nonverbal IQ), and somatic (sleep and GI problems ) factors. Current and previous research findings support the need for a comprehensive and multidisciplinary approach for assessing and managing SIB in ASD. It is critical that interventions that target the risk factors associated SIB be identified and implemented in clinical practice. Providing empirically supported behavioral interventions to autistic individuals with self-aggressive behavior will not only impact directly on the problem behavior, but will their enhance social, educational, and adaptive functioning as well. Further research is clearly needed to better understand additional contributing factors that may influence these complex behaviors in children with ASD. For example, temperament, ability to self-regulate emotions, and medication usage might contribute to increased self injury.
Key References 

Christensen T, Ringdahl J, Bosch J, et al. (2009). Constipation associated with self-injurious and aggressive behavior exhibited by a child diagnosed with autism. Education & Treatment of Children, 32, 89–103.

Devine D. (2014). Self-injurious behaviors in autistic children: a neuro-developmental theory of social and environment isolation. Psychopharmacology, 231, 979–997. 

Duerden, E. G., Oatley, H. K., Mak-Fan, K. M., McGrath, P. A., Taylor, M. J., Szatmari, P., & Roberts, S. W. (2012). Risk factors associated with self-injurious behaviors in children and adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42:2460–2470. DOI 10.1007/s10803-012-1497-9

Mahatmya, D., Zobel, A., & Valdovinos, M. G. (2008). Treatment approaches for self-injurious behavior in individuals with autism: Behavioral and pharmacological methods. Journal of Early and Intensive Behavior Intervention, 5, 106-118.

Moseley, R. L., Gregory, N. J., Smith, P., Allison, C., & Baron-Cohen, S. (2019). A 'choice', an 'addiction', a way 'out of the lost': exploring self-injury in autistic people without intellectual disability. Molecular autism10, 18. doi:10.1186/s13229-019-0267-3

Soke, G. N., Rosenberg, S. A., Hamman, R. F., Fingerlin, T., Rosenberg, C. R., Carpenter, L., … DiGuiseppi, C. (2017). Factors associated with self-injurious behaviors in children with autism spectrum disorder: Findings from two large national samples. Journal of autism and developmental disorders47(2), 285–296. doi:10.1007/s10803-016-2951-x

Summers, J., Shahrami, A., Cali, S., D'Mello, C., Kako, M., Palikucin-Reljin, A., … Lunsky, Y. (2017). Self-Injury in autism spectrum disorder and intellectual disability: Exploring the role of reactivity to pain and sensory input. Brain sciences7(11), 140. doi:10.3390/brainsci7110140

Waters, P., & Healy, O. (2012). Investigating the relationship between self-injurious behavior, social Deficits, and co-occurring behaviors in children and adolescents with autism spectrum disorder. Autism research and treatment2012, 156481. doi:10.1155/2012/156481

Wilkinson, L. A. (2017). Best practice in special education. In L. A. Wilkinson, A best practice guide to assessment and intervention for autism spectrum disorder in schools (pp. 157-200). London and Philadelphia: Jessica Kingsley Publishers.

Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, chartered psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition)

Wednesday, October 5, 2016

Approved Online Continuing Education Course for School Psychologists


This 3-hour online course, Autism Spectrum Disorder: Evidence-Based Screening & Assessment, is APA-approved for continuing education credit for school psychologists. Epidemiological studies indicate a progressively rising prevalence trend for autism spectrum disorders (ASD) over the past decade. School professionals and clinicians must be prepared to recognize the presence of risk factors and/or early warning signs of ASD and be familiar with screening and assessment tools in order to ensure that students are being identified and provided with the appropriate programs and services. The objectives of this course are to identify DSM-5 diagnostic changes in the ASD diagnostic criteria, summarize the empirically-based screening and assessment methodology in ASD, and describe a comprehensive developmental approach for assessing children, adolescents, and young adults with ASD. Course #30-69 | 44 pages | 40 posttest questions. CE Credit: 3 Hours
                                                         
              
Learning Objectives 
  1. Identify the changes in the new DSM-5 criteria for ASD 
  2. Distinguish between DSM diagnosis and IDEA classification schemes 
  3. Identify the three levels of a multi-tier assessment strategy to screen for ASD 
  4. List the components of a comprehensive developmental assessment for ASD 
  5. Name co-occurring conditions commonly found in ASD 
  6. Name key components of programs and services for ASD.
Adapted from Wilkinson, L. A. (2017). A best practice guide to assessment and intervention for autism spectrum disorder in schools. London and Philadelphia: Jessica Kingsley Publishers.

CE Information  

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; by the Continuing Education Board of the American Speech-Language-Hearing Association (ASHA Provider #AAUM) to provide continuing education activities in speech-language pathology and audiology; by the National Board of Certified Counselors (NBCC) to offer home study continuing education for NCCs (Provider #5590); by the Association of Social Work Boards (ASWB Provider #1046, ACE Program); by the National Association of Alcoholism & Drug Abuse Counselors (NAADAC Provider #000279); by the American Occupational Therapy Association (AOTA Provider #3159); by the Commission on Dietetic Registration (CDR Provider #PR001); by the California Board of Behavioral Sciences (#PCE1625); by the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635), Dietetics & Nutrition (#50-1635), and Occupational Therapy Practice (#34); by the Illinois DPR for Social Work (#159-00531); by the Ohio Counselor, Social Worker & MFT Board (#RCST100501); by the South Carolina Board of Professional Counselors & MFTs (#193); and by the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).
 About the Author
Lee A. Wilkinson, EdD, PhD, NCSP, is a licensed and nationally certified school psychologist, chartered psychologist, and certified cognitive-behavioral therapist. Dr. Wilkinson is also a university educator and teaches graduate courses in psychological assessment, clinical intervention, and child and adolescent psychopathology. His research and professional writing has focused on behavioral consultation and therapy, and children and adults with autism spectrum disorders. He has published numerous journal articles on these topics both in the United States and internationally. Dr. Wilkinson is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a best selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in SchoolsHis latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

Tuesday, October 4, 2016

Book Review - "THE LOVING PUSH"

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

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

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