Transcript The Centralized Evaluation Team Process

EDUCATION-BASED
EVALUATIONS FOR ASD
KELLY DUNLAP, PSY.S
STEPHANIE DYER, ED.S.
AGENDA
• The New Evaluation Reality
• The Three Prongs of Educational
Eligibility
• Process Components
• REED
• Evaluation Components
• Determination of Eligibility (Results
Review Process)
• Evaluation Report
• IEP
• Differential Eligibility
Considerations
New Reality:
MORE KIDS
Number of Michigan Students with ASD
*Based on 2012 MDE, OSE Eligibility Count
18000
16,591
16000
Number of students
14000
12000
10000
8000
6000
4000
1,208
2000
0
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Number of Michigan Students with ASD by Age
* Based on 2012 MDE, OSE Eligibility Count
1600
1400
1354
1279
1241 1231
1200
1171
1134
1117
1065
1000
1038
955
900
818
800
630
600
553
395
400
339
280
236
189 193
200
153
124 128
51
13
4
0
1
2
3
4
5
6
7
8
9
10
11
12
13
Age
14
15
16
17
18
19
20
21
22
23
24
25
26
NEW REALITY: MORE PLAYERS
• Autism Insurance Legislation
• http://www.michigan.gov/autism
• http://autismallianceofmichigan.org/news-info/autismlegislation/
• The Autism State Plan
• http://michigan.gov/autism
• The Autism Council
MICHIGAN AUTISM COUNCIL
• Purpose: Implementation of the
Autism State Plan
• Autism State Plan:
http://michigan.gov/autism
• Subcommittee Work
• Early identification and intervention
• Adults services and supports
• Education
AUTISM COUNCIL
SUBCOMITTEES
Early
Intervention
Adult
Services
Workgroups
Screening and
Assessment /
ASD Eligibility
Determination
Education
CURRENT PLAYERS AT THE TABLE
Special Ed
Autism Insurance Benefit (AIB)
Private Insurance
Medicaid / MIChild
Criteria
ASD / MARSE
ASD = Autistic Disorder, AS,
PDD-NOS (DSM IV)
ASD = Autistic Disorder,
AS, PDD-NOS (DSM IV)
Plan for Evaluation
REED / Timeline
------------------
-------------------
Who Evaluates
Psych, SSW, SLP
Licensed Psych or Physician
CMHP
Using What Tools
Prescriptive for
Child / Purpose
Must include an “Autism
Diagnostic Observation
Schedule” (e.g. ADOS-2)
Must include ADOS-2
and Developmental
Family History (e.g. ADI-R)
Diagnosis of Condition
Diagnosis of Condition
Determination of
Impairment /
Diagnosis
IFSP / IEP Team
Determines
Impairment
Eligibility for
Services
IFSP / IEP Team
determines
adverse impact
Treatment prescribed or
ordered by evaluator
CMHP + Medicaid
Agency final approval
Service Plan
IFSP / IEP
Treatment Plan developed
by board certified or
licensed provider
IPOS developed through
PCP process
Types of Services
IFSP=Early
Intervention
services; IEP=SE,
RS, and SAS
Behavioral Health,
Pharmacy, Psychiatric,
Psychological, Therapeutic
ABA
(EIBI and ABI)
ACRONYM DECIPHERING TOOL
• SE = Special Education
• ASD = Autism Spectrum Disorder
• MARSE = Michigan Administrative
Rules for Special Education
• REED = Review of Existing Evaluation
Data
• MET = Multidisciplinary Evaluation
Team
• IFSP = Individual Family Service Plan
• IEP = Individualized Educational
Program
• SAS = Supplementary Aids and
Services
• P&S = Programs & Services
• FAPE = Free and Appropriate Public
Education
• LRE = Least Restrictive Environment
• AIB = Autism Insurance Benefit
• DSM = Diagnostic and Statistical
Manual of Mental Disorders
• PDD-NOS = Pervasive Developmental
Disorder – Not Otherwise Specified
• ADOS = Autism Diagnostic Observation
Schedule
• ADI = Autism Diagnostic Interview
• CMHP = Child Mental Health
Professional
• PCP = Person-Centered Plan
• IPOS = Individual Plan of Service
• ABA = Applied Behavioral Analysis
• EIBI = Early Intensive Behavioral
Intervention
• ABI = Applied Behavioral Intervention
• ABLLS = Assessment of Basic Language
and Learning Skills
• VB-MAPP = Verbal Behavioral
Milestones Assessment and Placement
Program
NEW REALITY IN EVALUATIONS FOR
ASD
• Potential increase in referrals
• Potential increase in pressure to
accept clinical diagnoses
• Increased need for collaboration
across systems
So, where do we start?
Ensure quality special education
eligibility evaluations for ASD
(i.e. Clean up our own backyard!)
NEW REALITY: MORE COMPLEXITY
• Common Comorbid Conditions:
•
•
•
•
•
•
Seizures and epilepsy
Anxiety
Depression
Attention difficulties
Bipolar Disorder
Obsessive Compulsive
• Some are considered part of ASD, so when is condition
at a level that warrants an different or additional dx?
Today’s Guiding Principle
• NO OPINIONS
• ALL DECISIONS INFORMED BY….
• THE LAW
• THE RESEARCH
• THE DATA
WARNING
•I heard that….
•I was told….
PRACTICE IS NOT NECESSARILY
LAW, POLICY, or RULE
WE MUST ENSURE
QUALITY EVALUATIONS
• All staff need to be competent at ASD
screening / evaluation
• Current Issues:
– Not recognizing there are THREE required eligibility areas
– Not recognizing that “educational impact” can be in one of
THREE areas (e.g. academic, behavior, social)
– Use of tools with no observational data
– Not understanding terms:
• Marked
• Qualitative
• Adverse Impact
AGENDA
• The New Evaluation Reality
• The Three Prongs of Educational
Eligibility
• Process Components
•
•
•
•
•
REED
Evaluation Components
Determination of Eligibility
Evaluation Report
IEP
• Differential Eligibility
Considerations
THE THREE PRONGS OF ELIGIBILITY
•CRITERIA
•IMPACT
•NEED
GUIDING PRINCIPLE
“There is no single behavior that is
always typical of Autism and no
behavior that would automatically
exclude an individual child from a
diagnosis of Autism.” (NRC)
PREPONDERANCE OF EVIDENCE
(Dave Schoemer)
Continuum of Skills for Individuals with Autism
Measured IQ
Social
Interaction
Communication
Motor Skills
Fine & Gross
Sensory
Severe MR
Aloof
Gifted
Passive
Active/Odd
Non-verbal
Verbal
Awkward
Agile
Hyposensitive
Hypersensitive
The Advocate (2003)
AUTISM SPECTRUM DISORDER TRIAD
DSM-V CHANGE: ASD
Persistent Deficits
in Social
Communication &
Social Interaction
Restricted &
Repetitive Patterns
of Behavior
SEVERITY RATING LEVELS 1-3:
3 = Requiring very substantial support
1 = Requiring support
ELIGIBILITY VS DIAGNOSIS
MICHIGAN
DEFINITION
OF ASD
DEPARTMENT OF EDUCATION / STATE BOARD OF EDUCATION
SPECIAL EDUCATION PROGRAMS AND SERVICES
Filed with the Secretary of State on 9-7-04, and take effect on 9-15-04.
