Documentos de Académico
Documentos de Profesional
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z Introduction: Reasons for Increased Vigilance z Autistic spectrum disorders are much more
z Diagnostic Classifications and Special common than previously suggested.
Education Eligibility 60 (vs. 4 to 6) per 10,000 in the general population
(Chakrabarit & Fombonne, 2001).
z School Psychologist Roles, Responsibilities,
600% increase in the numbers served under the
and Limitations
autism IDEA eligibility classification (U.S. Department of Education,
z Case Finding 2003).
z Changes in diagnostic criteria. Total Number of Student Classified as Autistic and Eligible for
Special Education Under IDEA by Age Group
z Heightened public awareness of autism.
100,000
z Increased willingness and ability to diagnose
80,000
autism.
60,000
z Availability of resources for children with 40,000
autism. 20,000
z Yet to be identified environmental factors. 0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
2.51
2.13
1.79
2
1.49
1.21
offered to the child whose primary eligibility
1.01
0.84
0.67
0.55
0.48
0.38
0.32
0.25
0.09
0
classification is mental retardation.
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
z Autism can be identified early in development, z Not all cases of autism will be identified before
and school entry.
Average Age of Autistic Disorder identification is 5 1/2
z Early intervention is an important determinant years of age.
of the course of autism. Average Age of Aspergers Disorder identification is
11 years of age Howlin and Asgharian (1999).
z Most children with autism are identified by school z Introduction: Reasons for Increased Vigilance
resources. z Diagnostic Classifications and Special
Only three percent of children with ASD are identified Education Eligibility
solely by non-school resources.
z School Psychologist Roles, Responsibilities,
All other children are identified by a combination of
school and non-school resources (57 %), or by school
and Limitations
resources alone (40 %) Yeargin-Allsopp et al. (2003). z Case Finding
z Screening and Referral
z Assessment: Diagnostic and Psycho-educational
Evaluation
z First used by Swiss psychiatrist Eugen Bleuler in 1911. z In 1980, infantile autism was first included in the third
Derived from the Greek autos (self) and ismos (condition), Bleuler edition of the Diagnostic and Statistical Manual
used the term to describe the concept of turning inward on ones
self and applied it to adults with schizophrenia. (DSM), within the category of Pervasive
z In 1943 Leo Kanner first used the term infantile autism to Developmental Disorders.
describe a group of children who were socially isolated, were z Also occurring at about this time was a growing
behaviorally inflexible, and who had impaired communication. awareness that Kranners autism (also referred to a
z Initially viewed as a consequence of poor parenting, it was not classic autism) is the most extreme form of a
until the 1960s, and recognition of the fact that many of these spectrum of autistic disorders.
children had epilepsy, that the disorder began to be viewed as
having a neurological basis. z Autistic Disorder is the contemporary classification
used since the revision of DSMs third edition (APA,
1987).
z For special education eligibility purposes distinctions z However, it is less clear if students with milder forms
among PDDs may not be relevant. of ASD are always eligible for special education.
z While the diagnosis of Autistic Disorder requires z Adjudicative decision makers almost never use the
differentiating its symptoms from other PDDs, DSM IV-TR criteria exclusively or primarily for
determining whether the child is eligible as autistic
Shriver et al. (1999) suggest that for special (Fogt et al.,2003).
education eligibility purposes the federal definition
z While DSM IV-TR criteria are often considered in
of autism was written sufficiently broad to hearing/court decisions, IDEA is typically
encompass children who exhibit a range of acknowledged as the controlling authority.
characteristics (p. 539) including other PDDs. z When it comes to special education, it is state and
federal education codes and regulations (not DSM
IV-TR) that drive eligibility decisions.
z Infant & Preschooler Warning Signs z Infant & Preschooler Warning Signs
Absolute indications for an autism screening Absolute indications for an autism screening
No big smiles or other joyful expressions by 6 months.b No 2-word spontaneous (nonecholalic) phrases by 24
months.a, b
No back-and-forth sharing of sounds, smiles, or facial
Failure to attend to human voice by 24 months.c
expressions by 9 months.b
Failure to look at face and eyes of others by 24 months.c
No back-and-forth gestures, such as pointing, showing,
Failure to orient to name by 24 months.c
reaching or waving bye-bye by 12 months.a,b
Failure to demonstrate interest in other children by 24
No babbling at 12 months.a, b months.c
No single words at 16 months.a, b Failure to imitate by 24 months.c
Any loss of any language or social skill at any age.a, b
Sources: aFilipek et al., 1999; bGreenspan, 1999; and cOzonoff, 2003. Sources: aFilipek et al., 1999; bGreenspan, 1999; and cOzonoff, 2003.
