Supporting Identification and Programming for Individuals with Autism Spectrum Disorders (ASD) Assessment of Cognitive and Adaptive Domains Dr. Jane Doelling

Assessment in ASD There is no one appropriate assessment battery; the evaluation plan is always based on screening and ongoing data collection. IDEA requires that the assessment correspond to problems identified in screening and that the data be used to support an individual education plan (IEP).

Utility of Cognitive/Adaptive Evaluation Differential Diagnosis - AD and AS. Delays and arrests - Are social communication delays greater than expected given cognitive level? Assessment of strengths, weaknesses, differences: verbal and nonverbal communication patterns; concept formation; generalization; modeling; imitation; memory. (Goldstein, Naglieri, & Ozonoff, 2009)

Considerations Intelligence and adaptive skills often defined as differences in every day behavior and responses; we test using standard stimuli that are frequently problematic for this population.

National Research Council (2001) Individuals with ASD have the most difficulty with language and social tasks on tests. Least difficulty on nonverbal tasks that are not timed and do not require motor skills, rote memory, and perception tasks.

Impact of ASD Additional problems noted in testing: attending joint attention understanding of personal pronouns imitation pointing behavioral regulation ( Ashoomoff, 2006; Dawson et. al, 2004; Rogers et al., 2003; Sigman, et al., 1986).

Skills/Behaviors Common to IQ Tests memory & problem solving, discrimination &verbal skills comprehension, spatial & mechanical aptitude, analogies & detail recognition, sequencing, induction & vocabulary, general information & motor behavior, generalization & abstract reasoning (Salvia & Ysseldyke, 2007)

Considerations: CA & MA What is the discrepancy? For individuals with severe delays can scores be translated into meaningful descriptions of ability? If older individual, would it be best to select an instrument with a wider age range? For a young child would it be better to focus on mental age scores w/a focus on developmental level vs. IQ? Are families members of young, or very developmentally delayed, asked to observe the assessment and confirm findings?

Cognitive Development Used interchangeably with intelligence. Refers to a variety of mental processes to include reasoning, memory, comprehension, judgment. (Simpson & Zionts, 2000)

Assessment of Cognitive Ability No other area of assessment has generated as much attention, controversy, and debate as the testing of what we call intelligence. ( Salvia and Ysseldyke 2007 p. 281)

Cognitive Testing Issues Intelligence is an inferred construct – determination of skills and abilities may be made from a limited sample of test behavior. May be problems with technical adequacy (validity issues due to nebulous nature of the construct; reliability impacted due to characteristics of individuals w/ASD).

Issues: Cognitive Testing Emphasis on scores vs. skills not conducive to comprehensive programming. Individuals w/an ASD exhibit characteristics that limit the options w/traditional, norm referenced instruments.

Best Practices Cognitive Assessment Ensure that the test assesses individual ability to the extent possible accommodate: sensory deficits; communication modes; medical and motor issues; as well as cultural factors.

Best Practices Use scores as one indicator of ability. Analyze performance across subtests. Increase reliability through consideration of multiple data sources.

Best Practices Be Aware of the Behaviors/Skills Sampled By the Test and Interpret Performance Accordingly. Be Aware of Stimulus Response Demands Making Appropriate Test Selection and Accommodations. Consider Standardized Sample In An Effort to Control Bias.

Best Practices Norm referenced assessment should minimize, as much as possible, problems noted in screening (communication, response time, sustained visual and auditory attending). Cognitive/adaptive behaviors should be documented through communication, adaptive, ecological, and ASD specific instruments and context based performance tasks (integrated assessment, multiple data sources).

Ecological Variables Checklist ___cues/prompts needed (visual, auditory, physical – identify) ___ time needed for task ___transition aids needed ___format and response demands ___physical arrangement of setting ___communication systems

Adaptive Behavior The way individuals adapt themselves to the requirements of their physical and social environments (p. 559). (Salvia & Ysseldyke, 2007)

Adaptive Skills Example: Physical Environment - Avoiding or response to danger. Will the individual w/ASD use environmental cues to: Select clothing appropriate to the climate? Respond to visual or auditory cues to avoid traffic? Demonstrate skills w/or w/out cues? Across settings? With reliability?

Considerations Adaptive Assessment Social & cultural expectations - vary across cultures, manifest in language usage. Age and Adaptation - Different expectations across the age span. Performance vs. ability - Does the individual know the behavior to be performed? Is it performed voluntarily and w/ consistency?

Considerations Maladaption - Caution when included on norm referenced tests. Absence of maladaptive behavior does not imply adaptive behavior. Maladaptive behavior is determined by context with a few taboo exceptions.

Considerations: Adaptive Context - Appropriates (social tolerance) w/in the specific situation a behavior occurs. Undressing independently a desirable behavior at home and at bedtime but does not meet adaptive standards in the classroom or workplace.

Adaptive Content & Considerations Frequency and amplitude are important in determining adaptive skills or maladaptive behavior. Behavior - Child slaps head. What is the context, frequency, amplitude, consequent behavior?

Issues and Best Practice Adaptive Assessment Adaptive skills traditionally assessed by third person respondent. –Accuracy/assumes knowledge and non bias. –Contextual information may be limited. –Selective demonstration of behavior that may not be observed by respondent.

Issues and Best Practice Adaptive Assessment Adaptive assessment typically implemented when a cognitive ability is suspected. Individuals across the spectrum demonstrate adaptive deficits (communication, social, self care, and more).

Issues and Best Practice Adaptive Assessment Adaptive data may be obtained from assessment across domains (cognitive, communication, functional behavior assessment). Analysis of specific skill performances within context essential to programming.

Common Norm Referenced Cognitive Tests Pros & Cons Wechsler Scales - WISC IV, WAIS-III, WPPSI-III Stanford Binet Intelligence Scale – 5 Woodcock- Johnson Psycho- Educational Battery- III (Tests of Cognitive Ability) **Leiter – Revised (R) **Test of Nonverbal IntelligenceTONI-3 **Comprehensive Test of Nonverbal Intelligence - CTONI

Utility & Limitations of Developmental/Cognitive Ability Scales Developmental Profile Differential Ability Scales Mullen Scales of Early Learning Baley Infant and Toddler Scales of Infant and Toddler Development

Common Norm Referenced Adaptive Scales Vineland AAMD-ABS AAMR-S2 School Edition AAMR Residential and Community (ABS-RC2) Scales of Independent Behavior (SIB-R)

Additional Sources that Yield Cognitive/Adaptive Data Assessments of Executive Functioning Instruments Specific to Severe & Profound Integrated, Multi Domain Tools & CRTs Autism Specific Instruments

Application to Diagnosis: Case Scenario