R 340.1715 Autism spectrum disorder defined; determination.
Rule 15. (1) Autism spectrum disorder is considered a lifelong developmental disability
that adversely affects a student’s educational performance in 1 or more of the following
performance areas:
(a) Academic.
(b) Behavioral.
(c) Social.
Autism spectrum disorder is typically manifested before 36 months of age. A child who first
manifests the characteristics after age 3 may also meet criteria. Autism spectrum disorder is
characterized by qualitative impairments in reciprocal social interactions, qualitative
impairments in communication, and restricted range of interests/repetitive behavior.
(2) Determination for eligibility shall include all of the following:
(a) Qualitative impairments in reciprocal social interactions including at least 2 of the
following areas:
(i) Marked impairment in the use of multiple nonverbal behaviors such as eye-toeye gaze, facial expression, body postures, and gestures to regulate social
interaction.
(ii) Failure to develop peer relationships appropriate to developmental level.
(iii) Marked impairment in spontaneous seeking to share enjoyment, interests, or
achievements with other people, for example, by a lack of showing, bringing, or
pointing out objects of interest.
(iv) Marked impairment in the areas of social or emotional reciprocity.
(b) Qualitative impairments in communication including at least 1 of the following:
(i) Delay in, or total lack of, the development of spoken language not
accompanied by an
attempt to compensate through alternative modes of communication such as
gesture or mime.
(ii) Marked impairment in pragmatics or in the ability to initiate, sustain, or
engage in
reciprocal conversation with others.
(iii) Stereotyped and repetitive use of language or idiosyncratic language.
(iv) Lack of varied, spontaneous make-believe play or social imitative play
appropriate to
developmental level.
(c) Restricted, repetitive, and stereotyped behaviors including at least 1 of the following:
(i) Encompassing preoccupation with 1 or more stereotyped and restricted
patterns of interest that is abnormal either in intensity or focus.
(ii) Apparently inflexible adherence to specific, nonfunctional routines or rituals.
(iii) Stereotyped and repetitive motor mannerisms, for example, hand or finger
flapping or twisting, or complex whole-body movements.
(iv) Persistent preoccupation with parts of objects.
(3) Determination may include unusual or inconsistent response to sensory stimuli, in
combination with subdivisions (a), (b), and (c) of subrule 2 of this rule.
(4) While autism spectrum disorder may exist concurrently with other diagnoses or areas
of disability, to be eligible under this rule, there shall not be a primary diagnosis of schizophrenia
or emotional impairment.
(5) A determination of impairment shall be based upon a comprehensive evaluation by a
multidisciplinary evaluation team including, at a minimum, a psychologist or psychiatrist, an
authorized provider of speech and language under R 340.1745(d), and a school social worker.
MICHIGAN DEFINITION OF
AUTISM SPECTRUM DISORDER
Characterized by qualitative impairments in:
a. Reciprocal Social Interactions
b. Communication
c. Restricted Range of Interests / Repetitive
Behavior
“QUALITATIVE”
• Markedly Atypical
• Significantly different from other students at
the same age and developmental level
• Outside the typical sequence of
development
• Across all environments.
• Presence and Absence
• Unique to each Student
MICHIGAN DEFINITION OF
AUTISM SPECTRUM DISORDER
Characterized by qualitative impairments in:
Reciprocal Social Interactions
Communication
Restricted Range of Interests /
Repetitive Behavior
RECIPROCAL SOCIAL INTERACTION
A mutual exchange
(e.g. of words, actions, or feelings).
RECIPROCAL SOCIAL INTERACTION
AT LEAST 2 OF THE FOLLOWING 4
(i) Marked impairment in the use of multiple nonverbal behaviors
such as eye-to-eye gaze, facial expression, body postures, and
gestures to regulate social interaction.
•
•
Marked = Substantial & Sustained; Clearly Evident; Distinctive
and noticeably different from same-aged peers
PURPOSE of Nonverbal Behavior
• EXAMPLES:
• Seems to look “through” a person, lacks eye contact to initiate or sustain
interaction, has fleeting or inconsistent eye contact
• Lacks emotion or appropriate facial affect for the social situation, lacks
accurate facial expression to reflect internal feelings, facial expressions
seem rehearsed or mechanical
• Difficulty maintaining appropriate body space, awkward/stiff response or
movement, gait challenges
• Lacks understanding of the use of nonverbal cues (e.g. pointing, head
nod, waving), does not respond to communication partner signals to start
or end a conversation
RECIPROCAL SOCIAL INTERACTION
AT LEAST 2 OF THE FOLLOWING 4
(ii) Failure to develop peer relationships appropriate to
developmental level.
---NOTE: that results from deficits in social reciprocity and
inability to understand the perspectives of others,
another’s point of view, or predict another’s behavior.
• Examples:
•
•
•
•
•
•
•
•
•
•
Lack of understanding of age-appropriate humor and jokes
Disruption of ongoing activities when entering play or social circles
Lack of initiation or sustained interactions with others
Preference to play alone
Continuous failure in trying to understand the social nuances and follow
the social rules
Desire for friendships but with multiple failed attempts
Misinterpretation of social cues or communication intent of others
Tolerance of peers but no engagement in conversation or activity
Confusion with the telling of lies
Policing peers (e.g. reporting rule infractions on the playground)
THEORY OF MIND
(ToM) means the ability to
recognize and understand
thoughts, beliefs, desires and
intentions of other people in
order to make sense of their
behavior and predict what
they are going to do.(Atwood, 2007)
TOM—ability to understand the
feelings, intentions and
perspectives of others and
recognize that they are
different from our own.
DEVELOPMENTAL TRAJECTORIES
Experts on people
Normal
birth
ASD
Experts on things
RECIPROCAL SOCIAL INTERACTION
AT LEAST 2 OF THE FOLLOWING 4
(iii) Marked impairment in spontaneous (i.e. without
prompting) seeking to share enjoyment, interests, or
achievements with other people, for example, by a lack
of showing, bringing, or pointing out objects of interest.
