Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
Goal 1: Brief Overview of ASD
Clues in the Data: Evidenced Based ASD Assessment Georgia Association of School Psychologists Laura Dilly, PhD, NCSP
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Disclosures Information 2 Primary Symptom Areas
Financial Relationship: • Employed by Marcus Autism Center, Children’s • Social Communication and Interaction Healthcare of Atlanta • Royalties from Assessment of Autism Spectrum • Restricted, repetitive patterns of behavior, interests, Disorders in the Schools by Routledge and activities
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Developmental Goals: Social-Communication Trajectory in Autism
Typically developing 1) Brief Overview of ASD children have a predisposition to engage 2) Identification of ASD within the School Setting with and orient toward people, whereas children 3) Clues in the Data – Evidenced Based Assessment with autism tend to orient 4) Identifying ASD Across Diverse Populations to and become experts in objects 5) Comorbidities and Differential Assessments in ASD (Klin & 6) Explaining Assessment Results Jones, 2006) 7) Evidenced Based Interventions
Marcus Autism Center
Laura Dilly 1 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
Typically Developing Children Pay Attention to People Social Communication and Interaction
Communication Interaction HOW?
• Language • Gestures • Eye contact
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Children with Autism Tend to Pay Attention to Objects 16 Gestures by 16 Months
• Gives • Claps • Shakes head • Blows a kiss
• Reaches • Points with index Wetherby, A. 2014; First Words Project. • Raises arms finger http://firstwordsproject • Shows • Shhh .com/ • Waves • Nods head • Points with • Thumbs up open hand • Other gestures
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Developmental Trajectories Social Communication and Interaction
Communication Interaction HOW? WHY?
• Language • Initiate • Gestures • Request • Eye • Share contact enjoyment • Relationship
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Laura Dilly 2 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
Restrictive and Repetitive Behaviors Genetic Risk
• Self injurious • 25-30% have an identified genetic difference • Self stimulating • Comorbidity with ID, epilepsy, motor • Repetitive, restricted interest impairment, certain dysmorphic features • Insistence on sameness and routine supports underlying genetic etiology • Sensory sensitivities-visual, auditory, tactile, • olfactory, gustatory Estimated that between 600 and 1200 genes increase the risk of ASD, including over 50 • Activity level high-risk genes • Emotional Reactivity • Genetic testing recommended for all children with ASD (Baker & Jeste, 2015; (De Rubeis & Buxbaum, 2015; O'Roak et al., 2012; Marcus Autism Center Sanders et al., 2012) Marcus Autism Center 16
(Hallmayer et al., 2011; Sandin et al., 2014). Marcus Autism Center Marcus Autism Center 17
(Roberts et al., 2013; Sandin et al., 2012; Sandin et al., 2016; Shelton, Hertz-Picciotto, & Pessah, 2012; Weisskopf, Kioumourtzoglou, & Roberts, 2015; Zerbo et al., 2013)
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Laura Dilly 3 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
Educational 1986 Amendments to PL 94-142: Infants and Toddlers added Milestones 1986 Amendment to PL 94-142: Brown v. PARC v. IDEA; Autism area of eligibility Board of Commonwealth 1990 Education of Pennsylvania American with of Topeka and Mills v. Disabilities Act 1954 Board of Education, DC 1990 1972 Amendments to PL 94-142 1997 Section 504 of Individuals with Disabilities Rehabilitation Act Education Improvement 1973 Act (IDEIA): Education for All 2004 Handicapped Amendments to PL 94-142: Align with Children No Child Left Behind Act 94-142 1975 2004
1940 1947 1954 1961 1968 1975 1982 1989 1996 2003 2010
1952 1973 2013 DSM: ICD-9: DSM-V: Childhood schizophrenia Infantile Autism Autism Spectrum 1944 1994 Disorder Hans Asperger, 1968 DSM-II: DSM-IV: Asperger's Syndrome Autistic Childhood and PDD-NOS added Psychopathy schizophrenia 1943 1980 1993 Leo Kanner, DSM-III: Infantile Autism ICD-10: Childhood Autism, Early Infantile Autism separate from Asperger's Disorder, schizophrenia 1987 and Atypical Autism added DSM-III-R: Psychiatric Autistic disorder; Marcus Autism Center 19 Milestones Behavioral descriptors
Conceptualizing Differences, Disorders, Environmental Factors Disabilities
No increased risk All Children • Vaccinations Significant • Smoking Difference • ASD DSM In vitro fertilization Disorder 504 Protective factor Protection • Prenatal vitamins IDEA Eligibility (Kalkbrenner et al., 2012; Madsen et al., 2002; Sandin, Nygren, Iliadou, Hultman, & Marcus Autism Center 20 Marcus Autism Center Reichenberg, 2013)
Goal 2: Identification of ASD in the School Setting
Educational records identify 38% more children with ASD than when medical records alone are considered.
