Educational Assessment of Autism: A Team Approach

Video Transcript

Hello! We are the members of the Miami Valley Regional Center Assessment Team and we are happy to present this webinar today on the topic of comprehensive approach to autism evaluations. My name is Marcia Kress and I am one of the school psychologists on the assessment team. Before we begin with the webinar, we're going to take a minute to other members of the evaluation team. Hi, I'm Amy Wade. I'm one of the speech language pathologists on the assessment team. Hi, I'm Lisa Saylor. I am a school psychologist on the assessment team. Hi I'm Carol Dittoe and I'm a speech language pathologist. I'm Barb McPherson and I'm the occupational therapist on the team. Hi I'm Rosanne Douville the educational audiologist on the team and also one of the other speech pathologists.

The educational assessment team at the Miami Valley Regional Center is a multidisciplinary team that includes psychologists, speech pathologists, an audiologist, and an occupational therapist. This team works together in the planning, administration and reporting of the assessment. By working together, we have been able to develop an effective autism assessment process that results in reliable information that can assist the educational team as they determine the most appropriate disability category and develop a comprehensive IEP that will support all of the student's needs.

A team consisting of professionals representing multiple disciplines will allow for the most comprehensive assessment of students suspected of being on the autism spectrum for the purpose of eligibility determination. Accurate identification of students with Autism Spectrum Disorder is critical because it guides appropriate intervention planning as well as the understanding of parents and professionals regarding the student's needs.

The comprehensive approach to autism identification includes data collected from a variety of sources using several different methodologies. When considering a student for autism eligibility, the evaluation team must take very seriously their responsibility to review developmental information on the student as well as current functional information across the contexts in which the student performs. It is essential that the outcome of the evaluation include not only determination of eligibility, but also specific instructional recommendations that will enable the IEP team to develop a plan for the appropriate supports necessary for the student to achieve success.

School districts should identify a team of professionals who are competent to assess students who are suspected of an autism spectrum disorder. It will be important to determine the professional development needs of the school-based team in order to plan appropriately for the type of training and intensity of practice necessary to prepare each member of the team.

IDEIA identifies the responsibilities of a local school district to conduct Child Find. The intent of this law is "to provide a framework in which school districts identify, locate and evaluate all children with disabilities, birth through age 21, who are in need of early intervention or special education services. From birth through 2, services are provided by Help Me Grow. Beginning at age 3, services are provided by the local education agency."

As a part of conducting an appropriate evaluation, parents or guardians may provide information, documentation, or doctor's reports from agencies not associated with the local school district. IDEIA specifies that the school district must 'consider' information from all sources when making a determination of whether or not a student has a disability. The information obtained from all of these sources must be documented and carefully considered.

An important outcome of the evaluation process is the determination of the student's identified strengths and weaknesses. The educational implications of the educational data will impact the student's ability to access and make progress within the general curriculum. The implications provide a basis to develop interventions, accommodations, or modifications within the school setting and allow the team to determine the need for specialized instruction.

The definition of autism as identified in IDEIA incorporates the social, communication, repetitive, stereotypical, and unusual sensory behaviors that are key features of autism. However, IDEIA does not differentiate between Asperger's and Pervasive Developmental Disorder-Not Otherwise Specified . The definition contains provisions to consider a student under the category of autism if these behaviors are not demonstrated before the age of 3.

Under IDEIA rules and Ohio's Operating Standards for Students with Disabilities, the determination of autism does not require a medical diagnosis. Information from outside agencies, including the medical profession, can be extremely helpful in making appropriate education determinations. The school based team is obligated to consider information from outside agencies and should be cautious about delaying intervention or the provision of FAPE when evidence may suggest that this may be a student with autism.

Once a student is suspected of an autism spectrum disorder, the local school district has a responsibility to conduct a comprehensive evaluation that will determine if this student meets this definition.

The Miami Valley Regional Center Autism Evaluation Team provides comprehensive autism evaluations to students in the 52 school districts that comprise Region 10. Our team includes these professionals: school psychologist; communication specialist or speech pathologist; occupational therapist; and audiologist. Additionally, a physical therapist and vision specialist are available as needed.
The evaluation begins with a referral from the school district to the Evaluation Team. When the referral is received, a member of the team consults with the school district contact person to determine an evaluation plan. In some circumstances, the school district team completes portions of the multi-factored evaluation while the Regional Center team completes autism-specific assessments. In other instances, the Regional Center team completes all of the assessments. In either case, the Regional Center team always conducts at least 1 observation in the student's natural environment which is typically school or home. Following the observations, the direct evaluations are completed. These evaluations are typically done at the Regional Center where the testing suite has an observation window and a quiet, non-distracting environment. When appropriate, some of the testing may be completed at the student's school.

