Assessment Instrument for Assessing Autism - Term Paper Example

 Assessment Instrument for Assessing Autism Introduction: is there a need for better autism screening? The simplest type of screening for all developmental issues is the least technical of all: many American families: parents and other relatives become concerned about a perceived deficit in a child’s development in one or more skills area and they bring this to the notice of someone in the health or education professions. A recent study by Glasgoe (1997) of the development status of 408 children between 21 and 84 months of age explored whether parents’ views about their children’s development would be as accurate as standard screening programmes in identifying a need for referral and found that this measure was “reasonably accurate” across the range of screening criteria, although there was some under-reporting in cases where parents did not speak either English or Spanish well. This suggests that a system for eliciting parental views should be built into any assessment tool for autism, and that extra language support for non-native speakers of Spanish or English should be provided to ensure that this group is not left behind. There is a wealth of knowledge that parents can contribute, if a method can be found to elicit their views and record them in a consistent and comparable way. Parallel to the input of parents, there is the standard procedure of child development screening carried out at specified stages during health and educational interactions. The BRIGANCE Standard Diagnostic Comprehensive Inventory of Basic Skills (Glasgoe, 1999) was first devised in the 1970s and has been refined and extended since then to cover a wider age range and a more clearly defined set of criteria. In its present form it is widely accepted as a good standard instrument which allows both effective local assessment and wider collation of results across the United States which can be used to build a picture of changes in the patterns of child development as they emerge. This test certainly does pick up significant numbers of cases for further investigation but it is not specifically designed to screen for autism. Parents and broad based standard testing are therefore a crucial first line and very basic level of screening which are effective for the majority of children. A screening instrument in the UK for very young children around 18 months of age called the “Checklist for Autism in Toddlers” or simply “CHAT” has a series of yes/no questions. The questions in section one are general, such as “does your child enjoy being swung, bounced on your knee” and these are answered by the parent, while other are observational questions which the health professional answers, such as for example whether the child has made eye contact with the health professional during the session. (Baird et al., 2000, p. 695). This instrument was followed up and found to be very effective at predicting autism disorder in the cohort, once again showing the value of integrating the screening process within the standard healthcare system and involving parents in the questions. There is some suggestion in the literature that particular sub-sets of children who have autism-related developmental disorders may be missed by some of the conventional screening instruments in use at the present time. Apart from the issue of parental language competence interfering in screening results, there is also the question of some types of high functioning autism which do not show developmental deficits until school age or later (Baird et al., 2001, p. 468). The determining of criteria in screening tests should therefore concentrate not only on deficits, but also on other, sometimes positively viewed attributes such as higher than average skill levels in particular areas. Psychologists, educators and parents participation in Autism screening? With the numbers of autism cases apparently on the rise, there are grounds for investigating whether there are any better methods that could be used to screen for autism spectrum cases. There is a considerable amount of research on the best way of conducting a screening process specifically targeted at autism one of the difficulties for educators, psychologists and policy advisors is working out which of them to choose in a world where funding is tight and time is short. It is important that any screening method that is used should be thoroughly tested in order to ensure that it produces accurate results because the consequences of both under- and over-diagnosis can be very severe for the child and his or her family. Screening undertaken by school psychologists. A recent article by Bradley-Johnson et al. (2008) is aimed at school psychologists, and advocates a system run by this professional group. The definition of autism used by Bradley-Johnson et al. (2008) is that of the Disabilities Education Improvement Act (2004) which is broader than the DSM criteria. From the start there is an emphasis on “verifying eligibility for special services for autism” which betrays an interest in the funding and cost allocation regime as well as the purely educational and medical aspects of autism. This is not necessarily a negative feature of the article, and the authors make the valid point that diagnosis of autism carries with it considerable stress and sometimes also stigma for children and their families, so that finding a proper and fair diagnosis and assessment regime is a fundamental duty of the school psychology system. Bradley-Johnson et