best practices in asd assessment 1
DESCRIPTION
TRANSCRIPT
Assessment of Children with Autistic Spectrum Disorders: Best Practices
for Educators
Kristine Strong, Ph.D.,LEP #2314
Copyright 2012
Goals of the Workshop
Increase knowledge and awareness of effective assessment tools and methods for ASD
Develop understanding about multidisciplinary assessment teams
Develop understanding about the importance of the parent - school relationship and working effectively with parents
Learn about current evidence based practices Develop skills in IEP development
3
ASD Is A “Spectrum” Disorder
“Spectrum” ranges from mild (more able) to severe (less able). Mild = High-functioning Autism (HFA),
Asperger’s Syndrome, PDD, PDD-NOS Moderate = Classic Autism (As described by
Kanner) Severe = Autism with other collateral
conditions such as MR and seizures, Retts Disorder(females only), Childhood Disintegrative Disorder (rare), Landau-Kleffner Syndrome.
4
Statistics
Autism is increasing at an alarming rate. Department of Developmental
Services study: rates of autism have risen 210% in the past 10 years.
Increase of over 600% for Special Education eligibility under the autism category from 1994 to 2003 (US Dept of Ed).
5
Why the Increase?
1975 Education of the Handicapped Act identified “autism” and “pervasive developmental delay” as disabling categories. Prior to that change persons were labeled as MR.
DSM IV broadened the disability to include PDD-NOS, Autism and Asperger’s Syndrome.
1990 IDEA made autism a qualifying disability category. Many studies being conducted, with a causation model
including both genetic predisposition and environmental variables -- no one cause likely
The Anatomy of Autism
Neuro-imaging (fMRI and PET scans) indicate location of pathologyMultiple brain systems and brain functions are impacted by this disorder
Three Types of Autism?
Autism is considered to have a strong genetic component.
Pattern of onset may be related to specific type of autism: Predominant language
regression Predominant social
regression Early onset in both social
and language development
Center for Excellence in Developmental Disabilities UC Davis MIND research:
Interactive models of ASD include multiple environmental variables and gene interactions.
Deviation In:
Hippocampus and amygdala (emotional regulation and memory)
Cerebellum (motor coordination, shifting attention, concept formation, sequencing, working memory, complex problem solving, sensory discrimination)
Deviations In:
Brain stem (brain/body communication, basic functions)
Brain size, growth pattern, and white matter (axons -cables connecting brain cells)
Brain microstructures, minicolumns are narrower and made up of smaller cells vs. normal brain
Neocortex Particularly frontal lobe (higher level thinking and executive
functions, early speech acquisition, and integration of information)
temporal lobes (auditory processing)
Understanding Autism Spectrum Disorders Neurobiological differences lead to deficits in social
perception, theory of mind and social relatedness, that in turn lead to problem situations for group learning, peer interactions, and student-teacher interactions in school.
Problem behaviors are a result of known neurobiological differences and environmental influences but can be addressed through active, direct teaching of adaptive social skills and problem solving skills.
Social-Emotional Implications of autism spectrum disorders Few or no close friends--limited social
interests Avoidance of socially demanding situations Difficulty sensing or interpreting emotions in
self and others Greater likelihood of also having anxiety
and/or depression
Social and Emotional ImplicationsImpaired non-verbal communication,
including limited facial expressions
Impaired pragmatic language, including lack of cohesion to conversation
An inability to engage in goal-directed, future-oriented behaviors including: planning, flexibility, organized search, self-monitoring, and use of working memory.
Impaired Executive Functioning
“Behavior Problems” Associated With Executive DysfunctionNoncompliance Off Task Behaviors/Distractibility Inflexibility or RigidityProcrastination Prompt Dependence DisorganizationSocially Inappropriate Behaviors
Understanding HFA & AD cont.
Deficits in working memory, attention, and executive functioning, such as organization and planning, can lead to increased stressors in school, difficulty completing work, and escape and avoidance behaviors.
