AUTISM EVALUATION PLANNING AND ELIGIBILITY DETERMINATION

1. AUTISMEVALUATION PLANNINGANDELIGIBILITYDETERMINATION Kathy Meredith Complex Needs Consultant

2. Purpose of this session • To learn how to complete the evaluation process for the purpose of providing the ARC the sufficient information necessary to make the eligibility determination for the suspected disability of autism.

4. Autism: Kentucky Regulations Definition (5) "Autism" means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three (3) that adversely affects a child’s educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. The term shall not apply if a child’s educational performance is adversely affected primarily because the child has an emotional-behavior disability. KAR 1:300 §3(2)(3)

5. Pervasive Developmental Disorders • Autistic disorder • Asperger’s disorder • Rett’s disorder • Childhood disintegrative disorder • Pervasive developmental disorder, not otherwise specified (PDD-NOS)

6. Step 1: Review the eligibility form

7. 3 Basic Characteristics • Impairments Communication/Language, generally evident before the age of three. • Impairments in Social Interaction • Restricted, Repetitive, and Stereotyped Patterns of Behavior, Interests, and Activities

8. Developmental disability Generally before age 3 Effecting verbal and non verbal Communication.

9. As a group….. What do you think Some of the early sign Red flags are?

10. Early “Red Flags” for ASD • “Red flags” for ASD (AAP, 2007, p.1) • Not turning when parent says baby’s name • Not turning to look when parent points and says, “Look at…” • Not pointing to show parents an interesting object or event • Lack of back and forth babbling • Smiling late • Failure to make eye contact with people • CDC Handout/CHAT Handout

11. Early Signs of ASD Additional information about early signs of ASD can be found at: www.cdc.gov/ncbddd/autism/actearly www.autismspeaks.org/whatisit/learnsigns.php www.firstsigns.org

12. Thinking about some Of your students with Autism, What are some of their communication traits?

13. Communication Activity View: Communication>Expressive and Receptive Language> Expressive and Receptive Language: Sounds, Words, Prosody> 3, 4, & 5 on First Signs website http://www.firstsigns.org/asd_video_glossary/asdvg_about.htm

14. Communication • Expressive and receptive • Understanding and processing time • Social communication • Pragmatics • reciprocal conversation • Articulation / oral-motor skills • Syntax • Semantics • Qualitative differences • echolalia, rhythm, rate, intonation, stereotyped speech, overly formal, immature

15. Impairments in Communicationcont. • Language characteristics • Reversing pronouns • Lacking variety in sentence structure • Using simplistic and immature grammar • Inability to generalize

16. Impairments in Communication • Difficulty understanding the non-literal use of words and phrases • Concrete (literal) thinking • Poor imaginative play

17. Developmental Disability Effecting social interaction

18. Impairments in Social Interaction • Joint Attention • use of eye gaze • in pointing/understanding others’ use of pointing • in showing others things of interest http://www.firstsigns.org/asd_video_glossary/asdvg_about.htm

19. Impairments in Social Interaction • Difficulty attempting to interact with others and understanding social cues. • recognizing own emotions and beliefs • understanding other person has thoughts and feelings that may be different (theory of mind) • understanding irony, sarcasm, white lies and metaphors • theory of mind http://www.holah.karoo.net/sallyanne.gif

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

21. Secondary Characteristics That may Impact learning

22. Engagement in repetitive activities and stereotypic movements • often narrowly focused • often intense • content may be unusual • may interfere with functional activities • shifting attention away from special interest is often difficult

23. Resistance to change in environmental or daily routines • Change in physical structure can cause anxiety. • Development of routines and insistence on sameness • following routines can be comforting • change in routine can cause anxiety • transitions often hard

24. Repetitive cont. • are common but not universal in ASD • are also seen in young, typically developing children • frequency and intensity in ASD differ from those with typical development

25. Unusual responses to sensory experiences • Definition: Heightened or decreased experience of sounds, lights, movement, touch, smell or taste or fascination with sensory experiences • Contribute to distractibility, difficulty in shifting attention • May lead to avoidance behaviors • May lead to sensory seeking behavior • May impact learning, social interactions, behavior

