Education-Based Evaluations for ASD - PowerPoint Presentation

1. Education-Based Evaluations for ASDhttp://www.gvsu.edu/autismcenter/education-based-evaluations-for-asd-96.htm

2. Welcome INTRODUCTIONSWorking Agreements

3. Poll Everywhere2 ways to sign in

4. Required Members of the Evaluation Team for ASD?Additional Members?Contribution of All

5. Outcomes for TodayA home run for me would be…..

6. AGENDANew Reality in ASD EvaluationsFoundations in CET (Centralized Evaluation Team)MARSE Eligibility Criteria for ASDEssential Evaluation ComponentsDifferential EligibilityASD or ECDD, CI, EI

7. CDC Report

8. ASD Eligibility

9. Individualized family Service Plan Individualized Family Service Plan New Reality: Players at the TableDeveloped by MAASE ASD CoP to Address Confusions / Challenges with Collaboration with Insurance-covered ABA Providers# Useful Resources

10. Acronym Deciphering ToolSE = Special EducationASD = Autism Spectrum DisorderMARSE = Michigan Administrative Rules for Special EducationREED = Review of Existing Evaluation DataMET = Multidisciplinary Evaluation TeamIFSP = Individual Family Service PlanIEP = Individualized Educational ProgramSAS = Supplementary Aids and ServicesP&S = Programs & Services FAPE = Free and Appropriate Public EducationLRE = Least Restrictive EnvironmentAIB = Autism Insurance BenefitDSM = Diagnostic and Statistical Manual of Mental DisordersPDD-NOS = Pervasive Developmental Disorder – Not Otherwise SpecifiedADOS = Autism Diagnostic Observation ScheduleADI = Autism Diagnostic InterviewCMHP = Child Mental Health ProfessionalPCP = Person-Centered PlanIPOS = Individual Plan of ServiceABA = Applied Behavior AnalysisEIBI = Early Intensive Behavioral InterventionABI = Applied Behavioral InterventionABLLS = Assessment of Basic Language and Learning SkillsVB-MAPP = Verbal Behavioral Milestones Assessment and Placement Program

11. New Reality: Players at the Table

12. DSM-V Change: ASDPersistent Deficits in Social Communication & Social InteractionSEVERITY RATING LEVELS 1-3: 3 = Requiring very substantial support 1 = Requiring support

13. MARSE ASD Triad

14. New Reality in ASD EvaluationsIncrease in referralsIncreased need for collaboration across systems

15. New Reality: More ComplexityCommon Comorbid Conditions:Seizures and epilepsyAnxietyDepressionAttention difficultiesBipolar DisorderObsessive CompulsiveSome comorbid conditions are characteristics of ASD;Some cannot be primary for eligibility under ASD

16. FIRST STEP: Improve OUR ProcessAll staff need to be competent at ASD screening / evaluationCurrent Issues:Not recognizing there are THREE required eligibility areasNot recognizing that “educational impact” can be in one of THREE areas (e.g. academic, behavior, social)Use of tools with no observational dataNot understanding terms:PervasiveMarkedQualitativeAdverse Impact

17. Goals for Evaluation TeamsConfident and CompetentStrength in ProcessDefendableConsistent

18. The Michigan Autism Council Autism Council START

19. Foundations in CET(Centralized Evaluation Team)Educational Eligibility vs. Medical DiagnosisParent and Family EngagementFocus on Qualitative using QuadrantsCombined Report WritingUse of Meeting MechanicsOBJECTIVE Team

20. Foundations in CET (Centralized Evaluation Team)Educational Eligibility vs. Medical DiagnosisParent and Family EngagementFocus on Qualitative using QuadrantsCombined Report WritingUse of Meeting MechanicsOBJECTIVE Team

21. Eligibility vs Diagnosis (Pg.4)

22. Process & Application (page 4)Bar Talk (Single’s Bar) 30 Sec Speech “What is the difference between diagnosis and eligibility?”Share your speech with a partner you don’t knowLet your partner share their speechShare your PARTNER’s speech back at your home table

23. Foundations in CET (Centralized Evaluation Team)Educational Eligibility vs. Medical DiagnosisParent and Family EngagementFocus on Qualitative using QuadrantsCombined Report WritingUse of Meeting MechanicsOBJECTIVE Team