(i.e. Joint / Shared Attention)
• Examples:
• Deficits in the use of pointing to orient another to an object or
event
• Bringing objects or items to others for the purposes of getting
needs met, but not for a shared experience
• Shifting conversations to one’s own interest rather than
responding to the interests of others
RECIPROCAL SOCIAL INTERACTION
AT LEAST 2 OF THE FOLLOWING 4
(iv) Marked impairment in the areas of social or emotional
reciprocity (i.e. Identifying and responding appropriately to other’s
emotional states (e.g., comfort a crying person))
• EXAMPLES:
• Lack of social smiling; Lack of interest in the ideas of others
• Aloofness and indifference toward others
• Seemingly rude statements to others without filter or negative intent
Difficulty explaining their own behaviors in context of impact on others
• Difficulty predicting how others feel or think
• Problems inferring the intentions or feelings of others
• Failure to understand how their behavior impacts how others think or feel
• Problems with social conventions (e.g. turn-taking / personal space)
• Lack of appropriate responding to someone else’s pain or distress
• Creating arbitrary social rules to make sense of ambiguous social norms
MICHIGAN DEFINITION OF
AUTISM SPECTRUM DISORDER
Characterized by qualitative impairments in:
Reciprocal Social Interactions
Communication
Restricted Range of Interests /
Repetitive Behavior
COMMUNICATION
AT LEAST 1 OF THE FOLLOWING 4
(i) Delay in, or total lack of, the
development of spoken language not
accompanied by an attempt to
compensate
• Failure to understand that words have
a communicative intent
• About 40% of children with an ASD do not
talk at all.
• About 25%–30% of children with an ASD
have some words at 12 to 18 months of age
and then lose them.
• Remaining children speak, but sometimes
not until later in childhood and/or nonfunctional speech. http://www.cdc.gov/ncbddd/autism/signs.html
COMMUNICATION
(ii) Impairment in Pragmatics: The ability to initiate,
sustain, or
engage in reciprocal conversation with others
a. Using language for varying purposes (e.g.
greeting, informing, promising, requesting, etc.)
b. Changing language according to the needs of the
listener or situation (e.g., giving background
information to an unfamiliar listener, speaking
differently in a classroom than on a playground)
c. Following rules of conversations and storytelling
(e.g., taking turns in conversation, staying on
topic, rephrasing when misunderstood, proximity,
use of eye contact
EXAMPLES
• Difficulty with the social aspects of language (e.g.
understanding non-literal language used in
conversation)
• Issues with prosody (e.g. flat and emotionless or high
and pitchy with atypical rhythm or rate)
• Difficulty initiating, sustaining, or ending conversations
with others
• Difficulty using repair strategies when communication
breaks down
• Talking for extended periods of time about a subject of
the student’s liking, regardless of the listener’s interest
• Talking at someone in a monologue rather than
conversing
RECEPTIVE & EXPRESSIVE LANGUAGE
ARE NOT EQUAL
•
•
•
•
•
•
•
I didn’t say she stole my money.
I didn’t say she stole my money.
I didn’t say she stole my money.
I didn’t say she stole my money.
I didn’t say she stole my money.
I didn’t say she stole my money.
I didn’t say she stole my money.
COMMUNICATION
(iii) Stereotyped / repetitive use of language /
idiosyncratic
• Idiosyncratic = contextually irrelevant or not
understandable to the listener; may have private meaning /
be understood by the speaker or to those familiar to the
situation (e.g. movie lines)
• Can include:
• Echolalia
• Repeat videos / scripts
• Nonsense language
• Verbal Fascinations
(IV) LACK OF VARIED, SPONTANEOUS MAKEBELIEVE PLAY OR SOCIAL IMITATIVE PLAY
APPROPRIATE TO DEVELOPMENTAL LEVEL.
• Compared to Developmental
Level
• Extremely Stilted
• Embracing Play
MICHIGAN DEFINITION OF
AUTISM SPECTRUM DISORDER
Characterized by qualitative impairments in:
Reciprocal Social Interactions
Communication
Restricted Range of Interests /
Repetitive Behavior
RESTRICTIVE, REPETITIVE, STEREOTYPED BEHAVIORS
AT LEAST 1 OF THE FOLLOWING 4
(i) Encompassing preoccupation with 1 or more
stereotyped and restricted patterns of interest that is
abnormal either in intensity or focus.
• Intrusive; frequent, interfere with participation in daily activities
• DISTRESS OVER DISRUPTION
(ii) Apparently inflexible adherence to specific,
nonfunctional (e.g. no purpose) routines or rituals.
• Eat only one type, color, texture of food
• Self imposed rules (must touch 3 doors before opening)
(iii) Stereotyped and repetitive motor mannerisms,
for example, hand or finger flapping or twisting, or
complex whole-body movements.
(iv) Persistent preoccupation with parts of objects.
(III) STEREOTYPED AND REPETITIVE MOTOR
MANNERISMS, FOR EXAMPLE, HAND OR FINGER
FLAPPING OR TWISTING, OR COMPLEX WHOLEBODY MOVEMENTS.
• Cautions – Prioritize Criteria
• Comprehensive Evidence of ASD
(IV) PERSISTENT PREOCCUPATION WITH
PARTS OF OBJECTS.
• Observations and Interactions
Over Time
• Dave – Air Conditioner Parts
THE THREE PRONGS OF ELIGIBILITY
CRITERIA
•IMPACT
•NEED
MICHIGAN
DEFINITION
OF ASD
IMPACT
DEPARTMENT OF EDUCATION / STATE BOARD OF EDUCATION
SPECIAL EDUCATION PROGRAMS AND SERVICES
Filed with the Secretary of State on 9-7-04, and take effect on 9-15-04.
R 340.1715 Autism spectrum disorder defined; determination.
Rule 15. (1) Autism spectrum disorder is considered a lifelong developmental disability
that adversely affects a student’s educational performance in 1 or more of the following
performance areas:
(a) Academic.
(b) Behavioral.
(c) Social.
Autism spectrum disorder is typically manifested before 36 months of age. A child who first
manifests the characteristics after age 3 may also meet criteria. Autism spectrum disorder is
characterized by qualitative impairments in reciprocal social interactions, qualitative
impairments in communication, and restricted range of interests/repetitive behavior.
(2) Determination for eligibility shall include all of the following:
(a) Qualitative impairments in reciprocal social interactions including at least 2 of the
following areas:
(i) Marked impairment in the use of multiple nonverbal behaviors such as eye-toeye gaze, facial expression, body postures, and gestures to regulate social
interaction.
(ii) Failure to develop peer relationships appropriate to developmental level.
(iii) Marked impairment in spontaneous seeking to share enjoyment, interests, or
achievements with other people, for example, by a lack of showing, bringing, or
pointing out objects of interest.
(iv) Marked impairment in the areas of social or emotional reciprocity.
(b) Qualitative impairments in communication including at least 1 of the following:
(i) Delay in, or total lack of, the development of spoken language not
accompanied by an
attempt to compensate through alternative modes of communication such as
gesture or mime.
(ii) Marked impairment in pragmatics or in the ability to initiate, sustain, or
engage in
reciprocal conversation with others.
(iii) Stereotyped and repetitive use of language or idiosyncratic language.
(iv) Lack of varied, spontaneous make-believe play or social imitative play
appropriate to
developmental level.
