EducationBased Evaluations for ASD http START Project Education

Education-Based Evaluations for ASD http: //START Project Education- Based Evaluations for ASD

INTRODUCTIONS Working Agreements

Poll Everywhere 2 ways to sign in

AGENDA • New Reality in ASD Evaluations • Foundations in CET (Centralized Evaluation Team) • MARSE Eligibility Criteria for ASD • Essential Evaluation Components • Differential Eligibility – ASD or ECDD, CI, EI

Michigan Students with an ASD Eligibility 20, 595 15000 10000 9. 9% of the population of students receiving special education services 5000 1, 208 19 90 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 20 17 0 19 Number of Students 20000

New Reality: Players at the Table Area Special Ed Autism Insurance Benefit (AIB) Private Insurance Medicaid / MIChild Criteria ASD / MARSE ASD = Autistic Disorder, AS, PDD-NOS (DSM IV) ASD = Autistic Disorder, AS, PDD-NOS (DSM IV) Plan for Evaluation REED / Timeline ------------------- Who Evaluates Psych, SSW, SLP Licensed Psych or Physician CMHP Using What Tools Prescriptive for Child / Purpose Must include an “Autism Diagnostic Observation Schedule” (e. g. ADOS-2) Must include ADOS-2 and Developmental Family History (e. g. ADI-R) Determination of Impairment / Diagnosis IFSP / IEP Team Determines Impairment Diagnosis of Condition Eligibility for Services IFSP / IEP Team determines adverse impact Treatment prescribed or ordered by evaluator CMHP + Medicaid Agency final approval Service Plan IFSP / IEP Treatment Plan developed by board certified or licensed provider IPOS developed through PCP process Types of Services IFSP=Early Intervention services; IEP=SE, Behavioral Health, Pharmacy, Psychiatric, Psychological, Therapeutic ABA (EIBI and ABI)

Individualized Family Service Plan

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

DSM-V Change: ASD Persistent Deficits in Social Communication & Social Interaction SEVERITY RATING LEVELS 1 -3: 3 = Requiring very substantial support 1 = Requiring support

MARSE ASD Triad

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

New Reality: More Complexity • Common Comorbid Conditions: – Seizures and epilepsy – Anxiety – Depression – Attention difficulties – Bipolar Disorder – Obsessive Compulsive • Some comorbid conditions are characteristics of ASD; • Some cannot be primary for eligibility under ASD

FIRST STEP: Improve OUR Process • 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: • • Pervasive Marked Qualitative Adverse Impact

Goals for Evaluation Teams • Confident and Competent • Strength in Process –Defendable –Consistent

Autism Council

Autism Council START

Foundations in CET VIDEO (Centralized Evaluation Team) • Educational Eligibility vs. Medical Diagnosis • Parent and Family Engagement • Focus on Qualitative using Quadrants • Combined Report Writing • Use of Meeting Mechanics • OBJECTIVE Team

Foundations in CET (Centralized Evaluation Team) • Educational Eligibility vs. Medical Diagnosis • Parent and Family Engagement • Focus on Qualitative using Quadrants • Combined Report Writing • Use of Meeting Mechanics • OBJECTIVE Team

Eligibility vs Diagnosis (Pg. 4)

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 know • Let your partner share their speech • Share your PARTNER’s speech back at your home table

Foundations in CET (Centralized Evaluation Team) • Educational Eligibility vs. Medical Diagnosis • Parent and Family Engagement • Focus on Qualitative using Quadrants • Combined Report Writing • Use of Meeting Mechanics • OBJECTIVE Team

Process and Application 3 Advantages & 1 Disadvantage of Objective Team

TEAM Process for Evaluation ☺ Collaboration ☺ One voice ☺ One contact ☺ One report

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

AGENDA • New Reality in ASD Evaluations • Foundations in CET (Centralized Evaluation Team) • MARSE Eligibility Criteria for ASD • Essential Evaluation Components • Differential Eligibility – ASD or ECDD, CI, EI

The Three Prongs of Eligibility • CRITERIA • IMPACT • NEED

MARSE Criteria Autism Spectrum Disorder (ASD) 1. 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 Sp. Ed 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. )

Purpose of “LIFELONG” • Definition of ASD • Increases threshold for decisions • Reduces need to re-evaluate for evidence of ASD • Implies lasting impact, not permanent eligibility

MARSE Criteria ASD Age of Eligibility Autism 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.

