IMPROVING AUTISM ASSESSMENT SERVICES IN THE SCHOOLS

John Prickett

Donald Oswald

Commonwealth Autism Service

THE PROBLEM

Children with Autism Spectrum Disorders (ASDs) who receive early diagnosis and intervention experience better outcomes (Zwaigenbaum, 2010).

Interdisciplinary diagnostic assessment is the accepted state of the art.

Rural school divisions face particular challenges in providing interdisciplinary assessment and intervention.

Evidence suggests that local teams can be successfully trained to provide high-quality assessments of children with ASDs (McClure, MacKay, Mamdani, & McCaughey, 2010)

OVERCOMING BARRIERS TO EARLY IDENTIFICATION OF ASDS

Barriers to effective early identification include: Long wait time for external evaluationsExternal evaluations may not translate

easily into educational plansExternal evaluations may foster an

adversarial relationship between parents and school personnel

Single-discipline evaluations fail to capture the complexity of the child’s ability / disability profile.

GOAL OF THE PROJECT

To identify students with Autism Spectrum Disorders (ASDs) at an earlier age via: A school-based interdisciplinary team trained in

gold-standard, autism-specific assessments . Generate reliable diagnostic decisions. Used by Local Education Agencies (LEAs) for the

purposes of eligibility and IEP development.

COLLABORATORS

Commonwealth Autism Service (CAS) Shenandoah Valley Regional Program (SVRP),

a regional special education program consisting of: Page County Public Schools Shenandoah County Public Schools Rockingham County Public Schools Augusta County Public Schools Harrisonburg City Public Schools Staunton City Public Schools

Virginia Leadership Education in Neurodevelopmental Disabilities (Va-LEND)

REGIONAL AUTISM ASSESSMENT TEAM (RAAT)

The Regional Autism Assessment Team (RAAT) is a school-based interdisciplinary assessment service serving six rural school divisions.

The objectives of the collaboration were to train RAAT members in: The use of reliable, gold-standard diagnostic

assessment instruments; Interdisciplinary team functioning and family

centered practice; Integrating multi-disciplinary perspectives and

contributions to the diagnostic assessment process.

RAAT MEMBERSHIP

SVRP school-based interdisciplinary regional autism assessment team: school psychologists speech and language pathologists occupational therapists school social workers behavior analysts

TRAINING ACTIVITIES

RAAT members receive formal training in:Autism Diagnostic Observation Schedule

(ADOS) administration and codingAutism Diagnostic Interview – Revised

(ADI-R) administration and coding Interdisciplinary team functioningFamily-centered practice Interdisciplinary assessment: Role of the

occupational therapistADOS - Consensus codingEvidence-based interventions

TRAINING ACTIVITIES

Principles of interdisciplinary team assessment:

Ecological validity of assessmentsRecognizing uncertaintyCoordination and non-redundant testingDynamic nature of the assessment Respect for contributions of other disciplines

Cultural competenceRole of the familyRole of community providersInclusion and support

TRAINING ACTIVITIES (2010)

Previously provided trainings: December 9th : ADI Training provided to SVRP

RAAT November 29th & 30th: ADOS Training provided to

SVRP RAAT. October 7th : Consensus scoring for the (ADOS). February 22: Role of the occupational therapist in

assessing, designing and delivering services to support learners with ASD.

School-based assessment team members and trainees regularly observe evaluations at the CAS Transdisciplinary Diagnostic Assessment Clinic.

TRAINING RESULTS

o Trainees achieved the identified objectives and were satisfied with the training provided.

o Survey of Trainees:• Before-session: Participants indicated they were

‘not at all ‘ to ‘somewhat’ informed about assessment issues.

• After-session responses ranged from ‘somewhat’ to ‘well informed’

o Participants showed increased knowledge about the training topics.

o Training participants indicated that training was useful and would change their practice/behavior.

o Training participants indicated that they were satisfied with the overall training and that effective training tools were used.

RA

AT A

DM

INIS

TR

ATIV

E P

RO

CESS

SVRP and CAS staff worked with local school division personnel to devise an administrative process for:• referral to the assessment team • feedback of assessment results to the child’s eligibility team.

REFERRAL TO THE ASSESSMENT TEAM

Student is identified by the student’s local special education director with input from: The school psychologist, social worker, special

education teacher. Special Education Director makes a referral, in

writing, to the RAAT Coordinator. RAAT Coordinator recruits a trans-disciplinary

team from a pool of 22 various team members.

ASSESSMENT PROCESS

Referral is made by the relevant Special Education Director

Team is selected by the RAAT Coordinator Classroom Observation is conducted by the

behavior analyst (1.5 to 2 hours) The ADOS is administered at the testing center,

typically, the parent is present (2.5 to 3.5 hours) The ADI is administered at the student’s home

or at the testing center (2 to 3 hours). Review of previous reports (1 to 3 hours) Completion of summaries by the represented

disciplines. Report completion.

FEEDBACK TO THE CHILD’S ELIGIBILITY TEAM. Team members complete discipline specific

summaries. School psychologist combines summaries

and completes report Report is submitted by the RAAT coordinator

to the referring special education director. Behavior Analyst from the referring district

attends the student’s eligibility meeting.

OVERALL PROJECT RESULTS

A functioning Regional Autism Assessment Team consisting of 22 members that has over the period of 14 months, contributed to the eligibility determination and intervention planning of 15 children.

Of 12 parents who responded to surveys, 11 stated the assessment team: Helped them to feel informed about the

assessment process. That they (the parents) were involved in the

assessment process That the assessment team made sufficient effort

to get to know their child.

ENGAGING PRIMARY CARE PROVIDERS

Primary care providers in screening and interdisciplinary assessment: Primary care physicians (PCPs) – a critical link in

the process April 14th, 2010: SVRP in conjunction with CAS

hosted a dinner & provided presentations to provide information about the RAAT, screening & assessment issues for ASD.

ADDITIONAL ISSUES

Issues addressed in the implementation of the project included: administrative concerns of participating

school divisions about the quality of the reports from outside assessments, delays, etc.

distinguishing a clinical evaluation from an educational assessment

advertisement / marketing of the serviceadvantages of ongoing contact with the

children and families through school servicespossibility of further comprehensive single-

discipline evaluations (e.g., in-depth OT and Speech/ Language evaluations if needed).

REFERENCES

Guralnick, M.J. (2000). Interdisciplinary clinical assessment of young children with developmental disabilities. Baltimore MD: Paul H. Brookes Publishing Co.

McClure, I., MacKay, T., Mamdani, H., & McCaughey, R. (2010). A comparison of a specialist autism spectrum disorder assessment team with local assessment teams. Autism, 14, 1–15.

Zwaigenbaum, L. (2010). Advances in the early detection of autism. Current Opinion in Neurology, 23, 97-102.

CONTACT US

John Prickett, MA, BCBA jprickett@autismva.org

Donald Oswald, PhD doswald@autismva.org

QUESTIONS / COMMENTS