(c) Restricted, repetitive, and stereotyped behaviors including at least 1 of the following:
(i) Encompassing preoccupation with 1 or more stereotyped and restricted
patterns of interest that is abnormal either in intensity or focus.
(ii) Apparently inflexible adherence to specific, nonfunctional routines or rituals.
(iii) Stereotyped and repetitive motor mannerisms, for example, hand or finger
flapping or twisting, or complex whole-body movements.
(iv) Persistent preoccupation with parts of objects.
(3) Determination may include unusual or inconsistent response to sensory stimuli, in
combination with subdivisions (a), (b), and (c) of subrule 2 of this rule.
(4) While autism spectrum disorder may exist concurrently with other diagnoses or areas
of disability, to be eligible under this rule, there shall not be a primary diagnosis of schizophrenia
or emotional impairment.
(5) A determination of impairment shall be based upon a comprehensive evaluation by a
multidisciplinary evaluation team including, at a minimum, a psychologist or psychiatrist, an
authorized provider of speech and language under R 340.1745(d), and a school social worker.
MICHIGAN DEFINITION OF
AUTISM SPECTRUM DISORDER
#1. Considered a lifelong developmental
disability that adversely affects a student’s
educational performance in 1 or more of the
following areas:
a) Academic (e.g. ability to meaningfully participate and progress in the
general curriculum including lack of initiation, impaired quality of
participation, low grades, etc.)
(b) Behavioral (e.g. disruption, aggression, lack of appropriate
engagement, eloping, tantrums, etc.)
(c) Social (e.g. ability to develop and maintain relationships/friendships,
responses to social situations that alienates others and diminishes
acceptance, etc.)
ESTABLISHING NEED
IDEA §300.306
• To be eligible for special education services, the educational
impact of the student’s ASD must necessitate special education or
related services.
• Special education is defined as specially designed instruction
which means “adapting, as appropriate to the needs of an
eligible child…”
• Specialized instruction must be needed for the student to make
progress in school and benefit from general education instruction
to be eligible for services.
• Effectiveness of previously implemented interventions is one way
to determine the need for specialized instruction.
MICHIGAN
DEFINITION
OF ASD
AGE
SENSORY
Not Primary EI
TEAM
DEPARTMENT OF EDUCATION / STATE BOARD OF EDUCATION
SPECIAL EDUCATION PROGRAMS AND SERVICES
Filed with the Secretary of State on 9-7-04, and take effect on 9-15-04.
R 340.1715 Autism spectrum disorder defined; determination.
Rule 15. (1) Autism spectrum disorder is considered a lifelong developmental disability
that adversely affects a student’s educational performance in 1 or more of the following
performance areas:
(a) Academic.
(b) Behavioral.
(c) Social.
Autism spectrum disorder is typically manifested before 36 months of age. A child who first
manifests the characteristics after age 3 may also meet criteria. Autism spectrum disorder is
characterized by qualitative impairments in reciprocal social interactions, qualitative
impairments in communication, and restricted range of interests/repetitive behavior.
(2) Determination for eligibility shall include all of the following:
(a) Qualitative impairments in reciprocal social interactions including at least 2 of the
following areas:
(i) Marked impairment in the use of multiple nonverbal behaviors such as eye-toeye gaze, facial expression, body postures, and gestures to regulate social
interaction.
(ii) Failure to develop peer relationships appropriate to developmental level.
(iii) Marked impairment in spontaneous seeking to share enjoyment, interests, or
achievements with other people, for example, by a lack of showing, bringing, or
pointing out objects of interest.
(iv) Marked impairment in the areas of social or emotional reciprocity.
(b) Qualitative impairments in communication including at least 1 of the following:
(i) Delay in, or total lack of, the development of spoken language not
accompanied by an
attempt to compensate through alternative modes of communication such as
gesture or mime.
(ii) Marked impairment in pragmatics or in the ability to initiate, sustain, or
engage in
reciprocal conversation with others.
(iii) Stereotyped and repetitive use of language or idiosyncratic language.
(iv) Lack of varied, spontaneous make-believe play or social imitative play
appropriate to
developmental level.
(c) Restricted, repetitive, and stereotyped behaviors including at least 1 of the following:
(i) Encompassing preoccupation with 1 or more stereotyped and restricted
patterns of interest that is abnormal either in intensity or focus.
(ii) Apparently inflexible adherence to specific, nonfunctional routines or rituals.
(iii) Stereotyped and repetitive motor mannerisms, for example, hand or finger
flapping or twisting, or complex whole-body movements.
(iv) Persistent preoccupation with parts of objects.
(3) Determination may include unusual or inconsistent response to sensory stimuli, in
combination with subdivisions (a), (b), and (c) of subrule 2 of this rule.
(4) While autism spectrum disorder may exist concurrently with other diagnoses or areas
of disability, to be eligible under this rule, there shall not be a primary diagnosis of schizophrenia
or emotional impairment.
(5) A determination of impairment shall be based upon a comprehensive evaluation by a
multidisciplinary evaluation team including, at a minimum, a psychologist or psychiatrist, an
authorized provider of speech and language under R 340.1745(d), and a school social worker.
CET: CENTRALIZED EVALUATION TEAM
• Objective 3-person team
• Sole purpose is ASD eligibility
• Start with the child, not the characteristics (e.g. does the ASD
dominate the child’s thinking?)
• Use the quadrants for observation and organizing information
• Conduct a home visit with all 3 members
• MET meeting to determine eligibility (Meeting Mechanics)
• Preponderance of evidence
• One combined report
• Report follows the MARSE criteria
• Meet with parents BEFORE the IEP meeting
TEAM CONFIGURATIONS
TEAM EVALUATION
☺ Collaboration
☺ One voice
☺ One contact
☺ One report
AGENDA
• The New Evaluation Reality
• The Three Prongs of Educational
Eligibility
• Process Components
•
•
•
•
•
REED
Evaluation Components
Determination of Eligibility
Evaluation Report
IEP
• Differential Eligibility
Considerations
PROCESS COMPONENTS
• REED
• Evaluation Components
• Determination of Eligibility
• Evaluation Report
• IEP
REED
(REVIEW OF EXISTING EVALUATION DATA)
• Required at re-evaluations and at termination of eligibility.
• Recommended at initial evaluation, especially if evaluation data
from outside sources is available (e.g. diagnostic reports from a
private clinic). (NOTE: COLLABORATION OPPORTUNITY)
• Purpose of the REED is to:
• Review available information and assessment data (e.g. ADOS,
developmental history, rating scale results);
• Determine if the information is sufficient to make a determination of
eligibility (i.e. meets eligibility criteria that impacts academic,
behavioral, or social progress in school that necessitates special
education);
• If not, determine what else is needed to make a determination of
eligibility (e.g. observations to determine impact on educational
performance);
• Establish a plan for gathering the additional information.
