Kelly dunlap , Psy.s stephanie dyer, ed.s .

1. EDUCATION-BASED EVALUATIONS FOR ASD Kelly dunlap, Psy.sstephanie dyer, ed.s.

2. AGENDA The New Evaluation Reality The Three Prongs of Educational Eligibility Process Components REED Evaluation Components Determination of Eligibility (Results Review Process) Evaluation Report IEP Differential Eligibility Considerations

3. New Reality: MORE KIDS

6. New Reality: More Players • Autism Insurance Legislation • http://www.michigan.gov/autism • http://autismallianceofmichigan.org/news-info/autism-legislation/ • The Autism State Plan • http://michigan.gov/autism • The Autism Council

7. Michigan Autism Council • Purpose: Implementation of the Autism State Plan • Autism State Plan: http://michigan.gov/autism • Subcommittee Work • Early identification and intervention • Adults services and supports • Education

8. Autism Council SUBCOMITTEES Adult Services Early Intervention Education Workgroups Screening and Assessment / ASD Eligibility Determination

9. current Players at the Table

10. Acronym Deciphering Tool • SE = Special Education • ASD = Autism Spectrum Disorder • MARSE = Michigan Administrative Rules for Special Education • REED = Review of Existing Evaluation Data • MET = Multidisciplinary Evaluation Team • IFSP = Individual Family Service Plan • IEP = Individualized Educational Program • SAS = Supplementary Aids and Services • P&S = Programs & Services • FAPE = Free and Appropriate Public Education • LRE = Least Restrictive Environment • AIB = Autism Insurance Benefit • DSM = Diagnostic and Statistical Manual of Mental Disorders • PDD-NOS = Pervasive Developmental Disorder – Not Otherwise Specified • ADOS = Autism Diagnostic Observation Schedule • ADI = Autism Diagnostic Interview • CMHP = Child Mental Health Professional • PCP = Person-Centered Plan • IPOS = Individual Plan of Service • ABA = Applied Behavioral Analysis • EIBI = Early Intensive Behavioral Intervention • ABI = Applied Behavioral Intervention • ABLLS = Assessment of Basic Language and Learning Skills • VB-MAPP = Verbal Behavioral Milestones Assessment and Placement Program

11. New Reality in Evaluations for ASD • Potential increase in referrals • Potential increase in pressure to accept clinical diagnoses • Increased need for collaboration across systems

12. Ensure quality special education eligibility evaluations for ASD (i.e. Clean up our own backyard!) So, where do we start?

13. New Reality:More Complexity • Common Comorbid Conditions: • Seizures and epilepsy • Anxiety • Depression • Attention difficulties • Bipolar Disorder • Obsessive Compulsive • Some are considered part of ASD, so when is condition at a level that warrants an different or additional dx?

14. Today’s Guiding Principle • NO OPINIONS • ALL DECISIONS INFORMED BY…. • THE LAW • THE RESEARCH • THE DATA

15. WARNING • I heard that…. • I was told…. PRACTICE IS NOT NECESSARILY LAW, POLICY, or RULE

16. We must Ensurequality evaluations • All staff need to be competent at ASD screening / evaluation • Current Issues: • Not recognizing there are THREE required eligibility areas • Not recognizing that “educational impact” can be in one of THREE areas (e.g. academic, behavior, social) • Use of tools with no observational data • Not understanding terms: • Marked • Qualitative • Adverse Impact

17. AGENDA The New Evaluation Reality The Three Prongs of Educational Eligibility Process Components REED Evaluation Components Determination of Eligibility Evaluation Report IEP Differential Eligibility Considerations

18. The Three prongs of eligibility • CRITERIA • IMPACT • NEED

20. “There is no single behavior that is always typical of Autism and no behavior that would automatically exclude an individual child from a diagnosis of Autism.” (NRC) PREPONDERANCE OF EVIDENCE (Dave Schoemer) GUIDING PRINCIPLE