24. Objective Team

25. Process and Application3 Advantages & 1 Disadvantage of Objective Team

26. TEAM Process for Evaluation Collaboration One voice One contact One report

27. TEAM CONFIGURATIONS (Pg 30)Which best represents your current configuration? Considerations for Changes?

28. AGENDANew Reality in ASD EvaluationsFoundations in CET (Centralized Evaluation Team)MARSE Eligibility Criteria for ASDEssential Evaluation ComponentsDifferential EligibilityASD or ECDD, CI, EI

29. The Three Prongs of EligibilityCRITERIAIMPACTNEED

30. MARSE Criteria Autism Spectrum Disorder (ASD)Considered a lifelong developmental disability that adversely affects a student’s educational performance in 1 or more of the following areas: (Establishes IMPACT and NEED for SpEd Services)a) Academic (e.g. ability to meaningfully participate and progress in the general curriculum including lack of initiation, impaired quality of participation, low grades, etc.)(b) Behavioral (e.g. disruption, aggression, lack of appropriate engagement, eloping, tantrums, etc.)(c) Social (e.g. ability to develop and maintain relationships/friendships, responses to social situations that alienates others and diminishes acceptance, etc.)(a) Academic

31. Purpose of “LIFELONG”Definition of ASDIncreases threshold for decisionsReduces need to re-evaluate for evidence of ASDImplies lasting impact, not permanent eligibility

32. MARSE Criteria ASDAge of EligibilityAutism spectrum disorder is typically manifested before 36 months of age. A child who first manifests the characteristics after age 3 may also meet criteria. Autism spectrum disorder is characterized by qualitative impairments in reciprocal social interactions, qualitative impairments in communication, and restricted range of interests/repetitive behavior.

33. National Research Council “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.”National Research Council

34. MARSE Criteria forAutism Spectrum Disorder (ASD)Characterized by :Qualitative Impairment in Reciprocal Social InteractionsQualitative Impairment in CommunicationRestricted, Repetitive, and Stereotyped Behaviors

35. “Qualitative”Collected primarily through observation / interviewsAtypical in the natural environmentSignificantly different from other students at the same age and developmental level in contextOutside the typical sequence of developmentAcross all environmentsPresence and AbsenceUnique to each Student

36. MARSE Definition Reciprocal Social Interaction(i) Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction.(ii) Failure to develop peer relationships appropriate to developmental level.(iii) Marked impairment in spontaneous seeking to share enjoyment, interests, or achievements with other people, for example, by a lack of showing, bringing, or pointing out objects of interest.(iv) Marked impairment in the areas of social or emotional reciprocity.(a) Qualitative impairments in reciprocal social interactions including at least 2 of the following areas:

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

38. Qualitative Impairment in Reciprocal Social InteractionAt least 2 of the 4(i) Marked impairment 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 peersTypicalDifferentMarkedLikert Scale for Marked

39. Qualitative Impairment inReciprocal Social InteractionAt least 2 of the 4(i) Marked impairment 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 peersPURPOSE / FUNCTION of Nonverbal BehaviorEXAMPLES:Seems to look “through” a personLacks eye contact to initiate or sustain interactionHas fleeting or inconsistent eye contactLacks emotion or appropriate facial affect for the social situationfacial expressions seem rehearsed or mechanicalDifficulty maintaining appropriate body space

40. Qualitative Impairment inReciprocal Social InteractionAt least 2 of the 4(ii) Failure to develop peer relationships appropriate to developmental level.Impaired perspective taking: viewing situations from another’s point of view / emotional state; predicting other’s behavior (THEORY OF MIND)AnthropomorphicExamples: Misinterprets intentnot understanding humor / jokesdisrupting activities (play)rarely initiates or sustains interactiontolerates pbut not engaged in interaction

41. Qualitative Impairment in Reciprocal Social InteractionAt least 2 of the 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 eventBringing objects or items to others for the purposes of getting needs met, but not for a shared experienceShifting conversations to one’s own interest rather than responding to the interests of others

42. Resources for ComparisonsAutism Navigator/First SignsShow a comparison of typically developing children and children with ASDYou will need to register (free)Early Signs of Autism – Kennedy Krieger

