class2 tsatsanis clear
TRANSCRIPT
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 1/42
Autism and Related
Disorders:
CHLD 350a/PSYC350
Lecture II: Assessment
Katherine D !satsanis" PhD
Yale Child Stud# Center
Clinical Director"
De$elo%mental Disa&ilities Clinic
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 2/42
Per$asi$e De$elo%mentalDisorders
Communication
Restricted andRe%etiti$e 'eha$iors
Reci%rocal SocialInteraction
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 3/42
Per$asi$e De$elo%mentalDisorders
Im%airments in:a (on$er&al &eha$iors: e#e
)a*e" +acial e,%ression"&od# %ostures" and)estures to re)ulatesocial interaction
& Peer relationshi%s
c See-in) to shareen.o#ment" interests" orachie$ements ith other%eo%le
d Social or emotionalreci%rocit#
a Dela# in" or lac- o+de$elo%ment o+" s%o-enlan)ua)e
& Im%airment in the a&ilit# toinitiate or sustain acon$ersation ith others
c Stereot#%ed and re%etiti$e
use o+ lan)ua)e oridios#ncratic lan)ua)e
d Lac- o+ $aried" s%ontaneousma-e&elie$e %la#
•1otor stereot#%ies
•Re%etiti$e &eha$iors
•(arro Interests
•Rituals" routines
•Preoccu%ation ith %arts o+
o&.ects
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 4/42
Autistic
Disorder
(Autism)
Pervasive
Developmental
Disorder, NOS
(PDD-NOS)
Asperger’s
Disorder
Pervasive Developmental Disorders/Autism Spectrum Disorders
Childhood Disintegrative Disorder
Rett’s Disorder
Dia)nosis
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 5/42
AssessmentCase 2,am%le: Ro&ert a)e 0
Am 4 Ps#chiatr#" ol-mar et al" 56789" 8886
Auto&io)ra%hical Statement
1# name is Ro&ert I am an intelli)ent"
unsocia&le &ut ada%ta&le %erson I ouldli-e to dis%el an# untrue rumors a&out
me I cannot +l# I cannot use tele-inesis
1# &rain is not lar)e enou)h to destro#
the entire orld hen un+olded I did notteach m# lon)haired )uinea %i)" Chronos" toeat e$er#thin) in si)ht 7that is the nature o+the lon)haired )uinea %i)9
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 6/42
Com%rehensi$e Assessment1odel
• 1ultidisci%linar# team• Assess multi%le areas o+ +unctionin)
• Collect in+ormation across a $ariet# o+
settin)s
• Pro$ide a sin)le coherent $ie
• Pro$ide im%lications +or ada%tation and
learnin)
• Communicate ith schools and outside
%ro$iders to su%%ort im%lementation o+
recommendations
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 7/42
De$elo%mental Histor#
* Psychologists, Psychiatrists, Social WorkersCo)niti$e/De$elo%mental/'eha$ioral
* Psychologists
Dia)nostic Assessment
* Psychologists, Psychiatrists
S%eech" Lan)ua)e" ; Communication
* Speech & Language Pathologists
Assessment o+ Sensor# and 1otor S-ills
* Occupational Therapists, Physical Therapists
S%eciali*ed 1edical 2$aluations
* Neurologists, Geneticists, GI
(euro%s#cholo)ical" Academic" ocational 2$aluations
* Psychologists, Educational and ocational Specialists
1ultiDisci%linar# Assessments
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 8/42
De$elo%mental Histor#
* Psychologists, Psychiatrists, Social WorkersCo)niti$e/De$elo%mental/'eha$ioral
* Psychologists
Dia)nostic Assessment
* Psychologists, Psychiatrists
S%eech" Lan)ua)e" ; Communication
* Speech & Language Pathologists
Assessment o+ Sensor# and 1otor S-ills
* Occupational Therapists, Physical Therapists
S%eciali*ed 1edical 2$aluations
* Neurologists, Geneticists, GI
(euro%s#cholo)ical" Academic" ocational 2$aluations
* Psychologists, Educational and ocational Specialists
1ulti%le Areas o+ <unctionin)
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 9/42
Across Settin)s
• Collection o+ in+ormation throu)ho&ser$ation" inter$ie" and/or
=uestionnaires
• Across a $ariet# o+ settin)s such as
home" school" and communit#
• Role +or %arent o&ser$ation
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 10/42
Parent >&ser$ation
• Is this an accurate re%resentation o+child?s &eha$ior/-noled)e &ase
• Le$el o+ e++ort/com%liance
• @nderstandin) and acce%tin) $alidit#
o+ results
• Shared o&ser$ations
• Parental %ers%ecti$es
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 11/42
Histor#
•Developmental history, behavioral history,educational history, family history, history of
treatment/interventions
• Importance for diagnosis and for differential
diagnosis
• How to obtain developmental history?
