MDT EVALUATION MODEL FOR DETERMINING AUTISM IN STUDENTS WITH VI

1. MDT EVALUATION MODEL FOR DETERMINING AUTISM IN STUDENTS WITH VI Marnee Loftin, M.A, School Psychologist, TSBVI loftinm@tsbvi.edu loftinm@att.net

2. 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

3. GOAL 1 GENERAL KNOWLEDGE OF THE DIAGNOSTIC AND STATISTICAL MANUAL (DSM) FIFTH EDITION

4. DSM: AN OVERVIEW • Provides guidelines for diagnosis of psychological conditions • Regular revisions • Significant changes in autism in Fifth Version

5. 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

6. 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

7. 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

8. SOCIAL AND COMMUNICATION Exhibits deficits in (all three) 1. Social-emotional reciprocity 2. Non-verbal communication 3. Developing and maintaining relationships

9. 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

10. 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

11. 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

12. GOAL 2 The Multidisciplinary Team (MDT) Process

13. 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

14. THE MDT PROCESS • Decreases redundancy in gathering information • Integrates different information obtained • Synthesizes information for general conclusion

15. PROBLEMS WITH MDT PROCESS • Lack of time to implement • Difficulty with synthesizing • Handling disagreement • Implementing consensus

16. 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

17. 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

18. 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

19. GOAL 3 DETERMINING NEED FOR EVALUATION

20. 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

21. 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

22. 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

23. BEHAVIORAL FEATURES AS PREDICTORS • Unusual responses to environment • Insistence on routines • Stereotypic behaviors • Special interests or abilities

24. 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

25. WHY EVALUATE FOR ASD? • Determine eligibility for programs • Develop appropriate IEP • Develop plan for transitions

26. ETIOLOGIES FREQUENTLY ASSOCIATED WITH ASD • Retinopathy of Prematurity • Optic Nerve Hypoplasia • Septo-optic Dysplasia • CHARGE Syndrome • Congenital Rubella

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

28. GOAL 4 Knowledge of specific evaluation procedures

29. 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

30. EVALUATION OF STUDENTS WITH VI INCLUDES • Developmental History • Observations and Interviews • Evaluation of Communication, Sensory, Behavioral and Cognitive Functioning • Synthesis of Results

31. SPECIFIC EVALUATION PROCEDURES Developmental History

32. DEVELOPMENTAL HISTORY REQUIRES DATA ABOUT: • Pregnancy and birth • Perinatal experiences • Medical history/medication • Family history • Previous evaluations and results

33. 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

34. CONTINUED: • Unusual interests on part of child • Lack of responsiveness from their child • Savant skills • Self-abusive behaviors

35. 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

36. 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

37. 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

38. SPECIFIC TYPES OF INFORMATION INCLUDE: • Sensory • Social-Communication • Behavioral

39. SPECIFIC OBSERVATIONS WILL VARY BASED UPON: • Age and functional level of student • Access to formal testing procedures • Professional discipline that is observing

40. 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

41. 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

42. 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

43. SENSORY ISSUES OFTEN IDENTIFIED • Problems with motor control and development • Gross and fine motor delays • Abnormal muscle tone • Sensory defensiveness • Self regulation/modulation deficits

44. 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

45. 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

46. 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

47. 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

48. 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

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

50. 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