Thursday, December 21, 2017

A Multi-Tiered Approach to Screening for Autism

A Multi-Tiered Approach to Screening for Autism

There has been a dramatic worldwide increase in reported cases of autism over the past decade. Yet, compared to population estimates, many students remain underidentified and underserved in our schools. It is not unusual for children with less severe symptoms of autism spectrum disorder (ASD) to go unidentified until well after entering school. As a result, it is critical that school-based educational support personnel (e.g., school psychologists, speech/language pathologists, special educators, counselors, and social workers) give greater priority to case finding and screening to ensure that children with ASD are identified and have access to the appropriate programs and services. 
   Screening and Identification

Until recently, there were few validated screening measures available to assist school professionals in the identification of students with the core ASD-related behaviors. However, our knowledge base is expanding rapidly and we now have reliable and valid tools to screen and evaluate children more efficiently and with greater accuracy. The following tools have demonstrated utility in screening for ASD in educational settings and can be used to determine which children are likely to require further assessment and/or who might benefit from additional support. All measures have sound psychometric properties, are appropriate for school-age children, and time efficient (10 to 20 minutes to complete). Training needs are minimal and require little or no professional instruction to complete. However, interpretation of results requires familiarity with ASD and experience in administering, scoring, and interpreting psychological tests.
The Autism Spectrum Rating Scales (ASRS; Goldstein & Naglieri, 2009) is a norm-referenced tool designed to effectively identify symptoms, behaviors, and associated features of ASD in children and adolescents from 2 to 18 years of age. The ASRS can be completed by teachers and/or parents and has both long and short forms. The Short form was developed for screening purposes and contains 15 items from the full-length form that have been shown to differentiate children diagnosed with ASD from children in the general population. High scores indicate that many behaviors associated with ASD have been observed and follow-up recommended.
The Social Communication Questionnaire (SCQ; Rutter, Bailey, & Lord, 2003), previously known as the Autism Screening Questionnaire (ASQ), is a parent/caregiver dimensional measure of ASD symptomatology appropriate for children of any chronological age older than four years. It is available in two forms, Lifetime and Current, each with 40 questions. Scores on the questionnaire provide a reasonable index of symptom severity in the reciprocal social interaction, communication, and restricted/repetitive behavior domains and indicate the likelihood that a child has an ASD. The lifetime version is recommended for screening purposes as it demonstrates the highest sensitivity value. 
The Social Responsiveness Scale, Second Edition (SRS-2; Constantino & Gruber, 2012) is a brief quantitative measure of autistic behaviors in 4 to 18 year old children and youth. This 65-item rating scale was designed to be completed by an adult (teacher and/or parent) who is familiar with the child’s current behavior and developmental history. The SRS items measure the ASD symptoms in the domains of social awareness, social information processing, reciprocal social communication, social anxiety/avoidance, and stereotypic behavior/restricted interests. The scale provides a Total Score that reflects the level of severity across the entire autism spectrum.
A Multi-Tiered Screening Strategy
The ASRS, SCQ, and SRS-2 can be used confidently as efficient first-level screening tools for identifying the presence of the more broadly defined and subtle symptoms of higher-functioning ASD in school settings. School-based professionals should consider the following multi-step strategy for identifying at-risk students who are in need of an in-depth assessment.
Tier  one. The initial step is case finding. This involves the ability to recognize the risk factors and/or warning signs of ASD. All school professionals should be engaged in case finding and be alert to those students who display atypical social and/or communication behaviors that might be associated with ASD. Parent and/or teacher reports of social impairment combined with communication and behavioral concerns constitute a “red flag” and indicate the need for screening. Students who are identified with risk factors during the case finding phase should be referred for formal screening.
Tier two. Scores on the ASRS, SCQ, and SRS-2 may be used as an indication of the approximate severity of ASD symptomatology for students who present with elevated developmental risk factors and/or warning signs of ASD. Screening results are shared with parents and school-based teams with a focus on intervention planning and ongoing observation. Scores can also be used for progress monitoring and to measure change over time. Students with a positive screen who continue to show minimal progress at this level are then considered for a more comprehensive assessment and intensive interventions as part of Tier 3.  However, as with all screening tools, there will be some false negatives (children with ASD who are not identified). Thus, children who screen negative, but who have a high level of risk and/or where parent and/or teacher concerns indicate developmental variations and behaviors consistent with an autism-related disorder should continue to be monitored, regardless of screening results.
Tier three. Students who meet the threshold criteria in step two may then referred for an in-depth assessment. Because the ASRS, SCQ, and SRS-2 are strongly related to well-established and researched gold standard measures and report high levels of sensitivity (ability to correctly identify cases in a population), the results from these screening measures can be used in combination with a comprehensive developmental assessment of social behavior, language and communication, adaptive behavior, motor skills, sensory issues, and cognitive functioning to aid in determining eligibility for special education services and as a guide to intervention planning.
Limitations