– Clinical intervie
– !ecord revie
– "ideo recordings
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 12/42
Co)niti$e Assessment
• Le$els o+ co)niti$e +unctionin)
• Pro+iles o+ co)niti$e +unctionin)
• Im%lications +or test selection"
inter%retation" and inter$ention
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 13/42
Le!els o+ Co)niti$e<unctionin)
55 70 5 !00 !!5 !"0 !#5
$" $% $! 0 ! % "
MEAN = 100
STANDARD DEVIATION = +/- 15
Appro&' 70$75(o) individualsith autism
Appro& #5( o) individuals ith ASD
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 14/42
5597-107102Full Scale*
160-7865Processing Speed
4791-10799Working Memory
6698-11106Percep!ual"easoning
96118-11126#er$al%ompre&ension
Percentil
e Rank
Confdence
Interval
Standar
d Score
WISC-IV Index/I
#$mportant not to interpret $% score in isolation
Pro"iles: Scatter is common
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 15/42
and at the Su&test Le$el
&'&&&*+./'&
WISCIII
&
&'0
&
+0
'&
12D &134A '1AS
!ean of Subtest Scores
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 16/42
Common !est 'atteries:
* Wechsler Scales (WPPSI-III; WISC-IV; WAIS-III)
* Differential Ability Scales, Second dition (DAS-!)
* "aufman Assessment #attery for Children, Seconddition ("-A#C!)
* Stanford-#inet, $ th dition (S#-$)
(on$er&al 1easure:
* %eiter International Performance Scale & 'eised
(%eiter-')
De$elo%mental Assessments:
* ullen Scales of arly %earnin* (birth to + months)
* #ayley Scales of Infant Deeloment, .rd dition +!month to #% months,
2,am%les o+ Co)niti$e1easures
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 17/42
Selection 7and Inter%retation9o+ Co)niti$e 1easure
• Le$el o+ lan)ua)e s-ills re=uired
• De)ree o+ com%le,it# o+ instructionsand tas-s
• Le$el o+ structure
• 2,tent o+ social demands
• @se o+ timed tas-s
• Le$el o+ motor in$ol$ement
*-a. optimie or diminish per)ormance*
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 18/42
Anal#sis and Inter%retation
>&ser$ations are im%ortant too
• (um&ers #ielded are im%ortant &ut
also interested in ho the score as
o&tained
• Inte)ration o+ o&ser$ations and
thorou)h -noled)e o+ histor# as ell
as other $aria&les that mi)ht im%act
%er+ormance 7e)" +ati)ue" illness" and%rimar# lan)ua)e in the home other
than 2n)lish" etc9
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 19/42
Categor. luenc.
