Mdt evaluation model for determining autism in students with vi
Download
1 / 71

MDT EVALUATION MODEL FOR DETERMINING AUTISM IN STUDENTS WITH VI - PowerPoint PPT Presentation


  • 90 Views
  • Uploaded on

MDT EVALUATION MODEL FOR DETERMINING AUTISM IN STUDENTS WITH VI. Marnee Loftin, M.A, School Psychologist, TSBVI [email protected] [email protected] GOALS. Acquire knowledge about DSM V criteria Develop skills in Multidisciplinary Team evaluation process

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' MDT EVALUATION MODEL FOR DETERMINING AUTISM IN STUDENTS WITH VI' - odeda


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Mdt evaluation model for determining autism in students with vi

MDT EVALUATION MODEL FOR DETERMINING AUTISM IN STUDENTS WITH VI

Marnee Loftin, M.A,

School Psychologist, TSBVI

[email protected]

[email protected]


Goals
GOALS VI

  • Acquire knowledge about DSM V criteria

  • Develop skills in Multidisciplinary Team evaluation process

  • Develop skills in determining need for evaluation

  • Acquire knowledge about specific instruments and procedures used in evaluation

  • Develop skills in writing reports and recommendation


Goal 1

GOAL 1 VI

GENERAL KNOWLEDGE OF THE

DIAGNOSTIC AND STATISTICAL MANUAL (DSM) FIFTH EDITION


Dsm an overview
DSM: AN OVERVIEW VI

  • Provides guidelines for diagnosis of psychological conditions

  • Regular revisions

  • Significant changes in autism in Fifth Version


Why do i need to understand the dsm v
WHY DO I NEED TO UNDERSTAND THE DSM V? VI

  • Provides a common language

  • Guides the diagnostic process

  • Determines if an individual qualifies for the diagnosis


Changes in dsm criteria
CHANGES IN DSM CRITERIA VI

  • Changes name of category from “Pervasive Developmental Disorder” to “Autism Spectrum Disorder

  • Deletes different categories including Aspergers Disorder

  • Simplifies criteria

  • Emphasizes levels of severity and required support


Criteria in dsm v
CRITERIA IN DSM-V VI

MAJOR CRITERIA ARE DEFICITS IN:

  • Social-Communication and Social Interactions

  • Restricted, Repetitive Patterns of Behavior, Interests, or Activities

    AND THAT:

  • Are present in Early Childhood

  • Limit and Impair Everyday Functioning


Social and communication
SOCIAL AND COMMUNICATION VI

Exhibits deficits in (all three)

1. Social-emotional reciprocity

2. Non-verbal communication

3. Developing and maintaining relationships


Restricted repetitive patterns of behavior interests or activities
RESTRICTED, REPETITIVE PATTERNS OF BEHAVIOR, INTERESTS OR ACTIVITIES

Exhibits the following behaviors (at least two)

  • Stereotyped speech, motor movements, echolalia, repetitive use of objects, idiosyncratic phrases

  • Extreme adherence to routines, rituals, excessive resistance to change


Continued
CONTINUED ACTIVITIES

  • Restricted, fixated interests that are abnormal in intensity or focus

  • Hyper- or hypo-activity to sensory input or unusual interest in sensory aspects

    of environment


Implementation of new dsm v criteria
IMPLEMENTATION OF NEW DSM V CRITERIA ACTIVITIES

  • Scheduled to be implemented in May 2013

  • Will be preceded by massive training

  • Simple overview of current criteria

  • Still considerable conflict over changes


Goal 2

GOAL 2 ACTIVITIES

The Multidisciplinary Team (MDT) Process


Advantages of mdt
ADVANTAGES OF MDT ACTIVITIES

  • Gather large amounts of data

  • From a variety of perspectives

  • From experts with unique training

  • Who often focus on particular aspects of person

  • Allows data to be shared

  • Shortens time for evaluation


The mdt process
THE MDT PROCESS ACTIVITIES

  • Decreases redundancy in gathering information

  • Integrates different information obtained

  • Synthesizes information for general conclusion


Problems with mdt process
PROBLEMS WITH MDT PROCESS ACTIVITIES

  • Lack of time to implement

  • Difficulty with synthesizing

  • Handling disagreement

  • Implementing consensus


Solving the problem
SOLVING THE PROBLEM ACTIVITIES

  • Administrative support of membership

  • Administrative support of time commitment

  • Establishing procedure for leadership

  • Developing format and procedure

  • Developing standards for resolving conflicts and writing conclusions


Special issues with evaluation of students with vi
SPECIAL ISSUES WITH EVALUATION OF STUDENTS WITH VI ACTIVITIES