Although the ASRS, SCQ, and SRS can be used confidently as efficient screening tools for identifying children across the broad autism spectrum, they are not without limitations. Some students who screen positive will not be identified with an ASD (false positive). On the other hand, some children who were not initially identified will go on to meet the diagnostic and/or classification criteria (false negative). Therefore, it is especially important to carefully monitor those students who screen negative to ensure access to intervention services if needed. Gathering information from family and school resources during screening will also facilitate identification of possible cases. Autism specific tools are not currently recommended for the universal screening of typical school-age children. Focusing on referred children with identified risk-factors and/or developmental delays will increase predictive values and result in more efficient identification efforts.

Concluding Comments
Compared with general population estimates, children with mild autistic traits appear to be an underidentified and underserved population in our schools. There are likely a substantial number of children with equivalent profiles to those with a clinical diagnosis of ASD who are not receiving services. Research indicates that outcomes for children on the autism spectrum can be significantly enhanced with the delivery of intensive intervention services. However, intervention services can only be implemented if students are identified. Screening is the initial step in this process. School professionals should be prepared to recognize the presence of risk factors and/or early warning signs of ASD, engage in case finding, and be familiar with screening tools in order to ensure children with ASD are being identified and provided with the appropriate programs and services. 

Best practice screening and assessment guidelines are available from: 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).

Wednesday, December 20, 2017

Autism: Parent Acceptance and Empowerment


Patent Acceptance and Empowerment

Parents are often overwhelmed by the challenges presented by a child with autism. Research has shown that parents of children on the spectrum exhibit a characteristic stress profile which includes anxiety related to the child's uneven intellectual profiles, deficits in social relatedness, disruptive and maladaptive behaviors (internalizing and externalizing problems) and long-term care concerns. Among these stressors, the child’s maladaptive behavior profile is most reliably linked to parent stress. 

Studies indicate that raising children with autism is associated with higher levels of parenting stress and psychological distress than parenting typically developing children, children with a physical disability, or children with developmental delays without autism. Mothers, in particular, appear to face unique challenges related to the characteristics of autism. Because autism impairs social relatedness and adaptive functioning, parent stress can decrease helpful psychological processes and directly influence the parent or caregiver’s ability to support the child with disabilities.
Research

Increased attention is now being given to the psychological well-being of parents of children and youth with autism. A number of studies have examined the factors that can influence the impact of children’s problem behavior on parent mental health. A study in the Journal Autism examined the relationships between child problem behavior, parent mental health problems, psychological acceptance (e.g., accepting and not being adversely influenced by negative emotions and thoughts that a parent may have about their child), and parent empowerment (e.g., actively attempting to change or eliminate potentially stressful events through the application of knowledge and skills).
The researchers found that the more positive parents’ psychological acceptance and empowerment, the less they reported severe mental health problems. Although greater parent empowerment was associated with fewer parent mental health problems, psychological acceptance had the greatest impact on parent mental health problems, after controlling for ASD symptomatology, negative life events, parent and child gender, and child age. 
Implications

This study has several important implications. The relatively chronic nature of behavior problems in children with autism may explain why acceptance is a more significant psychological construct for explaining parent mental health than is empowerment. If difficulties are manageable and support readily available, then an active, problem-focused coping style would be related to improved parent adjustment. However, for children with autism who exhibit more persistent behavior problems, or for highly stressed and frustrated parents, a problem-focused process may not be enough to ensure positive parent adjustment. If problems are less controllable and/or support less accessible, it may be impossible for parents to focus exclusively on trying to change or avoid their current experience. The authors comment, “In these situations, parents need a different coping strategy, one that allows them to acknowledge their current experience without trying to change it or avoid it.”  Therefore, it may be critically important to understand and evaluate the situation of the family, and offer parents both types of coping skills (acceptance and empowerment) for use across different situations.
This study supports the exploration of acceptance and mindfulness-based interventions as effective approaches for parents of children with autism and underscores the importance of considering the parent psychological experience when developing treatments for child problem behavior. The authors conclude, “Child-focused therapy should not focus exclusively on the child. At the same time that we provide parents with skills and supports to improve their children’s experience, we must also invest in helping parents to deal with their own emotions and coping strategies. 
Weiss, J. A., Cappadocia, M. C., MacMullin, J. A., Viecili, M., & Lunsky, Y. (2012). The impact of child problem behaviors of children with ASD on parent mental health: The mediating role of acceptance and empowerment. Autism, 16, 261-274. DOI: 10.1177/1362361311422708
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).

