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

Savant Skills and the Autism Spectrum


What are savant skills?
There is a long history of reports of individuals who despite having severe intellectual impairments, demonstrate remarkable skills in a particular area. The term “savant” has been variously defined as those individuals who show (a) normatively superior performance in an area and (b) a discrepancy between their performance in that area and their general level of functioning. Some researchers have differentiated “prodigious” savants (e.g., individuals possessing an exceptional ability in relation to both their overall level of functioning and the general population) from “talented” savants (e.g., individuals showing an outstanding skill in comparison with their overall level of functioning). 

Savant skills have been reported much more frequently in males than in females and have been identified in a wide range of neurological and neurodevelopmental disorders. The most commonly reported savant skills are mathematical skills (calendrical calculations, rapid arithmetic and prime number calculations), music (especially the ability to replay complex sequences after only one exposure), art (complex scenes with accurate perspective either created or replicated following a single brief viewing) and memory for dates, places, routes or facts. Less frequently reported are “pseudo-verbal” skills (hyperlexia or facility with foreign languages), coordination skills and mechanical aptitude.
Research
Research in the past 10 years has generated some controversy about the actual incidence of savant syndrome in autism. Once thought to be rare in people with autism, found in no more than 1 out of 10 individuals, research over the past few years suggests savant skills may be more common than previous estimates. Although there have been many single case or small group studies of individuals with autism who possess savant abilities or exceptional cognitive skills, there have been few systematic, large-scale investigations in this area. Inconsistencies in definition and wide variation in diagnostic criteria, ages and ability levels of the cases reported are problematic, as is a paucity of valid information on rates of savant skills in ASD. The objective of this research study was to investigate the nature and frequency of savant skills in a large sample of individuals with autism who had been initially diagnosed as children.
The total sample was comprised 137 individuals, first diagnosed with autism as children, who were subsequently involved in an ongoing, longitudinal follow-up study. Cognitive assessments (Wechsler Scales) were completed for all participants (100 males and 37 females) between the ages of 11 and 48 years (mean age of 24). Parental report data on savant skills were obtained approximately 10 years later at a subsequent follow-up.  Cognitive ability ranged from severe intellectual impairment to superior functioning. Savant skills were judged from parental reports and specified as “an outstanding skill/knowledge clearly above participant’s general level of ability and above the population norm.”
Results
Of the 93 individuals for whom parental questionnaire and cognitive data were available, 16 (17.2%) met criteria for a parent-rated skill, 15 (16.8%) had an exceptional cognitive skill and 8 (8.6%) met criteria for both. There were 14 calendrical calculators (one also showed exceptional memory and another also showed skill in computation and music). There were four others with computational skills (in one case combined with memory and in another case with music). Visuospatial skills (e.g., directions or highly accurate drawing) were reported in three individuals. One individual had a musical talent, one an exceptional memory skill and one had skills in both memory and art. The subtest on which participants were most likely to meet the specified criteria for an area of unusual cognitive skill was block design followed by digit span, object assembly and arithmetic.
There was a sex difference (albeit statistically non-significant) in the prevalence of savant skills. Almost one-third (32%) of males showed some form of savant or special cognitive skill compared with 19 percent of females. No individual with a non-verbal IQ below 50 met criteria for a savant skill and contrary to some earlier hypotheses; there was no indication that individuals with higher rates of stereotyped behaviors/interests were more likely to demonstrate savant skills.
Discussion
In total, 39 participants (28.5%) met criteria for a savant skill. Cognitively, 23 individuals (17% of total sample) met criteria for one or more exceptional area of skill on the Wechsler Scales. Combining the two, 37 per cent of the sample showed either savant skills or unusual cognitive skills or both, a far higher proportion than previously reported. These results suggest that the rates of savant skills in autism are significant, particularly among males, and although these estimates are higher than reported by other researchers, the findings parallel those of previous studies. Based on these findings, it appears likely that at least a third of individuals with autism show unusual skills or talents that are both above population norms and above their own overall level of cognitive functioning. It should be noted that these data offer no support to claims that savant skills occur most frequently in individuals with autism who are intellectually challenged or that individuals with higher rates of stereotyped behaviors/interests are more likely to demonstrate savant skills.
Apart from the need for further research examining the underlying basis of savant skills and why certain individuals go on to develop any area of exceptional skill and why these skills encompass such different areas, there is a more practical and pressing question; “how can these innate talents be developed to form the basis of truly ‘functional’ skills?” In the present study, only five individuals with exceptional abilities (four related to math and one related to visuospatial ability) had succeeded in using these skills to find permanent employment. For the majority, the isolated skill remained just that, leading neither to employment nor greater social integration. As the authors conclude, “The practical challenge now is to determine how individuals with special skills can be assisted, from childhood onward, to develop their talents in ways that are of direct practical value (in terms of educational and occupational achievements), thereby enhancing their opportunities for social inclusion as adults.”
Key References

