Autism Spectrum Autism Spectrum DisordersDisorders

©©Carrie Cadwell, Psy.D.HSPPCarrie Cadwell, Psy.D.HSPP

““Social and behavioral competence Social and behavioral competence in young children predict their in young children predict their academic performance in the 1academic performance in the 1stst grade over and above their cognitive grade over and above their cognitive skills and family backgrounds” skills and family backgrounds” (Raver & Knitzer 2002)(Raver & Knitzer 2002)

APA Monitor (DeAngelis, April 2010)APA Monitor (DeAngelis, April 2010)

““SOCIAL AWARENESS SOCIAL AWARENESS + EMOTIONAL SKILLS + EMOTIONAL SKILLS = = SUCCESSFUL KIDS”SUCCESSFUL KIDS”

AutismAutismFirst described by Leo Kanner in 1943First described by Leo Kanner in 1943

Asperger’sAsperger’sFirst described by Hans Asperger in 1944First described by Hans Asperger in 1944

Comparison yields: the two groups were Comparison yields: the two groups were similar in terms of social-communication similar in terms of social-communication deficits and restricted/repetitive patterns of deficits and restricted/repetitive patterns of interest BUT differed in speech, motor interest BUT differed in speech, motor deficits, age of onsetdeficits, age of onset

DSM-IV-TRDSM-IV-TR

AutismAutism

Asperger’s DisorderAsperger’s Disorder

Pervasive Developmental Disorder Pervasive Developmental Disorder NOSNOS

SimilaritiesSimilarities

Social-Relation/InteractionSocial-Relation/InteractionRestrictive/Repetitive BIA Restrictive/Repetitive BIA Communication: verbal or non-verbalCommunication: verbal or non-verbalSensory-MotorSensory-Motor

DifferencesDifferences

Issue of delayed verbal/speech Issue of delayed verbal/speech Issue of cognitive abilitiesIssue of cognitive abilities

What about HFA vs Asperger’s IssueWhat about HFA vs Asperger’s Issue

Prevalence (based on Prevalence (based on publicatoin dates)publicatoin dates)

20 yrs ago= 1 in 20 yrs ago= 1 in 20002000

CDC 2005= 1 in 166CDC 2005= 1 in 166CDC 2007= 1 in 150CDC 2007= 1 in 150 THEN…estimates 1 in 125 (one study THEN…estimates 1 in 125 (one study

found 1 in 99)…then 2009 1 in 110found 1 in 99)…then 2009 1 in 110

NOW…..NOW…..

CDC published new prevalence data March CDC published new prevalence data March 2012 (in a rears from data collection in 2012 (in a rears from data collection in 2008)2008) 1 in 88 children1 in 88 children 1 in 54 boys; 1 in 252 girls1 in 54 boys; 1 in 252 girls

Indiana # (based on special education child count Indiana # (based on special education child count data)data)

---previously 1 in 163 (2005)---previously 1 in 163 (2005)

NOW…..1 in 83 (IRCA)NOW…..1 in 83 (IRCA)

What does this look like?What does this look like?

Social-Relational (Yale Study Center, Social-Relational (Yale Study Center, Vicker, NIMH, Rutter et al 2003):Vicker, NIMH, Rutter et al 2003): One-sided monologues on high interest areasOne-sided monologues on high interest areas Perseveration on topicsPerseveration on topics Poor perspective-taking/social cognitionPoor perspective-taking/social cognition Monosensory: demanded eye gaze make Monosensory: demanded eye gaze make

further restrict person’s ability to attend to further restrict person’s ability to attend to auditory messagesauditory messages

One thing/person at a timeOne thing/person at a time Poor understanding of social cues/non-verbal Poor understanding of social cues/non-verbal

gestures in othersgestures in others Inappropriate statementsInappropriate statements

Difficulty initiating, sustaining, closing social interactionDifficulty initiating, sustaining, closing social interaction When does initiate may have poor social timingWhen does initiate may have poor social timing may fail to provide sufficient information/detail to may fail to provide sufficient information/detail to

another person (TOM issue)another person (TOM issue) Poor comprehension (even in the face of great Poor comprehension (even in the face of great

expressive skills)expressive skills) May tend to be by him or herself (behavior does not May tend to be by him or herself (behavior does not

translate automatically in disinterest)translate automatically in disinterest) Difficulty in awareness/monitoring self non-verbals: eye Difficulty in awareness/monitoring self non-verbals: eye

gaze, gestures, voice tone/speed/volume, affect gaze, gestures, voice tone/speed/volume, affect inflectionsinflections