Tuesday, December 12, 2017

The Gender Gap in Autism: Where are the Girls?


The Gender Gap in Autism: Where are the Girls?

There has been a dramatic increase in reported cases of autism over the past decade. Prevalence rates have risen steadily, from one in 150, to one in 110, and now to one in every 59 children (or 16.8 per 1,000 8-year-olds). According to the CDC's Autism and Developmental Disabilities Monitoring (ADDM) Network, autism is 4 times more common among boys (1 in 37) than among girls (1 in 151). Statistics also indicate that referrals for evaluation of boys are nearly ten times higher than for girls. Moreover, girls are diagnosed with autism at later ages compared to boys. This gender “gap” raises serious questions because many female students with ASD are being overlooked and will not receive the appropriate educational supports and services. 
Why are fewer girls being identified?  Why do parents of girls experience a delay in receiving a diagnosis?  Are there gender differences in the expression of the disorder? Answers to these questions have practical implications in that gender specific variations may have a significant impact on identification practices and the provision of clinical and educational services. Although few studies have examined gender differences in the expression of autism spectrum disorders, we do have several tentative explanations for the underdiagnosis and late identification of girls with ASD. They include the following. 
  • Social communication and pragmatic deficits may not be readily apparent in girls because of a non-externalizing behavioral profile, passivity, and lack of initiative. Girls who have difficulty making sustained eye contact and appear socially withdrawn may also be perceived as “shy,” “naive,” or “sweet” rather than   having the social impairment associated with an autism spectrum disorder.
  • The diagnosis of another disorder often diverts attention from autism-related symptomatology. In many cases, girls tend to receive unspecified diagnoses such as a learning disability, processing problem, or internalizing disorder. A recent survey of women with Asperger syndrome indicated that most received a diagnosis of anxiety or mood disorder prior being identified with an autism spectrum disorder.
  • The perseverative and circumscribed interests of girls with autism spectrum disorders may appear to be age-typical. Girls who are not successful in social relationships and developing friendships might create imaginary friends and elaborate doll play that superficially resembles the neurotypical girl.
  • Although Students with ASD are more likely to be the target of bullying than typical peers, this may not be recognized in girls due to gender differences in preferred modes of aggression. For example, girls may use covert verbal, social, and psychological forms of aggression while boys tend to rely on confrontational and direct modes of bullying. As a result, the more subtle nature of relational and indirect aggression (social exclusion and rejection) used by girls may be taken less seriously than the more obvious, direct aggression exhibited by boys.
  • Although girls may appear less symptomatic than boys, the genders do share similar profiles. Research suggests that when IQ is controlled, the main gender difference is a higher frequency of idiosyncratic and unusual visual interests and lower levels of appropriate play in males compared to females. As a result, the behavior and educational needs of boys are much more difficult to ignore and are frequently seen by teachers and parents as being more urgent, further contributing to a referral bias.
  • Over reliance on the male model with regard to diagnostic criteria might contribute to a gender “bias” and underdiagnosis of girls. Clinical instruments also tend to exclude symptoms and behaviors that may be more typical of females with ASD. For example, assessment instruments such as the Autism Spectrum Rating Scales (ASRS) and Social Responsiveness Scale (SRS) have generally reported higher mean scores for boys than girls. The lower symptom scores for girls may reflect gender differences and expression of the phenotype. Recent research suggests that certain single test items may be more typical of girls than of boys with ASD, and examining symptom gender differences at the individual level might lead to a better understanding of the gender difference in ASD.
  • Apart from biases in reporting or diagnosis, there is significant evidence to suggest that multiple biological factors contribute to the sex differences seen in autism. These include genetic and hormonal differences between males and females that may provide a “protective” mechanism for girls and lead to differences in symptoms and vulnerability to the disorder.
If girls do process language and social information differently than boys, then clinical and educational interventions based largely on research with boys may be inappropriate. As a result, girls may receive less than optimal academic and behavioral interventions. If gender specific variations do exist, then the predictive validity of the diagnosis and developmental course may well differ between the sexes. Unfortunately, the consequences of a missed or late diagnosis can result in social isolation, peer rejection, lowered grades, and a greater risk for mental health and behavioral distress such as anxiety and depression during adolescence and adulthood. As a result, there is an urgent need for research to compare girls with ASD to typical boys and girls to more fully comprehend the implications of being a girl on the autism spectrum. 