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. ”

MARSE Criteria for Autism Spectrum Disorder (ASD) Characterized by : Qualitative Impairment in Reciprocal Social Interactions Qualitative Impairment in Communication Restricted, Repetitive, and Stereotyped Behaviors

“Qualitative” • 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

MARSE Definition Reciprocal Social Interaction (a) Qualitative impairments in reciprocal social interactions including at least 2 of the following areas: (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.

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

Reciprocal Social Interaction At 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 peers Likert Scale for Marked Typical Different Marked

Reciprocal Social Interaction At 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 peers – PURPOSE / FUNCTION 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

Reciprocal Social Interaction At 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) – Anthropomorphic – Examples: not understanding humor / jokes, disrupting activities (play), rarely initiates or sustains interaction, tolerates peers but not engaged in interaction

RECIPROCAL SOCIAL INTERACTION AT 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 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

RECIPROCAL SOCIAL INTERACTION AT LEAST 2 OF THE 4 (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 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

Developmental Trajectories Theories

Shape Shifter 3 Key Points What squared away with what you already knew? What’s still circling in your mind? • Part 1: – Draw each shape on a sheet of paper – Reflect on Day 1 content for each shape • Part 2: – Start with ____, clockwise, share your reflections – Identify themes in each shape • Part 3: Report Out

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.

MARSE Criteria: Communication At 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 communicative intent • Some 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. Autism Spectrum Disorder CDC

Communication (ii) Impairment in Pragmatics: The ability to initiate, sustain, or engage in reciprocal conversation with others a. b. c. 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 • 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

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

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

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

(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

3 – 2 – 1 (Pgs 8 -10) 3 Confirmations 2 New Concepts / Framing 1 Question / Confusion

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.

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

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.

MARSE CRITERIA Other 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.

Process and Application Quick Check The 3 -prong requirement for eligibility is: The triad required for ASD eligibility is qualitative impairment in _______ and ___________ YES or NO: All 3 prongs and all three areas of criteria in the triad are required for ASD eligibility.

AGENDA • New Reality in ASD Evaluations • Foundations in CET (Centralized Evaluation Team) • MARSE Eligibility Criteria for ASD • Essential Evaluation Components • Differential Eligibility – ASD or ECDD, CI, EI

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.

Other Considerations • Consideration of ALL potential disabilities • Information to assist in differential eligibility • Information to assist in developing the IEP – Communication needs of the student including assistive technology – The student’s social needs including peer to peer support – The student’s behavioral needs including the need for a functional behavioral assessment, positive behavioral support plan, or an emergency crisis plan – Academic needs of the student (i. e. accommodations and differentiation)

Evaluation Checklist Meeting • Attended 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

Evaluation Plan Checklist

ESSENTIAL EVALUATION COMPONENTS • Teacher / Staff Interviews / Surveys • Parent / Family Interviews & Home Visit • DIRECT OBSERVATION • Standardized Test Considerations

Survey Questions • Talking Points vs. Questions • Challenges with published tools: – Don’t match MARSE criteria – Don’t focus on impact and need – May not facilitate robust discussion AREAS TO CONSIDER • Reciprocal Social Interaction • Communication • Restrictive / Repetitive Behavior • Differential Eligibility: – – Developmental History Medical History Cognitive / Adaptive Skills Educational Skills

Documentation Form Record Reviews Observations Interviews Meetings

FACILITATED MEETING Referring Team / Teacher – Staff Interviews Social Interaction Communication Behaviors Sensory OTHER (e. g. academic, cognitive functioning)

Process & Application 3 ADVANTAGES OF FACILITATED MEETING TO GATHER SCHOOL TEAM INFO

ESSENTIAL EVALUATION COMPONENTS • Teacher / Staff Interviews / Surveys • Parent / Family Interviews & Home Visit • DIRECT OBSERVATION • Standardized Test Considerations

Home Visit Advantages of the Home Visit • Build Relationship • Pervasiveness of Characteristics • Describe Behaviors from Varying Perspectives (Report) Visit student’s room if possible!!