!he cate)or# is animals
7 .r old girl ith AS7 .r old girl ith ASSul)ur crested coc1atooSul)ur crested coc1atoo
Chesapea1e 2a. retrieverChesapea1e 2a. retriever
3og nose viper3og nose viper
Desert tortoise4Desert tortoise4
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 20/42
<rames the 2$aluation
• Co)niti$e 7(on$er&al9: SS B 80
• er&al: SS B 0
• Ada%ti$e 7Social9: SS B8
• <riendshi% res%onse 7AD>S9:
6 realie that it is ala.s a truce 2e)ore theo))icial )riendship' 6t’s ver. di))icult to e&plain2ut 6 ma1e all the rules i) the. )ollo therules it ill guide them toard a path o))riendship' 8ut people are getting moreslipper. i) .ou tell them the rules9 the.)ollo them deli2eratel.':
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 21/42
Im%lications +or Dia)nosis
• <rames the e$aluation ;'g'9 CA < # .ears= -A < % .ears= Social
unctioning < % .ears
• Identi+ies %resence/a&sence o+
si)ni+icant de$elo%mental dela#s Autism vs Asperger’s disorder diagnosis
• In+orms hether the child has an Intellectual #isa$ility
In con/unction 0ith assessment ofadatie behaior
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 22/42
Im%lications +or Inter$ention
Identi+#in) stren)ths/ea-nesses
in+orms inter$ention: • Areas o+ ea-ness/challen)e hel% to de+ine
)oals/o&.ecti$es +or the child ;'g'9 CA < .ears= -A < % .ears= Set goals and
e&pectations to meet child at current level o)
)unctioning• Areas o+ ea-ness/challen)e hel% to account +oras%ects o+ &eha$ioral %resentation ;'g'9 Child appears inattentive9 does not )ollo
through on directions assessment shos poorver2al comprehension despite good e&pressivevoca2ular.
• Areas o+ stren)th are e=uall# to im%ortant toidenti+# as these can &e used to hel%accommodate areas o+ ea-ness ;'g'9 >isual ? >er2al @se visual strategies to
support communication
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 23/42
Lan)ua)e ; CommunicationAssessment
• (ot onl# the +ormal as%ects o+ lan)ua)e
e,%ression and com%rehension
• And at#%ical +eatures: 2)" 2cholalia" %ronoun
re$ersal" scri%ted lan)ua)e
• 'ut also:
Prosod# 7e)" in+lection" $olume" re)ister9
>ther non$er&al +orms o+ communication
7e)" )estures" e#e contact9
!he use o+ lan)ua)e +or 7social9
communication
A%%reciation o+ nonliteral lan)ua)e
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 24/42
Ada%ti$e 'eha$ior
• Definition" capacity for personal and social
selfsufficiency in reallife situations /
independent living s#ills
• Importance" clinic and representative
environments
• What if intelligence is greater than adaptive
s#ills?
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 25/42
Realli+e 7ada%ti$e +unctionin)9 in hi)her+unctionin) indi$iduals ith autism and
PDDs
• Autism" AS" and PDD(>S
• (B5• 1ean A)e: 8 #ears 7SD 89 7Ran)e to
#ears9• 1ean er&al IE: 03 7SD 839
• 1ean Sociali*ation Score 7ineland9: 58 7SD89
• 1ean Inter%ersonal A)e 2=ui$alent:
3 #ears 7SD 6 #ears9
4rom 5lin, Saulnier, Sparro, Cicc6etti, 7ord 8 "ol9mar (')
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 26/42
ineland Ada%ti$e 'eha$ior Scales"8nd 2dition 7inelandII9
5 domains o+ ada%ti$e +unctionin)• Communication
• Dail# Li$in) S-ills
• Sociali*ation
• 1otor
• 1alada%ti$e 'eha$ior
3 editions: sur$e#" e,%anded"classroom
1easurin) Ada%ti$e 'eha$ior
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 27/42
Im%lications +or Inter$ention
• Social disa&ilit# 7AD>S9 and a&ilit# 7ineland9:to relati$el# dissociated domainsFF