Best practice recommends that when a girl presents with a combination of social immaturity, restricted interests, limited eye gaze, repetitive behaviors, social isolation, and is viewed as “unusual” or “different” by parents, teachers and peers, the possibility of an ASD should be given consideration. Clinicians and school-based professionals might also question the presence of ASD in girls referred for internalizing disorders such as anxiety or depression. 

Best practice assessment and intervention guidelines are available from: A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition.) and Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. 
Adapted from 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, 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. 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)

Friday, November 17, 2017

Best Book Awards - A Best Practice Guide to Assessment & Intervention for Autism Spectrum Disorder in Schools


A Best Practice Guide to Assessment & Intervention for Autism Spectrum Disorder in Schools (2nd Edition) was selected as an Award-Winning Finalist in the "Education/Academic" category of the 2017 Best Book AwardsFully updated to reflect current assessment tools, procedures and research, this award-winning book 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, each chapter features a consolidated and integrative description of best practice assessment and intervention 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 Adult 

“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 Edition) is available from Jessica Kingsley PublishersAmazon.comBarnes & NobleBooks-A-MillionBook DepositoryTarget.com,Walmart.comand other booksellers. The book is available in both print and eBook formats.
Author
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. He is also a university educator and school psychology trainer. His research and professional writing has focused primarily on behavioral consultation and therapy, and evidence-based practice in assessment and intervention for autism spectrum disorder. He has published numerous journal articles on these subjects both in the US and internationally. Dr. Wilkinson is author of the award-winning book,  A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and 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 previous book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT, was honored as an “Award-Winning Finalist in the “Psychology/Mental Health” category of the 2016 Best Book Awards.”

Wednesday, November 1, 2017

Sensory Sensitivity in Autistic Adults


Sensory Sensitivity in Autistic Adults

Anecdotal reports and empirical evidence suggest that atypical or unusual sensory responses are a common feature of autism spectrum disorder (ASD). Studies report that from 45 to more than 90 percent of people with autism either ignore or overreact to ordinary sights, sounds, smells or other sensations. Sensory issues are now included in the DSM-5 symptom criteria for restricted, repetitive patterns of behavior, interests, or activities (RRB). This includes hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment; such as apparent indifference to pain/heat/cold and adverse response to specific sounds or textures.  Although no one single type of sensory problem is consistently associated with ASD, auditory sensitivity is often cited as the most disturbing and challenging for autistic individuals.
We live in an incessant cacophony of noise. In fact, scientists say it’s the noisiest age in human history. We know that “noise pollution” can cause hypertension, high stress levels, tinnitus, hearing loss, sleep disturbances, and other harmful effects. Sound becomes unwanted when it either interferes with normal activities such as sleeping, conversation, or disrupts or diminishes one's quality of life. Certain sounds are particularly annoying collectively to us all. However, many of the everyday noises other people take for granted can be very painful and cause unwanted intrusions for autistic adults. For example, many autistic adults report sound sensitivity problems such as hyperacusis, misophonia, hypersensitive hearing at certain frequencies, and phobias (phonophobia) related to specific sounds. When present, sensory problems can interfere with adaptability in many areas of life (communication, daily living, socialization, occupational). Understanding sensory issues in adults on the autism spectrum is critical to the identification and prescription of appropriate interventions especially considering studies that suggest a link between anxiety and sensory over-responsivity which can further compromise an individual's ability to function successfully in daily life.
Research