Howlin, P., Goode, S., Hutton, J., & Rutter, M. (2009). Savant skills in autism: Psychometric approaches and parental reportsPhilosophical Transactions of the Royal Society B: Biological Sciences, 364, 1359–1367. doi:10.1098/rstb.2008.0328 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2677586/

Marsa, L. (2016). Extraordinary minds: The link between savantism and autism. https://spectrumnews.org/features/deep-dive/extraordinary-minds-the-link-between-savantism-and-autism/

Treffert D. (2000). Extraordinary people: Understanding savant syndrome. Ballantine Books: New York, NY.

Treffert, D. (2009). The Savant Syndrome: An Extraordinary Condition. A Synopsis: Past, Present, Future. Philosophical Transactions of the Royal Society B: Biological Sciences, 364, 1351–1358.

Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, registered psychologist, and certified cognitive-behavioral therapist. He provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum 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).




Monday, November 21, 2016

Best Practice Guidelines for Assessment of Autism Spectrum Disorder (ASD) in Schools


Best Practice Guidelines for Assessment of Autism Spectrum Disorder

The number of children identified with autism has more than doubled over the last decade. School-based and mental health professionals are now being asked to participate in the screening, assessment, and educational planning for children and youth on the spectrum more than at any other time in the recent past. Moreover, the call for greater use of evidence-based practice has increased demands that professionals be prepared to recognize the presence of risk factors, engage in case finding, and be knowledgeable about “best practice” guidelines in assessment and intervention for autism spectrum disorder (ASD) to ensure that students are being identified and provided with the appropriate programs and services.

Best practice guidelines are developed using the best available research evidence in order to provide professionals with evidence-informed recommendations that support practice and guide practitioner decisions regarding assessment and intervention. Best practice requires the integration of professional expertise, each student’s unique strengths and needs, family values and preferences, and the best research evidence (rigorous peer-review) into the delivery of services. Professionals and families collaborate and work together as partners to prioritize domains of functioning for assessment and intervention planning. Best practices for school-based practitioners are best practices for students and their families.    
    