21 24 (Pettygrove et al., 2013)
Laura Dilly 4 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
Characteristics of Children More Likely to Rates of Autism Spectrum Disorders be Identified at School 20 • Lower Socio-Economic Status
15 US School ASD Eligibility for • Children Age 3- White, Hispanic
10 21 Years CDC ADDMN ASD Prevalence • First Born Children
5 Rates • Average Cognitive Abilities
0 Prevalene per 1.000 Children1.000per Prevalene (Christensen et al., 2016; Locke et al., 2017) -5 Year
(Autism and Developmental Disabilities Monitoring Network Surveillance Year 2000 Principal Investigators, 2007; Baio et al., 2018; Christensen et al., 2016; National Center for Educational Statistics,Marcus 2012; Autism National Center 25 Marcus Autism Center 28 Center for Education Statistics, 2017)
Primary Eligibilities of Children with ASD ASD and Response to Intervention
Children identified with ASD by ADDMN • The logistics, appropriateness, and effectiveness of the RTI model to identify ASD is not clear
• Little, if any, research is available to document 36% effective RTI practices Primary Non-ASD Primary ASD Eligibility Eligibility 64% Primary Non-ASD Eligibility
Primary ASD Eligibility
(Hammond, Campbell, & Ruble, 2013; Sansosti, 2010)
(Rubenstein et al., 2018) Marcus Autism Center 26 Marcus Autism Center 29
Rates of ASD Eligibility for 3-5 year olds; 2016 Data Initial Concerns in RTI
• Expressive language delay • Weak ability to follow instructions • Behavioral problems • Social problems • Poor oral recall or reading comprehension • Anxiety • Sensory sensitivities
1 in 59 = 170/10,000
Rate of ASD eligibility per 10,000 Children Marcus Autism Center Marcus Autism Center Dilly, L. J., Hendrix, N., McCracken, C. (2020). 30
Laura Dilly 5 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
Federal Definition of Autism
• Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three, that adversely affects a child's educational performance. Other characteristics often associated with autism are engagement Goal 3: Clues in the Data – in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and Evidenced Based Assessment unusual responses to sensory experiences. 34 CFR 300.8 (c) (1) (i) • The federal definition also states that “Autism does not apply if a child's educational performance is adversely affected primarily because the child has an emotional disturbance” and allows for identification after the age 3.
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“Educational Performance” Components of an ASD Assessment
• Detailed medical and developmental history • Includes academic, social, and • Detailed social history behavioral domains • Measures of cognitive functioning: including language and nonverbal problem solving • Adverse impact on education • Measures of adaptive behavior performance must be shown in the • Formal ASD measures/interviews classroom or school experience • Observation of play/interaction
(Q.W. v. Board of Education of Fayette County, Kentucky, 2015)
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Memorandum to State Directors of Special Education from Director, Office of Special Education Developmental History
• Medical history
• Family history of ASD
• Early communication skills and language development “States and LEAs have an obligation to ensure that – Regression evaluations of children suspected of having a disability are not delayed or denied because of • Social/play history implementation of an RTI strategy.” • Secondary symptoms – eating, sleeping, etc. Musgrove, 2011, p. 1
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Laura Dilly 6 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
Cognitive Patterns Social/Emotional Patterns • A word about rating scales to assess ASD