43. (iv) Marked impairment in the areas of social or emotional reciprocity (i.e. Identifying and responding appropriately to other’s emotional states)EXAMPLES:Lack of social smiling; Lack of interest in the ideas of othersAloofness and indifference toward othersSeemingly rude statements to others without filter or negative intent Difficulty explaining their own behaviors in context of impact on othersDifficulty predicting how others feel or think Problems inferring the intentions or feelings of othersFailure to understand how their behavior impacts how others think or feelProblems with social conventions (e.g. turn-taking / personal space)Lack of appropriate responding to someone else’s pain or distressCreating arbitrary social rules to make sense of ambiguous social normsQualitative Impairment in Reciprocal Social InteractionAt least 2 of the 4

44. Developmental Trajectories Theories

45. Shape Shifter (pgs 6-8)Part 1:Draw each shape on a sheet of paperReflect on Reciprocal Social InteractionComplete reflections in each shapePart 2:Start with person most centered to frontClockwise, each share your reflections (30 seconds) – others listen, don’t respond.Part 3:After all share, identify themes in each shape1 Key PointsWhat’s still circling in your mind?What squared away with what you already knew?

46. MARSE Criteria: Communication(b) Qualitative impairments in communication including at least 1 of the following:(i) Delay in, or total lack of, the development of spoken language not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime.(ii) Marked impairment in pragmatics or in the ability to initiate, sustain, or engage in reciprocal conversation with others.(iii) Stereotyped and repetitive use of language or idiosyncratic language.(iv) Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.

47. MARSE Criteria: 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 compensateFailure to understand that words have communicative intentSome students with an ASD do not talk at all;Some students with ASD have words at 12 to 18 months of age and then lose them;Some students with ASD speak, but sometimes not until later in childhood and/or use non-functional / atypical speech.http://www.cdc.gov/ncbddd/autism/signs.html

48. Communication(ii) Impairment in Pragmatics: The ability to initiate, sustain, or engage in reciprocal conversation with othersUsing 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 contactEXAMPLES: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 othersDifficulty using repair strategies when communication breaks downTalking for extended periods of time about a subject of the student’s liking, regardless of the listener’s interestTalking at someone in a monologue rather than conversing

49. RECEPTIVE & EXPRESSIVE LANGUAGE are not equalI 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.I didn’t say she stole my money.

50. Literal Language Interpretation Hidden Directions“We’re gonna make a day of it!”“Put your shoes and socks on.”“Say these numbers backward.”

51. Communication(iii) Stereotyped / repetitive use of language / idiosyncraticIdiosyncratic = 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:EcholaliaRepeat videos / scriptsNonsense languageVerbal Fascinations

52. (iv) Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.Compared to Developmental Level (Pg 26)Play Scheme vs. Directive Repetitive Play

53. Learning Partner (Pgs 8-10)1 Aha1 Confirmation1 Clarification

54. MARSE Criteria: Restricted, 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.DISTRESS OVER DISRUPTION(ii) Apparently inflexible adherence to specific, nonfunctional (e.g. no purpose) routines or rituals.(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.

55. Punctuation Action (Pgs 10-12)Confirms what I know! This is new? I have questions

56. MARSE Criteria – Sensory (3) Determination may include unusual or inconsistent response to sensory stimuli, in combination with subdivisions (a), (b), and (c) of subrule 2 of this rule.

57. MARSE CRITERIAOther Considerations(4) While autism spectrum disorder may exist concurrently with other diagnoses or areas of disability, to be eligible under this rule, there shall not be a primary diagnosis of schizophrenia or emotional impairment.(5) A determination of impairment shall be based upon a comprehensive evaluation by a multidisciplinary evaluation team including, at a minimum, a psychologist or psychiatrist, an authorized provider of speech and language under R 340.1745(d), a school social worker.

58. Process and Application Quick CheckThe 3-prong requirement for eligibility is:The triad required for ASD eligibility is qualitative impairment in _____________ and _______________ and _____________________YES or NO: All 3 prongs and all three areas of criteria in the triad are required for ASD eligibility.