Following the evaluations, the team develops a collaborative report which includes a summary and interpretation of the evaluation data as well as the instructional implications. This information is then shared with the student's school district team and family at a meeting held within the district of residence. The school district then takes the lead in discussing the next steps with the student's family. If there is a request for technical assistance in implementing the suggested interventions, a referral can then be made to the Regional Center Autism Coaching Team for follow-up support.

The Regional Center Autism Evaluation Team is comprised of professionals who have a great deal of evaluation experience with students on the autism spectrum as well as with students with other various disabilities. Having a broad range of experience with other disabilities is important because of the need to differentiate an autism determination from other disabilities that may resemble autism. Additionally, members of the evaluation team need to have a background in measurement as well as an extensive experience working collaboratively on a team with professionals from other disciplines. Each team member should have the required professional licensure or certification in his/her area of expertise.

Prior to launching the Autism Evaluation Team, several team members attended the 2-day ADOS training either through OCALI or University of Michigan Autism and Communication Disorders Center. Following that training, we asked members of the Autism Parent Group if they would allow us to work with their already identified children for practice purposes. We used the ADOS with approximately 10 students spanning each of the 4 modules. We also assessed several students who were not suspected of having autism for comparison purposes. Additionally, we viewed the ADOS videos and discussed the scoring.

Recently, we have begun using the ADOS discussion board hosted by the University of Michigan as a resource for our own professional development when we have questions regarding administration and interpretation of the ADOS modules.

Implementation of the steps included in the Evaluation Section of Ohio's Guidance document ensures that the school-based team follows federal and state mandates for each suspected disability category. For some disability categories, specific evaluation procedures and/or data are required. When planning an evaluation for the disability category of autism, multiple sources of information should be considered.
The disability category of autism does not specify or require observations, yet a school-based team would be remiss if they did not plan and conduct observations of the student in the natural context. For some students, this may mean observation(s) in the home or the daycare setting. It is important to include observations in environments where the student is demonstrating difficulty and those in which the student performs well.

This first video clip introduces Devin, our student who will be followed during the webinar. Devin is a four year old student currently attending a special education preschool program. This is a clip of the classroom observation completed prior to Devin's evaluation at the Regional Center.

Rating scale tools that assess the manifestation and frequency of autism spectrum-related behaviors are used with both teachers and families. This information, along with personal interviews, provides valuable insight into the student's functioning across a variety of contexts.
Direct assessment tools, administered either under standardized or non-standardized conditions, provide critical data used in making a determination of eligibility. The Autism Diagnostic Observation Schedule or ADOS is one example of a standardized, direct assessment tool that school-based teams can use. However, it is also important that teams consider the results from a direct assessment conducted under non-standard conditions. These results provide a school-based team with qualitative or diagnostic data that is often more informative than a single standard score.

In this clip, Devin is exhibiting anticipation and shared enjoyment outside of the context of the evaluation session. As will be seen in later clips, he did not exhibit this level of reciprocal interaction during the direct assessment.

Critical to conducting a comprehensive evaluation is the thoughtful planning of that evaluation.
School-based teams should consider addressing these domains either through direct or indirect assessment methods. When planning the evaluation, the team must refer to the educational definition of autism and the evaluation procedures outlined in Ohio's Guidance Document to ensure that the information needed to determine eligibility and need for specialized instruction is obtained.

In the subsequent slides, each domain will be discussed in the format of 'Guiding Questions' that teams may use as they plan and conduct the comprehensive evaluation.