• Look for significant variation between verbal and • Ages 1.5 to 5 years nonverbal cognitive functioning – SRS, CBCL Withdrawal, CBCL PDD scales have been shown – Nonverbal ability is often stronger to have good sensitivity and specificity with ASD – Verbal ability is sometimes stronger, particularly in school populations age children • Ages 6+ years – CBCL -Elevated Thought, Anxiety, Social, Affective, and • Look for stronger expressive language than receptive Attention Problems language – BASC - Elevated Atypicality, Functional Communication, and Withdrawal (Maljaars, Noens, Scholte, & Berckelaer-Onnes, 2012; Matthews et al., 2015; Volden et al., 2011) (Ellison, Bundy, Wygant, & Gore, 2016; Hampton & Strand, 2015; Norris & Lecavalier, 2010; Marcus Autism Center Predescu, ŞIpos, Dobrean, & MicluȚIa, 2013; Schroeder, Weiss, & BebkoMarcus, 2011) Autism Center 40
Adaptive Functioning Patterns in ASD Social/Emotional Patterns
Rating scales can assist - Adaptive functioning is often lower than cognitive in identifying comorbid abilities, particularly with average cognitive conditions functioning (Pandolfi, Magyar, & Norris, - The gap between cognitive functioning and adaptive 2014) functioning often increases with age
- Daily Living Skills and Socialization are often lower on the VABS-2 (Kanne et al., 2011)
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Direct Observation of Core ASD Symptoms Psychological Processing Patterns
• ADOS-2 and ADI-R are considered the “gold Most common processing weaknesses: standard” – Working memory – Processing speed • CARS-2 – Executive functioning – Shows good sensitivity and specificity – CARS was shown to be slightly less sensitive than the ADOS in detecting ASD (more false negatives)
(Assouline, Foley Nicpon, & Dockery, 2012; Hedvall et al., 2013; St John, Dawson, & Estes, 2017; Troyb, Rosenthal, et al., 2014; Wang et al., 2017)
(Chlebowski, Green, Barton, & Fein, 2010; Falkmer, Anderson, Falkmer,Marcus Autism & Horlin, Center 2013)39 Marcus Autism Center 42
Laura Dilly 7 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
Achievement Testing Patterns
Heterogeneity in academic patterns!
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Reading Skills Math Skills
• 35% and 80% of students with ASD have problems • 6-40% of children with ASD with one or more of the areas of literacy have particular difficulty • 6-20% of children with ASD demonstrate symptoms with math of hyperlexia • 16-20% of children with ASD • Reading comprehension is most frequently affected may demonstrate symptoms academic area of hypercalculia • Processing – verbal, working • Processing – working memory, processing speed, memory, RAN, social thinking verbal reasoning (Aagten-Murphy et al., 2015; Assouline et (Finnegan & Mazin, 2016; Solari et al., 2017; al., 2012; Brosnan et al., 2016; Estes, Rivera, Ostrolenk, Forgeot d’Arc, Jelenic, Samson, & Bryan, Cali, & Dawson, 2011; Jones et al., Mottron, 2017; Knight & Sartini, 2015; Ricketts et al., 2013Marcus) Autism Center 44 2009; St John et al., 2017) Marcus Autism Center 47
Writing Skills
• Children with ASD may struggle more with prose and story construction than in punctuation or mechanics • Write less lengthy compositions, have poorer legibility, and write slower • Processing – working memory, executive functioning, verbal reasoning (Assouline et al., 2012; Brown & Klein, 2011; St John et al., 2017 ; Finnegan & 45 Accardo, 2017; Keen et al., 2016; Troyb, Orinstein, et al., 2014;Marcus Zajic Autismet Center al., 201648)
Laura Dilly 8 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
Additional Evaluations Prevalence
. Speech and Language . Pragmatic Language . Occupational & Physical
. Medical Evaluations . Hearing Tests . Genetic Testing (e.g., Fragile X, chromosomal microarray) . Neurology (e.g., micro or macrocephaly, motor problems)
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Recap of Patterns in the Data Bilingual children with ASD • Verbal versus nonverbal cognitive split? • Language development and communication does not • Lower scores in receptive versus expressive skills? differ in monolingual and bilingual children with ASD • Adaptive scores weaker than cognitive abilities? – Bilingually-exposed children with ASDs do not experience additional delays in language development • Adaptive communication and social skills weaker? • Stronger written than expressive/recep. lang. on VABS-3?
