AUTISMEVALUATION PLANNING

ANDELIGIBILITY

DETERMINATION

Kathy MeredithComplex Needs Consultant

Purpose of this session

• To learn how to complete the evaluation planning form completely to provide the ARC the sufficient information necessary to make eligibility determination for the suspected disability.

Non purpose of this session

• To discuss interventions or placement• To discuss autism for any purpose

other than evaluation process and eligibility determination.

• To get involved in side bars during the lecture.

• To discuss individual cases.

Gallery Walk1. Review the eligibility form for autism and the

evaluation planning form.2. Using the eligibility definition and the evaluation

planning form, brainstorm under each area on the posters, what types of assessments and the titles of professionals will be needed to conduct a comprehensive evaluation to determine eligibility.

Autism: Kentucky Regulations Definition

(5) "Autism" means a developmental disability significantly affecting verbal and nonverbal

communication and social interaction, generally evident before age three (3) that adversely

affects a child’s educational performance. Other characteristics often associated with autism are

engagement in repetitive activities and stereotyped movements, resistance to

environmental change or change in daily routines, and unusual responses to sensory experiences. The term shall not apply if a child’s educational

performance is adversely affected primarily because the child has an emotional-behavior

disability. KAR 1:300 §3(2)(3)

Pervasive Developmental Disorders

• Autistic disorder• Asperger’s disorder• Rett’s disorder• Childhood disintegrative disorder• Pervasive developmental disorder, not

otherwise specified (PDD-NOS)

April 7, 2008

3 Basic Characteristics

• Impairments Communication/Language, generally evident before the age of three.

• Impairments in Social Interaction

• Restricted, Repetitive, and Stereotyped Patterns of Behavior, Interests, and Activities

Early “Red Flags” for ASD

• “Red flags” for ASD (AAP, 2007, p.1) – Not turning when parent says baby’s

name– Not turning to look when parent points

and says, “Look at…”– Not pointing to show parents an

interesting object or event– Lack of back and forth babbling– Smiling late– Failure to make eye contact with people

Early Signs of ASD

Additional information about early signs of ASD

can be found at:

www.cdc.gov/ncbddd/autism/actearlywww.autismspeaks.org/whatisit/learnsigns.phpwww.firstsigns.org

Communication Activity

View: Communication>Expressive and Receptive Language> Expressive and Receptive Language: Sounds, Words, Prosody> 3, 4, & 5 on First Signs website

http://www.firstsigns.org/asd_video_glossary/asdvg_about.htm

Communication

• Expressive and receptive – Understanding and processing time

• Social communication• Pragmatics– reciprocal conversation

• Articulation / oral-motor skills• Syntax• Semantics• Qualitative differences– echolalia, rhythm, rate, intonation,

stereotyped speech, overly formal, immature

Impairments in Communicationcont.

• Language characteristics

– Reversing pronouns– Lacking variety in sentence structure– Using simplistic and immature grammar– Inability to generalize

Impairments in Communication

• Difficulty understanding the non-literal use of words and phrases

• Concrete (literal) thinking

• Poor imaginative play

Impairments in Social Interaction

• Joint Attention–use of eye gaze– in pointing/understanding others’

use of pointing– in showing others things of

interest

http://www.firstsigns.org/asd_video_glossary/asdvg_about.htm

Impairments in Social Interaction

• Difficulty attempting to interact with others and understanding social cues.– recognizing own emotions and beliefs – understanding other person has thoughts and

feelings that may be different (theory of mind)– understanding irony, sarcasm, white lies and

metaphors– theory of mind

http://www.holah.karoo.net/sallyanne.gif

Impairments in Social Interaction

Theory of Mind False Belief Task Example:

A child watches while a puppet named Eddie places a toy car under a cup and then leaves. After Eddie has left, another puppet comes along and moves his toy car into a box, without Eddie witnessing this switch. When Eddie returns, the child participant is asked where Eddie will search for the toy, under the cup or in the box. A typically developing child would say under the cup. However a child with ASD would say that Eddie will look in the box, demonstrating inability to take viewpoint of another.