Considerations
• We still have obligation to address MARSE
eligibility criteria (ex: ADHD)
• What do we know from what they provided?



Diagnostic information/rating scale scores
Developmental history
ADOS score
• What do we still need to know?




What does child look like across settings?
Impact on social, behavioral, academic
Additional parent/teacher info specific to triad
Communicate with evaluator
OTHER CONSIDERATIONS
• Consideration of ALL potential disabilities
• Information to assist in differential eligibility
• Gather information to assist in developing the IEP
• Communication needs of the student including assistive
technology
• The student’s social needs including peer to peer support
• The student’s behavioral needs including the need for a
functional behavioral assessment, positive behavioral support
plan, or an emergency crisis plan
• Academic needs of the student (i.e. accommodations and
differentiation)
PROCESS COMPONENTS
• REED
• Evaluation Components
• Determination of Eligibility
• Evaluation Report
• IEP
EVALUATION COMPONENTS
• Teacher / Building Staff Interviews
• Parent / Family Interviews & Home Visit
• Observations Across Settings
• Standardized Assessment Domain
Considerations
EVALUATION
PLAN
CHECKLIST
Clinton County
RESA Example
Attended by MET members (Psych, SSW, SLP)
Critical for coordination of scheduling
Discussion and assignments of evaluation components
Allows time for training, questions, problem solving, etc.
INTERVIEWS; SURVEYS; HOME VISIT
• School
• Home
• Facilitated Meeting
Social Interaction
Behaviors
Communication
Sensory
• Face to Face
• Surveys
OTHER (e.g.
academic,
cognitive
functioning)
• In the home
WHY?
• Build Relationship
• Pervasiveness of
Characteristics
• Describe Behaviors
from another
perspective
What makes you think the child / student has ASD?
OTHER SURVEY QUESTIONS
• Talking Points vs. Questions
• Challenges with published
tools:
• Don’t match MARSE criteria
• Don’t focus on impact and
need
• May not facilitate robust
discussion
AREAS TO CONSIDER
• Reciprocal Social Interaction
• Communication
• Restrictive / Repetitive Behavior
• Differential Eligibility:
•
•
•
•
Developmental History
Medical History
Cognitive / Adaptive Skills
Educational Skills
EVALUATION COMPONENTS
• Teacher / Building Staff Interviews
• Parent / Family Interviews & Home Visit
• Observations Across Settings
• Standardized Assessment Domain
Considerations
OBSERVATIONS
PUBLIC SCHOOL INVESTIGATOR
• Evidence of presence / absence of behaviors across
settings; Is the ASD dominating the child’s interaction with
the environment?
• “JUST THE FACTS”— examples / non-examples but NOT
interpretation!!! <that meeting is coming!!>
• The Importance of Context
• INVESTIGATE: Dig down below the surface
• PARTICIPATE to get more detailed information
• CONDUCT mini experiments to see the impact or
response
OBSERVATIONS
• All team members need to conduct
observations
• Make sure all settings, times of day,
contexts are covered
• Allow room in schedule for additional
observations
• Powerful…allows for considering
function of behavior (“eyes on kid,
eyes on kid…”)
• Dig down below the surface
DIRECT OBSERVATION
“EYES ON KID”
Qualitative Impairment
in Communication
Qualitative Impairment
in Reciprocal Social
Interaction
Restrictive, Repetitive
and Stereotyped
Behaviors
Sensory
ASD EVALUATION TEAM – RESULTS REVIEW MEETING TEMPLATE
SOCIAL: Qualitative impairments in reciprocal social interactions including at least 2 of the following 4 areas:
SOCIAL
1
Parent
Marked impairment in use of multiple nonverbal
behaviors to regulate social interactions 3/4
SOCIAL
2
Parent
Teacher
Teacher
Evaluation
Team
Evaluation
Team
Failure to develop peer relationships
appropriate to developmental level.
CHAR-EM ELIGIBILITY
GUIDELINES
Observations in Context
The Tip of the Iceberg Analogy
• The tip is the observable
behavior;
• The context cues us into
what underlies the
behavior (e.g.
motivation, intent,
function)
• Function = Differential
Eligibility
CAUTION: Attribution Theory
ASD
EI / SM
?
?
Fundamental Attribution Error
Jarod - Outcomes
Told the teacher he liked her moustache
ASD
EXPLAIN BEHAVIOR
EI / SM
EXPLAIN BEHAVIOR?
Identifying Underlying Issue
Antecedents
Behavior
Context
Underlying ASD:
--Deficits in Social Reciprocity
--Deficits in Theory of Mind
--Communication Deficits
--Restrictive / Repetitive Behavior
Consequence
Context
Underlying EI / SM:
--Emotional Dysfunction
--Abuse / Trauma
--Mental Health Dx
--Risk Factors (e.g. SES)
Identifying Underlying Issue
Antecedents
Behavior
Consequence
Teacher instructs
“time to get in line”
Ss tries to be first in
line and yells and
screams when prevented
Teacher re-states
who the line-leader is
Underlying ASD:
--Deficits in Social Reciprocity
--Deficits in Theory of Mind
Underlying EI:
--Difficulty regulating emotion
--low self-esteem / worth
THINK IN FUNCTION / PURPOSE
• Marci was observed grabbing toys and objects from
others and appeared unaware that the other child was
using or playing with the object. Marci was observed
tickling peers under the chin while giggling, moving from
one peer to the next. None of the children appeared to
be enjoying this, but Marci did not seem to recognize
their displeasure.
• Marci was observed pulling at girls’ ponytails and
accessories; Marci has not been noted to pull hair other
than in pony/pigtails or when there are accessories
present. Marci was noted to state, “I want to poke her in
the eye” and “I want to kick her” in a very unemotional
manner not directed at anyone. Despite her statement,
Marci has not attempted to do the things that she says.
THE IMPORTANCE OF CONTEXT
Marci was observed grabbing toys and objects from
others and appeared unaware that the other child was
using or playing with the object. Marci was observed
tickling peers under the chin while giggling, moving from
one peer to the next. None of the children appeared to be
enjoying this, but Marci did not seem to recognize their
displeasure.
Marci was observed pulling at girls’ ponytails and
accessories; Marci has not been noted to pull hair other
than in pony/pigtails or when there are accessories
present. Marci was noted to state, “I want to poke her in
the eye” and “I want to kick her” in a very unemotional
manner not directed at anyone. Despite her statement,
Marci has not attempted to do the things that she says.
THE IMPORTANCE OF CONTEXT
Marci was observed grabbing toys and objects from
others, while yelling, “I had it first!” and pushing peers
away. Marci was observed tickling peers under the chin
while giggling, moving from one peer to the next. None of
the children appeared to be enjoying this, but Marci kept
saying, “Am I bugging you yet?” and “Isn’t this so funny?”