Remember, behaviors happen for a reason and are likely in large part a symptom of these underlying deficits and lack of adaptive skills to respond to these deficits.
ProblemBehavior
Core Neuro -Developmental Deficits
PoorCopingSkills
Poor SocialSkills
LackAdequatesupports
Model of Problem Behaviors
California Code of Regulations 3030 g:
A pupil exhibits any combination of the following autistic like behaviors, to include but not limited to: An inability to use oral language for appropriate
communication.A history of extreme withdrawal or relating to people inappropriately and continued impairment in social interaction from infancy through early childhood.
California Code cont.:
An obsession to maintain sameness.Extreme preoccupation with objects or inappropriate use of objects or both.
Extreme resistance to controlsDisplays peculiar motoric mannerisms and motility patterns.Self stimulating- ritualistic behavior.
19
DSM IV Diagnosis of Autism Spectrum DisordersA. 1. Social Interactions (Must have at least 2 of the following)
Impaired use of nonverbal behaviors Impaired peer relations Limited sharing of enjoyment limited social or emotional reciprocity
2. Communication (Must have at least 1 of the following) Delay of development of spoken language Impairment in conversation Repetitive use of language or idiosyncratic language and
prosody Lack of varied make believe play
3. Restrictive and Repetitive/Stereotyped Patterns of Behavior (Must have at least 1 of the following) Restricted interests Adherence to nonfunctional routines Stereotyped motor mannerisms Preoccupation with parts of objects
20
DSM IV Diagnosis for Autism Cont.
B. Delays or abnormal functioning in at least one of the following areas:
1. Social Interaction 2. Language as used in social interactions 3. Symbolic or imaginative playThe disturbance is not accounted for by Rett’s orChildhood Disintegrative Disorder.
To be diagnosed with Autism, at least six symptoms from A (at least two from A1 and one each from A2 and A3), one from B, and C must be present.
To be diagnosed with PDD-NOS, disorders will be apparent in all areas (A-C), but some will be atypical or sub-threshold. This disorder is often recognized later than autism.
21
DSM IV Diagnosis of Asperger’s Syndrome (AS)
A. Social Interactions (Must have at least two of the following)
Impaired use of nonverbal behaviors Impaired peer relations Limited sharing of enjoyment Limited social or emotional reciprocity
B. Activities and Interests (Must have at least one of the following)
Restricted interests Adherence to nonfunctional routines Stereotyped motor mannerisms Preoccupation with parts of objects
22
DSM IV Criteria for Asperger’s Cont...C. The disturbance causes clinically significant impairment in
social, occupational, or other important functioning.D. There is no clinically significant general delay in language
(e.g. single words used by age 2, communicative phrases by age 3).
E. There is no clinically significant delay in cognitive development or in the development of age appropriate self help skills, adaptive behavior (other than social interaction), and curiosity about the environment in childhood.
F. The criterion are not met for other specific Pervasive Developmental Disorders or Schizophrenia.
Autism - utube videos
Samples of autistic like behaviors
What is Different about the Assessment of ASD vs. other Educational Categories?More comprehensive because of the
pervasive nature of the disorderRequires more specialists and service
providers, requiring increases in communication and collaboration--systemic challenges
An ASD requires more specialized services and increasingly more demands on educators to develop expertise in autism specific strategies
Educators Responsible for Ed. Code EligibilityAlthough the DSM-IV criteria are
important to know and use as a reference for determining “autistic like” behaviors, educators do not diagnose using the DSM-IV.
Autism specific measures use the DSM-IV diagnostic criteria as a part of their content validity - so need to be knowledgeable about DSM-IV criteria
What is Different cont.:
Adaptations for standardized tests, including use of structured reinforcement
Increased use of non-standardized assessment methods, including both natural and structured observations
Critical to differentiate between ASD and other disorders, such as ADHD, Emotional Disturbance, and Language Disorders--course of educational planning is different
Team Activity
What are the core deficits in children with ASD?
