Assessment of Students with High Functioning Autism and Asperger’s Syndrome

1. Assessment of Students with High Functioning Autism and Asperger’s Syndrome Terri Carrington, M.A., CCC-SLP

2. Implications for Living • Quality of Life for Adults with Autism, Asperger’s Syndrome and PDD-NOS • 6 to 12% had Full-time jobs • 3 to 4% were Independent • Quality of Life for Adults with “High Functioning” Autism and Asperger’s • 6 to 12% had Full-time jobs • 0-3% were Independent • Information gathered and reported in Relationship Development Intervention (RDI) Brochure, Third Generation Treatment for Autism Asperger’s and PDD-NOS

3. DSM-IV Criteria for AS • Qualitative impairment in social interaction • Restricted repetitive and stereotyped patterns of behavior, interests and activities • Clinically significant impairments in social, occupational, or other important areas of functioning • No clinically significant general delay in language • No clinically significant delay in cognitive development, self-help skills, adaptive skills, or curiosity about the environment

4. Educational Impact • Paradoxical nature of Asperger’s Syndrome and High Functioning Individuals • Difficulty with: • Perspective Taking • Sociocommunicative understanding and expression • Reading/language comprehension • Executive Dysfunction • Problem Solving • From “Blinded by Their Strengths: The Tospsy Turvy World of Asperger’s Syndrome by Diane Twachtman-Cullen on O.A.S.I.S On-line Asperger’s Syndrome Information and Support

5. Educational Impact (cont.) • Insistence on Sameness • Impairment in Social Interaction • Restricted Range of Interests • Poor Concentration • Poor Motor Coordination • Academic Difficulties • From Karen Williams, Understanding the Student with Asperger Syndrome: Guidelines for Teachers in Focus on Autistic Behavior, Vol. 10, No. 2

6. Grades are not the only determinant of educational impact. • Can the student work in a group? • Does the student easily follow the same schedule and routine as others? • Does the student have friends and participate in extra-curricular activities? • Does the student share the same interests as others in his grade level? • Is the student demonstrating skills necessary to move to post-secondary environments?

7. AR Required Evaluation Data • Social History • Individual Intelligence • Individual Achievement • Adaptive Behavior • Communicative Abilities (receptive/expressive) • Other • Observation • Medical

8. Social History and HFA/Asperger’s • Example: Project ACCESS form • With higher functioning individuals the social history may be very important in establishing criteria, as skills may have changed over time.

9. Individual Intelligence Assessment • Students with higher functioning autism are generally thought to have average to above-average intelligence. • Non-verbal intelligence testing may have some merit with this population

10. Individual Achievement Assessment • Results may vary according to student’s interest areas • May struggle with timed portions of test • May have interfering behaviors such as a need to erase perceived errors, not being able to move past an unknown task • May expect “holes” in performance rather than lower than average performance overall • Many perform well on standardized tests of achievement

11. Adaptive Behavior Assessment • Although typically thought of as assessment for lower functioning students, careful completion of the Vineland Adaptive Behavior Scales or similar test may reveal strengths and weaknesses not typical of peers with same cognitive level. • Vineland • Birth to 19 • Domains • Daily Living Skills • Socialization • Motor Skills • Maladaptive Behaviors

12. Communicative AbilitiesPossible Referral Characteristicsfrom AR Guidelines • Impaired understanding of spoken language • Spoken language not used for communication, as in initiating an sustaining social conversation • Articulation usually adequate • Expressive skills many times exceed receptive skills

13. Referral Characteristics (cont.) • May produce babble jargon, stereotypic or idiosyncratic language • May appear deaf although hearing is normal • May have abnormal pitch, stress, intonation, rate or rhythm of speech • (Characteristics are not limited to those suggested under AR Autism guidelines)

14. Formal Assessments • Most Formal Assessments consist of observational and interview information which is assigned some sort of rating and indicates a “likelihood” of Asperger’s Syndrome. Autism is behaviorally defined. Others involved structured observation. • Usually based on DSM-IV Criteria • The educational diagnosis of Autism does not require the use of specific test scores. Arkansas guidelines do require specific assessments as noted earlier. Specific areas must be assessed.