– often narrowly focused – often intense– content may be unusual–may interfere with functional

activities– shifting attention away from special

interest is often difficult

Engagement in repetitive activities and stereotypic

movements

Resistance to change in environmental or daily routines

• Change in physical structure can cause anxiety.

• Development of routines and insistence on sameness

– following routines can be comforting

– change in routine can cause anxiety

– transitions often hard

Repetitive cont.

• are common but not universal in ASD– are also seen in young, typically

developing children– frequency and intensity in ASD

differ from those with typical development

Unusual responses to sensory experiences

• Definition: Heightened or decreased experience of sounds, lights, movement, touch, smell or taste or fascination with sensory experiences

– Contribute to distractibility, difficulty in shifting attention

– May lead to avoidance behaviors– May lead to sensory seeking behavior– May impact learning, social interactions, behavior

Sensory Issues

Sensory experiences can be overwhelming, even painful.

“When people touched me, I experienced an overwhelming drowning wave of over stimulation. … Certain noises affected me like a dentist’s drill hitting a nerve. … I often became anxious when balloons were present because I was afraid they would pop. Other noises that hurt my ears were the school bell’s ringing and the hum of the big industrial vacuum cleaner that was used to clean the elementary school classrooms.” (Grandin, 2005, pp. 1280-1281)

Sensory Issues

• Assess influence of sensory issues on learning, development, and interactions with others

Sensory Issues

• Assess influence of sensory issues on learning, development, and interactions with others

– Autism Screenings– Checklists– Observation– Occupational therapists typically assess

atypical sensory responses

Co-occurrence with Other Disorders

April 7, 2008

• Intellectual disability

• Seizures

• Genetic syndromesFragile X syndrome (25-67% of males with FXS have autistic behaviors or meet criteria), tuberous sclerosis (17-64%), Down syndrome (6-7%)

• Mental health conditionsPhobias, obsessive compulsive disorder, attention deficit hyperactivity disorder, depression, anxiety

CULTURE OF AUTISM

SOCIAL RELATEDNESSJOINT ATTENTION & RECEPROCITY

COMMUNICATIONExpressive deficits

Problems with intent as well as meansReceptive deficits

Problems with meaning and processing

SENSORY PROCESSINGIntegration and modulation of inputs

DIFFICULTY WITH CHANGELimited interests, repetitive behavior, rigidity

COGNITIVE STYLEProblems with organization and sequencing &planning

Problems with attention & relevanceProblems with abstraction & generalization

•Sensory

•Language and

communication

•Need for sameness

•Distractibility

•Sequencing

•Relevance

•Organization

•Understanding of time

•Perseveration

•Social understanding

•Concrete

•Central Coherence

•Executive Functioning

•Generalization

•Motivation

•Confusion

•Anxiety

And, don’t forget……..

• Assistive Technology• Transition• English Language Learner• Cultural issues• Cognitive Data (only if a mental

disability is suspected) or (to observe behavioral issues that hinder educational performance).

Determination of Eligibility3. Adverse Affect

36

To determine adverse affect, the ARC must compare the

student’s performance to the performance of peers, in the same learning environment.

This information can come from peer comparisons to behavior, rating scales, and curriculum

based assessment.

DEVELOPING THE

EVALUATION PLAN

Suspecting a DisabilityStudent experiences problems in: May consider assessment for:

Communicating with others Autism, Speech/Language Impairment

Speech and Language Speech/Language Impairment

Academics Specific Learning Disability

Behaviors and Emotions Emotional Behavior Disability

Child development (up to age 9) Developmental Delay

Cognition (thinking and problem solving)

Mental Disability (MMD, FMD), Autism

Health Other Health Impairment

Physical Areas Orthopedic Impairment

Vision Blind or Visually Impaired

Hearing Deaf or Hard of Hearing

Issues due to an old or recent accident Traumatic Brain Injury

Gallery Walk1. Look at the eligibility form for autism and the

evaluation planning form2. Remembering the characteristics and eligibility

definition, brainstorm under each area of the posters, what types of assessments and the titles of professionals that will be needed to conduct a comprehensive evaluation to determine eligibility.