The diagnostic criteria for autism outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) stipulate that there must be delays or abnormal functioning in social interaction, social communication and/or play with onset prior to 3 years. The IDEIA definition of autism includes the phrase 'generally evident before the age of three'. Therefore, it is critical that the autism evaluation team obtain an in-depth developmental history to ascertain whether the characteristics of concern were present during the student's early years.
The person obtaining the developmental history should ask about the specific red flags for autism such as:
- no smiles by 6 months
- no babbling by 12 months
- no back and forth gestures (pointing, showing, reaching, etc) by 12 months
- any loss of speech, babbling or social skills at any age
With recent research indicating a strong genetic link in the incidence of autism, knowledge of the student's family history can be helpful. Knowledge about the student's early medical history is also considered relevant.
Other questions might include "When your child was a toddler..."
-What were his favorite toys/activities?
-Was she responsive to people?
-Did he engage in imitative play ( peek-a-boo, pat-a-cake)?
-How did she handle changes in routine?
-Did he or she exhibit any unusual sensory behaviors?

The purpose of assessing a student's hearing is to rule out a hearing problem as causing or contributing to more significant educational and social difficulties. Additionally, information about a child's hearing status should also guide the selection of assessment materials because some tests, like the ADOS, were designed to only be used for students without significant hearing impairments. A hearing assessment for a student suspected of having autism should include informal observations as well as objective and behavioral audiometric measures.
Prior to an audiological evaluation, the student's parents will be asked about a history of middle ear problems and/or family history of hearing loss. Both the student's teacher and parents will be asked to describe how the student reacts when sudden loud sounds occur or when noise is present in the classroom or home. Observing the student in a familiar environment will help the team determine how the student responds or localizes to his/her name or other sounds as well as observe how the student reacts when noise is present or when sudden loud sounds occur. Since so many children with autism exhibit sound sensitivities, case histories should incorporate questions about adverse reactions to specific sounds and audiologists should assess loudness discomfort levels as part of the formal audiological evaluation.
Objective audiological measures may include immittance testing to assess middle ear functioning, acoustic reflex testing to estimate thresholds and distortion product otoacoustic emissions testing to assess cochlear or outer hair cell functioning. Behavioral and traditional audiometric testing will assess how this child responds to calibrated speech and sounds. During the assessment, the audiologist will note whether or not the child startles, localizes, and reacts to speech and other sounds. Attempts will be also be made to obtain pure tone thresholds with play audiometry or with traditional techniques to help the evaluation team answer the following questions.
Does the student have normal hearing?
Does the student respond when his/her name is called?
Does the student localize to sounds?
Does the student startle to loud sounds?
How does the student react to noise or sudden loud sounds?
Does the student seek out or avoid noise making toys?

Visual problems are very common in individuals with autism. Some of the visual behaviors that are commonly noted in this population may include:
avoidance of eye contact; seeking out visual input like flashing or rotating lights; flicking hands to watch them; looking at something, then looking away before picking it up; peering out of the sides of the eyes; using peripheral rather than central vision for many activities; regarding objects from various angles.
These distinct visual symptoms typically occur because persons with autism use visual information inefficiently or they have hyper-sensitive vision and react by being visually defensive.
The vision evaluation of persons with autism varies depending upon their developmental, emotional and physical level. After a thorough history, a comprehensive vision evaluation should be attempted. The examination includes but is not limited to, an evaluation of: visual acuity; eye tracking and fixations; depth perception; color vision; focusing; the presence of nearsightedness or farsightedness and/or astigmatism; eye health; and visual fields.
Students on the autism spectrum often develop stronger visual skills than auditory skills. They often benefit from visual supports that allow them to use their visual strengths to process, organize, remember and respond to information which then in turn allows them to more fully participate in reciprocal social interaction. The visual supports also have the added benefit of reducing stress levels of inappropriate behaviors that may develop when students cannot effectively communicate or when they do not understand the expectations of the environment. For these reasons, information about the student's visual functioning is an important component of the evaluation.

Since autism is defined as a disability affecting verbal and nonverbal communication as well as social interaction, a comprehensive autism evaluation should assess how the student communicates and uses language for social interaction to develop and maintain relationships. Observing and interacting with a student provides a natural environment to obtain a detailed language sample so that form, function, and use of language can be analyzed . Obtaining a representative language sample of a student using language for a variety of uses, including solving problems, narrating stories, assuming the role of pretend characters, and responding to questions can help the evaluators determine:
-The average length of student's typical utterance; Gather examples of typical phrases or sentences
-Determine how intelligible the student is; Whether the student's speech sounds abnormal in terms of rhythm, rate, intonation, and volume
-Whether the student produces novel statements or just echoes what others say; If the child repeats what his conversational partner says, does he use the echoed utterance as a conversational strategy or to allow him a longer time to process what is said to him
-If the student uses words or phrases in stereotypical or idiosyncratic ways
-If the language used by the student is rote/scripted language, such as what might be heard in movie or TV dialogues
-Whether the student understands figurative and literal expressions, idioms, sarcasm, ambiguous statements, or humor
-Determine the length of oral directions that the child can process; And how much "wait time" is needed for the child to answer or react
-Other areas to investigate when analyzing a language sample include: types of vocabulary the student uses to describe, inform, or request information; Evidence of word finding, basic sentence structure, how the student offers information, asks questions, responds to yes/no and wh-questions