  • Regulations usually require Psychologist, SLP, Autism Specialist, and Parent

  • OT is often added in clinical settings

  • Important that TVI must be included in evaluation of student with VI

  • TVI is not typically included

  • Will have to advocate for this to occur


Role of the tvi in the mdt process
ROLE OF THE TVI IN THE MDT PROCESS ACTIVITIES

  • Provide information about developmental process for students with VI

  • Summarize interventions attempted

  • Facilitate appropriate test administration

  • Assist with accommodations or modifications of test protocol


Goal 3

GOAL 3 ACTIVITIES

DETERMINING NEED FOR EVALUATION


Developmental process and sighted children
DEVELOPMENTAL PROCESS AND SIGHTED CHILDREN ACTIVITIES

  • Emphasis has been on earlier diagnosis

  • Process depends upon identifying early discrepancies from expected development

  • Difficult to generalize these discrepancies separate from the visual impairment


Early diagnosis with sighted children
EARLY DIAGNOSIS WITH SIGHTED CHILDREN ACTIVITIES

  • Poor eye contact

  • Poor eye coordination with gestures or vocalization

  • No pointing or showing of objects

  • Inability to follow focus of another

  • Less pre-verbal babbling

  • No reciprocity in babbling


Early diagnosis with students with vi
EARLY DIAGNOSIS WITH STUDENTS WITH VI ACTIVITIES

  • Are not supported by extensive research

  • Should occur at an older age

  • Should always consider developmental patterns

  • Are based upon slightly different criteria


Behavioral features as predictors
BEHAVIORAL FEATURES AS PREDICTORS ACTIVITIES

  • Unusual responses to environment

  • Insistence on routines

  • Stereotypic behaviors

  • Special interests or abilities


Other factors for vi students include
OTHER FACTORS FOR VI STUDENTS INCLUDE ACTIVITIES

  • Failure to develop language

  • Loss of skills that have been acquired

  • Intense stereotypic behaviors

  • Failure to respond to early interventions

  • Specific etiologies associated with ASD


Why evaluate for asd
WHY EVALUATE FOR ASD? ACTIVITIES

  • Determine eligibility for programs

  • Develop appropriate IEP

  • Develop plan for transitions


Etiologies frequently associated with asd
ETIOLOGIES FREQUENTLY ASSOCIATED WITH ASD ACTIVITIES

  • Retinopathy of Prematurity

  • Optic Nerve Hypoplasia

  • Septo-optic Dysplasia

  • CHARGE Syndrome

  • Congenital Rubella


THESE CONDITIONS ARE HIGH RISK AND OFTEN ASSOCIATED WITH OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.


Goal 4

GOAL 4 OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

Knowledge of specific evaluation procedures


Cautions
CAUTIONS OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Always consists of formal and informal data

  • Requires MDT that is aware of and sensitive to needs of VI population

  • Requires clinical skills rather than reliance on scores


Evaluation of students with vi includes
EVALUATION OF STUDENTS WITH VI INCLUDES OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Developmental History

  • Observations and Interviews

  • Evaluation of Communication, Sensory, Behavioral and Cognitive Functioning

  • Synthesis of Results


Specific evaluation procedures

SPECIFIC EVALUATION PROCEDURES OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

Developmental History


Developmental history requires data about
DEVELOPMENTAL HISTORY REQUIRES DATA ABOUT: OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Pregnancy and birth

  • Perinatal experiences

  • Medical history/medication

  • Family history

  • Previous evaluations and results


Predictors of asd in developmental history
PREDICTORS OF ASD IN DEVELOPMENTAL HISTORY OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Family history of ASD or unusual behaviors

  • Pattern of early concerns of parent, particularly about hearing and language

  • Early requests for intervention


Continued1
CONTINUED: OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Unusual interests on part of child

  • Lack of responsiveness from their child

  • Savant skills

  • Self-abusive behaviors


Specific evaluation procedures1

Specific Evaluation Procedures OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