• Social a&ilit# is ne)ati$el# correlated ith a)e7decline relati$e to %eers" relati$e to increasin)demands o+ the en$ironment9
• >+ten %ro)rams em%hasi*e reduction o+s#m%toms
• Conclusion Prioritie adaptive )unctioning +R;AB$B6;S6BBS,
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 28/42
Assessment o+ S#m%toms
* Parent Re%ort
* %odi"ied hecklist "or 'utis( in Toddlers 71
CHA!9G Social Communication Euestionnaire
7SCE9G Social Res%onsi$eness Scale 7SRS9
* !eacher Re%ort
* 'utis( )eha!ior hecklist ')+, SS
* Parent Inter$ie
* 'utis( #iagnostic Inter!ie- e!ised '#I.+
* Child >&ser$ation and Ratin)
* hildhood 'utis( ating Scale 'S+
* 'utis( #iagnostic O$ser!ation Schedule
'#OS+
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 29/42
Autism Dia)nostic Inter$ieRe$ised
7ADIR9(%ord et al1, 2334)
* Semi$structured9 investigator$2asedintervie )or caregivers
* riginall. developed as a researchinstrument9 2ut clinicall. use)ul
* e.ed to DS-$6>/6CD$!0 Criteria
* Considera2le training needed )or use
* 'eliability must be established
* Eood in)ormation on relia2ilit. andvalidit.
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 30/42
Fhe Autism Diagnostic2servation Schedule +ADS,
* @nstructured %la# assessment elicitschild?s on initiations
* Social initiations9 pla.9 gestures9 reGuests9 e.econtact9 Hoint attention9 etc' pressed )or9 o2served9 Icoded 2. e&aminer
* ;&aminer pulls )or target 2ehaviors through speci)icuse o) to.s9 activities9 I intervie Guestions
* Stereot.pical 2ehaviors9 sensor. sensitivities9a2errant 2ehaviors also o2served I coded
* Dia)nostic <ormulation
* # -odules 2ased on communication level* 6tems coded on a #$point severit. rating scale
* Diagnostic Algorithm Autism9 ASD9 non-ASD
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 31/42
Di++erential Dia)nosis
• Autism" As%er)er s#ndrome" otherPDDs
• Intellectual Disa&ilit#
• Lan)ua)e Disorders
• >&sessi$e Com%ulsi$e Disorder
• Schi*o%hrenia
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 32/42
DS1I!R Criteria +or PDDs
Autism
Asperger
disorder
PDD-
NOS
A:normalities
in !eciprocal
Social$nteraction
Communication
$mpairments
!estricted,
!epetitive,
Stereot;pedPatterns o<
=e6avior
Onset
> / ;ears?
A:normal
language, social
attac6ments, or
pla;
Single ords :; ';ears@ P6rases :; /;ears@ No adaptive:e6avior de<icits
:e<ore / ;ears
None speci<ied@
Possi:l; late age
o< onset group
Bo
o
Bo
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 33/42
Clinical <eatures o+ Autism and AS
$High %unctioning& 'utism
• Sociall; isolated it6
limited social interest@ littlesocial c6at@ aloo< andresist interactions
• Passive :ut acceptinteractions 6en ot6erspress on t6em andstructure t6e interaction
• 7ittle initiation@ reducedsee9ing 6elp or com<ort
'sperger Disorder
•Sociall; isolated :ut not it6dran
in t6e presence o< ot6ers• Approac6 ot6ers :ut in an
inappropriate <as6ion@ ma; epress
interest in <riends6ips•a; :e a:le to descri:e ot6er’s
emotions, intentions, social
conventions :ut do not act on t6is9noledge in spontaneous or
intuitive manner
!eciprocal Social $nteractions
C i ti
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 34/42
$High %unctioning& 'utism
• A:sent or dela;ed language
• c6olalia, pronoun reversal@reliance on scripted language
• C6aracteristic monotonespeec6 pattern
• Povert; o< speec6@ :rie<responses
• !espondent role incommunication
• !educed conventionalgestures@ gaEe and pointing<or instrumental purposes
