Class2 Tsatsanis CLEAR

8/10/2019 Class2 Tsatsanis CLEAR

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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



Per$asi$e De$elo%mentalDisorders

Communication

Restricted andRe%etiti$e 'eha$iors

Reci%rocal SocialInteraction



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



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



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



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



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



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)



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



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



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



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



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



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



and at the Su&test Le$el

&'&&&*+./'&

WISCIII

&

&'0

&

+0

'&

12D &134A '1AS

!ean of Subtest Scores



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



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*



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



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



<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.':



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



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



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



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?



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 (')



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



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,



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+



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.



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



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



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



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




• 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




• 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



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



<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



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



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



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



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)



!han- #ouF

Yale Child Stud# Center

Autism Pro)ram

autism+m

Documents

Class2 Tsatsanis CLEAR