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

27. Sensory Issues • Assess influence of sensory issues on learning, development, and interactions with others

28. Sensory Issues • Assess influence of sensory issues on learning, development, and interactions with others • Autism Screenings • Checklists • Observation • Occupational therapists typically assess atypical sensory responses

29. Intellectual disability Seizures Genetic syndromes Fragile X syndrome (25-67% of males with FXS have autistic behaviors or meet criteria), tuberous sclerosis (17-64%), Down syndrome (6-7%) Mental health conditions Phobias, obsessive compulsive disorder, attention deficit hyperactivity disorder, depression, anxiety Co-occurrence with Other Disorders

30. CULTURE OF AUTISM • SOCIAL RELATEDNESS • JOINT ATTENTION & RECEPROCITY • COMMUNICATION • Expressive deficits • Problems with intent as well as means • Receptive deficits • Problems with meaning and processing • SENSORY PROCESSING • Integration and modulation of inputs • DIFFICULTY WITH CHANGE • Limited interests, repetitive behavior, rigidity • COGNITIVE STYLE • Problems with organization and sequencing &planning • Problems with attention & relevance • Problems with abstraction & generalization

31. Sensory • Language and • communication • Need for sameness • Distractibility • Sequencing • Relevance • Organization • Understanding of time • Perseveration • Social understanding • Concrete • Central Coherence • Executive Functioning • Generalization • Motivation • Confusion • Anxiety

32. And, don’t forget…….. • Assistive Technology • Transition • English Language Learner • Cultural issues • Cognitive Data

33. Determination of Eligibility3. Adverse Affect To determine adverse affect, the ARC must compare the student’s performance to the performance of peers, in the same learning environment. This information can come from peer comparisons to behavior, rating scales, and curriculum based assessment.

34. DEVELOPING THE EVALUATION PLAN

35. Suspecting a Disability

36. ACTIVITY Gallery Walk Look at the eligibility form for autism and the evaluation planning form Remembering the characteristics and eligibility definition, brainstorm under each area of the posters, what types of assessments and the titles of professionals that will be needed to conduct a comprehensive evaluation to determine eligibility. Based on what you know about this process, what else do we need to consider?

37. ACTIVITY Gallery Walk Review the eligibility form for autism and the evaluation planning form. Using the eligibility definition and the evaluation planning form, brainstorm under each area on the posters, what types of assessments and the titles of professionals will be needed to conduct a comprehensive evaluation to determine eligibility.

39. Evaluation Planning Form KAR 1:300 §3(2)(3)

40. Develop the Evaluation Plan Based on referral information & eligibility requirements, determine additional information needed; • Determine needed areas of evaluation; • Determine types of personnel to complete evaluation components; • Target specific areas for observation; • Determine the need for Assistive Technology Evaluation; and • Determine the need for modifications to evaluation procedure(s).

41. Complete the Form based on group results on flip charts KAR 1:300 §3(2)(3)

42. Evaluation Planning Form Medical Statement KAR 1:300 §3(2)(3)

43. Evaluation Planning Form (cont.) KAR 1:300 §3(2)(3)

45. Evaluation Planning 707 KAR 1:300 Section 4 (10) 34 CFR 300.304 (c) (4) The child shall be assessed in all areas related to the suspected disability, including, if appropriate: health, vision, hearing, and motor social and emotional status general intelligence academic performance communicative status

46. IDEA Guidelines for Assessment of ASD • Components that must be included in assessments • Vision and hearing screenings • Cognitive assessment • Speech-language assessment • Adaptive behavior assessment • Social-emotional and behavioral assessment • Developmental and health history • Observation (school, home, social/community) 34 CFR 300.304 (c) (4)

47. ARC’s make educational eligibility determinations, not medical diagnoses. KAR 1:300 §3(2)(3)

48. Diagnosis vs Eligibilty

49. What Do the Results of Screening Tell Us? • Indicates level of risk for delay or disability • Provides guidance on need for additional evaluation or services • Does not provide sufficient information for diagnosis or determination of educational eligibility

50. Selected Measures for Assessment of ASD • Autism Diagnostic Observation Schedule (ADOS) • Autism Diagnostic Interview – Revised (ADI-R) • Childhood Autism Rating Scale (CARS)