Psych-educational
Assessment
z School psychologists are exceptionally well qualified z CHecklist for Autism in Toddlers (CHAT)
to conduct the behavioral screening of students Designed to identify risk of autism among 18-month-olds
suspected to have an ASD. Takes 5 to 10 minutes to administer,
z Several screening tools are available Consists of 9 questions asked of the parent and 5 items
z Initially, most of these tools focused on the that are completed by the screeners direct observation of
identification of ASD among infants and the child.
preschoolers. 5 items are considered to be key items. These key items,
z Recently screening tools useful for the identification assess joint attention and pretend play.
of school aged children who have high functioning If a child fails all five of these items they are considered to
autism or Aspergers Disorder have been developed. be at high risk for developing autism.
The M-CHAT was used to screen 1,293 18- to 30- 1. Does your child enjoy being swung, bounced on your knee, etc.? Yes No
8. Can your child play properly with small toys (e.g. cars or bricks) No
without just
Data regarding false negative is not currently 9. Does your child ever b ring objects over to you (parent) to show No
you something?
available, but follow-up research to obtain such is 10. Does your child look you in the eye for more than a second or two? Yes No
currently underway. 11. Does your child ever seem oversensitive to noise? (e.g., plugging ears) Yes No
z Childhood Asperger Syndrome Test (CAST) 1. Does s/he join in playing g ames with other children easily? YES NO
Scott, F. A., Baron-Cohen, S., Bolton, P., & Brayne, C. (2002). 2. Does s/he co me up to you spontaneou sly for a chat? YES NO
The CAST (Childhood Asperger Syndrome Test). Autism, 6, 9- 3. Was s/he speaking by 2 yea rs old? YES NO
z Has 37 items, with 31 key items contributing to the childs total 8. When s/he was 3 yea rs old, did s/her spend a lot of time pretending (e.g. p lay-
acting begin a superhero, or holding a teddys tea parties)?
YES NO
score. 9. Does s/he like to do things over and over aga in, in the same way all the time? YES NO
z The 6 control items assess general development. 10. Does s/he find it easy to interact with other children? YES NO
z Rate of false negatives is not available 16. Does s/he often bring you things s/he is interested in to show you? YES NO
From Scott et al. (2002, p. 27)
18. Does s/he have difficulty understanding the rules for polite behavior? YES NO
19. Does s/he appear to have an unusual memory for details? YES NO
http://www.autismresearchcentre.com/tests/cast_test.asp
20. Is his/her voice unusual (e.g., ove rly adult, flat, or very monotonous)? YES NO
24. Does s/he play imaginatively with other children, and engage in role-play? YES NO
25. Does s/he often do or say things that are tactless or so cially inappropriate? YES NO
26. Can s/he coun t to 50 without leaving out any numbers? YES NO
28. Doe s s/he have any unusu al and rep etitive move ments? YES NO
29. Is his/her social behaviour very one -sided and always on his/her own terms? YES NO
30. Doe s s/he sometimes say youor s/hewhen s/he means I? YES NO
31. Doe s s/he prefer imaginative activities such as play-acting or story-telling,
YES NO
rather than numbers or lists of facts?
32. Doe s s/he sometimes lose the listener bec ause of no t explaining what s/he is
YES NO
talking about?
33. Can s/he ride a bicycle (even if with stabilizers)? YES NO
34. Doe s s/he try to impose routines on h im/herself, or on others, in such a way
YES NO
that is causes problems?
35. Doe s s/he care how s/he is perceived by the rest of the group? YES NO
36. Doe s s/he often turn the conversations to his/her favo rite subject rather than
YES NO
following wha t the other person wants to talk about?
37. Doe s s/he have odd or unusua l phrases? YES NO
From Scott et al. (2002, pp. 27-28)
Rutter, M., LeCouteur, A., & Lord, C. (2003). Social Communication Questionnaire. Los Angeles, CA:
Western Psychological Services.