59. AGENDANew Reality in ASD EvaluationsFoundations in CET (Centralized Evaluation Team)MARSE Eligibility Criteria for ASDEssential Evaluation ComponentsDifferential EligibilityASD or ECDD, CI, EI

60. REED (Review of Existing Evaluation Data)Required at re-evaluations and at termination of eligibility. Recommended at initial evaluation, especially if evaluation data from outside sources is available (e.g. diagnostic reports from a private clinic). (NOTE: COLLABORATION OPPORTUNITY)Purpose of the REED is to:Review available information and assessment data (e.g. ADOS, developmental history, rating scale results);Determine if the information is sufficient to make a determination of eligibility (i.e. meets eligibility criteria that impacts academic, behavioral, or social progress in school that necessitates special education);If not, determine what else is needed to make a determination of eligibility (e.g. observations to determine impact on educational performance);Establish a plan for gathering the additional information.

61. Other ConsiderationsConsideration of ALL potential disabilitiesInformation to assist in differential eligibilityInformation to assist in developing the IEPCommunication needs of the student including assistive technologyThe student’s social needs including peer to peer supportThe student’s behavioral needs including the need for a functional behavioral assessment, positive behavioral support plan, or an emergency crisis planAcademic needs of the student (i.e. accommodations and differentiation)

62. ASD Evaluation Process

63. Evaluation Checklist MeetingAttended by MET members (Psych, SSW, SLP)Critical for coordination of scheduling (ie. IEP, RRM, observations…)Discussion and assignments of evaluation components (evaluation checklist)Allows time for training, questions, case study, problem solving

64. Evaluation Plan Checklist

65. ESSENTIAL EVALUATION COMPONENTSTeacher / Staff Interviews / SurveysParent / Family Interviews & Home VisitDIRECT OBSERVATIONStandardized Test Considerations

66. Survey QuestionsAREAS TO CONSIDERReciprocal Social InteractionCommunicationRestrictive / Repetitive BehaviorDifferential Eligibility:Developmental HistoryMedical HistoryCognitive / Adaptive Skills Educational SkillsTalking Points vs. QuestionsChallenges with published tools:Don’t match MARSE criteriaDon’t focus on impact and needMay not facilitate robust discussion

67. Documentation FormRecord ReviewsObservationsInterviewsMeetings

68. FACILITATED MEETINGReferring Team / Teacher – Staff Interviews

69. Process & Application3 ADVANTAGES OF FACILITATED MEETING TO GATHER SCHOOL TEAM INFO

70. ESSENTIAL EVALUATION COMPONENTSTeacher / Staff Interviews / SurveysParent / Family Interviews & Home VisitDIRECT OBSERVATIONStandardized Test Considerations

71. Home VisitAdvantages of the Home VisitBuild RelationshipPervasiveness of CharacteristicsDescribe Behaviors from Varying Perspectives (Report)Visit student’s room if possible!!

72. ESSENTIAL EVALUATION COMPONENTSTeacher / Staff Interviews / SurveysParent / Family Interviews / SurveysDIRECT OBSERVATIONStandardized Test Considerations

73. OBSERVATION FORMATQualitative Impairment in CommunicationDelay or Lack of DevelopmentPragmaticsStereotypical or RepetitiveCreative Pretend PlayQualitative Impairment in Reciprocal Social InteractionNon-Verbal Behavior Peer RelationshipsShowing and SharingSocial/Emotional ReciprocityRestrictive, Repetitive and Stereotyped BehaviorsRestricted InterestsNonfunctional RoutinesMotor MannerismsParts of ObjectsSensory

74. Char-Em Eligibility Guidelines

75. Observations (pg 33 – 35)“Eyes on Kid”All Team MembersAll Settings & TimesCapture Presence / Absence of BehaviorsExamples / non-examples but NOT interpretation—that meeting is laterIs ASD dominating student’s thinking / interaction with environmentIntegrated Observations:Participate to get more detailed informationInvestigate – dig down below the surfaceConduct mini experiments to see the impact or responseConsider context and FUNCTION

76. Observations in ContextINTEGRATED OBSERVATIONSThe Tip of the Iceberg AnalogyThe tip is the observable behavior;The context cues us into what underlies the behavior (e.g. motivation, intent, function)Function = Differential Eligibility

77. Caution Fundamental Attribution Error

78. Possible Function?When peers try to talk to her, Mariah turns away, does not respond verbally, and pulls her sweater over her head; peers move away.When the teacher gives her corrective feedback about her work, Mariah turns away, does not respond verbally, and pulls her sweater over head; the teacher sits next to her, rubs her shoulders and says comforting words.