Verbalization may emphasize semantic information due Verbalization may emphasize semantic information due to great memory for facts, names, dates, etcto great memory for facts, names, dates, etc

Difficulties with knowing social etiquette of Difficulties with knowing social etiquette of time/place/persontime/place/person

Language Issues (Yale Study Center, Language Issues (Yale Study Center, Vicker, NIMH, Rutter et al, 2003):Vicker, NIMH, Rutter et al, 2003): Clearly social pragmatics are troublesomeClearly social pragmatics are troublesome Literal interpreters, difficulty with Literal interpreters, difficulty with

understanding multiple meanings to understanding multiple meanings to words/phraseswords/phrases

Some have extraordinary expressive language, Some have extraordinary expressive language, some are “non-verbal” (spectrum)some are “non-verbal” (spectrum)

Some are hyperlexicSome are hyperlexic Issue of echolalic speech & reversal (you for I)Issue of echolalic speech & reversal (you for I) Difficulty with humor/metaphors, etcDifficulty with humor/metaphors, etc May attend to words/phrases instead of gestalt May attend to words/phrases instead of gestalt

of communication of communication

Repetitive/Restricted/Stereotypes BIAs (Yale Repetitive/Restricted/Stereotypes BIAs (Yale Study Center; Vicker; NIMH; Rutter et al Study Center; Vicker; NIMH; Rutter et al 2003)2003) OCD-like (can be a co-morbid diagnosis)OCD-like (can be a co-morbid diagnosis) High interest areaHigh interest area Routines/rituals (ex: night-time ritual)Routines/rituals (ex: night-time ritual) Small changes in environment lead to significant Small changes in environment lead to significant

distressdistress Repetitive motor actions: flapping, rocking, hand Repetitive motor actions: flapping, rocking, hand

wringing, spinning, bouncing, finger movements wringing, spinning, bouncing, finger movements Splinter skillsSplinter skills Stereotyped/Repetitive- spinning wheels of match Stereotyped/Repetitive- spinning wheels of match

box cars, opening/closing cabinets, fascination box cars, opening/closing cabinets, fascination with fans, lining toys up, rolling lint ballswith fans, lining toys up, rolling lint balls

Additional thoughts on RSBs (Hendren & Additional thoughts on RSBs (Hendren & Horst 2007):Horst 2007):Not specific to ASDs…..present in OCD, Not specific to ASDs…..present in OCD,

Tourettes, schizophrenia, mental Tourettes, schizophrenia, mental retardationretardation

Also present in normal developmentAlso present in normal developmentNormative to 12 months and declineNormative to 12 months and declineAt 24 mos children with autism can begin to be At 24 mos children with autism can begin to be

distinguished from typical child based upon RSBdistinguished from typical child based upon RSBBy 36-48 months difference substantialBy 36-48 months difference substantial

Additional thoughts on RSBs (Hendren & Additional thoughts on RSBs (Hendren & Horst, 2007):Horst, 2007): Higher v Lower level RSBsHigher v Lower level RSBs

Lower level: motor stereotypiesLower level: motor stereotypiesHigher level: insistence on sameness, Higher level: insistence on sameness,

preoccupations, restricted patterns of interestpreoccupations, restricted patterns of interestHigher level more specific to autism whereas lower Higher level more specific to autism whereas lower

level more specific to developmental level more specific to developmental delay/intellectual disabilitydelay/intellectual disability

OCD v RSBsOCD v RSBsNeuro-biological similaritiesNeuro-biological similaritiesQualitatively differentQualitatively different

Underlying/AssociatedUnderlying/Associated

Joint AttentionJoint AttentionSymbolic/ImaginativeSymbolic/ImaginativeTheory of MindTheory of MindExecutive FunctionsExecutive FunctionsSensory-Motor IssuesSensory-Motor IssuesANXIETYANXIETYOther mental health issuesOther mental health issues

Joint attentionJoint attention

Shared attention/shared mental/emotional Shared attention/shared mental/emotional state between an child and other person state between an child and other person often focused on another objectoften focused on another object

Initiation may come from either party and Initiation may come from either party and may be led by verbalization and/or pointingmay be led by verbalization and/or pointing

Some differ between shared attention and Some differ between shared attention and joint attentionjoint attention Shared attention—3-6 mos (may be like social-Shared attention—3-6 mos (may be like social-

emotinal reciprocity)emotinal reciprocity) Joint attention---12-18 mosJoint attention---12-18 mos