'sperger Disorder
• Preserved earl; language 8 <ormal
language s9ills• Speec6 nota:le <or rate
and volume• ar9ed ver:osit;• 2angential@ looseness
• one-sided st;le
• <ailure to provide contet• does not mar9 topic c6anges• <ailure to suppress vocal outputaccompan;ing internal t6oug6ts• li9el; to 6ear same monologueacross peopleBsettings
• $nitiators :ut do not <ollo ot6er’slead or reFuest <or in<ormation• 4ormal, pedantic Fualit;• aggerated gestures
Communication
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 35/42
$High %unctioning& 'utism
• Stereot;ped, restrictedpatterns o< interest
• Preoccupation it6
unusual aspects o<o:Gects in pla;• !igid ad6erence to
non<unctional routines• Stereot;ped, repetitive
motor mannerisms
• Splinter s9ills – spatial,mec6anical
'sperger Disorder
• All a:sor:ing special
interests, amass in<ormation• 7ess li9el; to see
preoccupation it6 parts o<o:Gects• =e6avioral rigidit;@
resistance to c6ange• 7ess pronounced motor
mannerisms• cellent rote 9noledge
=e6aviors
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 36/42
Di++erential Dia)nosis
• Autism" As%er)er s#ndrome" otherPDDs
• Intellectual Disa&ilit#
• Lan)ua)e Disorders
• >&sessi$e Com%ulsi$e Disorder
• Schi*o%hrenia
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 37/42
<urther Assessments
• 'eha$ioral >&ser$ation
Jith adult
Jith peers
At home
6n communit.
• 'eha$ioral Assessment
• (euro%s#cholo)ical Assessment
• >ccu%ational !hera%# Assessment
Sensor. and -otor
• Academic S-ills
• 1edical: (eurolo)#" )enetics" hearin)" etc
• ocational
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 38/42
6mportance o) Assessment
• Dia)nosis
– mp6asis on individual pro<iles, not Gust t6e la:el – 3oever, importance o< la:els
• Access to Ser$ices
School ;ducational Classi)ication $$ 6D;A categories
Eovernment Agencies Department o) Developmental
Services +ormerl. D-R, Eovernment Resources 'nichd'nih'gov/autism=
'nimh'nih'gov/pu2licat/autism'pd)
Kational Resources e'g'9 Autism Spea1s+'autismspea1s'org,
Communit. Resources e'g'9 Autism Spectrum Resource
Center +'ct$asrc'org,• !reatment/Inter$ention
Assessment )irst step toard developing treatment goalsand intervention planning
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 39/42
vervie o) AssessmentProcess
* Fa1ing Fhorough 3istor.
* ;sta2lishing Developmental9 Cognitive9I Banguage 8aseline
* Assessing S.mptoms o) Autism* Social9 8ehavioral9 I Pla. Presentation
* Adaptive unctioning
* -edical 6ssues I Comor2idit.
* Sensor. I -otor unctioning
* Keurops.chological9 Academic9>ocational
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 40/42
6mportant 6ssues in Assessment o)ASD
• >aried leels o) )unctioning• >aried rofiles o) )unctioning
• Per)ormance ma. var. according to level o)structure9 t.pes o) demands
• Presentation ma. change over time• Presentation ma. change across settings
Fhus assessment o) ASDs is comprehensive
$$ involves multiple disciplines9 measures o)a2ilit. and disa2ilit.9 and collection o)in)ormation across people and conte&ts
8/10/2019 Class2 Tsatsanis CLEAR
http://slidepdf.com/reader/full/class2-tsatsanis-clear 41/42
Comprehensive Assessment -odel
• 1ultidisci%linar# team
• Assess multi%le areas o+ +unctionin)
• Collect in+ormation across a $ariet# o+
settin)s
• Pro$ide a sin)le coherent $ie
• Communicate ith schools and outside
%ro$iders to su%%ort im%lementation o+
recommendations• Pro$ide im%lications +or ada%tation and
learnin)