79. Example Situation Marci was observed grabbing toys and objects from others and appeared unaware that the other child was using or playing with the object. Marci was observed tickling peers under the chin while giggling, moving from one peer to the next. None of the children appeared to be enjoying this, but Marci did not seem to recognize their displeasure.Marci was observed pulling at girls’ ponytails and accessories; Marci has not been noted to pull hair other than in pony/pigtails or when there are accessories present. Marci was noted to state, “I want to poke her in the eye” and “I want to kick her” in a very unemotional manner not directed at anyone. Despite her statement, Marci has not attempted to do the things that she says.

80. Example Situation Marci was observed grabbing toys and objects from others and appeared unaware that the other child was using or playing with the object. Marci was observed tickling peers under the chin while giggling, moving from one peer to the next. None of the children appeared to be enjoying this, but Marci did not seem to recognize their displeasure. Marci was observed pulling at girls’ ponytails and accessories; Marci has not been noted to pull hair other than in pony/pigtails or when there are accessories present. Marci was noted to state, “I want to poke her in the eye” and “I want to kick her” in a very unemotional manner not directed at anyone. Despite her statement, Marci has not attempted to do the things that she says.

81. Example Situation Marci was observed grabbing toys and objects from others, while yelling, “I had it first!” and pushing peers away. Marci was observed tickling peers under the chin while giggling, moving from one peer to the next. None of the children appeared to be enjoying this, but Marci kept saying, “Am I bugging you yet?” and “Isn’t this so funny?” Marci was observed pulling at girls’ ponytails and accessories; she will say, “I don’t like your hair like that-it looks stupid.” Marci was noted to state, “I want to poke her in the eye” and “I want to kick her” while being redirected from an argument with a peer. Marci has previously shoved, kicked and poked this girl when she doesn’t do what Marci wants her to do.

82. Data to Support Impact / Needhttp://www.gvsu.edu/autismcenter/individual-student-data-collection-forms-217.htm

83. Process & ApplicationAt least ONE way to improve your observation procedures…..

84. ESSENTIAL EVALUATION COMPONENTSTeacher / Staff Interviews / SurveysParent / Family Interviews / SurveysDIRECT OBSERVATIONStandardized Test Considerations

85. Supporting Evidence for ASDChecklistsInterview FormsDirect Assessment Tools

86. Be Intentional with Standardized ToolsRemember: Tools were not designed to align with the MARSE criteria or measure impact / need.ASD characteristics that may negate results:Difficulty establishing rapport Lack of motivation to pleaseChallenges with attention, engagement, and persistence in task demandsDifficulty transitioningLanguage deficits Interfering and challenging behaviorsTools are only as good as their technical adequacy

87. MARSEhttp://www.michigan.gov/documents/mde/MARSE_Supplemented_with_IDEA_Regs_379598_7.pdf

88. Technical Adequacy SampleReliabilityValidityEXAMPLE: ADOS-2:Test / Re-test Reliability—2 Weeks:Classification changed for 9 of the 39 children (23%)Technical Adequacy

89. ASIEP-3 (Autism Screening instrument for educational planning)Consists of 5 Separate Measures The Autism Behavior Checklist (ABC) = 47 item checklist Results indicate the probability of the student having ASDContent Validity: Items were developed based on an extensive review of the literature describing the characteristics of autism“The ability of the ABC to discriminate among different diagnostic groups needs to be examined further”

90. Assessment ToolsCentral Assessment Lending Library (CALL) https://www.cmich.edu/colleges/chsbs/Psychology/call/pages/default.aspx/ ASIEP-3: Autism Screening Instrument for Educational PlanningADOS-2 (Autism Diagnostic Observation Schedule)ADI-R: Autism Diagnostic Interview CARS-2: Childhood Autism Rating ScaleGARS-2: Gilliam Autism Rating ScaleGADS: Gilliam Asperger Disorder ScaleKADI: Krug Asperger Disorder IndexPEP-3: Psycho-Educational ProfileABLLS-R: Assessment of Basic Language and Learning SkillsVB-MAPP: Verbal Behavior – Milestones Assessment and Placement Program

91. Questions to Guide the Use of Standardized ToolsDoes the tool have adequate technical adequacy?What is the purpose or intended outcomes?What questions are you attempting to answer and will the tool provide that information? What are the language requirements and do they match the ability level and communication modality of the student? Given the student’s behavioral challenges, will the tool likely produce reliable and valid results?How current is the tool (e.g. when was it published and standardized)?What are the potential challenges in using the tool (e.g. results are not consistent with other information)?