22. Autism Spectrum Disorder Triad Qualitative Impairments in Reciprocal Social Interaction Qualitative Impairments In Communication ASD Restrictive, Repetitive & Stereotyped Behavior

23. DSM-V Change: ASD Restricted & Repetitive Patterns of Behavior Persistent Deficits in Social Communication & Social Interaction SEVERITY RATING LEVELS 1-3: 3 = Requiring very substantial support 1 = Requiring support

24. Eligibility vs Diagnosis

25. Michigan Definition of ASD

26. Michigan Definition of Autism Spectrum Disorder Characterized by qualitative impairments in: a. Reciprocal Social Interactions b. Communication c. Restricted Range of Interests / Repetitive Behavior

27. “Qualitative” • Markedly Atypical • Significantly different from other students at the same age and developmental level • Outside the typical sequence of development • Across all environments. • Presence and Absence • Unique to each Student

28. Michigan Definition of Autism Spectrum Disorder Characterized by qualitative impairments in: Reciprocal Social Interactions Communication Restricted Range of Interests / Repetitive Behavior

29. Reciprocal Social Interaction A mutual exchange (e.g. of words, actions, or feelings).

30. Reciprocal Social InteractionAt least 2 of the following 4 (i) Markedimpairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction. • Marked = Substantial & Sustained; Clearly Evident; Distinctive and noticeably different from same-aged peers • PURPOSE of Nonverbal Behavior • EXAMPLES: • Seems to look “through” a person, lacks eye contact to initiate or sustain interaction, has fleeting or inconsistent eye contact • Lacks emotion or appropriate facial affect for the social situation, lacks accurate facial expression to reflect internal feelings, facial expressions seem rehearsed or mechanical • Difficulty maintaining appropriate body space, awkward/stiff response or movement, gait challenges • Lacks understanding of the use of nonverbal cues (e.g. pointing, head nod, waving), does not respond to communication partner signals to start or end a conversation

31. Reciprocal Social InteractionAt least 2 of the following 4 (ii) Failure to develop peer relationships appropriate to developmental level. ---NOTE: that results from deficits in social reciprocity and inability to understand the perspectives of others, another’s point of view, or predict another’s behavior. • Examples: • Lack of understanding of age-appropriate humor and jokes • Disruption of ongoing activities when entering play or social circles • Lack of initiation or sustained interactions with others • Preference to play alone • Continuous failure in trying to understand the social nuances and follow the social rules • Desire for friendships but with multiple failed attempts • Misinterpretation of social cues or communication intent of others • Tolerance of peers but no engagement in conversation or activity • Confusion with the telling of lies • Policing peers (e.g. reporting rule infractions on the playground)

32. Theory of Mind (ToM) means the ability to recognize and understand thoughts, beliefs, desires and intentions of other people in order to make sense of their behavior and predict what they are going to do.(Atwood, 2007) TOM—ability to understand the feelings, intentions and perspectives of others and recognize that they are different from our own.

33. Developmental Trajectories Experts on people Normal birth ASD Experts on things

34. Reciprocal Social InteractionAt least 2 of the following 4 (iii) Marked impairment in spontaneous (i.e. without prompting) seeking to share enjoyment, interests, or achievements with other people, for example, by a lack of showing, bringing, or pointing out objects of interest. (i.e. Joint / Shared Attention) • Examples: • Deficits in the use of pointing to orient another to an object or event • Bringing objects or items to others for the purposes of getting needs met, but not for a shared experience • Shifting conversations to one’s own interest rather than responding to the interests of others

35. Reciprocal Social InteractionAt least 2 of the following 4 (iv) Marked impairment in the areas of social or emotional reciprocity (i.e. Identifying and responding appropriately to other’s emotional states (e.g., comfort a crying person)) • EXAMPLES: • Lack of social smiling; Lack of interest in the ideas of others • Aloofness and indifference toward others • Seemingly rude statements to others without filter or negative intent Difficulty explaining their own behaviors in context of impact on others • Difficulty predicting how others feel or think • Problems inferring the intentions or feelings of others • Failure to understand how their behavior impacts how others think or feel • Problems with social conventions (e.g. turn-taking / personal space) • Lack of appropriate responding to someone else’s pain or distress • Creating arbitrary social rules to make sense of ambiguous social norms