z Introduction: Reasons for Increased Vigilance A. A total of six (or more) items for (1), (2), and (3), with
at least two from (1), and one each for (2) and (3):
z Diagnostic Classifications and Special (1) qualitative impairment in social interaction, as manifested
Education Eligibility by at least two of the following:
a) marked impairment in the use of multiple nonverbal
z School Psychologist Roles, Responsibilities, behaviors such as eye-to-eye gaze, facial expression, body
postures, and gestures to regulate social interaction
and Limitations b) failure to develop peer relationships appropriate to
developmental level
z Case Finding c) a lack of spontaneous seeking to share enjoyment,
interests, or achievements with other people (e.g., by lack
z Screening and Referral of showing, bringing, or pointing out objects of interest)
z Assessment: Diagnostic and Psycho-educational d) lack of social or emotional reciprocity
Evaluation
A. A total of six (or more) items for (1), (2), and (3), with A. A total of six (or more) items for (1), (2), and (3), with at
at least two from (1), and one each for (2) and (3): least two from (1), and one each for (2) and (3):
(2) qualitative impairments in communication as manifested (3) restricted repetitive and stereotyped patterns of behavior,
by at least one of the following: interests, and activities, as manifested by at least one of
a) delay in, or total lack of, the development of spoken the following:
language (not accompanied by an attempt top compensate a) encompassing preoccupation with one or more stereotyped
through alternative modes of communication such as and restricted patterns of interest that is abnormal either in
gesture or mime) intensity or focus
b) in individuals with adequate speech, marked impairment in b) apparently inflexible adherence to specific, nonfunctional
the ability to initiate or sustain a conversation with others routines or rituals
c) stereotyped and repetitive use of language or idiosyncratic c) stereotyped and repetitive motor mannerisms (e.g., hand or
language finger flapping or twisting, or complex whole-body
d) lack of varied, spontaneous make-believe play or social movements)
imitative play appropriate to developmental level d) persistent preoccupation with parts of objects
z Aspergers Disorder:
Motor delays or clumsiness may be some of the first symptoms z Aspergers Disorder is the only ASD not typically associated
noted during the preschool years. with some degree of mental retardation.
Difficulties in social interactions, and symptoms associated with z Autistic Disorder is associated with moderate mental
unique and unusually circumscribed interests, become apparent retardation. Other associated features include:
at school entry. unusual sensory sensitivities
Duration is typically lifelong with difficulties empathizing and abnormal eating or sleeping habits
modulating social interactions displayed in adulthood.
unusual fearfulness of harmless object or lack of fear for real
z Retts and Childhood Disintegrative Disorders: dangers
Lifelong conditions. self-injurious behaviors
Retts pattern of developmental regression is generally z Childhood Disintegrative Disorder is associated with severe
persistent and progressive. Some interest in social interaction mental retardation.
may be noted during later childhood and adolescence.
The loss of skills associated with Childhood Disintegrative
z Retts Disorder is associated with severe to profound mental
Disorder plateau after which some limited improvement may retardation.
occur.
Childhood z Regression following at least two years z Mutations in the MECP2 gene
Disintegrative Disorder of normal development Selective Mutism z Normal language in certain situations or
Aspergers Disorder z Expressive/Receptive language not settings
delayed z No restricted patterns of behavior
z Normal intelligence Language Disorder z No severe impairment of social
z Later symptom onset interactions
z No restricted patterns of behavior
z The Gilliam Autism Rating Scale (GARS) z The Gilliam Autism Rating Scale (GARS)
Normative group, 1092 children, adolescents, and young adults
Gilliam, J. E. (1995). Gilliam autism rating scale. reported by parent or teacher to be a person with autism.
Austin, TX: Pro-Ed. Age range 3 to 22.
Designed for use by parents, teachers, and professionals
56 items, 4 scales.
Social Interaction, Communication, and Stereotyped Behavior
scales assesses current behavior.
Developmental Disturbances scale assesses maladaptive behavior
history.
Behaviors are rated on a 4-point scale (Never Observed to
Frequently Observed).
z The Gilliam Autism Rating Scale (GARS) z The Gilliam Autism Rating Scale (GARS)
South, M., Williams, B. J., McMahon, W. M. Owlye, T.,
Yields an Autism Quotient (AQ) Filipek, P. A., Shernoff, E., Corsello, C. C., Lainhart, J. E.,
AQs are classified on an ordinal scale ranging Landa, R., & Ozonoff, S. (2002). Utility of the Gilliam autism
rating scale in research and clinical populations. Journal of
from Very Low to Very High probability of Autism and Developmental Disorders, 32, 593-599.
autism. A score of 90 or above specifies that the z Among a sample of 119 children with strict DSM-IV diagnoses
child is probably autistic. of autism, the GARS consistently underestimated the
likelihood that autistic children in this sample would be
classified as having autism.
z The South et al. (2002) sample mean (90.10) was significantly
below the GARS mean (100).
z The Gilliam Autism Rating Scale (GARS) z The Asperger Syndrome Diagnostic Scale
Gilliam, J. E. (2005). Gilliam autism rating scale (ASDS)
(2nd ed.). Austin, TX: Pro-Ed.
z The Asperger Syndrome Diagnostic Scale (ASDS) z The Autism Diagnostic Interview-Revised (ADI-R)
Age range 5-18. Rutter, M., Le Couteur, A., & Lord, C. (2003). Autism
50 yes/no items. diagnostic interview-revised (ADI-R). Los Angeles, CA:
10 to 15 minutes. Western Psychological Services.