What do you already know about how to evaluate those areas?
What parts or aspects of ASD assessments do you believe are the most challenging?
Case Study: Bobby V.
Transitioning from Early Start2 years - 10 monthsRecent dx of ASDHighly verbalBrightConcurring assessment by NPAAdvocate already involved
Case Study cont.
Priority on parent-district relationshipHome visits, natural environment was
primary assessment settingCritical to respond to parent concernsLanguage evaluation utilized a range of
tools - on the surface he looked fineTeaming was critical - the team was
able to identify core deficits and needs-got agreement on our assessment
Goals of Assessment: Why do we assess? Establish eligibility
under Ed. Code. Identify student
unique needs that will lead to specific goals and objectives
Understanding unique needs directs team when determining FAPE
Good Data = Good Planning
Team who is knowledgeable about the child develops trust and credibility with agencies and families
Develop appropriate intervention plans
The Autism Assessment/Intervention TeamTeam Members should include a
Behavior Analyst, Behavior Specialist, Speech Therapist, Occupational Therapist, Classroom teacher, Special Education Teacher, Nurse, School Psychologist and Administrator.
The Assessment Process: Developmental Areas and the Trans-Disciplinary Model
Specialists collaborate to provide a multi-method assessment across developmental areas
Trans-disciplinary teams design assessment tasks and activities together for mutual benefit
The TDT generates rich information about the child leading to meaningful goals, integrated services, and a meaningful report to parents
Assessment Areas
Health and Medical Behavioral
assessment- baseline of behaviors that interfere with learning
Fine and Gross Motor
Sensori-Integration
Social - emotional Cognitive
functioning Adaptive Behaviors Communication Pre-academic and
academic areas
Assessment Methods
Developmental health history
Natural Observations
Structured Observations
Standardized Assessments
Parent InterviewReview of
records/reports
Developmental and Medical HistoryInitial eligibility assessment requires
extensive parent interview about the child’s early development and medical history.
Important to gather data on early signs of ASD, including, lack of gestures, little or no babbling, delayed language, lack of pointing, lack of interest in children, limited shared attention, lack of eye contact during feeding and games.
Developmental History cont.:
Feeding or sleeping problems Unusual sensory reactions, ie., noise or touch Unusual focus or attention toward limited
areas of interest Range of affect, flat vs. full range Verbal and nonverbal forms of
communication--intent to communicate needs Unusual motoric movements Fine and gross motor development
Natural Observations
Occur in several settings such as home, preschool/school or child care
Take place with no structured activities other than those that occur naturally within the setting
Important to observe on more than one occasion and by multiple observers
When possible, chose one or two “controls” to observe in relation to student, ie., Tommy completed the task at the same pace as his peers, but needed twice as many prompts
Structured Observations-Play Based Structured
observations provide specific tasks to be performed, such as putting puzzles together, imitation tasks, and pretend play activities
Activities are play based - interactive
Specific behaviors are elicited, including Reciprocal turn taking Pretend play Social reciprocity Imitation of novel acts Ability to be directed by examiners Use of toys and objects Use of spontaneous language Quality of spontaneous and prompted verbal and nonverbal
communication Play imitation Joint referencing Eye gaze, following a point Eye contact, seeking eye contact to gain attention of others
Play-based assessment
Toys and materials of interest to child’s age or mental age
Variety of toys to engage and illicit interest
Include books, musical toys, balls, cars, pretend play
Develop a play based assessment box or “tool kit”
Include toys that are sensory based, symbolic play, cause and effect, can be used to prompt imitation
Standardized Assessments: Uses and LimitationsStandardized assessments provide
objective data about broad functioning and abilities in specific developmental areas.
Important to cross reference standardized results with observation data and interview data to make relevant, as well as to point out where there are discrepancies.
Limitations to Standardized Tests ASD children often do not perform well on
these types of measures, and therefore they can underestimate their ability
Reliability is also an issue due to highly variable performance of skills
Note in your report the specific limitations of the results.