A study published in
Autism investigated sensory over-responsivity in adults compared to control participants and the extent to which daily life experiences were endorsed as uncomfortable or distressing by those on the spectrum. The researcher’s hypothesized that adults with autism would report more sensory over-responsivity than controls. A second objective was to test whether sensory over-responsivity is linked to autistic traits in adults with and without autism.
Adults with (n = 221) and without (n = 181) autism spectrum conditions participated in an online survey. The Autism Spectrum Quotient (AQ), the Raven Progressive Matrices and the Sensory Processing Scale were used to characterize the sample. Adults with autism spectrum conditions reported more sensory over-responsivity than control participants across all sensory modalities (vision, hearing, touch, smell, taste and proprioceptive). However, the highest mean scores were reported for Hearing and Touch on the Sensory Processing Scale.
These findings highlight the importance of measuring each sensory domain separately rather than combining scores from various sensory domains. Notable in this study was the association between sensory over-responsivity and autistic traits. Increased sensory sensitivity was associated with more self-reported autistic traits, both across and within groups. These results indicate that autistic adults experience sensory over-responsivity to daily sensory stimuli to a high degree and that a positive relationship exists between sensory over-responsivity and autistic traits.
Implications

Despite its limitations, this study shows that autistic adults self-report over-responsivity across multiple sensory domains (vision, hearing, touch, smell, taste and proprioceptive) that affect their daily life routines and thus quality of life. Auditory over-responsiveness was among the most frequently reported by participants indicating that autistic adults experience challenges to daily auditory stimuli to a high degree. Although sensory symptoms may improve with maturation for typical individuals, sensory features in ASD remain stable and often become more challenging during adulthood. Likewise, sensory over-responsivity has also been linked to higher rates of depression and anxiety. Although there is no cure for sensory sensitivity, there are various techniques as well as some lifestyle modifications that can tone down the symptoms of auditory sensitivity, so it does not severely interfere with everyday life. They include exposure and response prevention (E/RP) treatment; habituation training, applied relaxation, positive imagery, attention shifting, psychoeducation, cognitive restructuring, and background sounds to cope with hyperacusis. The most effective solutions involve increasing the tolerance of noise by exposing the person to sufficient noise to build up his or her “immunity.” Over-protection may only further increase the effect of extreme sensitivity to sound. Evaluating and attending to over-responsivity have implications for understanding and addressing the sensory components of autistic adults' daily life routines and roles. Appropriate intervention should be directed towards sensory issues that may be contributing to emotional and psychological challenges and towards designing sensory friendly domestic and work environments.
Tavassoli T., Miller, L. J., Schoen, S. A., Nielsen, D. M., & Baron-Cohen, S. (2014). Sensory over-responsivity in adults with autism spectrum conditions. Autism, 18, 428–432.  
doi: 10.1177/1362361313477246

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 the 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).

Monday, October 16, 2017

What Do School Personnel Know About Autism?

School Personnel Knowledge of Autism

Autism spectrum disorder (ASD) affects approximately 1 to 2 % of the school-age population.  The majority of children with autism are educated within the public school system, most often in general education classes, either full- or part-time. Thus, teachers (regular and special education) and other school personnel must be familiar with current best practices for identifying and treating children with ASD. However, many do not have formal training in educating and intervening with this group of children. To address the increased need for services in school settings, it has been recommended that school personnel participate in trainings to develop the skills and competencies necessary to provide effective services to students with ASD. 