92. Creative Uses of Standardized Tools“Breaking Standardization”Observe performance under various conditions (e.g. use of visuals supports)Create conditions not easily observed in natural settings. NOTE: Such expansions can be beneficial in capturing rich information on the student’s learning needs, strengths, and challenges, but invalidates obtained scores. Avoid by first administering under standardized conditions. Some options for breaking standardization include the following:Administer subscales or items within subscales in a different order so highly preferred tasks can follow less preferred ones to increase motivation;Start at the beginning of a particular subscale (easiest item) rather than the age-suggested starting point to create behavioral momentum;Take frequent breaks; Use tangible reinforcers;Use a multiple-choice or fill-in-the-blank formats rather than an open-ended;Paraphrase instructions and/or simplify language to match child’s level;Use terms and phrases that are familiar to the child (e.g., “match” vs. “find me another one just like this”); 

93. Other Assessment AreasConsiderations DiscussionIQ AssessmentSpeech / Language AssessmentsAchievement TestsSocial / Emotional Tools

94. ASD Evaluation Process

95. Recommending EligibilityResults Review MeetingFormal Meeting w/ METUse Meeting Mechanics / Quadrants / BoardReview documentation from all sourcesIntegrate quantitative & qualitative informationFocus on the child and spectrum, not just individual characteristics“Preponderance of the Evidence”

96. Preponderance of EvidenceThe Results Review MeetingSocialCommunicationOTHERBehaviorSensoryIMPACT / NEED

97. ASD Evaluation Team

98. Brainstorming

99. TAKE NOTES

100. Of primary concern is Johnny’s level of independence. Due to difficulties in pragmatic language and communication, sensory modulation, and socialization, Johnny’s independence is limited. In order to participate with the routines and activities of the classroom, Johnny currently requires considerable physical and verbal prompting from adults. His independence is significantly impacted in the following areas:Transition (task to task and place to place)Group participationDirection followingSelf careInteractions with peersOutside playInside play with free choice timeSpontaneous conversationFoundation for Impact and Need Statement

101. How does the ASD impact access and progress in general education curriculum and environments?Independence: Due to Sean’s lack of reciprocity and engagement and his restricted range of interests, he does not independently navigate the daily schedule and requires 6-7 verbal and visual prompts by adults before following simple tasks. He also does not independently get materials he needs to complete classroom activities and tasks, and requires up to 10 adult prompts to complete his classroom work. Independence is also impacted in the following areas:Group participationDirection followingSelf careBehavior / Instruction: As many as 6 times an hour, Sean attempts to leave the classroom to seek out his preferred activity (basketball) and as a result, he misses instruction 3-4 times per day for 5-10 minutes.The Impact and Need StatementFoundation for PLAAFP

102. Write a Report

103. Organization of ReportCOMBINED: Three Evaluators - ONE ReportOutline Details from the ASD Eligibility CriteriaRELEVANT HistoryMARSE ASD CriteriaEvaluation Results:Reciprocal Social InteractionCommunicationRestrictive / Repetitive Patterns of BehaviorEXPLAIN what does NOT align with conclusions – PERSUASIVE WRITING

104. Report Template ExamplePacket Page 38

105. Report Template Example

106. Report Template Example

107. Process and Application“NO WAY”No Report Considerations

108. The MET Form

109. AGENDANew Reality in ASD EvaluationsFoundations in CET (Centralized Evaluation Team)MARSE Eligibility Criteria for ASDEssential Evaluation ComponentsDifferential EligibilityASD or ECDD, CI, EI

110. Differential EligibilityDo you think its ______________________ASD or ECDD? CI? EI?

111. Key Early Indicators of ASDhttp://www.cdc.gov/ncbddd/autism/index.html Lack of:Reciprocal social smiling by 6 monthsResponse/Orientation to name by 12 monthsReciprocal gestures by 14 months (showing objects, pointing, reaching, waving)Avoids eye contact / wants to be or play aloneNo words by 16 months (and meaningful 2-word phrases by 24 months)Not play “pretend” games (feed a doll) by 18 monthsPlays with parts of objects (e.g. wheels)More Info at: (www.autisminternetmodules.org) Dashboard: Recognizing ASD—What Early Interventionists Should Know (What are some of the red flags you might see during the first three years of the child's life?)

