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To comply with professional boards/associations standards:• I declare that I (or my family) do not have a financial relationship in any amount, occurring in the last 12 months with a commercial interest whose products or services are discussed in my presentation. Additionally, all planners involved do not have any financial relationship.•Requirements for successful completion are attendance for the full session along with a completed session evaluation.•Vyne Education and all current accreditation statuses does not imply endorsement of any commercial products displayed in conjunction with this activity.
Session 303: Evidence‐Based Assessments & Interventions for Children with Autism Spectrum Disorder
Robyn Otty, OtD, OTR/L, MEd, BCPR
Leading the Way in Continuing Education and Professional Development. www.Vyne.com
Course DescriptionWith the increasing prevalence of children diagnosed with Autism Spectrum Disorder, there is a growing need to ensure functional outcomes translate into their environment. Such provision of services requires time to warrant the intensive therapeutic services for the child are justified. Through this session, you will have the opportunity to learn the latest evidence‐supported intervention approaches and assessment methods to support and document therapy services for children with ASD.
Learning Objectives1. Examine various assessment tools to inform, guide, and validate your plan of care.
2. Quantify skilled observations to effectively justify your services to third‐party payors.
3. Appraise existing methods of assessment and daily documentation practices to inform your plan of care.
Session Outline1) Appraise current methods of assessments: Strengths and weaknesses
2) Overview of various assessment tools: Clinical utility and research
3) Further quantify intervention to justify the small changes
4) Hands‐on experiences: Rotation
Case Activity
Outpatient Pediatric ClinicJAMES
James is an OT who works in a busy freestanding outpatient clinic uses only naturalistic observations using levels of assistance to quantify the clients’ functional abilities (i.e. Ind, Min A, Mod A, etc.), and occasional use of parent questionnaires.
James has a difficult time managing his time and will often document at the end of the week. Unfortunately, his manager has to provide specific direction to ensure documentation is adequate for reimbursement.
MONICA
Monica is an OT who works in the same busy freestanding outpatient clinic utilizes various methods to complete her clients’ evaluations. She uses assessment tools and screeners, structured interviews with the parent, and naturalistic observations of performance.
Monica also takes it upon herself to serve a local university as a fieldwork educator. She manages her time well with frequent notes and continual documentation system that includes collecting data during each treatment session.
JamesSTRENGTHS WEAKNESSES
MonicaSTRENGTHS WEAKNESSES
Suggestions for James
The Problem(Tomcheck, Little, & Dunn, 2015)
Low Energy/Weak
Tactile/Movement Sensitivity
Taste/Smell Sensitivity
Auditory/Visual Sensitivity
Hyporesponsivity Scores
Receptive Expressive
Considerations: Assessment and ASD (Schaaf & Lane, 2015)
Relationship between restrictive and repetitive behaviors and sensory reactivity
Association between sensory features and social engagement
Sensory features change with age – Further research needed
Sensory Profile
Sensory Processing Measure
Sensory Experiences Questionnaire
Sensory Processing Scales
Sensory Integration and Praxis Test
Assessment ToolsCLINICAL UTILITY AND RESEARCH
The Rehabilitation Institute of Chicago
Types of Standardized Tests (Brown, 2017)NORM‐REFERENCE
Compared with other
Purpose:
Determine if scores are within or outside of a typical range (p. 129).
CRITERION‐REFERENCE
Based on standard/fixed point (by experts)
Purpose:
Determine individual’s performance compares to the established benchmark.
Assessment Tool ConsiderationsVALIDITY
Evaluates the desired purpose/domain
CONSTRUCT
Predictive of performance
PREDICTIVE
Alternative tool to evaluate purpose/domain
CONCURRENT
RELIABILITY
Outcome accuracy
Stamina & Consistency
TEST‐RETEST
Between raters
INTERRATER
Same rater
INTRARATER
CorrelationPOSITIVE NEGATIVE
Correlation: StrengthClosest to 1.00
.70 to .99 STRONG
.50‐.69 MODERATE
.30‐49 WEAK
<.30 VERY WEAK
Other Assessment Considerations
Responsiveness
One that can detect change
Ceiling Effect
A high score has little room for improvement
Assessment ToolsSCREENING TOOL
Modified Checklist for Autism in Toddlers (MCHAT)
‐ Screening for ASD
http://www2.gsu.edu/~psydlr/Diana_L._Robins,_Ph.D._files/M‐CHAT_new.pdf
Assessment ToolsSCREENING TOOL
The First Year Inventory
‐Screening for ASD
http://www.med.unc.edu/ahs/pearls/research/development‐of‐the‐first‐year‐inventory
Assessment Tools (Hansen & Jirikowic, 2013; Parham & Eckler, 2007)
SENSORY‐BASED
Sensory Processing Measure
5‐12 years of age
75‐item questionnaire
Home (parent) & School (teacher)
Responses: never, occasionally, frequent, or always
Assessment Tool (Polatajko & Mandich, 2004)
ACTIVITY PERFORMANCE
Dynamic Performance Analysis Record (DPAR)
Framework to enable occupational competence
Assessment Tool (Polatajko & Mandich, 2004)
ACTIVITY PERFORMANCE
Performance Quality Rating Scale (PQRS)
Evaluate performance and change in performance, based on observation
Part A: 1‐10 (p.155)
1= no activity criteria are met
10= all activity criteria are met
Assessment ToolsMEMORY
Visual Memory Task
Adapted from Snodgrass Vanderwart’s (1980) object database
Used in research (Chan, Han, Sze, & Lau, 2015)
Procedure:
1) Stimulus for 3 minutes
2) 3 minutes delay
Assessment Tools
EXECUTIVE FUNCTION
Weekly Calendar Planning Activity
Performance‐based
Insert 18 appointments and errands into a weekly calendar
Collected objective measures on multiple items
(Toglia, 2015)
Retrieved from https://myaota.aota.org/shop_aota/prodimages/271083346.Def.L.png
WCPA Performance Examples
Results: WCPA
Results: WCPA
Assessment Tools (Watling & Hauer, 2015)
GOAL ATTAINMENT SCALE (GAS)
Meaningful goals are set
Each are then weighted by the client/parent
Provides partial accomplishment of given goals.
