Monday, April 24, 2017

Schools Need Improved Definitions & Evaluation Procedures for Autism

The dramatic increase in the number of students qualifying for special education under autism in our schools may be due, in part, to vague definitions together with ambiguous, variable, and irrelevant evaluation procedures, according to a study published in the journal, Autism Research and Treatment. The study examined the definition of autism published by each state education agency (SEA) and the District of Columbia, as well as SEA evaluation procedures for determining student eligibility for autism. The researchers compared components of each SEA definition from two authoritative sources: DSM-IV-TR and IDEA-2004.
The results indicated that many more SEA definitions incorporate IDEA-2004 features than DSM-IV-TR features. However, despite similar foundations, SEA definitions of autism displayed considerable variability. Many of the definitions were too vague to be of much use. Evaluation procedures were found to vary even more across SEAs. There often was little concordance between the definition (what autism is) and evaluation procedures (how autism is identified). 

Definition components often were not addressed by evaluation features, even in a cursory way. One of the least recommended evaluation features was the requirement to administer an autism-specific evaluation as part of the eligibility process. Of the SEAs that included an autism assessment in the evaluation process, none specified the use of a recognized instrument such as the Autism Diagnostic Observation Schedule (ADOS) or the Childhood Autism Rating Scale (CARS). Although several of these SEAs did indicate the required use of a state-created autism checklist, none gave any reference to a source or psychometric characteristics of those checklists
Recommendations for state and federal policy changes are discussed. For example, the researchers suggest that the publication of DSM-5 provides SEAs with the opportunity to expand and update their current definition of autism. They note that the DSM-5 criteria for autism spectrum disorder (ASD) encompass all of the elements stated by the current IDEA definition. The DSM-5 also recognizes the salience of sensory processing problems and co-occurring (comorbid) disorders (e.g., ADHD). The study recommends that SEAs consider the DSM-5 criteria for ASD as they consider revisions to their state definition of autism and corresponding procedures by which assessors will provide data for eligibility determination. Likewise, IDEA-2004 is overdue for Congressional reconsideration and possible amendment, so there is an opportunity to also update and clarify the federal educational definition of autism. Improved, more specific definitions and evaluation procedures will enable SEAs and school districts to better serve students with autism and more efficiently allocate resources.
Malinda L. Pennington, Douglas Cullinan, and Louise B. Southern, “Defining Autism: Variability in State Education Agency Definitions of and Evaluations for Autism Spectrum Disorders,” Autism Research and Treatment, vol. 2014, Article ID 327271, 8 pages, 2014.

Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a 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, April 3, 2017

Parental Stress and Autism Respite Care

 “Just one additional hour of respite care per week was related to an increase in marital quality” 
Parents of children with neurodevelopmental conditions face challenges that place them at an elevated risk for distress and negative psychological outcomes. For example, the demands placed on parents caring for a child with autism contribute to a higher overall incidence of parental stress which can adversely affect family functioning and marital relationships. Research suggests that respite care can be an appropriate and effective intervention to potentially reduce stress and improve marital quality.
For example, Harper et al. obtained survey data regarding daily responsibilities, marital quality, and the amount of respite care received from 101 mother and fathers who were together raising at least one child with an autism spectrum disorder (ASD). Parents indicated that approximately 64 percent of their children spent time with a respite care provider, including grandparents, babysitters, community agencies, and extended family members. The researchers found that the number of hours of respite care was positively related to improved marital quality for both husbands and wives and that a 1 hour increase in weekly respite care was associated with an improvement in marital quality. This relationship was significantly mediated by perceived daily stresses and uplifts (qualities that led to better relationships) in both husbands and wives. More respite care was associated with increased uplifts and reduced stress; increased uplifts were associated with improved marital quality; and more stress was associated with reduced marital quality. The number of children in the family was associated with greater stress and reduced relational quality and daily uplifts.
The study’s findings offer hope to couples parenting a child with ASD and have important implications for professionals who work with families caring for a special needs child. Respite care should be a critical component in a comprehensive family support plan because even a small increase in the number of hours of respite care has the potential to significantly improve marital quality. Counselors, therapists, psychologists, physicians, school administrators, special education teachers, social workers, and family advocates need to be aware of the respite care options available and be unified in their approach to informing and helping parents access these services.  As the researchers conclude, “A coordinated approach to helping parents obtain and navigate ongoing respite care is long overdue.” 
Harper, A., Dyches, T. T., Harper, J., Roper, S. O., & South, M. (2013). Respite care, marital quality, and stress in parents of children with autism spectrum disorders. Journal of Autism and Developmental Disorders. doi: 10.1007/s10803-013-1812-0

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