Parent Interview for Initial EligibilityCan be structured or informal -- strongly
recommend including a home visit.Use of structured interviews such as
The Autism Diagnostic Interview, R (ADI-R) (can be used for children through adults) is critical for establishing clear developmental clusters consistent with ASD.
Family Centered
Family centered format--this is often the first impression the family gets of educators.
Highly sensitive time for parents, make sure you provide ample time to answer their questions.
The Faces of Autism
Parent perspectives reflect the wide range of needs of children
with ASD and highlight the individual nature of autism.
Areas to Assess: Core Deficits
Reflect - what are the core deficits?
Comprehensive evaluations need to include all areas related to a suspected disability
What will most assessment plans need to consider?
Develop assessment plans with parent input.
Team Assessments
Set up stations such as, fine motor, pretend play, academic, sensory
Tag team - take turns observing and evaluating
Tag team - one team member with parent, two with child and then rotate.
Cognitive Assessment
Use good comprehensive tools: DAS-2, WPPSI-2, KABC-2,
Consider using processing tests, ie., WRAML-II for older children,and NEPSY - can use with 2 1/2 year olds, DAS-2
Note the type of support needed to learn a new task -- how many trials does the child need to learn new information?
Note processing profiles, visual memory vs. verbal
Cognitive cont.
With young children between 2 and 5, important to explain validity of results - IQ or cognitive functioning is not yet stable and can change especially following intensive program
Focus on the cognitive functioning and how areas of deficit may impact learning, ie., verbal processing deficits likely to impact ability to take teacher instruction in a large group
Important to let parents know the possibilities, such as mental retardation,processing challenges, while at the same time recognizing that cognition is difficult to determine at a young age, and need to see how child will respond to intervention.
Cognitive cont.
Case Study: Mark
Six year old still in preschool NPA program Transition to school Standardized evaluation difficult Standardized results indicate moderate MR,
however, adaptive skills and academic skills indicate much higher functioning.
Following transition, child is now reading and able to access general education setting.
Adaptive Behavior
Parent and teacher interview are integral to a comprehensive assessment and often lead to specific needs to generate goals and objectives.
Cross reference adaptive behavior with other areas of functioning -- are there discrepancies?
How much support does the student need to perform these tasks?
Use standardized questionnaires, such as Vineland, to establish baseline and to provide objective data on the student’s development.
Fine and Gross Motor
Fine and gross motor deficits are often deficit areas in children with ASD, often requiring direct assessment and intervention.
Occupational Therapists are best equipped to provide a comprehensive assessment of these two areas, in addition to sensory issues.
Observe child’s grasp, use of writing and drawing tools, visual-perceptual issues, motor planning, and ability to keep up with written motor tasks - pace of instruction.
Behavior & ASD Specific Measures: Use of standardized measures:
BASC-2 Achenbach Child Behavior Checklist Childhood Autism Rating Scale - 2 (CARS-2)--very
strong validity Gilliam ARS (moderate validity) Social Responsiveness Scale -ages 4 and up Autism Diagnostic Observation Schedule (ADOS) The Autism Diagnostic Interview-R (ADI-R)--
highest validity
Determine Interfering Behaviors
Observation and data collection: Target behaviors, or interfering behaviors,
level of intensity, frequency, impact on learning
Critical to gather baseline data on target behaviors, determine if a BSP is needed or FAA
Tools Looking at “Autistic Like Behaviors”Solid Psychometric Support
The Autism Diagnostic Interview-R (ADI-R)Social Communication Questionnaire (SCQ)
Sufficient SupportChildhood Autism Rating Scales (CARS)Social Responsiveness Scales (SRS)
Adequate Support Autism Diagnostic Observation Schedule (ADOS)Child Behavior Checklist (CBC)Psycho-educational Profile -R (PEP-R)
Modest SupportAutism Behavior ChecklistGilliam Autism Rating Scales (GARS)Asperger’s Syndrome Diagnostic Interview (ASDI)
A Closer Look at the CARS 2
CARS 2 has high reliability and validity
Utilizes three data points: observation in multiple environments, parent survey/interview/ and teacher survey and interview
Group Think
Sample Reports: Jigsaw in groups of 3 How are ASD
specific issues addressed?