• Basic academic skills stronger than applied skills? (Hambly and Fombonne 2012; Valicenti-McDermott, Tarshis et al. 2013; Kay-Raining Bird, Genesee et al. 2016) • Weaknesses in WM, PS, EF? • Developmental history - Family history of ASD? Early
50 language delays? Feeding or sleeping problems? Marcus Autism Center 53
Talking to parents
• Parents are often told to speak only the majority Goal 4: ASD in Diverse language to their children or they chose to do so. Populations • Parents often expressed loss or sadness as well as difficulty communicating in majority language.
• This contradicts most of the research that suggests that use of 2 languages does not exacerbate ASD symptoms. (Kay-Raining Bird, Genesee, & Verhoeven, 2016)
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Laura Dilly 9 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
Bilingual children with ASD cont. Girls with ASD – Differences in Phenotypes
• Bilingual preschool children with ASD may use more – Girls with ASD may demonstrate more gestures. gestures and better joint attention
– Girls may have fewer restricted/repetitive behaviors
(Kay-Raining Bird, Genesee, & Verhoeven, 2016; Valicenti- McDermott et al., 2013)
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Girls with Considerations When Assessing Autism Spectrum Disorders Girls for ASD • Compare girls to typically-developing same-age girls, not to boys with ASD. • Girls with ASD may have fewer “acting out” behaviors and social problems than boys with ASD. • Look for restricted interests that are typical in content (e.g., My Little Pony, Justin Bieber, “Frozen”), but unusual in intensity. • Girls may show fewer or less intense motor mannerisms (e.g., flapping, hand posturing, spinning). • Teenage girls with ASD may particularly lack insight into social roles, avoid social relationships, and have comorbid 4 Boys for Every 1 Girl internalizing disorders (e.g., anxiety, depression).
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ASD girl video 1
Look for: • Gestures • Directed facial expressions • Requests • Shared enjoyment • Repetitive movements
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Laura Dilly 10 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
Gender Dysphoria Feeding in Children with ASD
• Higher levels of gender dysphoria in adolescents and Chronic feeding concerns generally involve either: adults with ASD – Volume - Food Refusal – • Significantly more "birth assigned male" were Variety - Food Selectivity affected compared to "birth assigned female" Autism Spectrum Disorder (ASD) – Estimates ranged from 46% and 89% of children with ASD displaying significant feeding problems – Preference - carbohydrates, snacks, fats, and/or processed food – Rejection - fruits and vegetables – Lower calcium and protein George & Stokes (2018); Heylens et. al (2018); Mahfouda et. al (2019) (Sharp et al., 2013)
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Goal 5: Comorbidities and Pediatric feeding disorders - Variety Differential Diagnosis
ASD
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Sleep in Children with ASD Elopement
• Prevalence of sleep problems in children with ASD • 26%-49% of children with ASD estimated to range from 44–83%
• Sleep-onset insomnia and nocturnal awakenings are the • 38% of 6-11 year olds wander away most frequent • Wandering in public places
• Big Red Safety Box (Goldman et al., 2009) http://nationalautismassociation.org/big-red-safety-box/
Marcus Autism Center 63 (Kiely, Migdal, Vettam, & Adesman, 2016; Rice etMarcus al., Autism2016) Center 66
Laura Dilly 11 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
Coexisting Developmental Medical Comorbidities Problems • Epilepsy – 5-38% • Vision Impairments and Hearing Impairments – Retinopathy of prematurity; congenital blindness
• Gastroentological problems – 7x more • Intellectual Disabilities – 18-28%
• ADHD – 40% • Ear infections – 2.4x more often
(Spence and Schneider 2009, 2013, Adams, Susi et al. (Christensen et al., 2016; Schieve et al.) 2016, Jin, Homsy et al. 2017, Thomas, Hovinga et al. 2017)
