Assessment of Students with High Functioning Autism and Aspergers Syndrome

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Assessment of Students with High Functioning
Autism and Aspergers Syndrome

• Terri Carrington, M.A., CCC-SLP

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Implications for Living

• Quality of Life for Adults with Autism,
  Aspergers 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 Aspergers
• 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 Aspergers and
  PDD-NOS

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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

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Educational Impact

• Paradoxical nature of Aspergers 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 Aspergers Syndrome by Diane
  Twachtman-Cullen on O.A.S.I.S On-line Aspergers
  Syndrome Information and Support

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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

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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?

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AR Required Evaluation Data

• Social History
• Individual Intelligence
• Individual Achievement
• Adaptive Behavior
• Communicative Abilities (receptive/expressive)
• Other
• Observation
• Medical

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Social History and HFA/Aspergers

• 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.

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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

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Individual Achievement Assessment

• Results may vary according to students 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

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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

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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

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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)

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Formal Assessments

• Most Formal Assessments consist of observational
  and interview information which is assigned some
  sort of rating and indicates a likelihood of
  Aspergers 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.

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Formal AssessmentsExamples

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

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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

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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 SpeechChild/Adolescent
• Module 4-Fluent SpeechAdolescent/Adult
• Requires specific training and materials are
  expensive

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Autism Screening Instrument for Educational
Planning (ASIEP-2)

• 18 months through adult
• Five components
• Sensory
• Relating
• Body concept
• Language
• Social, self-help

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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

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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.

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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

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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

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Assessment of Social Skills

• Recognizing the qualitative social
  deficitusually 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

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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 ones bank of social
  knowledge.
• Formulate a response inside ones head based on
  the above, after considering several possible
  options.

• Draw upon ones 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

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Social Skills Rating System (SSRS)

• Three rating forms
• Teacher
• Parent
• student
• Three Scales
• Social Skills Scale
• Problem Behaviors Scale
• Academic Competence Scale

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Test of Problem Solving-3

• Six subtests
• Making Inferences
• Predicting
• Determining Causes
• Sequencing
• Negative Questions
• Problem Solving

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Test of Pragmatic Languge-2(TOPL)

• Ages 6 to 18
• Analysis of social communication in context

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Parents 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

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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 persons
  ability to deal with specific communication
  challenges
• Indiana Resource Center for Autism (IRCA
  Articles) Can Social Pragmatic Skills Be Tested?
  By Beverly Vicker

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The Work of Michelle Garcia Winner

• Observing the student with his peers and in
  different environmental contexts
• Interacting with the student without facilitating
  the students social success
• Informal assessment tools
• Administering carefully considered standardized
  measures
• Interviewing teachers and peers
• www.socialthinking.com