What would you add/change?
Your concerns questions about addressing ASD specific behaviors
Assessment Environment“When clinically indicated, observations of a child in
various settings and at different times increases the validity of information obtained and assists in diagnosis, case management and intervention.”
Looking at the child in multiple environments is beneficial and necessary
Home, preschool, playground, backyard, daycare, school/clinic
Collaborative assessment with other team members allows for better observation/data collection
Autism Spectrum Disorders: Best Practice Guidelines for Screening, Diagnosis and Assessment
California Dept. of Developmental Services 2002
ASSESSMENT TOOLS: Direct/Standardized
1. Preschool Language Scale-4
2. Peabody Picture Vocabulary Test
3. Receptive and Expressive One Word Picture Vocabulary Tests
4. Sequenced Inventory of Communicative Development-Revised(SICD-R)
5. Comprehensive Assessment Comprehensive Assessment of Spoken Language (CASL) of Spoken Language (CASL)
6. Reynell Developmental 6. Reynell Developmental Language ScalesLanguage Scales
7. Goldman Fristoe Test of 7. Goldman Fristoe Test of Articulation-2/KLPA-2Articulation-2/KLPA-2
8. Clinical Assessment of 8. Clinical Assessment of Articulation and Phonology Articulation and Phonology (CAAP)(CAAP)
9. Language Sample9. Language Sample
1.1.Rossetti Infant Toddler Language Scale Rossetti Infant Toddler Language Scale (Linguisystems)(Linguisystems)2.2.Pragmatics Profile of Everyday Communication Skills Pragmatics Profile of Everyday Communication Skills in Preschool Children (Hazel Dewart and Susie in Preschool Children (Hazel Dewart and Susie Summers )Summers )3.3.Pragmatic Communication Skills Protocol (Academic Pragmatic Communication Skills Protocol (Academic Communication Associates)Communication Associates)4.4.Functional communication Profile Revised Functional communication Profile Revised (Linguisystems)(Linguisystems)
Parent Interview and Observation Tools
DIRECT ASSESSMENT MEASURES-LANGUAGE/COMMUNICATION SKILLS
PLS-4 -measures Auditory Comprehension and Expressive Communication for Birth-6-11
PPVT-measures receptive single word vocabulary
ROWPVT/EOWPVT-measures receptive single word/expressive single word vocabulary(2-18)
SICD-R Receptive and Expressive portions(4mos-48 mos)
Direct Assessment cont
CASL-Research-based, theory-driven oral language assessment battery for ages 3-21. Fifteen tests measure language processing skills,comprehension, expression, and retrieval—in four language structure categories:Lexical/Semantic, Syntactic, Supralinguistic, and Pragmatic. Subtests can “stand-alone”.
PRAGMATICS PROFILE OF EVERYDAY COMMUNICATION SKILLS/PRESCHOOL
Interview questionsTypically done in home
with parent/caregiver4 domain areas:
Communicative Function, Response to Communication, Interaction and Conversation, Contextual Variation
Information gathered can be helpful for parents to understand all aspects involved in communication
Information also helpful in identifying specific areas of need, writing goals and planning intervention
Website to download profile: http://wwwedit.wmin.ac.uk/psychology/pp/documents/Pragmatics%20Profile%20Children.pdf
Language Goals
•Important to meet as a team to discuss who will write which goals•Behavior specialists/analysts have expertise in writing ABA type goals•Language goals should not be addressed solely in pull-out therapy –Language opportunities happen all day!!•Important for classroom teachers/aides to be familiar with goals and how to implement them within the classroom.