Normed on 227 persons with Asperger Syndrome, autism,
learning disabilities, behavior disorders and ADHD.
ASQs are classified on an ordinal scale ranging from Very
Low to Very High probability of autism. A score of 90 or
above specifies that the child is Likely to Very Likely to have
Aspergers Disorder.
z 15-item structured observation tool. z Data can also be obtained from parent interviews and student
z Items scored on a 4-point scale ranging from 1 (normal) to 4 record reviews.
(severely abnormal). z When initially developed it attempted to include diagnostic
z In making these ratings the evaluator is asked to compare the criteria from a variety of classification systems and it offers no
child being assessed to others of the same developmental level. weighting of the 15 scales.
Thus, an understanding of developmental expectations for the 15 z This may have created some problems for its current use
CARS items is essential. z Currently includes items that are no longer considered essential
z The sum ratings is used to determine a total score and the for the diagnosis of autism (e.g., taste, smell, and touch
severity of autistic behaviors response) and may imply to some users of this tool that they are
Non-autistic, 15 to 29 essential to diagnosis (when in fact they are not).
Mildly-moderately autistic 30-37 z Psychometrically, the CARS has been described as
Severely autistic, 37 acceptable, good, and as a well-constructed rating scale.
z Carefully pre-select task difficulty. z Students with ASD are a very heterogeneous group,
z Modify test administration and allow nonstandard and in addition to the core features of ASD, it is not
responses. unusual for them to display a range of behavioral
symptoms including hyperactivity short attention span
impulsivity, aggressiveness, self-injurious behavior,
and (particularly in young children) temper tantrums.
z Observation of the student with ASD in typical
environments will also facilitate the evaluation of test
taking behavior.
z Observation of test taking behavior may also help to
document the core features of autism.
z Childs level of verbal abilities. z Assessment of cognitive function is essential given that,
z Ability to respond to complex instructions and social with the exception of Aspergers Disorder, a significant
expectations. percentage (as high as 80 percent) of students with
z Ability to work rapidly. ASD will also be mentally retarded.
z Ability to cope with transitions during test activities. z Severity of mental retardation can also provide some
guidance regarding differential diagnosis among ASDs.
z IQ is associated with adaptive functioning, the ability to
z In general, children with autism will often perform learn and acquire new skills, and long-term prognosis.
best when assessed with tests that require less social Thus, level of cognitive functioning has implications for determining
engagement and verbal mediation. how restrictive the educational environment will need to be.
z A powerful predictor of ASD symptom severity. z Regardless of the overall level of cognitive functioning,
z However, given that children with ASD are ideally first it is not unusual for the student being tested to display
evaluated when they are very young, it is important to an uneven profile of cognitive abilities.
acknowledge that it is not until age 5 that childhood IQ z Thus, rather that simply providing an overall global
correlates highly with adult IQ. intelligence test score, it is essential to identify these
Thus, it is important to treat the IQ scores of the very young cognitive strengths and weaknesses.
child with caution when offering a prognosis, and when making z At the same time, however, it is important to avoid the
placement and program planning decisions.
temptation to generalize from isolated or splinter skills
However, for school aged children it is clear that the
appropriate IQ test is an excellent predictor of a students when forming an overall impression of cognitive
later adjustment and functioning in real life (Frith, 1989, p. 84). functioning, given that such skills may significantly
overestimate typical abilities.
z Selection of specific tests is important to z On the other hand, for students who have more
obtaining a valid assessment of cognitive severe language delays measures that
functioning (and not the challenges that are
minimize verbal demands are recommended
characteristic of ASD).
(e.g., the Leiter International Performance
z The Wechsler and Stanford-Binet scales are
Scale Revised, Raven Coloured Progressive
appropriate for the individual with spoken
language. Matrices)
z Given that diagnosing mental retardation requires examination z Profiles of students with ASD are unique.
of both IQ and adaptive behavior, it is also important to Individuals with only mental retardation typically display flat
administer measures of adaptive behavior when assessing profiles across adaptive behavior domains
students with ASD.