112. EARLY CHILDHOOD CONSIDERATIONSIdentify or Not?Retrospective studies (e.g., looking at home videos)Prospective studies (following the development of children at low and high risk for autism) Signs of autism are often present in the first year of life, and especially by the first birthday (Landa, Holman, & Garrett-Mayer, 2007). If pay close attention to red flags, experts suggest that many children could be diagnosed by age 2 (Plauché Johnson, 2008), and perhaps up to 50% of children with autism could be diagnosed reliably as early as 14 months of age (Landa, 2007).

113. Common MisrulesNo ASD until age 5, age 8, kindergarten;Just use ECDD for now, parents aren’t ready to hear the A word;We are doing an ECDD eval;ECDD classroom is successful so can’t be eligible ASD;Hasn’t been in daycare or preschool (programming), so can’t consider ASD

114. Early Childhood Developmental Delay R 340.1711 “Early childhood developmental delay” defined; determination. Rule 11.(1) “Early childhood developmental delay”means a child through 7 years of age whoseprimary delay cannot be differentiated throughexisting criteria within R 340.1705 to R340.1710 or R 340.1713 to R 340.1716 andwho manifests a delay in 1 or more areas ofdevelopment equal to or greater than 1/2 of theexpected development. This definition does notpreclude identification of a child through existingcriteria within R 340.1705 to R 340.1710 or R340.1713 to R 340.1716.

115. Early Eligibility DeterminationKNOW typical developmentKNOW developmental issues that can mirror ASDHigher threshold given developmental changes / environmental impact

116. Early Implementation Resources Guidance Document ASD Eligibility: http://eotta.ccresa.org/Files/Uploads/New/188/ASD_MMSE_Guidance.pdf Appendix A – Chart: http://eotta.ccresa.org/Files/Uploads/New/188/MMSE_ASD_Guidance_Appendix_A.pdf Full Early On Implementation Manual: http://eotta.ccresa.org/Implementation_Manual.php

117. Differential EligibilityDo you think its ______________________?CI?

118. Overlapping Behavior Characteristics

119. MARSE CriteriaCognitive ImpairmentDevelopment at a rate at or below approximately 2 standard deviations below the mean as determined through intellectual assessment.Scores approximately within the lowest 6 percentiles on a standardized test in reading and arithmetic. This requirement will not apply if the student is not of an age, grade, or mental age appropriate for formal or standardized achievement tests.Lack of development primarily in the cognitive domain.Impairment of adaptive behavior.

120. MARSE ASD EligibilityReciprocal Social Interaction (2)Non-verbal behaviorPeer relationshipsShow and shareSocial / emotional reciprocityCommunicationDelay without compensationPragmaticsStereotyped / repetitiveMake-believeRestrictive / Repetitive BehaviorRestricted InterestsInflexible routinesMotor mannerismsParts of objects

121. ASD

122. Differential EligibilityDo you think its ______________________?EI?

123. EI (Emotional Impairment) CriteriaThe problems result in behaviors manifested by 1 or more of the following characteristics:Inability to build or maintain satisfactory interpersonal relationships within the school environment. Interpersonal relationships refer to developmentally appropriate actions and reactions to peers and adults. To meet this criteria, a student should demonstrate pervasive (generally all teachers and peers) aberrant behaviors that occur at a greater frequency, intensity and duration for others at that developmental level.Inappropriate types of behavior or feelings under normal circumstances. This criterion implies atypical behaviors for which no observable reason exists. Mere misconduct or refusal to comply does not qualify a student in this category. The pervasiveness and frequency, intensity, and duration should also be considered.