36. Michigan Definition of Autism Spectrum Disorder Characterized by qualitative impairments in: Reciprocal Social Interactions Communication Restricted Range of Interests / Repetitive Behavior

37. CommunicationAt least 1 of the following 4 (i) Delay in, or total lack of, the development of spoken language not accompanied by an attempt to compensate • Failure to understand that words have a communicative intent • About 40% of children with an ASD do not talk at all. • About 25%–30% of children with an ASD have some words at 12 to 18 months of age and then lose them. • Remaining children speak, but sometimes not until later in childhood and/or non-functional speech. http://www.cdc.gov/ncbddd/autism/signs.html

38. Communication (ii) Impairment in Pragmatics: The ability to initiate, sustain, or engage in reciprocal conversation with others • Using language for varying purposes (e.g. greeting, informing, promising, requesting, etc.) • Changing language according to the needs of the listener or situation (e.g., giving background information to an unfamiliar listener, speaking differently in a classroom than on a playground) • Following rules of conversations and storytelling (e.g., taking turns in conversation, staying on topic, rephrasing when misunderstood, proximity, use of eye contact

39. EXAMPLES • Difficulty with the social aspects of language (e.g. understanding non-literal language used in conversation) • Issues with prosody (e.g. flat and emotionless or high and pitchy with atypical rhythm or rate) • Difficulty initiating, sustaining, or ending conversations with others • Difficulty using repair strategies when communication breaks down • Talking for extended periods of time about a subject of the student’s liking, regardless of the listener’s interest • Talking at someone in a monologue rather than conversing

40. RECEPTIVE & EXPRESSIVE LANGUAGE are not equal • Ididn’t say she stole my money. • I didn’t say she stole my money. • I didn’t say she stole my money. • I didn’t say she stole my money. • I didn’t say she stole my money. • I didn’t say she stole my money. • I didn’t say she stole my money.

41. Communication (iii) Stereotyped / repetitive use of language / idiosyncratic • Idiosyncratic = contextually irrelevant or not understandable to the listener; may have private meaning / be understood by the speaker or to those familiar to the situation (e.g. movie lines) • Can include: • Echolalia • Repeat videos / scripts • Nonsense language • Verbal Fascinations

42. (iv) Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level. • Compared to Developmental Level • Extremely Stilted • Embracing Play

44. Michigan Definition of Autism Spectrum Disorder Characterized by qualitative impairments in: Reciprocal Social Interactions Communication Restricted Range of Interests / Repetitive Behavior

45. Restrictive, Repetitive, Stereotyped Behaviors At least 1 of the following 4 (i) Encompassing preoccupation with 1 or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus. • Intrusive; frequent, interfere with participation in daily activities • DISTRESS OVER DISRUPTION (ii) Apparently inflexible adherence to specific, nonfunctional(e.g. no purpose) routines or rituals. • Eat only one type, color, texture of food • Self imposed rules (must touch 3 doors before opening) (iii) Stereotyped and repetitive motor mannerisms, for example, hand or finger flapping or twisting, or complex whole-body movements. (iv) Persistent preoccupation with parts of objects.

47. (iii) Stereotyped and repetitive motor mannerisms, for example, hand or finger flapping or twisting, or complex whole-body movements. • Cautions – Prioritize Criteria • Comprehensive Evidence of ASD

48. (iv) Persistent preoccupation with parts of objects. • Observations and Interactions Over Time • Dave – Air Conditioner Parts

49. The Three prongs of eligibility • CRITERIA • IMPACT • NEED

50. Michigan Definition of ASD IMPACT