Comprehensive Developmental Assessment

The primary goals of conducting an autism spectrum assessment are to determine the presence and severity of an autism spectrum disorder (ASD), develop interventions for intervention/treatment planning, and collect data that will help with progress monitoring. Professionals must also determine whether an ASD has been overlooked or misclassified, describe co-occurring (comorbid) disorders, or identify an alternative classification. There are several important considerations that should inform the assessment process. First, a developmental perspective is critically important. While the core symptoms of are present during early childhood, ASD is a lifelong disability that affects the individual’s adaptive functioning from childhood through adulthood. Utilizing a developmental assessment framework provides a yardstick for understanding the severity and quality of delays or atypicality. Because ASD affects multiple developmental domains, the use of an interdisciplinary team constitutes best practice for assessment and diagnosis of ASD. A team approach is essential for establishing a developmental and psychosocial profile of the child in order to guide intervention planning. The following principles should guide the assessment process.
  • Children who screen positive for ASD should be referred for a comprehensive assessment.  Although screening tools have utility in broadly identifying children who are at-risk for an autism spectrum condition, they are not recommended as stand alone diagnostic instruments or as a substitute for a more inclusive assessment.
  • Assessment should involve careful attention to the signs and symptoms consistent with ASD as well as other coexisting childhood disorders.
  • When a student is suspected of having an ASD, a review of his or her developmental history in areas such as speech, communication, social and play skills is an important first step in the assessment process.
  • A family medical history and review of psychosocial factors that may play a role in the child’s development is a significant component of the assessment process. 
  • The integration of information from multiple sources will strengthen the reliability of the assessment results.
  • Evaluation of academic achievement should be included in assessment and intervention planning to address learning and behavioral concerns in the child’s overall school functioning.
  • Assessment procedures should be designed to assist in the development of  instructional objectives and intervention strategies based on the student’s unique pattern of strengths and weaknesses.
  • Because impairment in communication and social reciprocity are core features of ASD, a comprehensive developmental assessment should include both domains
  • Restricted, repetitive patterns of behavior, interests, or activities (RRB) are a defining feature of ASD and should be a focus of assessment.
A comprehensive developmental assessment approach requires the use of multiple measures including, but not limited to, verbal reports, direct observation, direct interaction and evaluation, and third-party reports. Assessment is a continuous process, rather than a series of separate actions, and procedures may overlap and take place in tandem. While specific activities of the assessment process will vary and depend on the child’s age, history, referral questions, and any previous evaluations and assessments, the following components should be included in a best practice assessment and evaluation of ASD in school-age children.
  •  Record review
  •  Developmental and medical history
  •  Medical screening and/or evaluation
  • Parent/caregiver interview
  • Parent/teacher ratings of social competence/interaction
  • Direct child observation
  • Cognitive assessment
  • Academic assessment
  • Adaptive behavior assessment
  • Social communication and language assessment
  • Assessment of RRB (including sensory issues)
Children with ASD often demonstrate additional problems beyond those associated with the core domains. Therefore, other areas should be included in the assessment battery depending on the referral question, history, and core evaluation results. These may include:
  • Sensory processing
  • Executive function, memory, and attention
  •  Motor skills
  • Family system 
  • Co-occurring (comorbid) behavioral/emotional problems   
The above referenced principles and procedures for the assessment of school-age children with ASD are reflected in recommendations of the American Academy of Neurology, the American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, and a consensus panel with representation from multiple professional societies. A detailed description of the comprehensive developmental assessment model and specific assessment tools recommended for each domain can be found in A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

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

Learners on the Autism Spectrum: A Best Practice Guide to Assessment & Intervention in Schools



A Best Practice Guide to Assessment & Intervention for Autism in Schools

Fully updated to reflect DSM-5 and current assessment tools, procedures and research, this second edition of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools provides a practical and scientifically-based approach to identifying, assessing, and treating children and adolescents with an Autism Spectrum Disorder (ASD) in school settings. Integrating current research evidence with theory and best practice, this book will support school-based professionals in a number of key areas including:
  • Screening and assessing children and youth on the autism spectrum.
  • Identifying evidence-based interventions and practices.
  • Developing and implementing comprehensive educational programs and providing family support.
    Each chapter features a consolidated and integrative description of best practice assessment and intervention/treatment approaches for children and youth with ASD. It brings the topics of assessment and intervention together in a single authoritative resource guide consistent with recent advances in evidence-based practice.  Illustrative case examples, glossary of terms, and helpful checklists and forms make this the definitive resource for identifying and implementing interventions for school-age children and youth with ASD.
    This Guide is intended to meet the needs of school-based professionals such as school psychologists, counselors, speech/language pathologists, occupational therapists, counselors, social workers, administrators, and both general and special education teachers. Parents, advocates, and community-based professionals will also find this guide a valuable and informative resource.