3. Based on what you know about this process, what else do we need to consider?

Evaluation Planning Form

KAR 1:300 §3(2)(3)41

Develop the Evaluation Plan

Based on referral information & eligibility requirements, determine additional information needed;

1.Determine needed areas of evaluation;2.Determine types of personnel to

complete evaluation components;3.Target specific areas for observation;4.Determine the need for Assistive

Technology Evaluation; and5.Determine the need for modifications

to evaluation procedure(s).

Complete the Form based on

group results on flip charts

KAR 1:300 §3(2)(3)43

KAR 1:300 §3(2)(3)44

Evaluation Planning Form

Medical

Statement

Evaluation Planning Form (cont.)

KAR 1:300 §3(2)(3)45

Evaluation Planning

The child shall be assessed in all areas related to the suspected disability, including, if appropriate:

• health, vision, hearing, and motor• social and emotional status • general intelligence• academic performance• communicative status

707 KAR 1:300 Section 4 (10)

34 CFR 300.304 (c) (4)

IDEA Guidelines for Assessment of ASD

• Components that must be included in assessments– Vision and hearing screenings– Cognitive assessment– Speech-language assessment– Adaptive behavior assessment– Social-emotional and behavioral

assessment– Developmental and health history – Observation (school, home,

social/community)

34 CFR 300.304 (c) (4)

ARC’s make educational eligibility

determinations, not medical diagnoses.

KAR 1:300 §3(2)(3)49

Diagnosis vs Eligibilty

50

What Do the Results of Screening Tell Us?

• Indicates level of risk for delay or disability

• Provides guidance on need for additional evaluation or services

• Does not provide sufficient information for diagnosis or determination of educational eligibility

Selected Measures for Assessment of ASD

• Autism Diagnostic Observation Schedule (ADOS)

• Autism Diagnostic Interview – Revised (ADI-R)

• Childhood Autism Rating Scale (CARS)

Commonly Used Screening Measures for ASD

• Autism Spectrum Screening Questionnaire (ASSQ)

• Gilliam Autism Rating Scale (GARS) – 2nd Edition

• Modified Checklist for Autism in Toddlers (M-CHAT)

• Pervasive Developmental Disorders Screening Test – II (PDDST-II)

• Screening Tool for Autism in Two- Year-Olds (STAT)

• Social Communication Questionnaire (SCQ)

Assessment of Adaptive Behavior

• Assess independence in specific areas:–Motor– Communication– Social– Personal / self-help

• Assess generalization of skills• Assess amount of support needed

Asperger’s Screenings

• Asperger Syndrome Diagnostic Scale

• Australian Scale for Asperger Syndrome (ASAS)

• Childhood Asperger Syndrome Test (CAST)

• Gilliam Asperger’s Disorder Scale

• Krug Asperger’s Disorder Index (KADI)

Resources for examples of information gathering

• Wisconsin Department of Public Instruction home page: http://dpi.wi.gov

• Autism: http://dpi.wi.gov/sped/autism.html • Cognitive Disability: http://dpi.wi.gov/sped/cd.html • Speech/language disability:

http://dpi.wi.gov/sped/speech.html • Functional Behavioral Assessment:

http://dpi.wi.gov/sped/sbfba.html Special Education Index (includes links to disability areas, Information Updates (bulletins), What’s New, statutes, and many other resources):

• http://dpi.wi.gov/sped/tm-specedtopics.html• www.autisminternetmodules.org

Activity

• Look at all of our posters and information.

• Is there anything that we need to add?

Ask yourself these questions

1. Are there a variety of assessment tools and procedures ?2. Are there a variety of appropriate settings covered for

observations?3. Did you consider the referral information.4. Did you include vision, hearing, and communication screenings?5. Did you include parent input?6. Did you include medical information if necessary?7. Is there sufficient assessments for adaptive behavior?8. Did you include the supports and/or modifications needed for

student to complete the assessments?9. Did you address developmental information in the areas of social

and communication?10. Did you plan for transition, limited English proficiency?11. Did you include assessments to rule out lack of instruction in

math and reading?12. Did you include sufficient assessments to rule out emotional-

behavior disability?