ESSENTIAL EVALUATION COMPONENTS • Teacher / Staff Interviews / Surveys • Parent / Family Interviews / Surveys • DIRECT OBSERVATION • Standardized Test Considerations

OBSERVATION FORMAT Qualitative Impairment in Communication Qualitative Impairment in Reciprocal Social Interaction Delay or Lack of Development Pragmatics Stereotypical or Repetitive Creative Pretend Play Non-Verbal Behavior Peer Relationships Showing and Sharing Social/Emotional Reciprocity Restrictive, Repetitive and Stereotyped Behaviors Sensory Restricted Interests Nonfunctional Routines Motor Mannerisms Parts of Objects

Char-Em Eligibility Guidelines

Observations (pg 33 – 35) “Eyes on Kid” • All Team Members • All Settings & Times • Capture Presence / Absence of Behaviors – Examples / non-examples but NOT interpretation—that meeting is later – Is ASD dominating student’s thinking / interaction with environment • Integrated Observations: – – Participate to get more detailed information Investigate – dig down below the surface Conduct mini experiments to see the impact or response Consider context and FUNCTION

Observations in Context INTEGRATED OBSERVATIONS The Tip of the Iceberg Analogy • The tip is the observable behavior; • The context cues us into what underlies the behavior (e. g. motivation, intent, function) • Function = Differential Eligibility

Caution Fundamental Attribution Error

Possible Function? When peers try to talk to her, Mariah turns away, does not respond verbally, and pulls her sweater over 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.

• 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 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.

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 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.

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.

Data to Support Impact / Need START Project Individual Student Data Collection Forms

Process & Application At least ONE way to improve your observation procedures…. .

ESSENTIAL EVALUATION COMPONENTS • Teacher / Staff Interviews / Surveys • Parent / Family Interviews / Surveys • DIRECT OBSERVATION • Standardized Test Considerations

Supporting Evidence for ASD • Checklists • Interview Forms • Direct Assessment Tools

Be Intentional with Standardized Tools • Remember: 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 please Challenges with attention, engagement, and persistence in task demands Difficulty transitioning Language deficits Interfering and challenging behaviors • Tools are only as good as their technical adequacy

MARSE http: //www. michigan. gov/documents/mde/MARSE_Supplemented_with_IDEA_Regs_379598_7. pdf

Technical Adequacy • Sample • Reliability • Validity • EXAMPLE: ADOS-2: • Test / Re-test Reliability— 2 Weeks: • Classification changed for 9 of the 39 children (23%)

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 ASD • Content 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”

Assessment Tools Central Assessment Lending Library (CALL) CALL • ASIEP-3: Autism Screening Instrument for Educational Planning • ADOS-2 (Autism Diagnostic Observation Schedule) • ADI-R: Autism Diagnostic Interview • CARS-2: Childhood Autism Rating Scale • GARS-2: Gilliam Autism Rating Scale • GADS: Gilliam Asperger Disorder Scale • KADI: Krug Asperger Disorder Index • PEP-3: Psycho-Educational Profile • ABLLS-R: Assessment of Basic Language and Learning Skills • VB-MAPP: Verbal Behavior – Milestones Assessment and Placement Program

Questions to Guide the Use of Standardized Tools • Does 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)?