Pre-Academics and Academic Assessment: Consider using
criterion referenced measures in addition to standardized, ie., Brigance, AEPS, Hawaii
Obtain work samples using age level / adjusted age level curriculum
Note the necessary accommodations needed for learning
Does the child need frequent breaks?
Note level of frustration tolerance.
Observe how well the child generalizes academic information, can they respond to a question in circle time?
Executive Function
Executive function is becoming a prominent area for assessment and intervention for a range of neuro-developmental disorders, in particular, ASD. Difficult to evaluate in children younger than 5.
Areas to assess: planning and organization, anticipating an event and preparing for it, ie.,forming goals, and strategies to reach them, attention, memory processing, cognitive flexibility, cognitive planning.
Assessment of Executive Function Behavioral Rating
Inventory of Executive Function (BRIEF), 5 and up
Conner’s-for Attention issues, ages 3-5
DAS-2 working memory ages 5 and up
NEPSY Developmental Neuropsychological Assessment-Attention/Concentration Scale
Cognitive Assessment System (CAS)-ages 5 and up-Attention Scale
Tower Tasks Wisconsin Card
Sorting Test Reference (Ozonoff
and Schetter)
Sensori-Integration
SI is an important area to assess due to the high probability of SI problems--about 70% or > in ASD population.
SI is related to ability to attend, adapt to new environments, fatigue, and emotional regulation.
Occupational Therapists are the most qualified to assess in this area.
include observing response to various sensory activities, checklists (Sensori-Integration and Praxis Test, Ayers clinic), parent interview, and natural observation.
HFA vs. AS: How do we tell the difference? High functioning autism
requires the same DSMIV conditions as autism, however, high functioning autism is characterized by higher cognitive skills, some in the normal or above average range, often with wide scatter across cognitive domains.
Definitive delay in language acquisition.
Asperger’s is typically not identified until age 7 or 8, and there is no discernable delay in language acquisition, and typically there is average or above average intelligence.
Assessment Tips
Find out best time of day to test (try to eliminate fatigue)
Use approved motivators or reinforcers, ie., favorite food or activity
Give clear directions using abbreviated instructions when possible
Use preferred activities throughout
Include caregiver or individual who is very familiar with the child to participate with you
Assess in teams of two to three
Plan on two to three assessment sessions
Case Study: Conner
2 years 10 months Parent referral Ambivalent about
delays Conflicted about
getting a dx Very young parents,
first child
Team strategies and approach
Four sessions, parent present throughout
Talked with parent prior to IEP
Presented possibilities and concerns for parent to consider
Translating Assessment Information into FAPE
Assessment data needs to be translated into:
1. Identifying Unique needs2. Goals that address all areas of need3. Accommodations/supports for educational
benefit4. Recommendations for
programming/placement, ie., ABA/EIBT instruction
Unique Needs
What does the assessment data indicate are unique needs of the child?
Deficit areas/weaknessesAreas directly related to educational
benefit, ie., those skills needed to benefit from education
Needs related to learning, accessing curriculum and instruction, accessing their environment
Goals - The Hallmark of a Good IEPGood goals indicate a quality
assessment and knowledgeable teamGoals are the driving force behind
rationale for services, accommodations and supports
ASD goals need to be comprehensive, intensive, and designed with a developmentally sequenced curriculum
Refer to Curriculum Assessment Sheet developed by Patty Schetter, ABTA
Goal activity
Refer to Sample Goals Look at a set of unique
needs and determine what type of goals will effectively address the needs
Goals set a trajectory for progress
How can we make goals meaningful?
Rationale for Services/Supports
General education opportunities Specialized Academic Instruction Individual Instruction, IA support Need for intensity, ratio of adult to child Need for ABA approach or other DIS services - is the model collaborative,
individual, both?
Rationale and LRE
Critical to know what empirically based practices (EPBs) are and provide clear direction for how these can be delivered, and in what setting they can most be effective in.