Although a review of the literature suggests that school personnel are receiving some specialized training related to autism, there continues to be a pressing need for more continuing education opportunities and improved preparation. It is vital that school personnel understand this complex disorder in order to help students achieve positive outcomes, especially since they share the responsibility of educating the increasing number of children being identified with ASD.
Pilot Study
Although there is a paucity of research focusing on school personnel's perceived and/or factual knowledge of autism, a pilot survey published in the School Psychologist provides us with an exploratory investigation of teacher, counselor, and paraprofessional knowledge of autism. The survey attempted to answer the following questions: (a) To what extent do school personnel (teachers, counselors, and paraprofessionals) perceive that they are competent in their understanding of autism?; (b) What is school personnel's factual knowledge of autism (definition, assessment/diagnosis, and treatments)?; and (c) To what extent do school personnel that work directly with students with autism differ in their perception and factual knowledge of autism in comparison to those who do not work with students with autism?
Participants
Fifty-four school personnel from a southwestern state participated in the pilot survey. Participants were school district employees enrolled in various graduate level majors who were attending a small university (within the college of education) in the Southwestern United States. The sample included 26 general education teachers, 14 special education teachers, 7 school counselors and 7 paraprofessionals. Seventy percent indicated that they worked directly with students diagnosed with autism (instructor, interventionist, care-provider, etc.), while approximately 30 percent indicated that they indirectly served students with autism (consultant, academic planning, multidisciplinary team member, etc.). A majority indicated that they had never participated in autism training(s) and when asked whether they would like to take part in future training(s), most indicated that they did not have a desire to participate.
Participants completed two measures developed by the authors, a Perceptions Survey and a Knowledge Survey. Both measures contained items derived from empirically-supported findings in the research literature. The Perceptions Survey items were designed to assess the respondents' perceived competence of their knowledge and ability to implement research findings. The Knowledge Survey items were designed to assess the respondents' factual knowledge of research findings about autism (definition, assessment/diagnosis, and treatment).
Results
The results of the survey indicated that overall, the perceived competence of general and special education teachers, school counselors, and paraprofessional regarding their knowledge of autism was average. Although school personnel that work directly and indirectly with students both reported having average perceived competence, those providing direct service had a statistically significantly higher level of perceived competence. The results of the Knowledge Survey indicated that school personnel who work directly with students correctly defined the disorder, while those that do not demonstrated moderate knowledge with some errors. However, school personnel's factual knowledge about the assessment/diagnosis and treatment of autism was low, regardless of whether services were delivered directly or indirectly.
    Implications
The findings of this pilot survey raise several important questions about school personnel’s perceived and factual knowledge about autism. A majority of participants indicated they had no prior training and expressed little interest in receiving education related to autism in the future. This is concerning, given that all participants working with students with autism, either directly or indirectly, reported average perceived competence yet demonstrated a low level of factual knowledge. This divergence suggests that teachers, school counselors, and paraprofessionals may overestimate their factual knowledge about autism and as a result, fail to see a need for additional training.
Despite the study’s limitations (e.g., small sample size) and need for further research relating to school personnel’s perceptions and knowledge, the results have significant implications for school-based practice. For example, administrators, supervisors, and support professionals such as school psychologists should exercise caution when assuming that school personnel have an adequate factual understanding and working knowledge of autism. It is also important to recognize that anecdotal reports are insufficient when determing the need for training and that direct assessment of factual knowledge is required. Failure to correctly identify training needs can have a negative effect on screening/assessment and intervention selection, planning, and implementation. The results also raise an important question as to what extent school personnel’s perceived knowledge about autism might limit their willingness to participate in training and contribute to resistance in consultation.
                                                                           Conclusion
There is a critical need for more coordinated efforts among community and school professionals for the training of teachers in evidence-based instruction and behavioral management practices for children with ASD. Because the knowledge base in ASD is changing so rapidly, it is imperative that school personnel remain current with the research and up to date on scientifically supported approaches that have direct application to the educational setting. For example, some intervention and assessment procedures require a specific knowledge base and skills for successful implementation. It is vital that service providers understand best practice procedures across school, community, and home settings. School personnel can help to ensure that students with ASD receive an effective educational program by participating in training programs designed to increase their understanding and factual knowledge about assessment and intervention /treatment approaches.
Key Sources

Azad, G., & Mandell, D. S. (2016). Concerns of parents and teachers of children with autism in elementary school. Autism : The International Journal of Research and Practice20(4), 435–441. doi:10.1177/1362361315588199

Baker, Laura Nichole, Perceived Levels of Confidence and Knowledge of Autism Between Paraprofessionals in Kentucky Schools and Parents of Children with Autism (2012). Online Theses and Dissertations. 106. https://encompass.eku.edu/etd/106

Evidence-Based Practice and Autism in the Schools an educator’s guide to providing appropriate interventions to students with autism spectrum disorder 2nd Edition National Autism Center | Randolph, Massachusetts (2015). https://www.unl.edu/asdnetwork/docs/NACEdManual_2ndEd_FINAL.pdf

Kabot, S., & Reeve, C. (2014). Curriculum and program structure. In L. A. Wilkinson (Ed.). Autism spectrum disorder in children and adolescents: Evidence-based assessment and intervention in schools. Washington, DC: American Psychological Association.

Klein, T. (2012). Consumer corner: Autism for public school administrators: What you need to know. Science in Autism Treatment, 9(1), 6-8.