Imaginative playImaginative play

Often children on the spectrum will not Often children on the spectrum will not engage in “imaginative”play….have to differ engage in “imaginative”play….have to differ between rote re-enactment and a more between rote re-enactment and a more creative, symbolic/pretend, spontaneous creative, symbolic/pretend, spontaneous imaginative playimaginative play

Example: using the remote control as a Example: using the remote control as a telephonetelephone

Most 2 year-olds are observed as evidencing Most 2 year-olds are observed as evidencing the above type of playthe above type of play

Kids on the spectrum more fascinated by Kids on the spectrum more fascinated by parts, properties of objects, using toys in a parts, properties of objects, using toys in a very restricted mannervery restricted manner

Are we losing imaginative play in Are we losing imaginative play in today’s world?today’s world?

What does that mean for social What does that mean for social skills/social problemskills/social problem

solvingsolving

Theory of MindTheory of Mind

Perspective-takingPerspective-taking Recognition that another person has “mind of their Recognition that another person has “mind of their

own” (ie thoughts, feelings, and resultant own” (ie thoughts, feelings, and resultant behaviors)behaviors) Social- referencing/reciprocity, joint attention, and Social- referencing/reciprocity, joint attention, and

imaginative play often thought as precursorsimaginative play often thought as precursors Sally-Anne task—by age 4 most children can Sally-Anne task—by age 4 most children can

answer correctly, majority of individuals with ASD answer correctly, majority of individuals with ASD cannotcannot

Without TOM we are “mind-blind” and it greatly Without TOM we are “mind-blind” and it greatly impairs social-relations/communcationsimpairs social-relations/communcations Think impaired empathy, think not understanding why you Think impaired empathy, think not understanding why you

cant come to the same conclusion as them, think not cant come to the same conclusion as them, think not filling in the blanks of communicationfilling in the blanks of communication

Executive FunctionsExecutive Functions

Problem-solving (Stokes 2004)Problem-solving (Stokes 2004)PlanningPlanningOrganizing (multi-sensory and motor Organizing (multi-sensory and motor

input to plan for apropo outputinput to plan for apropo outputEnactingEnactingMonitoringMonitoringShiftingShiftingWorking memoryWorking memoryResponse InhibitionResponse Inhibition

Do you know this youth?Do you know this youth?

Brian is 10 years old, parents and teachers Brian is 10 years old, parents and teachers are concerned by his emotional outbursts, his are concerned by his emotional outbursts, his mother got a call from the school that she mother got a call from the school that she had to come pick him up as he was “out of had to come pick him up as he was “out of control” and he was not calming down, Brian control” and he was not calming down, Brian had a substitute that day.Parent indicate that had a substitute that day.Parent indicate that Brian does not do well with change and gets Brian does not do well with change and gets stuck, if they tell him too far in advance he stuck, if they tell him too far in advance he obsesses and asks questions as anxiety obsesses and asks questions as anxiety builds, if he is taken by surprise he becomes builds, if he is taken by surprise he becomes emotionally unraveled and becomes so emotionally unraveled and becomes so locked in that nothing seems to sooth himlocked in that nothing seems to sooth him

Sensory-Motor IssuesSensory-Motor Issues

Sensory (Kranowitz)Sensory (Kranowitz)Hypersensitive/hyposensitiveHypersensitive/hyposensitiveOveraroused/underarousedOveraroused/underarousedModulationModulationNear Senses:Vestibular, Tactile, PropioceptiveNear Senses:Vestibular, Tactile, PropioceptiveFar Senses: Visual, Touch, Auditory, Far Senses: Visual, Touch, Auditory,

Olfactory, GustatoryOlfactory, GustatoryASD often present with additional sensory ASD often present with additional sensory

issues—loud noises, certain textures, lighting, issues—loud noises, certain textures, lighting, rocking, aversion/craving certain rocking, aversion/craving certain tastes/smellstastes/smells

ANXIETY ANXIETY

Anxiety is very prevalent in this populationAnxiety is very prevalent in this population Social anxiety, worried thoughts, panicSocial anxiety, worried thoughts, panic What appears to be aggressive behavior, What appears to be aggressive behavior,

tanrums,“non-compliance”, or self-stimulation tanrums,“non-compliance”, or self-stimulation behaviors may be anxiety-basedbehaviors may be anxiety-based

As we know high anxiety can impede As we know high anxiety can impede attention/awareness/learning/executive attention/awareness/learning/executive functions---so think about the role for ASD in functions---so think about the role for ASD in terms of social learning, interaction/performanceterms of social learning, interaction/performance

Habituation is not the answer!Habituation is not the answer! Consider overlap of sensory sensitivities and Consider overlap of sensory sensitivities and

anxietyanxiety

AD cont.AD cont.