Observation and Interviews

INFORMAL EVALUATION DATA

Informal survey of schools for blind indicate emphasis on these data

Informal consists of behavioral observations and interviews

Content and extent depend upon age and functional level


Informal evaluation
INFORMAL EVALUATION OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Informal survey of schools for blind indicate emphasis on informal evaluation data for determining ASD

  • These data may consist of behavioral observations and/or interviews

  • Content and extent depend upon age and functional level


Behavioral observations
BEHAVIORAL OBSERVATIONS OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

Data should be gathered with concepts of:

  • Definition of ASD

  • Ways these behaviors are evidenced in student with VI

  • Importance of observation in multiple environments


Specific types of information include
SPECIFIC TYPES OF INFORMATION INCLUDE: OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Sensory

  • Social-Communication

  • Behavioral


Specific observations will vary based upon
SPECIFIC OBSERVATIONS WILL VARY BASED UPON: OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Age and functional level of student

  • Access to formal testing procedures

  • Professional discipline that is observing


Information gathered should reflect
INFORMATION GATHERED SHOULD REFLECT OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Current functioning in areas of Sensory, Communication, and Behavioral

  • Strengths in these areas

  • Difficulties and specific ways that they are exhibited

  • Functional implications of these difficulties


Information being gathered
INFORMATION BEING GATHERED OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Can be gathered through actual observation or through video sources

  • Is completed by different disciplines

  • Is synthesized into a single summary

  • Can be gathered through either formal or informal observation systems


Sensory issues
SENSORY ISSUES OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Individuals with ASD often exhibit a variety of sensory issues listed below

  • Observation of sensory issues usually facilitated by OT and/or PT

  • Type of issue will vary by age and functional level


Sensory issues often identified
SENSORY ISSUES OFTEN IDENTIFIED OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Problems with motor control and development

  • Gross and fine motor delays

  • Abnormal muscle tone

  • Sensory defensiveness

  • Self regulation/modulation deficits


Problems with sensory issues may result in
PROBLEMS WITH SENSORY ISSUES MAY RESULT IN: OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Extreme responses to sound, touch, movement

  • Excessive movement and repetitive behaviors

  • Oversensitivity to textures

  • Difficulty with modulation in areas of physical, emotional, and voice tone


Social communication issues
SOCIAL-COMMUNICATION ISSUES OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

Language has been removed as a specific criteria necessary for diagnosis of ASD in the DSM V

Communication remains an important aspect of Social-Communication and Social Interactions


Social communication issues often observed
SOCIAL- COMMUNICATION ISSUES OFTEN OBSERVED OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Maintaining echolalic patterns of language

  • Lack of understanding of reciprocal nature of communication

  • Difficulty with interpreting or expressing emotions

  • Problems with gestures and non-verbal cues


Problems may manifest as difficulties with
PROBLEMS MAY MANIFEST AS DIFFICULTIES WITH: OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Responding to conversational cues

  • Managing changes in conversations

  • Inferring emotions from voice tones

  • Maintaining appropriate prosody in expressive language

  • Responding to non-verbal cues


These problems may result in
THESE PROBLEMS MAY RESULT IN: OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Difficulty in establishing and maintaining social relationships

  • Problems with anticipating consequences of actions

  • Difficulty in inferring emotions of others

  • Problems with maintaining appropriate level of voice


Behavioral

BEHAVIORAL OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

Although not specifically listed in the DSM criteria, behavioral issues are often the most significant for education.


Behavioral issues often observed
BEHAVIORAL ISSUES OFTEN OBSERVED OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Perseveration on tasks

  • Hypo- and hypersensitivity often result in high degrees of self-stimulatory behaviors

  • Poor social skills

  • Frequent behavioral outbursts


Problems are often evidenced by
PROBLEMS ARE OFTEN EVIDENCED BY OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Extreme resistance to change

  • “Motor-driven” types of self-stimulatory behavior

  • Social isolation

  • Poor executive functioning

  • Fixation on strange and unusual objects and/or interests


Specific instruments observations and interviews
SPECIFIC INSTRUMENTS: OBSERVATIONS AND INTERVIEWS OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Autism Diagnostic Observation Schedule

  • Autism Diagnostic Interview

  • Childhood Autism Rating Scale

  • Autism Behavior Checklist

  • Gilliam Autism Rating Scale

  • Social Relatedness Scale


Specific evaluation procedures2

Specific Evaluation Procedures OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

Psychological: Cognitive, Adaptive Behavior, Emotional


General information about cognitive skills
GENERAL INFORMATION ABOUT COGNITIVE SKILLS OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

Individuals may have intelligence that ranges from superior to profound intellectual disabilities. In about 75% of cases (with DSM IV criteria), intellectual disabilities were also present.