Marci was observed pulling at girls’ ponytails and
accessories; she will say, “I don’t like your hair like that-it
looks stupid.” Marci was noted to state, “I want to poke her
in the eye” and “I want to kick her” while being redirected
from an argument with a peer. Marci has previously
shoved, kicked and poked this girl when she doesn’t do
what Marci wants her to do.
OBSERVATIONS
EVALUATION COMPONENTS
• Teacher / Building Staff Interviews
• Parent / Family Interviews & Home Visit
• Observations Across Settings
• Standardized Assessment Domain
Considerations
OTHER SUPPORTING EVIDENCE
•Checklists
•Interview Forms
•Direct Assessment Tools
EVALUATION METHODS/TOOLS
• Predominantly OBSERVATION and INTERVIEW
• Not YES/NO, Black/White…Qualitative Evaluation
• Autism Diagnostic Observation Schedule (ADOS): Not
score, but observation opportunity
• Specific diagnostic tests (communication, cognitive,
social, sensory, adaptive)
• Caution: Questionnaires? CARS?
BE INTENTIONAL WITH
STANDARDIZED TOOLS
• Remember: Tools were not designed
to align with the MARSE criteria or
measure impact / need.
• ASD characteristics that may negate
results:
• Difficulty establishing rapport
• Lack of motivation to please
• Challenges with attention, engagement,
and persistence in task demands
• Difficulty transitioning
• Language deficits
• Interfering and challenging behaviors
• Tools are only as good as their
technical adequacy
Technical Adequacy
• Sample
• Reliability
• Validity
• EXAMPLE: ADOS-2:
• Test / Re-test Reliability—2 Weeks:
• Classification changed for 9 of the 39
children (23%)
ASIEP-3
(AUTISM SCREENING INSTRUMENT
FOR EDUCATIONAL PLANNING)
• Consists of 5 Separate Measures
• The Autism Behavior Checklist (ABC)
= 47 item checklist
• Results indicate the probability of
the student having ASD
• Content Validity: Items were
developed based on an extensive
review of the literature describing
the characteristics of autism
• “The ability of the ABC to
discriminate among different
diagnostic groups needs to be
examined further”
ASSESSMENT TOOLS
CENTRAL ASSESSMENT LENDING LIBRARY (CALL)
HTTPS://WWW.CMICH.EDU/COLLEGES/CHSBS/PSYCHOLOGY/CALL/PAGES/DEFAULT.ASPX/
• ASIEP-3: Autism
Screening Instrument for
Educational Planning
• ADOS-2 (Autism
Diagnostic Observation
Schedule)
• ADI-R: Autism Diagnostic
Interview
• CARS-2: Childhood
Autism Rating Scale
• GARS-2: Gilliam Autism
Rating Scale
• GADS: Gilliam Asperger
Disorder Scale
• KADI: Krug Asperger
Disorder Index
• PEP-3: PsychoEducational Profile
• ABLLS-R: Assessment of
Basic Language and
Learning Skills
• VB-MAPP: Verbal
Behavior – Milestones
Assessment and
Placement Program
QUESTIONS TO GUIDE THE USE OF
STANDARDIZED TOOLS
• Does the tool have adequate technical adequacy?
• What is the purpose or intended outcomes?
• What questions are you attempting to answer and will the tool
provide that information?
• What are the language requirements and do they match the
ability level and communication modality of the student?
• Given the student’s behavioral challenges, will the tool likely
produce reliable and valid results?
• How current is the tool (e.g. when was it published and
standardized)?
• What are the potential challenges in using the tool (e.g. results are
not consistent with other information)?
CREATIVE USES OF STANDARDIZED TOOLS
“BREAKING STANDARDIZATION”
• Observe performance under various conditions (e.g. use of visuals
supports)
• Create conditions not easily observed in natural settings.
• NOTE: Such expansions can be beneficial in capturing rich information
on the student’s learning needs, strengths, and challenges, but invalidates
obtained scores. Avoid by first administering under standardized
conditions.
• Some options for breaking standardization include the following:
• Administer subscales or items within subscales in a different order so highly
preferred tasks can follow less preferred ones to increase motivation;
• Start at the beginning of a particular subscale (easiest item) rather than the
age-suggested starting point to create behavioral momentum;
• Take frequent breaks; Use tangible reinforcers;
• Use a multiple-choice or fill-in-the-blank formats rather than an open-ended;
• Paraphrase instructions and/or simplify language to match child’s level;
• Use terms and phrases that are familiar to the child (e.g., “match” vs. “find me
another one just like this”);
PROCESS COMPONENTS
• REED
• Complete Evaluation Components
• Determination of Eligibility
• Evaluation Report
• IEP
Clinton County
RESA Example
Meeting Mechanics
Review Information / Data using 4 quadrants
Differential Eligibility
Note-taking / Beginning of Report Writing
Any more information needed to make determination?
RESULTS REVIEW MEETING
• Only Eval Team present (Psy, SSW, SLP)
• List all 12 criteria on board
• Color code information (teacher, parent, eval team)
• Ask BIG question in each area: Is there a qualitative
impairment in socialization?...
• Discuss each criterion; check criterion that has been
reached
• Report writer (on computer)
GO TO THE BOARD!
Communication
Reciprocal Social
Interaction
Restrictive and Repetitive
Behaviors
Sensory
DETERMINING ELIGIBILITY
• Start with the child, not the characteristics
• Integrate quantitative & qualitative
information
• Within qualitative assessment, discover
whether student meets criteria for Autism
Spectrum Disorder
• “Preponderance of the evidence”
Centralized Evaluation Team Evaluation Form
TAKE
NOTES
Student’s Name:_______DREW__________________ Date:__________
CET: Pam, Kathy, Kelly
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

Social
home/parent report staff observation:
Brother / tolerates but on own terms
school recess / tolerates-proximitylone acts
integrated with peers at recess
unifix—peers approached
wiggles—by himself
compartmentalizes people and need
unifix cubes
no response to other students
verbally
greeting others?? Just naming??
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Communication
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Parent reports—request action
Single words “no”-respond to
demand
Limited verbal interaction
Physically directs others to
communicate
No response to other students
verbally
Echolalia—repeats last word
someone says
Mumbles songs / cartoons
Behavior
unifix—interacting with Mr.
Wiggles? – followed a routine
(unique to doll-scripted)
Plays out script when dressing up
(not imaginary)
Certain people for certain needs
Thomas the tank throughout the
house
Intrusive: all over the house
Noticed when change occurred with
location of items
Movies with plots / plays out plot
with figures—very elaborate
Uses unifix cubes
Wiggles not available / imaginative
play?