OCD versus Aspergers (Neziroglu & OCD versus Aspergers (Neziroglu & Henriksen)Henriksen)Look at the social-relational piece: kids Look at the social-relational piece: kids

with OCD may experience peer with OCD may experience peer problems but do not have the social-problems but do not have the social-pragmatic challenges like ASDpragmatic challenges like ASD

Several similarities: shifting, emotions, Several similarities: shifting, emotions, incompleteness, obsessions, incompleteness, obsessions, compulsionscompulsions

AD cont.AD cont.

OCD vs Aspergers (Neziroglu & OCD vs Aspergers (Neziroglu & Henriksen)Henriksen)Shifting: need for sameness is a Shifting: need for sameness is a

similaritysimilarityOCD- difficulty with transition may be OCD- difficulty with transition may be

related to balancing/symmetry obsession related to balancing/symmetry obsession (everything must be completed in total)(everything must be completed in total)

ASD: even smallest changes can evoke ASD: even smallest changes can evoke extremely strong reponse; check sensory extremely strong reponse; check sensory issues; also check if you are interfering with issues; also check if you are interfering with a high interest areaa high interest area

AD cont.AD cont.

OCD vs Aspergers (Neziroglu & HenriksenOCD vs Aspergers (Neziroglu & Henriksen Obsessions/compulsions:Obsessions/compulsions:

OCD: intrusive, recurrent thoughts OCD: intrusive, recurrent thoughts elicit distresselicit distressASD: high interest areas do not -----distress only ASD: high interest areas do not -----distress only

elicited when interruptedelicited when interruptedCompulsions attached to obsessions----high interest Compulsions attached to obsessions----high interest

areas not attached to true compulsive behaviorareas not attached to true compulsive behavior Common compulsion such as checking, handwashing, Common compulsion such as checking, handwashing,

touching rare in ASDtouching rare in ASD

Other associated/co-Other associated/co-occurring:occurring:

Depression/Bipolar Disorder (2-6% increased prevalence of Depression/Bipolar Disorder (2-6% increased prevalence of BPD)BPD)

ADHD (40-95% overlap—Kolevzon, 2007))ADHD (40-95% overlap—Kolevzon, 2007)) OCDOCD TourettesTourettes Mental retardationMental retardation Non-verbal Learning Disability (neuropsychological Non-verbal Learning Disability (neuropsychological

designation)designation) Specific Learning Disabilities—WRITING!!!Specific Learning Disabilities—WRITING!!! Auditory Processing DisorderAuditory Processing Disorder Sleep concernsSleep concerns Gastrointestinal IssuesGastrointestinal Issues PICAPICA Ear Infections/AllergiesEar Infections/Allergies SeizuresSeizures

Early IdentificationEarly Identification Early identification + early intervention = Early identification + early intervention =

better outcomesbetter outcomes Asperger’s/HFA may not be easily identified in Asperger’s/HFA may not be easily identified in

the below age frames---development on track, the below age frames---development on track, may be verbally precocious, may not be the may be verbally precocious, may not be the most flexiblemost flexible

Research supports:Research supports: A portion of children can be accurately diagnosed by A portion of children can be accurately diagnosed by

18 mos…some research pointing to be ale to identify 18 mos…some research pointing to be ale to identify social-emotional delays even in the first yearsocial-emotional delays even in the first year

Most exhibit some symptoms between 18 and 36 Most exhibit some symptoms between 18 and 36 mos.mos.

Joint attention, gaze and pointing issues, imaginative playJoint attention, gaze and pointing issues, imaginative playParental concerns @ communication, peer socialization, Parental concerns @ communication, peer socialization,

sensory sensitivities, challenging behaviors sensory sensitivities, challenging behaviors

American Academy of Neurology American Academy of Neurology (AAN) 2000(AAN) 2000

More in-depth developmental evaluation More in-depth developmental evaluation is is requiredrequired if the following is not met: if the following is not met:Babbling by 12 mosBabbling by 12 mosGesturing (ie pointing/wave goodbye) by 12 Gesturing (ie pointing/wave goodbye) by 12

mosmosSingle word by 16 mosSingle word by 16 mosSpontaneous two word phrases (beyond Spontaneous two word phrases (beyond

echolalic) by 2 yearsecholalic) by 2 yearsLoss of language/social skills at any ageLoss of language/social skills at any age

NIMH-2004NIMH-2004

Other possible signs to be aware of:Other possible signs to be aware of:Eye gazeEye gazePlay behavior with toysPlay behavior with toysLining objects/toys upLining objects/toys upOver attachment to certain objects---Over attachment to certain objects---

example piece of stringexample piece of stringDeficits in social smiling Deficits in social smiling ““at times seems to be hearing impaired”at times seems to be hearing impaired”

AAN 2000 cont.AAN 2000 cont.