Does the child’s needs require a degree of intensity such as one to one and small group with highly controlled environment?
Or is the child able to observe and attend to small and large group instruction and generalize skills in group settings?
Accommodations and Supports
Small group Instructional Assitant Verbal cues Visual supports Sensory breaks BSP/BIP? Visual schedule Clear routine Alternative communication-PECS
FAPE Considerations:
Data needs to back up recommendations and provide rationale for placement considerations
Need to consider a full range of continuum of options
Tie goals to services - ie., functional communication needs/goals require …
FAPE considerations cont.
Tie unique needs to program components-what is a good fit or match to these needs?
Have clear descriptions of supports/accommodations program can provide, ie., good ratios, 1:1, developmentally sequenced curriculum, systematic instruction,etc.
National Autism CenterResources: Educator’s Manual
Evidenced Based Practices, National Standards Project
Established Treatments from National Standards Project:◖◖ Antecedent Package◖◖ Behavioral Package◖◖ Comprehensive Behavioral Treatment for Young Children◖◖ Joint Attention Intervention◖◖ Modeling◖◖ Naturalistic Teaching Strategies◖◖ Peer Training Package◖◖ Pivotal Response Treatment◖◖ Schedules◖◖ Self-management◖◖ Story-based Intervention Package
National Professional Development Center On Autism Spectrum Disorders
What are Evidence-Based Practices (EBP)?While many interventions for autism exist, only some have been shown to be effective through scientific research. Interventions that researchers have shown to be effective are called evidence-based practices. The NPDC has identified 24 evidence-based practices.
The Report
Consider team report-pros & cons
Reports need to provide specificity, be comprehensive yet readable for parent
Clear headings, meaningful sequence
Clear summary and conclusions
Clear recommendations for IEP team to use in determining FAPE
Journey of Hope:Parent Interview
Listen to the core message of this parent and reflect on your practice of working
with parents.
Parent Collaboration
Establish a positive rapport at the earliest point possible in the referral process
Explain the roles of each examiner, and explain what the assessment process will look like and the IEP process
Find out what the parent’s interests are
Parent Input
Find out their long term goals areEstablish shared interests based on the
child’s needsEstablish common goalsRefrain from making assumptionsProvide frequent follow-up and an
established routine of communication
Parent Collaboration cont.:
Provide regularly scheduled communications, such as quarterly review dates, monthly phone call, weekly note home.
When things get diverted, bracket knee jerk reactions, and redirect the discussion to the child’s needs and goals.
Parent Input cont.
Acknowledge parent concerns and needs -- communicate that you want to understand their perspective so that you can work jointly on behalf of their child.
Emphasize areas in which there is agreement and areas of common interest.
Parent Perspective
Important to convey to a parent that their input is valued-How do we do this?
This is their child for the rest of their lives - the issues for them are truly intense
Parents feel an urgency - they are in a crisis For a parent, trust is the most critical aspect,
with trust you can move forward Building relationships is critical to any
successful team - even when there is disagreement
When there is disagreement Remember, there is no “winner” in an
argument Goal is to maintain a positive relationship Shift from a framework that is argumentative
to one that is trying to gain common understanding of the child
Look for opportunities to build agreement Recognize when there is not agreement and
provide an environment where this is okay Recognize when mediation will be helpful
Parent shoes
Put yourself in the parent’s shoes - relate to having a child with an ASD like you would having a child or spouse with a life threatening disease or illness -- what are your likely emotions, actions, and needs?
Teaming: What does it mean?
Define “team” Reflect on positive
team experiences: what were the core elements of that experience? What are effective “team” behaviors?
What are the key characteristics of a strong team?
Your Team: Next Steps
Identify three goals in the next three weeks
What are potential barriers or road blocks?
What strengths do you bring to your team? -- dyad exercise
It’s the Journey not the Destination
The assessment process is like a journey, discovering unique needs, learning about families, and continuous new challenges as well as successes.