124. EI (Emotional Impairment) Criteriac. General pervasive mood of unhappiness or depression. This criterion means a student must exhibit depressive symptomatology which typically involves changes in all four major areas: (1) affective (emotions), (2) motivation (loss of interest), (3) physical/motor functioning (e.g. weight / appearance), and (4) cognition. Pervasiveness implies impact in almost all aspects of a person’s life. NOTE: Aggression and non-compliance can mask depression.d. Tendency to develop physical symptoms or fears associated with personal or school problems. First consider a student’s medical condition before considering eligibility under this criterion. This criterion is related to conditions like school phobia and other intense anxiety disorders that result in physical symptomology and somatic complaints (e.g. headache, tics, stomachache).

125. Example EI CharacteristicsInability to Maintain RelationshipsInappropriate Behaviors or FeelingsUnhappiness or DepressionPhysical Symptoms / FearsIn ability to maintain relationships due to:Responding aggressively toward othersShort temperStarts fightsWithdrawnHas intense emotional responses to typical peer disagreementsDemonstrates inappropriate sexual behaviorsSeeks excessive approval from othersOver-reacts to everyday occurrences (i.e. rage, excessive laughter, hysterics) Exhibits catastrophic or panic reactions to everyday occurrencesDemonstrates flat, distorted or excessive affectExhibits self-abusive behaviorsExhibits delusions and/or hallucinations or thought disordersDemonstrates extreme mood swings Decreased interest / pleasure in previously enjoyed activitiesExcessive guilt and/or self-criticism Expresses feelings of extreme sadness Predicts failure or refuses to attempt tasks (projects hopelessness)Demonstrates agitation or lethargyDifficulty concentrating and/or making decisionsChronic Somatic complaints (i.e. headaches, stomach aches)Intense anxiety not associates with a specific stimuliExtreme fear in response to a specific stimuliPanic reactions to everyday occurrences

126. MARSE ASD EligibilityReciprocal Social Interaction (2)Non-verbal behaviorPeer relationshipsShow and shareSocial / emotional reciprocityCommunicationDelay without compensationPragmaticsStereotyped / repetitiveMake-believeRestrictive / Repetitive BehaviorRestricted InterestsInflexible routinesMotor mannerismsParts of objects

127. EI (Emotional Impairment) Criteria(2) Emotional impairment also includes students who, in addition to the characteristics specified in subrule (1) of this rule, exhibit maladaptive behaviors related to schizophrenia or similar disorders. The term “emotional impairment” does not include persons who are socially maladjusted, unless it is determined that the persons have an emotional impairment.What is Social Maladjustment?Not defined by federal or state departments or clinical literatureUnderstanding is derived from the educational literature and practice, administrative decisions and court interpretationsOften associated with clinical Dx of CD, ODD, or Antisocial Definition Components: Pervasive intentional behaviors that violate socially acceptable rules and normsAccepting no responsibility for actionsDemonstrating little to no remorseBlame and intimidate / charm others while manipulating the situation to meet own needs

128. ASD vs. EI / SMBEHAVIORS:Refusal to do academic workNot following school expectations / rulesAggression toward peersDISTINGUISH BETWEEN:I don’t care about your rule vs. I don’t understand the rules and the rules frequently change;ODD vs. I already know how to do this and if I know, then you should know;I don’t care about your thoughts or feelings vs. I don’t understand you have different thoughts or feelings from me.

129. Making a Final DecisionPreponderance of EvidenceNo one behavior includes or excludes any specific eligibility area:There are always going to be instances that don’t fit the criteria!!MUST explain what does not alignMUST build a case for your conclusionHowever & DespiteIntelligent People can Disagree!!

130. What if there is Disagreement? Different purposes (diagnosis versus special education eligibility and IEP development)Adherence to strong evaluation process & report is defendableCommitment to CommunicationFocus on Student Needs What if there is Disagreement?(e.g. Medical says “YES” and School says “NO”)

131. What is there is Internal Disagreement? Keep true to the process (run the board)Presume Positive IntentAsk questions to obtain a deeper understanding of the disagreement -- PPPIs there a misunderstanding of ASD?Is there a focus on singular behaviors rather than preponderance of evidence?Is there an agenda or pressure to land on one decision vs. anotherGather additional information/dataAdd another evaluator / teamWrite a dissenting reportWhat if there is Internal Disagreement?

132. WRAP UP the C’sConceptsChangesCapacity