Since people not only communicate with words but also express themselves non-verbally with gestures, facial expressions, and pointing, it is essential to closely observe how the student communicates as well as listen to what is said. Non-verbal gestures might be descriptive, conventional, instrumental, informative, emphatic, and emotional in nature.
In addition to an analysis of a student's sound system, grammar, and semantics, an analysis of a student's use of language or pragmatic language system is essential to identifying characteristics of autism because numerous studies have concluded that autistic children fail to acquire the system that serves to orient discourse with regard to person, place, and time. Examining the student's pragmatic language skills closely parallels the assessment of the social reciprocity aspects of a comprehensive evaluation, which will also be addressed in the next section. Guiding questions for the pragmatic analysis include:
How does the student react to environmental/contextual cues?
Does the student effectively utilize the following skills in conversation: greeting, turn taking, topic maintenance, topic shift, initiation of topic, and termination of conversation?
Does the student ask questions or ask for help?
Does the student demonstrate signs of frustration because of ineffective or lack of communication efforts?
Does the student demonstrate negative or acting out behaviors because of difficulty expressing him/herself?

The next video clip illustrates how Devin expresses his desire for a particular object. Note whether or not he is able to use language to request an object. Note what his intent is and how did he achieve his goal.

Autism is characterized by significant, persistent deficits in social communication and interactions, as manifested by marked deficits in nonverbal and verbal communication used for social interaction, lack of social reciprocity, and failure to develop and maintain peer relationships that would be appropriate to the student's development level. Therefore, evaluators must not only assess a student's language and communication skills but also analyze the student's social skills, all of which are essential components of an autism evaluation. Observing a student during play activities or during conversation probes provides insight about how the student interacts with others. Guiding questions to assess social reciprocity include:
How does the student interact with others, including both peers and adults?
Does the student initiate interactions and how?
How does the student respond to prompts from the evaluator to attend to an object?
Does the student gaze or follow joint attention prompts from the evaluator?

In this next video clip, observe how the evaluator is able to interest Devin in the balloon activity. As you watch the clip, pay attention to whether or not he has demonstrated joint attention, or the ability to direct eye gaze from the evaluator to an object and then back again to the evaluator.

Other questions to guide your observations of a student include:
Does the student respond to social communication presses, such as when a conversational partner says "I had something sad happen in my house last summer?" Or "I just did something exciting last week."
Just how does the student participate in conversations? Is he/she over or under responsive? Does the student ask for help, initiate conversation and maintain topic?

Observing a child during play provides a natural context for eliciting a language sample and engaging in conversation. Observing play activities will help the evaluator determine whether the child's play is non-existent, parallel, cooperative, interactive, or perseverate in nature. Sometimes students violate social boundaries or use inappropriate ways to comment, such as saying, "boy are you fat." Play activities also provide contexts to watch how the child interacts, enters into social discourse, or uses objects and toys in novel or typical ways. Important guiding questions for this part of the assessment include:
Does the student make eye contact with adults or his communication partners?
Does the student initiate interactions and how?
Does the student assume the role of pretend people?
Does the student greet evaluators?
Does the student communicate empathy and insight about emotions?
Does the student assume another person's perspective?
Does the student demonstrate or convey any shared enjoyment during the interaction?
How does the student coordinate verbal and nonverbal communication attempts?

By observing the student in a variety of environments, the evaluators can determine a difference in communication in the variety of environments including the home, school, recess/free time vs academic time, with peers or with adults.
Additionally, observations in a variety of environments helps the team identify the student's ability to process information. Specifically, does student need other prompts to process or initiate interaction? And what types of prompts does the student need?
How does student react to changes in daily routine?
How does the child react in an unfamiliar environment or routine or to a disruption to the typical schedule?

