How to Assemble an Interdisciplinary Autism Evaluation Team

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Dr. Ruth Aspy and Dr. Barry Grossman are members of the Ziggurat Group, a team of professionals specializing in assessment and intervention of autism spectrum disorders. The Ziggurat Group offers evaluation and intervention services to individuals of all ages. In this webcast, Dr. Aspy and Dr. Grossman share information regarding the process of forming an interdisciplinary autism evaluation team.

Hi I'm Dr. Ruth Aspy and I'm Dr. Barry Grossman. We're both psychologists with the Ziggurat Group. We have a background of doing evaluation in the public schools. We both worked as psychologists in schools for many years and we specialize in autism evaluation and intervention. We are now working with OCALI to help to develop interdisciplinary evaluation teams across the state of Ohio. Today we're going to talk to you about the process of forming an interdisciplinary autism evaluation team. First we're going to discuss why it's important to have interdisciplinary evaluation teams. Before talking about how to assemble an interdisciplinary autism evaluation team, let's talk about why it's necessary. The short answer is it's the law. According to child find mandate, part of IDEA public schools are obligated to identify, locate and evaluate all children with disabilities who may need special education services. It's clear the responsibility for eligibility belongs to the schools. However, in practice we've seen that in some areas of the country, the public school systems routinely refer parents for private evaluations at the parents' expense. Parents who attempt to initiate a referral are asked to provide a written report by an outside professional before the school's willing to consider eligibility. These practice clearly do not comply with the law and place an unfair burden on families especially those who do not have the means to acquire private evaluations. The terminology surrounding assessment can be confusing. In particular the terms medical diagnosis, diagnosis and eligibility are frequently misunderstood. While the term medical diagnosis is often used, it's a misnomer. According to the Autism Society of America, there are no medical tests for diagnosing autism. An accurate diagnosis must be made based on observation of the individual's communication, behavior and developmental levels. Wide use of the term has also resulted in the false belief that the diagnosis must be made by a medical professional. Perhaps this myth is responsible for the tendency of schools to abdicate the responsibility for evaluation in the area of autism spectrum disorders. In fact, in the absence of specific medical concerns, many specialized teams do not require staff with medical training.

The interdisciplinary autism evaluation team should consist of a psychologist, a speech language pathologist and an educational diagnostician or teacher. Often, it's beneficial for an occupational therapist to participate in the evaluation process as well. When forming a new team, look for staff members who know or who are willing to learn about autism spectrum disorder. It is important to select staff who work well with others and are comfortable being part of a team. We find that some members on each team should have the following qualities: being good with parents, being good with students, good writers, good organizers, analytical thinkers are always helpful, people who are able to deal with ambiguity, people who have skills in dealing with conflict and a sense of humor.

It is expected that new members enter with good working knowledge of autism spectrum disorders. Ideally, existing evaluation teams are available to train new team members. If there is no existing evaluation team, individuals with the qualities mentioned earlier should be selected and members should seek outside training and ongoing consultation as they develop expertise. When there is an experienced evaluation team, new teams are formed in four phases. In the first phase, new team members join the existing team to conduct several evaluations together. New members observe while existing members model. And, new members participate in the discussion and the decision-making. During the second phase, two teams are formed. Each newly formed team incorporates experienced members and new members. During the third phase, it's understood that there is a learning curve. In this phase, experienced members continue to serve as mentors. New members are encouraged to ask questions and express concerns. During the final phase, two fully experienced teams are now available to consult with one another and to train and form new teams as needed.
Interdisciplinary teams work collaboratively as equal partners. There's no single team member who has the final say in determination of disability. Decisions are not made by vote rather by consensus. In our experience, we have found that team members do have different perspectives and there's often lively discussion prior to coming to a consensus. These discussions result in a stronger understanding of the student. Often, parents and staff have similar questions so exploring these questions as a team helps to prepare members to respond.

All teams will encounter complex cases. It's important to have a process for resolving differences or for coming to conclusions when it seems that an evaluation has resulted in more questions than answers. It's best to consult with other interdisciplinary teams or consult with an expert in the field who's respected by team members. Multiple technologies are available for those who may not have local access to another team or expert.

Serving on an interdisciplinary evaluation team has costs and benefits. Members learn a great deal through working with professionals from different fields. We find that we are better psychologists due to our close collaboration with members of other disciplines. Also, well-functioning teams help to support one another as they manage increasing caseloads. Each evaluation is an opportunity to work with new students and families. Each case is unique. Members feel that they make a difference through their work. Serving on a team has its costs as well. Research has shown that the rate of identification increases in areas where people are well-trained in evaluation and knowledgeable about autism spectrum disorders. This is sometimes misinterpreted by others to mean that the assessment team is over- identifying. In fact what we see is that most states are actually under-identifying ASD. Those who are higher in functioning and females are at greater risk for remaining unidentified, and therefore, underserved. Last, teams often find themselves in a position where they are asked to evaluate a student who has a previous private evaluation. We find that school teams are often more experienced and comprehensive in their evaluations than many who work privately. However, there can be a perception that those in the schools are less qualified.