al. (2008) propose a new model for assessment which has three levels ranging from subjective and general through to objective and specific. The evidence for the study is drawn from a meta-analysis of the research which has already been done on testing for autism. Evidence from interviews and from written school and medical records is categorized as level one, and the authors advise that this may be too general, due to lack of space for recording, and sometimes biased because of the different interests of those involved, but it is nevertheless valuable because it indicates what issues different people think are important, and how likely different people might be to follow recommendations. The authors acknowledge the importance of the knowledge that parents and teachers contribute at this level. Level two of the Bradley-Johnson et al. (2008) model consists of rating scales Bradley-Johnson et al. (2008) warn against the use of such scales, however accurate they might appear, as an independent measure of autism. The reason for this is that they may be conducted with bias, and they may be too narrow in focus, which means that they might miss other psychological conditions that may co-occur with autism. Several broad and narrow band autism screening instruments are evaluated. The third level of the model involves multiple sessions of both observation in the environment and interaction between the student and the trained examiner, and with the participation of at least one second observer on at least one occasion. Ratings and progress monitoring are needed if interventions are to be successful, and this shows that there is a role both for the professional educational psychologist and the educator in maintaining the best regime for children with autism. In fact the authors advise that a multidisciplinary team involving social workers,teacher consultants and speech and language therapists as well is the best approach. Assessment should start out broadly and become more and more specific, with increasing amounts of monitoring. The Bradley-Johnson (2008) article gives a good overview of the whole national context for the provision of assessment and support for children with autism. It is good to learn about all of the options available, and to read of the perspective of expert child psychologists on how an autism screening instrument should be designed. This approach represents a “gold standard” and if it were applied universally it would undoubtedly diagnose autism more accurately and speed up targeted intervention for the children concerned. The disadvantage of such a complex system involving highly qualified staff is that it is cumbersome and expensive to operate. There may also be an over-reliance in this article on applying one over-arching model to all children. Most practising teachers have experience of many different needs in relation to autism and similar conditions, and there is also a great variation in the range of competence and willingness of parents and some teachers to take on a leading role in the care of any particular child. The variables are very great and this would suggest that flexibility should be built in to any large scale system for assessing autism. The main point of this article, however, is very useful: during the course of a child’s educational career there should be an escalation of assessments starting with general and leading to more and more tailored tests as the child’s needs become more apparent. A screening undertaken by educators. A useful article by Ingram et al. (2007) describes an empirical study of 30 elementary school children using a method called “The Playground Observation Checklist.” It starts out by pointing out that severe social impairment is the most prominent feature of autism, as defined using the DSM criteria. The usual way of measuring behavior such as limited eye contact, lack of reciprocal social interaction, fewer greetings and failure to initiate interactions such as offering comfort to someone who is hurt, for example, is to observe how children react in certain contrived situations. This study hypothesizes that children with autism will behave differently from children with mental retardation and children with typical development during natural situations. It proposes that that a standardized way of observing children in the everyday context of school recess would be a helpful assessment tool. The playground observation checklist is just such an observation tool, and the article describes how it was used and the results it produced. These results were then checked for accuracy against other information obtained by the usual autism assessment methods. There were ten items on the behavior checklist, which is a very small amount, and for each child in the sample of 81 a score of yes/no was recorded against each item during a 15 minute observation period. Two observers recorded the sessions simultaneously, and any instance where a child interacted with an adult during the 15 minutes was discounted, and the observation was repeated until a session with only peer to peer interaction took place. The results showed a 94% success rate in identifying children with autism, and there were clear differences in the scores of the three categories of children. Variables such as age, parent occupation, gender and IQ were recorded, and small effects caused by these variables were noted. The authors conceded that the observers were not blind to the diagnosis of the children observed, and that this raises the possibility of observer bias. The