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Disorder % of children with disorder that Syndromes anddemonstrate ASD ASD symptoms Coexisting Psychiatric Problems Rett (MECP2) 50-61% (4% of females with ASD have Retts) • Anxiety Disorders – 43-84% Cohen 54-79% • Mood Disorders Cornelia de Lange 43-83% – Depressive Disorders – 11-30% Tuberous Sclerosis 36% – Bipolar Disorder Angelman 34-42% • Schizophrenia Spectrum CHARGE 15-50% Fragile X Males 30-67%; – 22q11 Mixed sex 22-63% • Obsessive Compulsive Disorder (1-5% of children with ASD have Fragile X) • Tics/Tourette’s Disorder Neurofibromatosis 4-18% (NF1) (De Bruin, Ferdinand et al. 2007;Kincaid, Doris et al. 2017; Leyfer, Down syndrome 16-19% Folstein et al. 2006; Salazar, Baird et al. 2015; Wing, 1981 ) Noonan 15% Marcus Autism Center 68 Marcus Autism Center 71 Williams 12%
Differential Diagnosis
Disorder % of children with disorder that • Our measures can give false positives for children demonstrate ASD symptoms with intellectual disabilities and Williams 12% emotional/behavioral problems 22q11.2 deletion 11-40% (DeGeorge syndrome) Phenylketonuria ~5-6% Prader-Willi 19-37% syndrome
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Laura Dilly 12 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
Similar symptoms to ASD Differentials Obsessive Repetitive thoughts and behaviors Developmental hx typical DJ Testing Compulsive Social problems Obsessive thoughts are unwanted Disorder Insight Anxiety Problems with transitions Language hx typical • VMI: 90 Social problems Socially relate in comfortable settings Social Insight • WISC-V: Verbal Comp: 84; Fluid Reasoning: 97 Depression Social withdrawal Developmental hx typical • Blunted affect and eye contact No repetitive/restricted VABS-3: ABC: 73; Communication: 88; Daily Living: behaviors/interests 71; Socialization: 62 ADHD Social problems Ability to share enjoyment, direct • ADOS-2: Meets criteria for ASD Difficulty sustaining conversation facial expressions, use gestures Tourettes Repetitive motor movements Developmental hx typical Social problems Socially relate in comfortable settings Thought Repetitive thoughts/language Problems do not appear until later Disorders Blunted affect Ability to share enjoyment, use Social problems gestures, engage in back and forth Intellectual Delayed language hx Development flat across domains Disability Immature social skills Social functioning consistent with cognitive level Marcus Autism Center 73 Marcus Autism Center 76
DJ History DJ Diagnosis and Special Education Rec Medical/Family/Services • Age 14 years F42.0 Obsessive Compulsive Disorder • Family history – ASD; possible thought disorder Monitor for possible thought problems, prodromal • Birth and medical – schizophrenia symptoms – 40 wks gestation, 5 pounds; 3 days NICU – Rx: Fluvoxaimine (SSRI), Guanfacine (non-stim ADHD), Olanzapine (antipsychotic) Recommend Emotional and Behavioral Disorder special • Development education eligibility – 1st concern age 10 years – change in affect and daily functioning – Language – Typical; Regression at age 10 years – No adaptive delays • IEP starting in the 5th grade for Other Health Impairment and
Speech/Language Impairment; problems withMarcus sustained Autism Center attn 74 Marcus Autism Center 77
DJ History Chris History Medical/Family/Services Social/Behavioral • Prior to age 10 he was very social; many friends • Age 10 years • Family history – depression, anxiety, schizophrenia, and seizures in • Currently, DJ stays to himself the immediate family • No history of early repetitive behaviors or strong • Birth and medical – interests – 35 wks gestation, 4 pounds; • Currently – Previous dx – dwarfism in utero – previous surgeries for hips, – DJ picks his skin and pulls out his hair legs, feet, and genitals; has a walker – DJ stays to himself • Development – Anxious, suicidal ideation – 1st concern age 2 years – toe walking – Fearful of demons – fearful of praying because if he does – Language - Hx of speech therapy, previous echolalia, not do so correctly, he fears that God will punish him stereotyped phrases – Dressing rituals – must wait for the precise proper moment – Adaptive delays, poor hygiene currently to put his head and arms through a t-shirt, or he might be • Homeschooled – initially due to surgeries; Georgia Cyber Academy;78 subject to malevolent spirits Marcus Autism Center 75 mom trying to get IEP Contamination fears – contracting HIV, polluted by rain
Laura Dilly 13 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