Siblings of children diagnosed with ASD Siblings of children diagnosed with ASD should be monitored for ASD sx, general should be monitored for ASD sx, general language delays, learning issues, language delays, learning issues, anxiety/depression, and social problemsanxiety/depression, and social problems(Lord, 2007) 1 in 10 to 1 in 20 odds that a (Lord, 2007) 1 in 10 to 1 in 20 odds that a

sibling would also have autismsibling would also have autism““Screening specifically for autism should Screening specifically for autism should

be performed on all children failing a be performed on all children failing a routine developmental surveillance routine developmental surveillance procedures using one of the validated procedures using one of the validated instruments”instruments”

Differential DiagnosisDifferential DiagnosisAACAP, 1999/McCracken, AACAP, 1999/McCracken,

2005/Stokes, 20042005/Stokes, 2004 ADHD (40-95% overlap)ADHD (40-95% overlap) OCD (keep in mind qualitative differences)OCD (keep in mind qualitative differences) Depression Depression Mental RetardationMental Retardation NVLD without ASDNVLD without ASD ODDODD Language/Motor DisorderLanguage/Motor Disorder Seizure DisorderSeizure Disorder Selective MutismSelective Mutism SchizophreniaSchizophrenia Other PDDsOther PDDs Social AnxietySocial Anxiety PTSDPTSD Reactive Attachment DisorderReactive Attachment Disorder Other Neurological/Medical Condition (Vision or Hearing problems, lead Other Neurological/Medical Condition (Vision or Hearing problems, lead

intoxication, tuberous sclerosis)intoxication, tuberous sclerosis) *** issue of schiziod, schizotypal, and question of narcissistic features*** issue of schiziod, schizotypal, and question of narcissistic features

Skills TrainingSkills Training

Anxiety management/Emotional Anxiety management/Emotional RegulationRegulation

Positive Behavior SupportPositive Behavior SupportCognitive-Behavioral InterventionsCognitive-Behavioral InterventionsSocial Skills…..Social Social Skills…..Social

Connections….Social OpportunitiesConnections….Social OpportunitiesGive parents the coaching they Give parents the coaching they

need, the tools they need to build need, the tools they need to build the skills in the community/at the skills in the community/at homehome

Skills Training cont.Skills Training cont.

Applied Behavior Analysis (ABA)Applied Behavior Analysis (ABA)DIR model (Floortime)DIR model (Floortime)Many other models (ie CERTS, Many other models (ie CERTS,

Ziggurat, etc)Ziggurat, etc)

My favorite things…My favorite things…

Visual SchedulesVisual Schedules Make the link as often as possible between visual-verbalMake the link as often as possible between visual-verbal

Social StoriesSocial Stories Social recreational groupsSocial recreational groups 5 point scale5 point scale First---then boardsFirst---then boards Visual CountdownsVisual Countdowns Using the high interest area!!!Using the high interest area!!! OCALI internet modules OCALI internet modules

(autisminternetmodules.org)(autisminternetmodules.org) HANDS in autism (www.handsinautism.org)HANDS in autism (www.handsinautism.org)

Social-Emotional learningSocial-Emotional learning

SEL, Emotional IQ, Social IQSEL, Emotional IQ, Social IQ Components:Components: Goleman/CASEL (Goleman/CASEL (www.casel.orgwww.casel.org))

Self-awarenessSelf-awarenessKnowing your feelings and how they influence Knowing your feelings and how they influence

choices/behaviorchoices/behavior Self-managementSelf-management

Regulating, controlling, motivating to achieve Regulating, controlling, motivating to achieve personal and social goalpersonal and social goal

Social awarenessSocial awarenessPerspective-taking, empathy, similarities/differencesPerspective-taking, empathy, similarities/differences

SEL cont…SEL cont…

Relationship Skills/managementRelationship Skills/managementReflective listening, clear communication, Reflective listening, clear communication,

conflict management, positive relationships, conflict management, positive relationships, resisting negative pressureresisting negative pressure