In this next video clip, observe whether or not our student responds to his name, directed gaze, and pointing attempts made by the evaluator.

An occupational therapist's primary role when assessing a child for autism is to look at how the child is processing sensory information. The sensory processing system's function is to regulate sensory input so that the individual can make sense of the physical world and stay as alert and comfortable as possible. The foundation and refinement of sensory processing skills are crucial for learning, behavior, social and emotional skills, and higher academic skills, such as reading.

We all have sensory processing issues. None of us are well regulated all of the time. It's estimated 12-30% of all children have sensory processing problems and 40-80% of children with disabilities have sensory processing disorders. Sensory processing is a significant issue for a child with autism.

The OT's role is to review each sensory system and determine if the child is having difficulty processing the information and to what extent that difficulty is interfering with the child's ability to function in daily life tasks, such as self care and school. The simple act of washing a child's face and hair can be a nightmare for a child and parent if the child is extremely tactile defensive.

*The sensory processing systems are:
-tactile (touch pressure, temperature, pain, and movement of the hair on the skin)
-vestibular (input from our inner ears, gives information about equilibrium, gravitational changes, movement experiences, and position in space)
-proprioception (input from the muscles and joints which provides information about the body's position, its weight, and its movement)
-in addition, we look at muscle tone coordination

A child with a sensory processing problem will frequently respond with atypical behavior. This behavior is often interpreted as deliberate/intentional. If the individual needs to avoid sensory input, the behavior is often mislabeled as oppositional. If the child needs to seek out sensory information, it is often mislabeled as deliberate. The first assumption is generally the child has a behavior problem.

This video clip shows Devin demonstrating unusual sensory behaviors. Watch what he does with his mouth. He often rubs food and objects over his mouth. He's seeking out more sensory input.

When looking at sensory processing, we look at sensory modulation, which is the ability of the nervous system to regulate, organize, and prioritize the incoming sensory information. We also look at sensory thresholds. The sensory threshold is the point at which there is enough sensory input for the individual to be aware of the input. For example, an individual with a low threshold notices the stimuli quickly. An individual with a high threshold will take longer to notice the stimuli.
Some individuals will often avoid sensory input as their needs are met quickly and additional input can be overwhelming which can result in a meltdown. Individuals with a high threshold will take longer to respond and some will seek out more stimulation.

When evaluating sensory processing it's helpful to see the child in a familiar environment engaged in a variety of tasks. An interview with the caregiver and others as well as the use of a sensory processing measurement tool provide the most accurate picture of the child's sensory processing functioning.

This video clip shows an interview with Devin's parents. In addition to completing an interview scale, it is important to actually sit down and question the parents about their responses and concerns. One of the problems with standardized instruments probing for sensory information is the reliance on the perception of the person completing the questionnaire. How the caregiver perceives specific behavior may be related to his or her own sensory processing. For example, when rating the behavior "jumps a lot," one of the test items, a parent's perception may differ from that of the evaluator.

I missed this because I walked in a little bit after the bubbles were introduced and dad was explaining to me his response with his fingers in his ears. There was a fan involved with the bubbles and that's what he was responding to. Dad was saying that typically at home you don't see him doing a lot of putting his fingers in his ears. Do you think that when new sounds are introduced...

Two of the common sensory measurement tools are:
The Sensory Processing Measure (SPM)- This tool recognizes that the sensory problems often manifest differently in different environments. This is a set of three integrated rating scales designed for elementary school children. It assesses sensory processing, praxis (the exercise of a skill), and social participation. It lets you see how well the child performs in different settings. Because it uses a multi-environmental approach. It lets you see how a child performs in a structured classroom setting verses a less structured setting, for example, the bus ride home. There are three forms:
-The Home Form- to be completed by the parent
-The Main Classroom Form- to be completed by the teacher
-The School Environment Form- which is a form for the art teacher, the bus driver, the cafeteria
You can use any of those or none of those. This tool gives a more comprehensive picture of the child. It's also a very easy assessment to score and summarize.