Recess interrupted –putting clothes
in order
Lined up food / stabbed food number
of times before taking a bite
Work tasks—required prompting
Completes highly preferred activities
Plays out plot from movies with
figures
Unifix cubes
Sensory


Clothes – orderly, summer (long
pants) winter (shorts)
Takes off clothes at home and wraps
self in blankets
ASD EVALUATION TEAM – RESULTS REVIEW MEETING TEMPLATE
SOCIAL: Qualitative impairments in reciprocal social interactions including at least 2 of the following 4 areas:
SOCIAL
1
Parent
Marked impairment in use of multiple nonverbal
behaviors to regulate social interactions 3/4
SOCIAL
2
Parent
Teacher
Teacher
Evaluation
Team
Evaluation
Team
Failure to develop peer relationships
appropriate to developmental level.
RESULTS REVIEW MEETING CONT…
• Process
• All data sources
• Determine eligibility / DECISION
• If eligible as ASD, determine how the ASD is impacting
progress in gen ed in the areas of socialization,
independence, communication, transition, self-regulation…
• Feedback/recommendations provided to building
team, parents, coach, sped rep
Of primary concern is Johnny’s level of independence.
Due to difficulties in pragmatic language and
communication, sensory modulation, and socialization,
Johnny’s independence is limited. In order to participate
with the routines and activities of the classroom, Johnny
currently requires considerable physical and verbal
prompting from adults. His independence is significantly
impacted in the following areas:
•
Transition (task to task and place to place)
•
Group participation
•
Direction following
•
Self care
•
Interactions with peers
•
Outside play
•
Inside play with free choice time
•
Spontaneous conversation
PROCESS COMPONENTS
• REED
• Complete Evaluation Components
• Determination of Eligibility
• Evaluation Report
• IEP
CRITICAL REPORT CONSIDERATIONS
• Write ONE Report
• Customize to the M.E.T. Form ( ASD Criteria)
• Build a case for your conclusion (e.g. you shouldn’t
get to end and question eligibility recommendation)
• Avoid “cut and paste” process (makes it challenging
to cohesively build a case)
• Use Persuasive Writing Skills
• Explain what does NOT align (e.g. standardized
scores, parent reports of behaviors, etc.)
REPORT ORGANIZATION
CONTEXTUALIZED REPORT
STRUCTURE
PROCESS COMPONENTS
• REED
• Complete Evaluation Components
• Determination of Eligibility
• Evaluation Report
• IEP
INFORMING THE IEP
Supplementary Aids & Services
PLAAFP Development Schedule Matrix Guide
This tool is intended to be used by IEP and behavioral planning teams to assist in goal development and identification of necessary supports and strategies.
Expectations &
Instructional Outcomes
Current Level of Skills
(Compared to Peers)
Current Supports,
Strategies & EBPs
Potential Goals &
Strategies Needed
In this column, identify the
expectations & instructional
outcomes for all students
during this part of the
schedule. Expectations and
instructional outcomes
include:
In this column, identify the
student’s performance,
compared to peers, in this
part of the schedule.
List in this column, all the
supports, strategies, and/or
supplementary aides and
services currently in place to
support the student. These
include but are not limited to:
In this column, based on
information in the previous
columns, list potential goal
areas (areas of need) and
additional strategies needed
for the student to
independently make adequate
progress in all areas.
Student Schedule
In this column, list the
student’s daily schedule
including all primary
activities, courses / classes
and/or transitions.
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Independence Skills
Social Interaction Skills
Communication Skills
Behavioral Skills
Academic Skills
including task initiation,
engagement, & output
For example, during
“arrival,” the instructional
outcomes may include
independently taking off
outerwear, getting materials
ready, taking a seat, and
completing morning work.
Also include in this section
any specific IEP goals
targeted during particular
times in the schedule for the
student with ASD.
Include the following:





Independent Skills
Social Interaction Skills
Communication Skills
Behavioral Response
Task Initiation,
Engagement, & Output
Deficits in these areas will be
targeted for intervention and
should be included in the last
column.

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Visual / Organizational
Supports / Strategies
Peer to Peer Supports
Functional
Communication System
Positive Behavioral
Interventions & Supports
Evidence-Based
Practices
Accommodations /
Modifications
Behavioral Response
Plan / Crisis Plan
Adult (Paraprofessional /
TA Support)
The PLAAFP
Present Levels of Academic Achievement
and Functional Performance
What about the ASD impacts access and progress in:
• The general education CURRICULUM
• General education ENVIRONMENTS (including social
skill development, independent skills, etc.)?
• Further education, employment, and independent living
THE IMPACT STATEMENT
IMPACT
How does the
ASD impact
access and
progress in
general
education
curriculum and
environments?
Due to Sean’s lack of reciprocity and restricted range of
interests, he does not independently engage in and
navigate the daily schedule and requires 6-7 verbal and
visual prompts by adults before following simple tasks.
He also does not independently get materials he needs
to complete classroom activities and tasks, and
requires up to 10 adult prompts to complete his
classroom work. As many as 6 times an hour, Sean
attempts to leave the classroom to seek out his
preferred activity (basketball) and as a result, he misses
instruction 3-4 times per day for 5-10 minutes.
.
AGENDA
• The New Evaluation Reality
• The Three Prongs of Educational
Eligibility
• Process Components
•
•
•
•
•
REED
Evaluation Components
Determination of Eligibility
Evaluation Report
IEP
• Differential Eligibility
Considerations
DIFFERENTIAL ELIGIBILITY
ECDD…SLI…CI…EI
• Don’t you think its ___________________?
CONSIDERATIONS FOR YOUNG
CHILDREN
• Given complexities and
range of developmental
changes, we need solid
understanding of typical
development and disorders
that mirror ASD in young
children
• Higher threshold for
determining communication,
social, and behavior
impairment may need to be
considered
CONSIDERATIONS FOR YOUNG
CHILDREN
• Not appropriate to recommend alternative
eligibility (such as SLI or ECDD) in order to
prolong or avoid the ASD eligibility
• According to MARSE, ECDD eligibility should
be used only when:
“primary delays cannot be differentiated
through existing criteria within [other eligibility
categories].”
• Policies that indicate age cutoffs for finding a
student eligible under the ASD classification
should also be eliminated.
EI (Emotional Impairment) Criteria
(1) Emotional impairment shall be determined through manifestation of
behavioral problems—
• Primarily in the affective domain---The affective domain involves the influence of
emotion on behavior and may include areas such as emotional stability and control,
interaction with, response to, and ability to work with others, and self-control. This item
implies that emotional and behavioral functioning departs from generally accepted and
developmentally appropriate norms.
• Over an extended period of time—Implies the student exhibits these behavioral
problems for at least ninety (90) school days. Selected period allows time for resolution
of situational responses as well as time for targeted interventions to be attempted. For
severe or dangerous behaviors, an abbreviated timeline may be needed (give rationale that
problem will continue without special education support).
• Which adversely affect the student’s education (implies pervasive and
marked impact (frequency, duration or intensity) in academic performance
or social functioning) to the extent that the student cannot profit from
learning experiences without special education support..
EI (Emotional Impairment) Criteria, cont.