    Editorial Reviews  
    “It is rare that one book can pack so many resources and easy to digest information into a single volume!  Families, school personnel, and professionals all need the extensive, and up-to-date tips, guides, and ‘must-knows’ provided here. It’s obvious the author is both a seasoned researcher and practitioner – a winning combination.”
     
    — Dr. Debra Moore, psychologist and co-author with Dr. Temple Grandin, of The Loving Push: How Parents & Professionals Can Help Spectrum Kids Become Successful Adults
    “Dr Wilkinson has done it again. This updated and scholarly Second Edition reflects important recent changes regarding diagnosis and services for students with Autism Spectrum Disorder. With its numerous best-practice suggestions, it is a must-read for school psychologists, school social workers, and those who teach in general and special education.”
    — Dr Steven Landau, Professor of School Psychology in the Department of Psychology, Illinois State University
    “This book is an essential resource for every educator that works with students with ASD! The easy-to-read format is complete with up to date research on evidence-based practices for this population, sample observation and assessment worksheets and case studies that allow the reader to apply the information presented.”
     — Gena P. Barnhill, PhD, NCSP, BCBA-D, LBA, Director of Special Education Programs at Lynchburg College, Lynchburg, VA  

    Availability

    A Best practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Ed.) is available from Jessica Kingsley Publishers, Amazon.com, Barnes & Noble, Books-A-MillionWalmart.comBook Depository, and other booksellers. The book is available in both print and eBook formats.

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

    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

    Legal and Appropriate Educational Programs for Children on the Autism Spectrum


    Individuals with Disabilities Education Act (IDEA)

    Since Congress added autism as a disability category to the Individuals with Disabilities Education Act (IDEA), the number of students receiving special education services in this category has increased over 900 percent nationally. The number of students receiving assistance under the special education category of autism over the past decade has increased from 1.5 percent to 9 percent of all identified disabilities. Autism now ranks fourth among all IDEA disability categories for students age 6-21. It’s critically important that parents and educators understand the provisions for providing legally and educationally appropriate programs and services for students identified with autism spectrum disorder (ASD).
    Research indicates that education is the most effective treatment/intervention for children with ASD. The most recent re-authorization of the Individuals with Disabilities Education Act (IDEA 2004) 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 legal and appropriate educational 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.
    Adapted from Wilkinson, L. A. (2016). A best practice guide to assessment and intervention for autism spectrum disorder in schools. London and Philadelphia: Jessica Kingsley Publishers.

    Key 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.

    Wagner, S. (2014). Continuum of Services and Individualized Education Plan Process. In L. A. Wilkinson (Ed.). Autism spectrum disorder in children and adolescents:  Evidence-based assessment and intervention in schools (pp. 173-193). Washington, DC: American Psychological Association.

    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. 
    Wilkinson, L. A. (Ed.). (2014). Autism spectrum disorder in children and adolescents:  Evidence-based assessment and intervention in schools. Washington, DC: American Psychological Association.

    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: Jessica Kingsley Publishers.

    Zirkel, P. (2014). Legal Issues Under IDEA. In L. A. Wilkinson (Ed.), Autism spectrum disorder in children and adolescents:  Evidence-based assessment and intervention in schools (pp. 243-257). Washington, DC: American Psychological Association. 
    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, NCSP is a licensed and nationally certified school psychologist, chartered psychologist, registered psychologist, and certified cognitive-behavioral therapist. He is also a university educator and trainer, and has published widely on the topic of autism spectrum disorders both in the US and internationally. 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 a best-selling text in the American Psychological Association (APA) School Psychology Book Series, Autism Spectrum Disorder in Children and AdolescentsEvidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).
    ©Lee A. Wilkinson, PhD

    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.

    Follow by Email

    Top 10 Most Popular Best Practice Posts

    Search BestPracticeAutism.com

    Blog Archive

    Best Practice Books

    Total Pageviews