15. Formal AssessmentsExamples • The Australian Scale for Asperger’s Syndrome (M.S. Garnett and A.J. Attwood) Available on-line through O.A.S.I.S. • indicates likelihood of Asperger’s Syndrome • Asperger Syndrome Diagnostic Scale (ASDS) • Subscales • Language • Social • Maladaptive • Cognitive • Sensorimotor • Asperger Syndrome Quotient indicating probability of Asperger Syndrome

16. The Childhood Autism Rating Scale (CARS) • Raw Scores fall along a continuum for • Non Autistic • Mildly Moderately Autistic • Severely Autistic • Categories • Relating to People • Imitation • Emotional Response • Body Use • Object Use • Adaptation to Change • Visual Response • Listening Response • Taste, Smell, and Touch Response • Fear or Nervousness • Verbal Communication • Nonverbal Communication • Activity Level • Level and Consistency of Intellectual Response • General Impressions

17. Autism Diagnostic Observation Schedule (ADOS) • Semi-structured, but standardized • Communication, social interaction, play and imaginative use of materials • Across a range of developmental levels and chronological ages • Module 1-Pre-verbal/Single Words • Module 2-Phrase Speech • Module 3-Fluent Speech*Child/Adolescent • Module 4-Fluent Speech*Adolescent/Adult • Requires specific training and materials are expensive

18. Autism Screening Instrument for Educational Planning (ASIEP-2) • 18 months through adult • Five components • Sensory • Relating • Body concept • Language • Social, self-help

19. Gilliam Autism Rating Scale (GARS-2) • Ages 3 through 22 • Quick, completed by persons knowing subject • Estimates severity • 42 Items • Stereotyped behaviors • Communication • Social interaction

20. Informal Assessments • Informal assessments include strategies such as: • History Taking • Observation • Interview • Informal Assessment is essential and always yields more usable information than test scores alone.

21. A Source for Interviews • Student Learning Traits Assessment • Setting Demands • Student Perspective Analysis • Asperger Syndrome and Adolescence: Practical Solutions for School Success by Brenda Smith Myles and Diane Adreon. 2001 Autism Asperger Publishing Company

22. Assessment of Social Skills • Complex and difficult to accurately assess • High functioning students often do well on standardized instruments, but fail miserably in social situations • Even when social skills are assessed and taught, there is evidence to indicate generalization to everyday environments is not good

23. Assessment of Social Skills • “Recognizing the qualitative social deficit…usually is the key to diagnosing autism.” • Autism and the Pervasive Developmental Disorders: Parts I and II by Stephen Bauer, MD in Pediatrics in Review, Vol 16 #s 4 & 5

24. An Example of the Complexity of Social Communication • Note the current social situation in which the communication interaction is occurring, including the nonverbal cues. • Pay attention and receive the complete verbal message delivered by the speaker. • Analyze the meaning of the verbal and nonverbal messages within the context of the conversational situation. • Check the tentative interpretation of the messages against one’s bank of social knowledge. • Formulate a response inside one’s head based on the above, after considering several possible options. • Draw upon one’s knowledge of vocabulary and grammar. • Speak or generate the message in a manner that is understandable to others. • Be prepared to receive and analyze the new incoming message response, complete with its nonverbal and hidden messages. • Begin the cycle all over again. • Indiana Resource Center for Autism (IRCA Articles) “Can Social Pragmatic Skills Be Tested? By Beverly Vicker

25. Social Skills Rating System (SSRS) • Three rating forms • Teacher • Parent • student • Three Scales • Social Skills Scale • Problem Behaviors Scale • Academic Competence Scale

26. Test of Problem Solving-3 • Six subtests • Making Inferences • Predicting • Determining Causes • Sequencing • Negative Questions • Problem Solving

27. Test of Pragmatic Languge-2(TOPL) • Ages 6 to 18 • Analysis of social communication in context

28. Parent’s Comments • HFA and Asperger's kids can test well in a pragmatic language test.  Particularly since some tests are not time limited, and so the kids get as long as they want to think about the answer.  Unfortunately in a social situation the kids do not have the luxury of waiting until the answer comes to them.  So if your are hoping to qualify your son based on pragmatic language deficits, when the real issue is social cognition, it can be a bust. • Our school tested a son for language pragmatics to exit him special education.  He has no friends etc, but until he flunks the test they won't give a _____. http://www.autism-pdd.net/testdump/test15464.htm

29. Informal Assessment of Social Skills • Observation • Interviewing numerous people about what communication situations are challenging and identification of particular difficulties • Completing inventories or checklists • Using informal situation to sample the person’s ability to deal with specific communication challenges • Indiana Resource Center for Autism (IRCA Articles) “Can Social Pragmatic Skills Be Tested? By Beverly Vicker

30. The Work of Michelle Garcia Winner • Observing the student with his peers and in different environmental contexts • Interacting with the student without facilitating the student’s social success • Informal assessment tools • Administering carefully considered standardized measures • Interviewing teachers and peers • www.socialthinking.com