Chris History Social/Behavioral Trauma and ASD • Content to play on own, few friends, plays with younger children • Children with ASD more likely to experience adverse • Repetitive watching of Sponge Bob videos and Sausage Party childhood experiences • Plays with parts of objects, stacks/lines objects • Greater foster care involvement for children with • Visual inspection ASD than children with ID or typically developing • Hand flapping children • Mother reports “imaginary friends are no longer fake to him”; • Higher rates of physical neglect and maltreatment indicated that one of his imaginary friends had told him to • Maltreatment associated with aggression, pour water on a lit lightbulb in his room, which caused the bulb to burst; he called 911 when the head of his Mickey hyperactivity, and tantrums for children with ASD Mouse plush animal fell in order to get assistance for it; at the • Many children in foster care demonstrate delays in funeral for his great-uncle he reported that people were there language development, social delays, and behavioral trying to kill his great-uncle problems 79 Cidav, Xie, & Mandell(2018); Leve et. al (2012); McDonnell et. al(2018).Marcus Autism Center 82
Trauma vs. ASD Chris History and Testing Similar symptoms to ASD Differentials
• Sleep problems – “he walks around the house checking on Trauma Social differences Similar expressive and family members receptive language levels Developmental delays • Feeding – picky, but a variety Fewer repetitive • WASI-2: Verbal Comprehension: 73; Perceptual Reasoning: Repetitive play behaviors/repetitive use of objects; play may be 97 repetitive but focuses on • ABAS-3, mother: GAC: 90; Conceptual: 80; Social: 94; intrusive memories Practical: 97 Overly familiar behavior – • CBCL – Elevated – Anxious/Depressed; Withdrawn/Depressed; cuddly, overly personal questions, socially motivated Thought Problems; Attention Problems vs. around repetitive interest (ASD – Hi, my name is Leo)
Hypervigilance Davidson et al. (2015); Kuhl-Meltzoff Nightmares Stavropoulos, Bolourian, & Blacher (2018); 80 Mayes et al. (2017) Irritability,Marcus low Autismpositive Center affect83
Chris Diagnosis and Special Education Rec
F84 Autism Spectrum Disorder F29 Unspecified Schizophrenia Spectrum and Other Psychotic Disorder
Recommended ASD and EBD special education eligibility Goal 6: Delivering Evaluation Results
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Laura Dilly 14 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
Breaking Bad News or Understanding the Family’s Beliefs Sharing Life Altering Information
“…any medical information that the patient or family might perceive as causing a significant change in the health or quality of life of the child and family.” We need to ask questions
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SPIKE Model- Recommendations from Pediatric Settings
I – Involvement: Family-centered, confirm agenda of meeting, encourage questions, consider culture of family
K – Knowledge: Connect with previous information, The MUM Effect use key points, use visual aids, avoid jargon, emphasize positive findings when possible, discuss possible The pervasive bias on the part of communicators to outcomes encode (transmit) messages that are pleasant for the recipient and to avoid encoding those that are unpleasant
(Merker, Hanson, & Poston, 2010; Tesser, Rosen, & Batchelor, 1972) (Wolfe et al., 2014) Marcus Autism Center 89
SPIKE Model- SPIKE cont. - Recommendations from Pediatric Settings Recommendations from Pediatric Settings S – Setting: Who will be there, minimize distractions, E – Empathize: Validate feelings of family, clarify what which family members present, team on the same page they are worried about
S – Strategy, Summary, Self-Reflection: Check if family P – Perceptions: What does the family already know, is ready to discuss plan, discuss next steps and correct misperceptions encourage family participation, balance hope/realism, reflect on the process yourself
(Wolfe et al., 2014) (Wolfe et al., 2014)
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Laura Dilly 15 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
Autism Conversations
Social Communication HOW?
Behaviors, Social Interactions Interests, Sensory (adapted from Monteiro, 2010) WHY? Marcus Autism Center 91 Marcus Autism Center 94
Questions parents ask? Communicating Results to Youth Trajectories and outcomes • Guardian’s permission/request
• Developmentally appropriate
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What will my child look like at age 18?
- Functional language by age 5
- Absence of cognitive impairment
- Higher adaptive functioning
- Earlier diagnosis
(Kanne et al., 2011)
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Laura Dilly 16 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
Will my child talk? Will my child go to college?