Life Journey Through Autism: An Educator’s Guide to Autism. Organization for Autism Research (OAR). Arlington, VA 22201 
https://researchautism.org/education/teachers-corner/

Wagner, S. (2014). Continuum of services and individual plan process. In L. A. Wilkinson (Ed.). Autism spectrum disorder in children and adolescents: Evidence-based assessment and intervention in schools. Washington, DC: American Psychological Association.

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

Williams, K., Schroeder, J. L., Carvalho, C., & Cervantes, A. (2011). School personnel knowledge of autism: A pilot survey. The School Psychologist, 65, 7-9.

Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist and a 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

FOUR "MUST HAVE" AUTISM SPECTRUM BOOKS



         http://amzn.to/2jcegH0  -  A Best Practice Guide to Assessment and
          Intervention for Autism Spectrum Disorder in Schools (2nd Edition)

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          Adolescents: Evidence-Based Assessment and Intervention

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          Autism Spectrum: A Self-Help Guide Using CBT

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Saturday, October 7, 2017

What is Pragmatic Language?

What is Pragmatic Language?

Synonyms
Natural language; social communication; social discourse; social language; social skills
Definition
Pragmatics is broadly defined as the ability to understand and use language in social-communicative contexts.
Description
Pragmatics is the area of communication function that involves the use of language in social contexts (knowing what to say, how to say it, when to say it, and where to say it).  It is the ability of natural language speakers to communicate more than that which is explicitly stated and to understand another speaker's intended meaning. Pragmatics includes both the verbal and nonverbal aspects of communication and may be thought of as a conversational code of conduct or a set of rules for communication. We learn this system of rules naturally and implicitly. If one has good pragmatic skills, he or she is able to communicate an appropriate message effectively in a real world social situation. Pragmatics involve the following social linguistic skills: (a) using language for different purposes (e.g., greeting and requesting); (b) changing language according to the needs of a listener or situation (e.g., talking differently to a peer than to an adult and speaking differently in a classroom than on a playground); (c) understanding non-literal language (e.g., metaphor, irony, figurative language, sarcasm); and (d) following rules for conversations (e.g., taking turns and staying on topic). The pragmatic aspect of language also includes appropriate eye contact, intonation, and the body movements and gestures that accompany communication.
Relevance to Autism
Children must be fluent and capable in the areas of pragmatic language in order to interact and participate successfully in school. When typical children engage in reciprocal conversation they are aware of the knowledge, interests and intentions of the other person, as well as the social rules which determine pragmatic competence. In contrast, children with poor pragmatic skills have significant problems using language socially in ways that are appropriate or characteristic of children their age. Many children with developmental disabilities have difficulties learning the complex rules of social interaction. For example, pragmatic language disorders are the most prominent communication deficit in children with autism spectrum disorder (ASD).  Because social communication deficits are among the core challenges of autism spectrum disorder, an evaluation of pragmatic competence is always a vital part of the assessment process. However, few standardized tests can effectively evaluate and quantify the complexity of pragmatic language. Valid norms for pragmatic development and objective criteria for performance are also limited. Indeed, formal testing may not identify the presence of a social pragmatic problem, thereby preventing the child from receiving the appropriate support. Assessment of pragmatic social skills requires more than a traditional standardized testing approach. Less formal naturalistic assessments are necessary, including observations of children’s pragmatic competency in everyday contexts. Given that pragmatic language is a critical part of everyday communication and social interaction, it is imperative that interventions for children with autism spectrum disorder focus on social (pragmatic) communication skills skills. 
Key References

Prizant, B. M., Wetherby, A. M., Rubin, E., Laurent, A. C., & Rydell, P. J. (2006). The SCERTS model: A comprehensive educational approach for children with autism spectrum disorders. Baltimore, MD: Paul Brookes Publishing Company.

Twachtman-Cullen, D., & Twachtman-Bassett, J. (2014). Language and social communication. In L. A. Wilkinson (Ed.), Autism spectrum disorder in children and adolescents:  Evidence-based assessment and intervention in schools (pp. 101-124). Washington, DC: American Psychological Association.
Winner, M. G. (2005). Think social! A social thinking curriculum for school-age students. San Jose, CA: Think Social Publishing.
Wilkinson, L. A. (2011). Pragmatics in Encyclopedia of Child Behavior and Development, Part 16, 1138-1139, DOI: 10.1007/978-0-387-79061-9_2209

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