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 agesuggested 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”);

Other Assessment Areas Considerations Discussion • IQ Assessment • Speech / Language Assessments • Achievement Tests • Social / Emotional Tools

Recommending Eligibility Results Review Meeting • Formal Meeting w/ MET • Use Meeting Mechanics / Quadrants / Board • Review documentation from all sources • Integrate quantitative & qualitative information • Focus on the child and spectrum, not just individual characteristics “Preponderance of the Evidence”

Preponderance of Evidence The Results Review Meeting Social Communication OTHER Behavior Sensory IMPACT / NEED

TAKE NOTES

Foundation for Impact and Need Statement 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 participation – Direction following – Self care – Interactions with peers – Outside play – Inside play with free choice time – Spontaneous conversation

The Impact and Need Statement Foundation for PLAAFP 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 participation • Direction following • Self care Behavior / 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.

Organization of Report • COMBINED: Three Evaluators - ONE Report • Outline Details from the ASD Eligibility Criteria – RELEVANT History – MARSE ASD Criteria – Evaluation Results: • Reciprocal Social Interaction • Communication • Restrictive / Repetitive Patterns of Behavior • EXPLAIN what does NOT align with conclusions – PERSUASIVE WRITING

Report Template Example Packet Page 38

Report Template Example

Report Template Example

Process and Application “NO WAY” No Report Considerations

The MET Form

AGENDA • New Reality in ASD Evaluations • Foundations in CET (Centralized Evaluation Team) • MARSE Eligibility Criteria for ASD • Essential Evaluation Components • Differential Eligibility – ASD or ECDD, CI, EI

Differential Eligibility ASD or ECDD? CI? EI? Do you think its ___________

Key Early Indicators of ASD • Lack of: Autism Spectrum Disorder CDC – Reciprocal social smiling by 6 months – Response/Orientation to name by 12 months – Reciprocal gestures by 14 months (showing objects, pointing, reaching, waving) – Avoids eye contact / wants to be or play alone – No words by 16 months (and meaningful 2 -word phrases by 24 months) – Not play “pretend” games (feed a doll) by 18 months – Plays with parts of objects (e. g. wheels) More Info at: (Autism Internet Modules ) 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? )

EARLY CHILDHOOD CONSIDERATIONS Identify 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).

Common Misrules No ASD until age 5, age 8, kindergarten; Just use ECDD for now, parents aren’t ready to hear the A word; ECDD classroom is successful so can’t be eligible ASD; Hasn’t been in daycare or preschool (programming), so can’t consider ASD

R 340. 1711 “Early childhood developmental delay” defined; determination. Rule 11. (1) “Early childhood developmental delay” means a child through 7 years of age whose primary delay cannot be differentiated through existing criteria within R 340. 1705 to R 340. 1710 or R 340. 1713 to R 340. 1716 and who manifests a delay in 1 or more areas of development equal to or greater than 1/2 of the expected development. This definition does not preclude identification of a child through existing criteria within R 340. 1705 to R 340. 1710 or R 340. 1713 to R 340. 1716.

Early Eligibility Determination • KNOW typical development • KNOW developmental issues that can mirror ASD • Higher threshold given developmental changes / environmental impact

Guidance Document ASD Eligibility: Determination of Eligibility Appendix A – Chart: Eligibility of Guidance chart for Infants and Toddlers Full Early On Implementation Manual: Full Early On Implementation Manual

Differential Eligibility CI? Do you think its ___________?

MARSE Criteria Cognitive Impairment (a) Development at a rate at or below approximately 2 standard deviations below the mean as determined through intellectual assessment. (b) 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 formal or standardized achievement tests. (c) Lack of development primarily in the cognitive domain. (d) Impairment of adaptive behavior.