The second most frequently used is The Sensory Profile by Dr. Winnie Dunn. This tool identifies sensory processing patterns and how these patterns affect the ability to participate in everyday life. There are four different profiles. It's very comprehensive and helps design strategies for managing daily stress.
-The Infant Toddler which is Sensory Profile for children, birth to 36 months. The caregiver completes a judgment based questionnaire reporting the frequencies with which infants respond to various sensory experiences.
-The Sensory Profile - for ages 3 to 10 years. This helps determine how well the child processes sensory information in everyday situations. It helps profile the sensory systems effect in functional performance. It is typically used in conjunction with the Sensory Profile School Companion.
-The Sensory Profile School Companion is for ages 3 years to 11 years 11 months. It involves the teacher's perspective of the child's interaction in an academic setting.
-Lastly, the Adolescent/Adult Sensory Profile, for ages 11 and older- enables clients to evaluate themselves using a self questionnaire.

As stated earlier during the previous video clip, the perception of the individual completing the assessment influences the responses. Consequently, parent and teacher responses should be used with the evaluator's own observations to complete the student's profile . There are also times when it's appropriate to use a sensory processing measurement tool in a non-standardized way. These tools may be used in conjunction with the Peabody Developmental Motor Scales (PDMS-2) for ages birth to 6 years or a Bruininks Oserestky Test of Motor Proficiency (BOT-2) for ages 4-21 to obtain gross and fine motor information, and/or visual perceptual/visual motor testing. There are many visual perceptual/visual motor tests. One of the most commonly used by our therapists at our Regional Center is the Developmental Test of Visual Perceptual Skills (DTVP-2). It is designed to be used with children ages 4-9. The addition of one of these tests aids in giving more clinical information as they provide various task demands.

During testing, one guiding question is, "Does the child demonstrate over responsive behavior (a low threshold) or under responsive behavior (a high threshold) in each sensory area?"
For example when reviewing the vestibular system, here are samples of behaviors that indicate over-responsiveness
1-Becomes anxious or distressed when the body leaves the ground
2-Dislikes or fears excessive movement, such as swings, rides, etc.
3-Acts cautious during gross motor activities
4-Experiences frequent car sickness
5-Experiences a fear of heights
6-Becomes agitated if pushed off balance
7-Fearful of walking down stairs
8-Avoids balancing activities, such as riding a bike
9-Frequently shifts in chair

Under-responsive or high threshold vestibular behaviors may include
1-May crave fast and spinning movements
2-Moves constantly
3-Rocks their body back and forth
4-Enjoys being upside down
5-Seems oblivious to heights and moving objects
6-Loves to run, hop, roll, or swing

The second guiding question is, "Does the child seek out sensory information or avoid it?"
Once the information is summarized, specific sensory strategies can be recommended. A common term used for these strategies is a "sensory diet". These strategies do not cure the sensory processing dysfunction, but help control the sensory input, so the child is calmer, alert, and more organized. Learning occurs best when the sensory system is optimally balanced.

Students on the Autism Spectrum often exhibit stereotyped behaviors that are considered atypical for persons not on the spectrum.
Unusual sensory interests in an object may include sniffing, smelling, or licking an object. It may involve gazing at the object from various angles or holding the object close and examining a moving piece of the object, such as a spinning wheel. It may be the unusual touching or feeling of the object's texture. The student may be hyperfocused on a particular sound.
A student on the spectrum may exhibit repetitive movements such as: hand or finger-flapping, rocking, spinning or atypical body postures.
You may also see self-injurious behaviors such as biting, hitting or head-banging.
You may see some compulsions or rituals. For example:
-Eats only specific foods
-Engages in unnecessary rituals or routines
-Lines up objects in orderly fashion; becomes upset when order is disturbed
-Persistent preoccupation with parts of objects
Circumscribed Interests or preoccupations may be noted such as:
-Prefers to do the same activity over and over
-Intense attachment to a particular object
-Obsession with specific topics such as dinosaurs, planets, weather, bus schedules
The student may have a need for environmental consistency.
-They may need to adhere to set schedule; over-reaction when schedule/routine is altered
-Transitions are difficult
-They may need to have everything in its place

In this upcoming video you will see our student repetitively opening and closing the door. Throughout the assessment, he showed an unusual interest in opening and closing drawers and doors. He often examined the door mechanism to see how it worked. At the end of the video, you will see him express his frustration by hitting himself in the chest.

Typically cognitive functioning progresses from birth to adolescence through a series of developmental stages. By the definition of autism, characteristics are typically evident before age 3. However, assessing cognitive functioning at these early ages can often be challenging. At a minimum, the psychologist should be familiar with cognitive developmental milestones, including the exploration of surroundings, imitation skills, language development, and problem-solving ability. It is important to gather information to address a student's cognitive skills, which may or may not require the use of a standardized norm-referenced assessment. Regardless of the age of the student, there are several broad areas to consider including: How does the student's cognitive functioning compare to typically developing same age peers?