Documenting & Detecting Sensory Processing Issues
Systematic data collection of the behavior
Identification patterns
Environmental influences
31VYNE EDUCATION
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www.caroldoey.com
VYNE EDUCATION
Rotation HANDS‐ON ACTIVITY
Rotation Directions
34
SEVEN
ONE
FOUR
SIX
FIVE
THREE
TWO
VYNE EDUCATION
Rotation HANDS‐ON ACTIVITY
Station ONEWeekly Calendar Planning Activity
Trial the Weekly Calendar Planning Activity while your partner attempts to record the strategies used.
Station TWO
Review the Available Measures–
Consider ways in which the findings from the measure can assist you with monitoring change and performance.
Station THREE Goal Attainment Scale
How might you apply the GAS to your everyday practice?
Develop a GAS for a client you have using, the presented templates.
Station FOUR
Using the PQRS, rate your partner’s ability to tie a tie.
◦ Trial ONE: Determine if the person has a general idea
◦ Trial TWO: Actual rating (pre‐test)
Do an intervention
◦ Trial THREE: Actual rating (post‐test)
Station FIVE
Resource and Question & Answer Station
Thank YOU!
CONTACT INFORMATION
Robyn Otty
Associate Professor
School of Occupational Therapy
(702) 777‐3095
Linkedin.com/in/robynotty
ReferencesAmerican Occupational Therapy Association. (2016). The AOTA practice guideline series: Occupational therapy practice guidelines for Individuals with autism spectrum disorder. Bethesda, MD: AOTA Press.
Brown, C. (2017). The evidence‐based practitioner: Applying research to meet client needs. Philadelphia, PA: F.A. Davis.
Chan, A.S., Han, Y.M., Sze, S.L., & Lau., E.M. (2015) Neuroenhancement of memory for children with autism by a mind‐body exercise. Frontiers in Psychology, 61‐71. doi: 10.3389/fpsyg.2015.01893
Hansen, K.D. & Jirikowic, T. (2013). A comparison of the Sensory Profile and Sensory Processing Measure home form for children with fetal alcohol spectrum disorders. Physical & Occupational Therapy in Pediatrics, 33(4), 440‐452. doi:10.3109/01942638.2013.791914
Parham, L.D. & Ecker, C. (2007). Sensory Processing Measure (SPM). Torrance, CA: WPS.
References
Polatajko, H.J. & Mandich, A. (2004). Enabling occupation in children: The cognition orientation to daily occupational performance (CO‐OP) Approach. Ottawa, Ontario CA: CAOT Publications.
Schaaf, R.C. & Lane, A.E. (2015). Toward a best‐practice protocol for assessment of sensory features in ASD. Journal of Autism Developmental Disabilities, 45, 1380‐1395. doi: 10.1007/s10803‐014‐2299‐z
Toglia, J. (2015). Weekly Calendar Planning Activity (WCPA): A performance test of executive function. Bethesda, MD: AOTA Press.
Tomcheck, S.D., Little, L.M., & Dunn, W. (2015). Sensory pattern contributions to developmental performance in children with autism spectrum disorder. American Journal of Occupational Therapy, 69, 6905185040. http://dx/doi.org/0.5014/ajot.2015.018044
Watling, R. & Hauer, S. (2015). Effectiveness of Ayers Sensory Integration and sensory‐based interventions for people with autism spectrum disorder: A systematic review. American Journal of Occupational Therapy, 69, 6905180030. http://dx.doi.org/10.5014/ajot.2015.018051