Responsible decision-makingResponsible decision-makingMaking sound responsible, ethical decisions Making sound responsible, ethical decisions

based on good problem-solving skills and based on good problem-solving skills and being accountable for those being accountable for those decisions/outcomesdecisions/outcomes

Schools and SELSchools and SEL

2004- Illinois adopted SEL standards for 2004- Illinois adopted SEL standards for education and performance indicatorseducation and performance indicators

SEL becomes a part of the educational SEL becomes a part of the educational curriculumcurriculumWith associated benchmarks for With associated benchmarks for

elementary, middle, jr high, and highschoolelementary, middle, jr high, and highschoolSee handoutsSee handouts

Schools and SELSchools and SEL Many places to locate information about solid SEL Many places to locate information about solid SEL

programsprograms CASEL; Dept of Education; SAMHSA; OJJDPCASEL; Dept of Education; SAMHSA; OJJDP

Programs should be “SAFE”Programs should be “SAFE” Sequenced—building skills step by step—lessons Sequenced—building skills step by step—lessons

introduced incrementally over time/gradesintroduced incrementally over time/grades Active- active/experiential learning experience-role Active- active/experiential learning experience-role

plays, behavioral rehearsalplays, behavioral rehearsal Focused-is sufficient time devoted to SEL developmentFocused-is sufficient time devoted to SEL development Explicit- target specific SEL skillsExplicit- target specific SEL skills

Examples of Lessons (JCCP, 2010)Examples of Lessons (JCCP, 2010) Feeling wordsFeeling words Feeling faces/developing mood metersFeeling faces/developing mood meters External cues on othersExternal cues on others Internal Cues for selfInternal Cues for self Differentiating feelings and behaviorsDifferentiating feelings and behaviors Making and sustaining friendshipsMaking and sustaining friendships Good mannersGood manners Taking turnsTaking turns SharingSharing Making up after conflictMaking up after conflict Reflective listeningReflective listening Communicating your viewpointCommunicating your viewpoint

Examples of Lessons (JCCP, 2010)Examples of Lessons (JCCP, 2010) Problem-solving skills Problem-solving skills

PATHS Control Signal PosterPATHS Control Signal PosterRed- STOP Calm DownRed- STOP Calm DownYellow- GO SLOW ThinkYellow- GO SLOW ThinkGreen- GO Try my planGreen- GO Try my plan

Class/milieu mailbox for Class/milieu mailbox for concerns/problems for “problem-solving concerns/problems for “problem-solving meetings”meetings”

Homework for SEL concepts---get parents Homework for SEL concepts---get parents involvedinvolved

WHY talk about SEL globally?WHY talk about SEL globally?

Consistent with PBS modelConsistent with PBS model Youth diagnosed on the spectrum need this Youth diagnosed on the spectrum need this

input input however…..however…..So do a lot of children of elementary age and it So do a lot of children of elementary age and it

positively impacts achievement scores and positively impacts achievement scores and proactively/preventatively addresses bullying issues, proactively/preventatively addresses bullying issues, emotiona/behavioral problems, social issues, etcemotiona/behavioral problems, social issues, etc

Recent meta-analysis of 213 SEL programs Recent meta-analysis of 213 SEL programs found 11 percentage pt gains on found 11 percentage pt gains on achievement tests (in press, Durlack, achievement tests (in press, Durlack, Weissberg)Weissberg)

Final thoughtsFinal thoughts

Lord, 2007:Lord, 2007: Early intervention has been associated with 10-Early intervention has been associated with 10-

20 point gains on IQ testing20 point gains on IQ testing Nonverbal IQ more relevant to comparison and Nonverbal IQ more relevant to comparison and

outcome:outcome:Using nonverbal problem-solving performance as Using nonverbal problem-solving performance as

base to compare social and communicative base to compare social and communicative impairmentsimpairments

Individuals with a nonverbal IQ less than 70= Individuals with a nonverbal IQ less than 70= decreased likelihood of independent livingdecreased likelihood of independent living

Individuals with borderline to average IQ scores Individuals with borderline to average IQ scores greater likelihood of achieving independencegreater likelihood of achieving independence

Final ThoughtsFinal Thoughts

Lord, 2007:Lord, 2007:Practitioners who had seen more than Practitioners who had seen more than

25 youth with ASD more reliable 25 youth with ASD more reliable diagnosticiansdiagnosticians

Two heads are better than one applies Two heads are better than one applies to improving reliability and validity of to improving reliability and validity of diagnosisdiagnosis