MARSE ASD Eligibility • Reciprocal Social Interaction (2) • Restrictive / Repetitive – Non-verbal behavior Behavior – Peer relationships – Show and share – Social / emotional reciprocity • Communication – – Delay without compensation Pragmatics Stereotyped / repetitive Make-believe – – Restricted Interests Inflexible routines Motor mannerisms Parts of objects

AREA ASD Cognitive Impairment Developmental Rate Range of Ability Output (Theory of Mind) 2 SD below mean Even Profile Academic Achievement Range of Ability Interest Areas Output (Theory of Mind) Below 6 th %til rdg / math Even Profile Adaptive Behavior Communication Reciprocal Social Restricted Behaviors Deficits can be present in both; ASD may have more uneven profile Impaired joint communication and/or pragmatics Integrating gaze with gestures is present at developmental level Impaired joint attention, gesture use, social awareness and understanding, and/or reciprocity Joint attention, (sharing/showing), gesture use, social awareness, reciprocity commensurate with development Can be present in both

Differential Eligibility EI? Do you think its ___________?

EI (Emotional Impairment) Criteria The problems result in behaviors manifested by 1 or more of the following characteristics: a. 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. b. 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.

EI (Emotional Impairment) Criteria c. 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).

Example EI Characteristics Inability to Maintain Relationships In ability to maintain relationships due to: • Responding aggressively toward others • Short temper • Starts fights • Withdrawn • Has intense emotional responses to typical peer disagreements • Demonstrates inappropriate sexual behaviors • Seeks excessive approval from others Inappropriate Behaviors or Feelings • • • Over-reacts to everyday occurrences (i. e. rage, excessive laughter, hysterics) Exhibits catastrophic or panic reactions to everyday occurrences Demonstrates flat, distorted or excessive affect Exhibits selfabusive behaviors Exhibits delusions and/or hallucinations or thought disorders Demonstrates extreme mood swings Unhappiness or Depression • • • Decreased interest / pleasure in previously enjoyed activities Excessive guilt and/or self-criticism Expresses feelings of extreme sadness Predicts failure or refuses to attempt tasks (projects hopelessness) Demonstrates agitation or lethargy Difficulty concentrating and/or making decisions Physical Symptoms / Fears • • Chronic Somatic complaints (i. e. headaches, stomach aches) Intense anxiety not associates with a specific stimuli Extreme fear in response to a specific stimuli Panic reactions to everyday occurrences

MARSE ASD Eligibility • Reciprocal Social Interaction (2) • Restrictive / Repetitive – Non-verbal behavior Behavior – Peer relationships – Show and share – Social / emotional reciprocity • Communication – – Delay without compensation Pragmatics Stereotyped / repetitive Make-believe – – Restricted Interests Inflexible routines Motor mannerisms Parts of objects

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 literature • Understanding is derived from the educational literature and practice, administrative decisions and court interpretations • Often associated with clinical Dx of CD, ODD, or Antisocial • Definition Components: – – Pervasive intentional behaviors that violate socially acceptable rules and norms Accepting no responsibility for actions Demonstrating little to no remorse Blame and intimidate / charm others while manipulating the situation to meet own needs

ASD vs. EI / SM • BEHAVIORS: – Refusal to do academic work – Not following school expectations / rules – Aggression toward peers • DISTINGUISH BETWEEN: – I don’t care about your rule vs. I don’t understand 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.

Making a Final Decision • Preponderance of Evidence • No one behavior includes or excludes any specific eligibility area: – There always going to be instances that don’t fit the criteria!! – MUST explain what does not align – MUST build a case for your conclusion – However & Despite • Intelligent People can Disagree!!

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

What if there is Internal Disagreement? • Keep true to the process (run the board) • Presume Positive Intent • Ask questions to obtain a deeper understanding of the disagreement -- PPP • Is 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. another • Gather additional information/data • Add another evaluator / team • Write a dissenting report

WRAP UP the C’s • Concepts • Changes • Capacity

Selected References • MARSE Rules • ISD Guidelines for Determining Eligibility of Emotional Impairment – Macomb – Char-Em – Ottawa • OCALI Online Identification Module • Other State Guidelines • NATTAP (Network of Autism Training and Technical Assistance Providers) 2008 Conference Session “Compare and Contrast EBD & ASD”—Columbus, OH • Trammell, B. , et. al. (2013) Assessment and Differential Diagnosis of Comorbid Conditions in Adolescents and Adults with ASD. Psychology in the Schools, 5 (9).