Profiles on iq tests for students with vi
PROFILES ON IQ TESTS OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.FOR STUDENTS WITH VI

  • Significant splinter skills on profile

  • Short-term memory is a strength

  • Vocabulary often is a strength for verbal students

  • Social judgment is a weakness


Specific instruments cognitive skills
SPECIFIC INSTRUMENTS: COGNITIVE SKILLS OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Wechsler scales

  • Woodcock Test of Cognitive Abilities


Remember

REMEMBER! OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

IQ scores are NOT a good predictor of educational performance or social judgment for children with ASD


Adaptive behavior
ADAPTIVE BEHAVIOR OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Adaptive behavior is a relative weakness for students with ASD

  • The typical pattern is for areas involving Socialization and Communication to be lowest for students with ASD and VI


Specific instruments adaptive behavior
SPECIFIC INSTRUMENTS: OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.ADAPTIVE BEHAVIOR

  • Vineland Adaptive Behavior Scale

  • Woodcock-Johnson Scales of Independent Behavior (Short Form for Visually Impaired)


Emotional behavioral
EMOTIONAL-BEHAVIORAL OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Much information comes from observations and interview

  • More is gathered through specific questionnaires and interviews

  • Purpose is to explore/rule out other condition


Questions to be addressed
QUESTIONS TO BE ADDRESSED OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Other factors that are manifesting as social disconnect

  • Extent to which student can adapt and focus in new situation

  • Adjustment to vision loss

  • Coping strategies in place

  • Concerns of student


Other helpful information
OTHER HELPFUL INFORMATION OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Complete neuropsychological evaluations are seldom possible

  • Portions of these types of evaluations should be considered

  • This information will be helpful in planning instruction and remediation


Memory
MEMORY OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Memory is often seen as significant strength

  • Important to explore what is being remembered

  • Often does not generalize to meaningful tasks

  • Will be critical information to teach new skills


Executive functioning
EXECUTIVE FUNCTIONING OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Ability to plan, inhibit, consider an action and its consequence

  • Significant problem in people with ASD

  • Results in their becoming “stuck” in non-functional routines

  • Will also be important in planning interventions


Specific instruments
SPECIFIC INSTRUMENTS OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • California Verbal Learning Test

  • Test of Problem Solving Skills

  • Test of Executive Functioning

  • Behavioral Assessment System for Children


Goal 5

GOAL 5 OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

WRITING REPORTS AND RECOMMENDATION


Synthesis of results
SYNTHESIS OF RESULTS OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • MDT process guarantees multiple results

  • Goal is to summarize into a single report

  • Report must reflect information from all


Individual profile as basis of report
INDIVIDUAL PROFILE AS BASIS OF REPORT OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Report should reflect the strengths and needs

  • Situations in which each of these are demonstrated

  • Extent to which these behaviors meet the criteria presented in the DSM for ASD


Recommendations should
RECOMMENDATIONS SHOULD OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Provide instruction to decrease need for supervision

  • Increase level of independence

  • Improve social-communication skills

  • Decrease repetitive and restricted patterns of behaviors and interests

  • Build upon strengths as well as needs


The evaluation process must always
THE EVALUATION PROCESS MUST ALWAYS OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

  • Focus on a clear understanding of the visual condition and implications

  • Consider the developmental level of student

  • Provide opportunities for evaluation in multiple settings by multiple individuals

  • Continually consider the most important caveat of evaluation


Caveat of evaluation

CAVEAT OF EVALUATION OTHER ISSUES. THE EVALUATOR MUST BE CAREFUL TO ASSESS FOR CO-MORBID CONDITIONS AS WELL.

CONDITIONS ARE NOT DIAGNOSED BY TESTS BUT RATHER BY KNOWLEDGEABLE AND CONCERNED INDIVIDUALS


ad