The problems result in behaviors manifested by 1 or more of the
following characteristics:
a. Inability to build or maintain satisfactory interpersonal
relationships within the school environment. Interpersonal
relationships refer to developmentally appropriate actions and
reactions to peers and adults. To meet this criteria, a student should
demonstrate pervasive (generally all teachers and peers) aberrant
behaviors that occur at a greater frequency, intensity and duration for
others at that developmental level.
b. Inappropriate types of behavior or feelings under normal
circumstances. This criterion implies atypical behaviors for which no
observable reason exists. Mere misconduct or refusal to comply does
not qualify a student in this category. The pervasiveness and
frequency, intensity, and duration should also be considered.
EI (Emotional Impairment) Criteria, cont.
c. General pervasive mood of unhappiness or depression. This
criterion means a student must exhibit depressive symptomatology which
typically involves changes in all four major areas: (1) affective (emotions),
(2) motivation (loss of interest), (3) physical/motor functioning (e.g. weight /
appearance), and (4) cognition. Pervasiveness implies impact in almost all
aspects of a person’s life. NOTE: Aggression and non-compliance can
mask depression.
d. Tendency to develop physical symptoms or fears associated with
personal or school problems. First consider a student’s medical
condition before considering eligibility under this criterion. This criterion is
related to conditions like school phobia and other intense anxiety disorders
that result in physical symptomology and somatic complaints (e.g.
headache, tics, stomachache).
Example Characteristics
Inability to Maintain
Relationships
In ability to maintain
relationships due to:
• Responding
aggressively toward
others
• Short temper
• Starts fights
• Withdrawn
• Has intense
emotional
responses to typical
peer disagreements
• Demonstrates
inappropriate
sexual behaviors
• Seeks excessive
approval from
others
Inappropriate
Behaviors or Feelings
•
•
•
•
•
•
Over-reacts to
everyday
occurrences (i.e.
rage, excessive
laughter, hysterics)
Exhibits
catastrophic or
panic reactions to
everyday
occurrences
Demonstrates flat,
distorted or
excessive affect
Exhibits selfabusive behaviors
Exhibits delusions
and/or
hallucinations or
thought disorders
Demonstrates
extreme mood
swings
Unhappiness or
Depression
•
•
•
•
•
•
Decreased interest /
pleasure in
previously enjoyed
activities
Excessive guilt
and/or self-criticism
Expresses feelings
of extreme sadness
Predicts failure or
refuses to attempt
tasks (projects
hopelessness)
Demonstrates
agitation or lethargy
Difficulty
concentrating
and/or making
decisions
Physical Symptoms /
Fears
•
•
•
•
Chronic Somatic
complaints (i.e.
headaches,
stomach aches)
Intense anxiety not
associates with a
specific stimuli
Extreme fear in
response to a
specific stimuli
Panic reactions to
everyday
occurrences
EI (Emotional Impairment) Criteria, cont.
(2) Emotional impairment also includes students who, in addition to the
characteristics specified in subrule (1) of this rule, exhibit maladaptive
behaviors related to schizophrenia or similar disorders. The term
“emotional impairment” does not include persons who are socially
maladjusted, unless it is determined that the persons have an
emotional impairment.
What is Social Maladjustment?
• Not defined by federal or state departments or clinical literature
• Understanding is derived from the educational literature and practice,
administrative decisions and court interpretations
• Often associated with clinical Dx of CD, ODD, or Antisocial
• Definition Components:
–
–
–
–
Pervasive intentional behaviors that violate socially acceptable rules and norms
Accepting no responsibility for actions
Demonstrating little to no remorse
Blame and intimidate / charm others while manipulating the situation to meet own needs
ASD vs. EI / SM
• BEHAVIORS:
– Refusal to do academic work
– Not following school expectations / rules
– Aggression toward peers
• DISTINGUISH BETWEEN:
– I don’t care about your rule vs. I don’t understand the
rules and the rules frequently change;
– ODD vs. I already know how to do this and if I know,
then you should know;
– I don’t care about your thoughts or feelings vs. I
don’t understand you have different thoughts or
feelings from me.
Preponderance of Evidence
Compare & Contrast
The Results Review Meeting
Social
Communication
Behavior
Sensory
OTHER
Preponderance of Evidence
Compare & Contrast Developmental History
ASD
• Developmental delays (e.g.
language, joint attention)
• Uneven development
• Unusual skills / interests (e.g.
door hinges, refrigerator letters
– making words)
EI
• Family history / concerns
• Hyperactivity
• Emotional extremes outside
typical developmental norms
• Ritualistic
• Nuance in restricted nature /
rituals
• Sophistication above
developmental level
CAUTION: Wrong Dx
Compare & Contrast History of Interventions
• Visual
Supports
• Social Facts
• Self
Management
• Social
Reinforcement
• Counseling
Compare / Contrast Specific Behaviors
Social Maladjustment vs. ASD
Social Maladjustment
– Pervasive intentional behaviors that violate socially
acceptable rules and norms
– Accepting no responsibility for actions
– Demonstrating little to no remorse
– Blame and intimidate / charm others while
manipulating the situation to meet own needs
• EXAMPLE: Jonathon
Preponderance of Evidence
Compare & Contrast Characteristics
COGNITIVE IMPAIRMENT
(1) Cognitive impairment shall be manifested during
the developmental period and be determined
through the demonstration of all of the following
behavioral characteristics:
(a) Development at a rate at or below approximately 2
standard deviations below the mean as determined through
intellectual assessment.
(b) Scores approximately within the lowest 6 percentiles on a
standardized test in reading and arithmetic. This requirement
will not apply if the student is not of an age, grade, or mental
age appropriate for formal or standardized achievement
tests.
(c) Lack of development primarily in the cognitive domain.
(d) Impairment of adaptive behavior.
(e) Adversely affects a student’s educational performance.
Making a Final Decision
• Preponderance of Evidence
• No one behavior includes or excludes
any specific eligibility area:
– There are always going to be instances that don’t fit
the criteria!!
– MUST explain what does not align
– MUST build a case for your conclusion
– However & Despite
• Intelligent People can Disagree!!
What if there is disagreement?
(e.g. Medical says “yes” and School says “no”)
• Remember, different purposes (diagnosis
versus special education eligibility and IEP
development)
• Adherence to strong evaluation process, report
is defendable
• Commitment to communication
• Make sure to meet student needs
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
Implementation of Universal Supports
Use of SW-PBIS practices
Selected References
• MARSE Rules
• ISD Guidelines for Determining Eligibility of Emotional
Impairment
– Macomb
– Char-Em
– Ottawa
• OCALI Online Identification Module
• Other State Guidelines
• NATTAP (Network of Autism Training and Technical
Assistance Providers) 2008 Conference Session
“Compare and Contrast EBD & ASD”—Columbus, OH
• Trammell, B., et.al. (2013) Assessment and Differential
Diagnosis of Comorbid Conditions in Adolescents and
Adults with ASD. Psychology in the Schools, 5 (9).