mdt evaluation model for determining autism in students with vi
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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

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goals
GOALS
  • 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

GENERAL KNOWLEDGE OF THE

DIAGNOSTIC AND STATISTICAL MANUAL (DSM) FIFTH EDITION

dsm an overview
DSM: AN OVERVIEW
  • 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?
  • Provides a common language
  • Guides the diagnostic process
  • Determines if an individual qualifies for the diagnosis
changes in dsm criteria
CHANGES IN DSM CRITERIA
  • 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

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

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
  • 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
  • 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

The Multidisciplinary Team (MDT) Process

advantages of mdt
ADVANTAGES OF MDT
  • 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
  • Decreases redundancy in gathering information
  • Integrates different information obtained
  • Synthesizes information for general conclusion
problems with mdt process
PROBLEMS WITH MDT PROCESS
  • Lack of time to implement
  • Difficulty with synthesizing
  • Handling disagreement
  • Implementing consensus
solving the problem
SOLVING THE PROBLEM
  • 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
  • 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
  • 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

DETERMINING NEED FOR EVALUATION

developmental process and sighted children
DEVELOPMENTAL PROCESS AND SIGHTED CHILDREN
  • 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
  • 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
  • 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
  • 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
  • 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?
  • Determine eligibility for programs
  • Develop appropriate IEP
  • Develop plan for transitions
etiologies frequently associated with asd
ETIOLOGIES FREQUENTLY ASSOCIATED WITH ASD
  • Retinopathy of Prematurity
  • Optic Nerve Hypoplasia
  • Septo-optic Dysplasia
  • CHARGE Syndrome
  • Congenital Rubella
slide27

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

Knowledge of specific evaluation procedures

cautions
CAUTIONS
  • 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
  • Developmental History
  • Observations and Interviews
  • Evaluation of Communication, Sensory, Behavioral and Cognitive Functioning
  • Synthesis of Results
specific evaluation procedures

SPECIFIC EVALUATION PROCEDURES

Developmental History

developmental history requires data about
DEVELOPMENTAL HISTORY REQUIRES DATA ABOUT:
  • 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
  • Family history of ASD or unusual behaviors
  • Pattern of early concerns of parent, particularly about hearing and language
  • Early requests for intervention
continued1
CONTINUED:
  • Unusual interests on part of child
  • Lack of responsiveness from their child
  • Savant skills
  • Self-abusive behaviors
specific evaluation procedures1

Specific Evaluation Procedures

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
  • 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

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:
  • Sensory
  • Social-Communication
  • Behavioral
specific observations will vary based upon
SPECIFIC OBSERVATIONS WILL VARY BASED UPON:
  • Age and functional level of student
  • Access to formal testing procedures
  • Professional discipline that is observing
information gathered should reflect
INFORMATION GATHERED SHOULD REFLECT
  • 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
  • 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
  • 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
  • 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:
  • 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

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
  • 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:
  • 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:
  • 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

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
  • 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
  • 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
  • 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

Psychological: Cognitive, Adaptive Behavior, Emotional

general information about cognitive skills
GENERAL INFORMATION ABOUT COGNITIVE SKILLS

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 TESTSFOR 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
  • Wechsler scales
  • Woodcock Test of Cognitive Abilities
remember

REMEMBER!

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

adaptive behavior
ADAPTIVE BEHAVIOR
  • 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:ADAPTIVE BEHAVIOR
  • Vineland Adaptive Behavior Scale
  • Woodcock-Johnson Scales of Independent Behavior (Short Form for Visually Impaired)
emotional behavioral
EMOTIONAL-BEHAVIORAL
  • 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 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
  • 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
  • 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
  • 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
  • California Verbal Learning Test
  • Test of Problem Solving Skills
  • Test of Executive Functioning
  • Behavioral Assessment System for Children
goal 5

GOAL 5

WRITING REPORTS AND RECOMMENDATION

synthesis of results
SYNTHESIS OF RESULTS
  • 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
  • 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
  • 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
  • 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

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

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