Transcript Assessment of Students with High Functioning Autism and

Assessment of Students with
High Functioning Autism and
Asperger’s Syndrome
Terri Carrington, M.A., CCC-SLP
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 PDDNOS
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
Educational Impact
• Paradoxical nature of Asperger’s Syndrome and
High Functioning Individuals
• Difficulty with:
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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
Educational Impact
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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
Grades are not the only determinant
of educational impact.
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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 postsecondary environments?
AR Required Evaluation
Data
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Social History
Individual Intelligence
Individual Achievement
Adaptive Behavior
Communicative Abilities
(receptive/expressive)
• Other
• Observation
• Medical
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.
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
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
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
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Daily Living Skills
Socialization
Motor Skills
Maladaptive Behaviors
Communicative Abilities
Possible Referral
Characteristics
from 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
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)
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.
Formal Assessments
Examples
• 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
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Language
Social
Maladaptive
Cognitive
Sensorimotor
– Asperger Syndrome Quotient indicating probability of
Asperger Syndrome
The Childhood Autism Rating
Scale (CARS)
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Raw Scores fall along a
continuum for
– Non Autistic
– Mildly Moderately Autistic
– Severely Autistic
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Categories
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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
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
Autism Screening Instrument for
Educational Planning (ASIEP-2)
• 18 months through adult
• Five components
– Sensory
– Relating
– Body concept
– Language
– Social, self-help
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
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.
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
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
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
An Example of the Complexity of
Social Communication
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Note the current social situation in which
the communication interaction is
occurring, including the nonverbal cues.
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Pay attention and receive the complete
verbal message delivered by the speaker.
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Analyze the meaning of the verbal and
nonverbal messages within the context of
the conversational situation.
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Check the tentative interpretation of the
messages against one’s bank of social
knowledge.
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Formulate a response inside one’s head
based on the above, after considering
several possible options.
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Draw upon one’s knowledge of vocabulary
and grammar.
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Speak or generate the message in a manner
that is understandable to others.
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Be prepared to receive and analyze the new
incoming message response, complete with
its nonverbal and hidden messages.
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Begin the cycle all over again.
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Indiana Resource Center for Autism (IRCA
Articles) “Can Social Pragmatic Skills Be
Tested? By Beverly Vicker
Social Skills Rating
System (SSRS)
• Three rating forms
– Teacher
– Parent
– student
• Three Scales
– Social Skills Scale
– Problem Behaviors Scale
– Academic Competence Scale
Test of Problem Solving-3
• Six subtests
– Making Inferences
– Predicting
– Determining Causes
– Sequencing
– Negative Questions
– Problem Solving
Test of Pragmatic Languge-2
(TOPL)
• Ages 6 to 18
• Analysis of social communication in
context
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
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
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