In this next video clip, note how the evaluator attempts to engage Devin in a play activity involving motor imitation. Look for whether or not he was able to interact cooperatively in the play and whether he demonstrated the early cognitive skill of imitation, which is typically evident by 1 year of age.

In addition to understanding how the student's cognitive functioning compares to same age peers, it is important to delve deeper into addressing the student's verbal and nonverbal cognitive skills. For example, ask yourself

How does the student demonstrate verbal reasoning abilities such as understanding and use of language?
How does the student demonstrate non-verbal reasoning abilities such as recognizing and/or solving patterns, analogies, classifying pictures or visual information, free from using language skills?
Is there a difference between the student's verbal and non-verbal reasoning abilities? Is one particularly stronger or weaker?

Additional questions to ask yourself:
Does the student demonstrate areas of exceptional skill/knowledge/talent?
What is the developmental history and current academic performance? Has the student demonstrated even or uneven learning patterns? And, additionally
How does the student demonstrate problem-solving skills such as putting together a puzzle, use of objects in a novel manner, and flexibility in thinking?

The purpose of evaluating the student's academic skills is to determine strengths and weaknesses in the child's academic profile and implications of that pattern for instructional planning. Students with autism spectrum disorders often have excellent rote memory skills but lack organizational skills and problem solving skills. They also have difficulty seeing patterns, themes and relationships. They may also have difficulty determining relevance or significance. Students on the autism spectrum tend to be more literal and often struggle with abstractions.

One of the hallmark features of autism is the inability to generalize - apply learned concepts to real-life situations. The team member who assesses the student's academic skill levels should be on the look-out for examples of generalization.

Other factors to consider during the academic evaluation include school behaviors such as:
- Following routines
- Compliance with adult directed task
- Level of activity
- Classroom participation
- Need of reinforcement
- Ability to complete work with independence
- Difference in performance during structured vs. non-structured class time
- Ability to transition between learning activities
- Strongest learning modality

Measurement of a student's adaptive behavior involves assessing the student's level of independence with:
-Skills needed for functioning in the community
-Planning and engaging in leisure and recreational activities
-Functional communication
-Skills needed for basic care of home/school environment
-Skills needed for protection of health and safety
-Skills needed to interact socially and to get along with others

With older students, the assessment of adaptive behavior includes a focus on the skills necessary to function successfully in a work environment

Adaptive behavior evaluations can also include an assessment of the student's maladaptive behaviors such as aggressiveness, negativity, anxiety, disruptiveness, etc.

These test instruments are some of the most frequently used tools by the Regional Autism Assessment Team.
A comprehensive autism evaluation includes data gathered from checklists, rating scales, interviews and direct assessment of the student.

When all of the evaluation data has been collected, the team members compile a collaborative report written in a clear, concise and reader-friendly format which should include the following:
-A description of the evaluation tools that were used and a summary of the assessment results. The report should summarize the student's strengths and weaknesses and should reference specific examples of the student's performance that are either related or unrelated to the diagnostic features of Autism Spectrum.
-The report should specifically identify the student's educational needs as well as the strategies and needed supports that will allow the student to benefit from instruction. The information should describe concrete and understandable strategies and interventions to support the educational needs of the child.
-The report's conclusions should provide a synthesis of the data and describe how the data either support or refute a determination of autism eligibility. Part of the eligibility decision is also based on whether the disability will have an adverse effect on the student's education, therefore the report should include statements regarding the need for specialized instruction, if it's appropriate.
-Also included in the report is a discussion of the related services that the student may need to support the specialized instruction.

By observing the student in his or her home or school environment prior to scheduling the autism evaluation, the assessment team can determine ways to prepare the student to participate in the testing. Sometimes visual supports, such as using a social story or visual schedule, will help the student understand that his or her daily routine will change and he will be asked to interact with new adults with unique toys. Visual supports, a visual contract (like "I am working for a desired reward), and/or a visual schedule may provide extra comfort to the student who fears change in routine by giving that student a pictorial sequence of activities that will be offered before a break or a snack opportunity.