Students with ASD might be expected to display relative
z Other uses of adaptive behavior scales when assessing strengths in daily living skills, relative weaknesses in
students with ASD are: socialization skills, and intermediate scores on measures of
a) Obtain measure of childs typical functioning in familiar communication abilities.
environments, e.g. home and/or school.
b) Target areas for skills acquisition. z To facilitate the use of the Vineland Adaptive
c) Identifying strengths and weaknesses for educational planning Behavior Scales in the assessment of individuals
and intervention with ASD, Carter et al. (1998) have provided special
d) Documenting intervention efficacy norms for groups of individuals with autism
e) Monitoring progress over time.
z Measures of single word vocabulary z Specific Tests (Myles & Adreon, 2001)
(receptive and expressive). Clinical Evaluation of Language Fundamentals
z Actual use of language (receptive and Third Edition
expressive). Comprehensive Receptive and Expressive
Vocabulary Test
z Articulation and Oral-Motor skills as indicated
Peabody Picture Vocabulary Test Third Edition
z Pragmatic Skills ( the childs capacities for Test of Language Competence Expanded
use of whatever level of communication skills Edition (Level 2)
he/she has in relation to the social context). Test of Pragmatic Language
Test of Problem Solving - Adolescent
z Helps to further identify learning strengths and weakness. z Assessment of academic functioning will often reveal a profile of
strengths and weaknesses.
z Depending upon age and developmental level, traditional
measures of such processes may be appropriate. It is not unusual for students with ASD be hyperverbal/hyperlexic,
while at the same time having poor comprehension and difficulties
z It would not be surprising to find relatively strong rote, mechanical, with abstract language. For others, calculation skills may be well
and visual-spatial processes; and deficient higher-order conceptual developed, while mathematical concepts are delayed.
processes, such as abstract reasoning. z For students functioning at or below the preschool range and with
z While IQ test profiles should never be used for diagnostic a chronological age of 6 months to 7 years, the
purposes, it would not be surprising to find the student with Autistic Psychoeducational Profile Third Edition may be an appropriate
Disorder to perform better on non-verbal (visual/spatial) tasks than choice.
tasks that require verbal comprehension and expression. z For students who are very severely cognitively delayed, the
The student with Aspergers Disorder may display the exact opposite Adolescent and Adult Psychoeducational Profile (AAPEP) may be
profile. an appropriate choice.
z 65% present with symptoms of an additional z There are occasional reports of schizophrenia developing in
psychiatric disorder such as AD/HD, oppositional adolescence.
defiant disorder, obsessive-compulsive disorder and z Given these possibilities, it will also be important for the school
other anxiety disorders, tics disorders, affective psychologist to evaluate the students emotional/behavioral status.
disorders, and psychotic disorders. z Traditional measures such as the Behavioral Assessment System
z AH/HD is the most common comorbid diagnosis for Children would be appropriate as a general purpose screening
among adolescents and adults. tool, while more specific measures such as The Childrens
Depression Inventory and the Revised Childrens Manifest Anxiety
z Disorders of mood (both depression and mania) are Scale would be appropriate for assessing more specific presenting
the second most common co-existing diagnosis and concerns.
are seen particularly in higher-functioning individuals
among individuals latency age and beyond.
16.9% of CBCL (parent) ratings have elevated depression
subscales.
When to consider comorbidity in ASD (Hendren, 2003, p. 39) z Occupational Therapy Assessments
1. When signs of problems outside the autism spectrum Particularly if there is some degree of sensory
are apparent. hyper or hyposensitivity or difficulties in motor
2. When there is an abrupt change in behavior from development.
baseline. z The Sensory Profile (Dunn, 1999)
3. When there is a severe and incapacitating problem z Short Sensory Profile (McIntosh et al., 1999)
behavior. z Sensory Integration Inventory Revised (Reisman &
4. When there is a worsening of symptoms already Hanschu, 1992)
present
5. When student does not respond as expected to
intervention.
z Identify and describe target behavior z Target specific areas of need and strive to
z Describe establishing operations and immediate build upon learning assets.
antecedents z Sample recommendations
z Collect baseline data/work samples
z Determine the function of the behavior
z Develop a behavior intervention plan
z Assessment tools
z http://www.csus.edu/indiv/b/brocks/Courses/EDS%20240/student_materials.htm
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