authors conclude that this method is therefore very suitable as an initial assessment tool, to be followed up by more detailed diagnosis later. This screening instrument is has the advantage of being is relatively inexpensive, easy to administer and suitable for operation in a school context in a way that does not place any undue pressure on the child. This article was an exploration of the method itself, and more needs to be done on that to ensure that the criteria are worded well, for example avoiding gender bias in the way interactions are described and scored. Assuming these details could be ironed out, this observation checklist does appear to be a good method for making initial assessments to indicate what kind of specialist referral, if any, would be appropriate for a particular child. So long as the observation is conducted by trained observers it could be introduced in an elementary school. There are far more educators available to roll out this such a simple and short instrument and so it would be much more likely to achive wide coverage than a more lengthy and specialised instrument. There are ethical issues about the method, of course, since parents would need to give permission for such observations to take place, whether for research purposes, or for the benefit of the children themselves. There could be a danger of over-diagnosis, or of inappropriate referrals if too much weight is placed on a single fifteen minute observation, and so any use of this tool would be best placed within a school policy on autism, to be called upon under specific circumstances and regulated by school protocols that protect everyone’s rights. Proposed screening instrument: a modified version of Ingram’s “Playground Observation Checklist.” The age group which appears most suitable for a new screening instrument appears to be around 3-4 years. There is great variation in the “normal” range of achievement levels in all the basic developmental skills at this age, and so very often it is difficult to separate autism related variation from this spectrum. The screening instrument should be a parent questionnaire with a few demographic details regarding languages spoken in the home, an then a set of questions modelled on those suggested by Baird et al. (2000) and upgraded for the 2-4 age range, and a 15 minute small group observation period modelled on Ingram’s “Playground Observation Checklist” (Ingram, 2007), modified this time in a simplifying way for the 2-4 age group. This instrument should be integrated within normal kindergarten enrolment and monitoring procedures and co-ordinated by the district school psychology service. Parents should provide the answers in a short interview with results recorded in a consistent fashion on a proforma. If necessary interpreting should be arranged for speakers who have difficulty with English or Spanish. The context for observation should be a standard story-time reading aloud session, involving one reader and four children. The observer should record the behavior of the selected child in listening to the story, responding to questions, volunteering information independently, interacting with the reader and interacting with the other children. The reader should not be informed which child is under observation and be instructed only to read the story and engage in conversation with all four children. This instrument is suitable for use on an annual basis. The advantages of this instrument are that it involve parents and educators as well as the school psychology service, and it is can be integrated within the child’s normal kindergarten day without any disruption. It is operative early in the child’s life, so that interventions can happen before school age, allowing the child to maximise his or her learning potential at the start of the school career. There is also a benefit to the parents in receiving early diagnosis because they can take decisions on family arrangements and access any support with better knowledge of their child’s needs. The disadvantages of this instrument are that some parents may opt out of it, and some children may not attend kindergarten on the relevant assessment days, or indeed at all. The instrument is has not been tested, and so it would have to run parallel with existing systems in the first instance at least. References Baird, G., Charmana, T., Baron-Cohen, S., Cox, A., Swettenham, J., Wheelwright, S. and Drew, D. (2000) A Screening Instrument for Autism at 18 Months of Age: A 6 Year Follow-up Study. Journal of the American Academy of Child & Adolescent Psychiatry 39 (6), pp. 694-702. Baird, G, Charman, T., Cox, A., Baron-Cohen, S., Swettenham, J., Wheelwright, S. and Drew, A. (2001) Screening and surveillance for autism and pervasive developmental disorders. Archive for the Diseases of Children 84, pp. 468-475. Bradley-Johnson, S., Johonson, C.M. and Vladescu, J.C. (2008) A Comprehensive Model for Assessing the Unique Characteristics of Children With Autism. Journal of Psychoeducational Assessment 26 (4), pp. 325-338. Glascoe, F.P. (1999) CIBS-R Standardization and Validation Manual of the BRIGANCE Diagnostic Comprehensive Inventory of Basic Skills- Revised. Glascoe, F.P. Parents’ Concerns About Children’s Development: Pre-screening Technique or Screening Test? Pediatrics 99 (4), (1997), pp. 522-528. Ingram, D.H., Mayes, S.D., Troxell, L.B. and Calhoun, S.L. (2007) Assessing children with autism, mental retardation, and typical development using the Playground Observation Checklist. Autism 11, pp. 311-319. Read More