Taking sensory breaks, proper positioning, and wearing earphones prior to and during the assessment will also facilitate the testing session. Additionally, sensory items or a transition object may calm a fearful individual. For younger students, a favorite toy can be used by the evaluators to demonstrate new activities. For example, an audiologist may help a fearful student use a flashlight or otoscope to examine a favorite doll's ears or to demonstrate proper adjustment of headphones.

The use of an alternative communication device or picture board may facilitate interactions with or by the student. Another example of how an assistive technology tool may interface with the evaluation process is the use of a Pulse Pen to capture specific examples of the student's verbal communication attempts which can be reviewed during the scoring process.

Notice in this final clip how Devin is able to communicate intent for appropriate social interactions. Contrast these interactions with his previous attempts when the communication device was unavailable to him.

What do you want? French P. You want French P. Alright, let me see if I can find French P. Yellow. (student) Yellow. (adult) You want yellow. Ok, let's do yellow. Ready? French P. French P, where are you? French P, yes, that's French P. Very nice. What else do you want? (adult) I want French P. (device) You have French P (adult). Green (device) Yes, French P is green (adult). This one's yellow (adult). This is a yellow one (adult). Mr. Squash (adult). Yeah, he's yellow. Can you find Mr. Squash? Where's Mr. Squash? Look right there. Right there. Mr. Squash. (adult) Yellow. (student) He's yellow. He is yellow.
(adult) Yellow. (device) Mr. Squash is yellow. (adult) Tickle me. (device) Tickling you. (adult) Stop it. (device) Ok, I'll stop it. (adult) Who's that? Who do you have? (adult) Who do you have Devin? (adult) Mr. Squash. (device) That's right you have Mr. Squash. (adult) Mr. Squash. (device) Who else do you have? (adult) Yes, the little one is French P. (adult) The little one, the little one. (device) There's the little one. He's the little one. (adult) You want more? (adult) Do you want more Devin? Tell me. (adult) Yellow. (student) What do you want? (adult) I want (device) I want (device) Do you want a yellow balloon? (adult) Blow it up. (device) Want me to blow it up? (adult) Blow it up. (device) Ok, here I go. You count. (adult) Count with me ready - one (adult) One (device) One (device) The yellow one. (adult) Yellow. (student) I want I want (device) What do you want? (adult) I want (device) What do you want? (adult) I want (device) What do you want Devin? (adult) What do you want Devin? (adult) The yellow one. (adult) You want Bob the Tomato. (adult) Bob the Tomato (device) Let me see if I can find Bob the Tomato. (adult) Where's Bob the Tomato? (adult) Here he is. (adult) Bob the Tomato. You have Bob the Tomato now. (adult) Bob the Tomato (device) Yep, that's Bob the Tomato. (adult) Bob the Tomato (device) Bob the Tomato (device) Bob the Tomato (device) Yes, that's Bob the Tomato. (adult) Bob the Tomato (student) Right, Bob the Tomato (adult) Bob the Tomato (student) Larry the Cucumber (device) Yes, I have Larry the Cucumber, look. (adult) Larry the Cucumber (adult) Do you want Larry the Cucumber? (adult) You want him? (adult) Say, I want. (adult) Ok, you tell me I want Larry the Cucumber. (adult) Like this. (adult)
I want (device) Larry? (adult) Who do you want? (adult) You want Larry the Cucumber? (adult) Who is that? (adult) Who is that? (adult) Larry the Cucumber (device)
Yeah (adult) Larry the Cucumber (device) You got Larry the Cucumber. (adult)

A comprehensive evaluation completed by a multi-disciplinary team provides the needed information for both eligibility determination and intervention planning. In the absence of the team approach to identification of autism, it is unlikely that the full range of the student's strengths and needs will be revealed. Without this critical information, the student's team will be unable to comprehensively plan the appropriate educational strategies for optimizing the student's performance across all environments.

Margot Prior, author of the book 'Learning and Behavior Problems in Asperger Syndrome' has stated "Educating a child with autism presents perhaps the most unique and difficult set of challenges facing education professionals today." A comprehensive evaluation provides the foundation for a high quality educational program for all of our students with autism spectrum disorders.

Thank you for joining our Miami Valley Regional Center Autism Assessment Team for this webinar on the comprehensive evaluation of students suspected of having autism spectrum disorders. Please feel free to contact any of us at anytime using the contact information contained on this slide. Thank you.

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