• About 35-40% of young adults with ASD participate in postsecondary education • Many severely language-delayed children attain phrase/fluent speech ≥ 4 years • Approximately half of students with ASD without intellectual disabilities attend postsecondary • Attaining phrase speech >10 years for children education with intellectual disability is limited • Majority of them attend 2 year colleges at some point (Wodka, Mathy, & Kalb, 2013) (Chiang, Cheung, Hickson, Xiang, & Tsai, 2012; Roux et al., 2015; Shattuck et al., 2012; Taylor, Henninger, & Mailick, 2015; Zuckerman, Friedman, Chavez, Shui, & Kuhlthau, Marcus Autism Center 97 Marcus Autism Center 100 2017)
Can my child “out-grow” ASD? Will my child have a job?
• 50% of young adults with ASD have had a job at some point ~10-20% of children originally diagnosed with ASD at • age 2 years will no longer meet the symptoms in the For ASD and average cognitive abilities, 25% were employed future • Only 16% were employed > 10+ hours a week • Low wage, entry level jobs
(Helt et al., 2008) (Roux et al., 2013; Shattuck et al., 2012; Taylor, Henninger, & Mailick, 2015; van Schalkwyk & Volkmar, 2017)
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Children with Optimal Outcomes Evidence Based Interventions
• Look more like kids with ADHD
• Demonstrate similar levels of agreeableness, Goal 7: Evidence Based rigidity, aloofness, openness to new experiences, and conscientiousness as typically developing Interventions children
(Fein et al., 2013; Helt et al., 2008; Moulton, Barton, Robins, Abrams, & Fein, 2016; Suh et al., 2016)
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Laura Dilly 17 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
NDBI – Naturalistic Developmental Psychopharmacology Behavioral Interventions • No medications directly address core symptoms of • Interventions which are implemented in natural ASD settings, involve shared control between child and practitioner, make use of natural opportunities for • When would psychopharmacologic agents be used to learning, and use a variety of behavioral strategies to treat problems in a person with Autism Spectrum teach developmentally appropriate skills Disorder (ASD)? – Maladaptive behaviors – Coexisting psychiatric problems Examples – Early Start Denver Model Project ImPACT Pivotal Response Training SCERTS Framework Marcus Autism Center 103 Marcus Autism Center 106
Primary Components of the SCERTS® MODEL Early Intervention (Prizant, Wetherby, Rubin, Laurent, & Rydell, 2006)
• Intervention that is autism specific that starts Social between the ages of 18 months and 36 months can change functioning Communication Emotional • Most research indicates the following are important: Regulation – Naturalistic applied behavior strategies – Deep parental involvement Transactional – Shared engagement with joint activities Support
(Dawson et al., 2010; Dawson et al., 2012; Wetherby & Woods, 2006; Zwaigenbaum et al., 2015)
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ABA – Applied Behavioral Analysis The SCERTS Model
• Uses the principles of learning to change behavior The Social Communication domain of the SCERTS • Focuses on Antecedent, Behavior, Consequence Model is focused on helping a child to be increasingly competent, confident, and active participant in social Examples – activities. – This includes communicating and playing with others in • Discrete Trial Training – skill is broken down and everyday activities and sharing joy and pleasure in social “built-up” using discrete trials that teach each step relationships. one at a time; reinforcers may not be natural
• Pivotal Response Training – reinforcers are more natural; more play based; intersperse maintenance items Marcus Autism Center 105 Marcus Autism Center
Laura Dilly 18 Clues in the Data: Evidence Based ASD 2/28/2020 Assessment
The SCERTS Model Acknowledgements The Emotional Regulation domain of the SCERTS Model • Thank you to the families that allowed their children focuses on supporting a child's ability to regulate to be videoed to aid in teaching others. emotional arousal and be available for learning. • Thank you to my colleagues.
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The SCERTS Model More Information
The Transactional Support domain of the SCERTS Model [email protected] refers to supports put in place by partners to help facilitate a child's learning and development. www.lauradilly.com – Interpersonal Support – Learning Support @DrLauraDilly – Support to Families- educational and emotional support – Support to Professionals- educational and emotional support Laura Dilly
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Write Goals to Address Primary Areas of Deficit • Social Communication • Emotional Regulation • Adaptive Skills
• The IEP team is encouraged to consider goals related to John’s social communication, emotional regulation, and adaptive skills. Possible areas of focus include…..
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