Childhood Schizophrenia

Jani and Rebecca exhibited behaviors that are quite disturbing to their parents. Their behaviors include hand flapping, hitting, hallucinations and inappropriate expression.
  Going back memory lane, autism spectrum disorder and schizophrenia are distinct disorder with unique characteristics, but they share similarities in social dysfunction. This similarities as observed in the video could led to confusion in diagnosis.
   Jani diagnosis could be difficult to be noticed earlier because it seems that while symptoms of ASD can be seen from very early in life, the onset of schizophrenia typically occurs in young adulthood. And individuals who have schizophrenia often experience hallucinations and delusional thoughts, which are far less common in individuals with autism. According to clips from the video, it seems that people with schizophrenia have a much higher likelihood than ASD to attribute ill will to others, and this is likely tied to their delusions.

Best Practices

This video by Dr Ozonoff encapsulate what we have learned in class about assessment of Autism.
There are several important considerations that should inform the assessment process. Development history is a very important perspective.The critical aspects of this history-taking are reviews of communication, social, and behavioral development. The information gained from these sources can be integrated into a DSM-IV-TR diagnosis.
      The second important consideration is that the evaluation of a child with ASD should include information from multiple sources and contexts, as symptoms of ASD may be dependent on environment. Reports from parent, teachers, and FBA may all be part of the most comprehensive ASD assessment.
  A good assessment is very important because its contribute to planning and evaluation of intervention.

Autism Assessment and Education Planning for Children Part 2

This week you will finish up viewing the last third of the video on 

Autism Assessment and Education Planning for Children

Begin looking at the video at 37.0 and  view it to the end. It will be about 20 minutes long.

This video completes the presentation by Patricia Schroder and Kristine Strong of the M.I.N.D. Institute in which they discuss the standardized and non-standardized approaches to assessing autism. After viewing the video, put the information  within the context of the reading, class discussion and video presentations you have experienced to date and discuss the implications for integrating various types of assessment data by various personnel.
I am continually impressed with the work you do individually and as a group, and I am looking forward to reading your posts.


 Autism Assessment and Education Planning for Children, Part 2
Dr. Lynch

1. 
   

Best Practices

The presentation by Dr. Ozonoff was very informative on the topic of assessments for individuals on the Autism Spectrum. Considering the range of differences between individuals with ASD, I can understand how assessments can be challenging.  Dr. Ozonoff discussed ways of creating an environment for a more effective assessment including creating a team of professionals to assist with different areas of the assessment, including developmental history and reports from parents and assessment follow-ups . As a behavior therapist I do not clinically assess children, I perform behavioral assessments on children who have already received a diagnoses. Although I have no part in providing a diagnosis to the children I work with, as an educator it is helpful to be aware of any diagnoses the child may have.  A part of assessing a child’s behavior involves looking at their medical, developmental and behavioral history.

An FBA is an assessment tool used to find the functions of certain behaviors an individual may engage in. FBAs can also help educators bridge the gap between clinical assessments and classroom practice by creating programs that benefit the student’s individual needs. Educators can also use clinical assessments to set goals for students and collaborate during IEPs and/or assessment follow-ups. 

Assessing Autism

In this video Dr. Ozonoff gives a nice summary of the assessment process of students with  Autism Spectrum Disorder.  She makes some very key points that are extremely applicable to my experience of an educator.  The point that I found to be the most important is that data needs to come from a variety of sources.  This makes a lot of sense.  A BCBA is not a speech pathologist.  These two professionals have very different clinical minds.  They view similar skills extremely differently and use very different assessment instruments.  However neither of these perspectives is any more (or less) important than the other.  They are both skilled in their respective field and have an important contribution to make to any assessment team.  Another exemplary point is that you should look at the validity data for your assessment tools.  Honestly I have been administering Vinelands for the past three years and am embarrassed to say that I have yet to look at the validity data for the instrument (I know that the higher up people at my company have but that is still no excuse!). 
The Functional Behavioral Assessment fits into this in that it is also an assessment tool and it requires a whole team a approach.  In fact that is one specific way it fits in.  There is no validity tables for FBA's.  This is because each child is so very different.  However although there is not a validity table, the use of FBA's has been proven time and time again in applied behavioral research.  In fact the best way to assess there validity is to look at all the contributors and see if there is a matching pattern, after this of course you can evaluate the assessment based on the effectiveness of the treatment designed by the results of the FBA.
Educators are ultimately responsible for bringing the gap between clinical assessment and classroom work i.e. accessing the curriculum.  This is something they do in a variety of ways.  A) Educators are able to process the clinical assessment data and use it to develop need based treatment to their students.  B) They are able to administer assessments in a more natural environment with students they have an established relationship with, C) They are able to use the assessment data as well as day to day data to establish effective programs that allow their students to better access the curriculum.  Best practices I would recommend are to know your students (know their assessment data, their records, take the time to build a wonderful rapport).  Secondly be a highly regarded member of their teams (be in constant contact with their other team members, reach out if you feel someone may have a better perspective than your own, make sure your opinion is highly regarded ie: RESPECT THE OPINION OF OTHERS AND BE PROFESSIONAL!).  The last best practice I would recommend is not something I hear talked about often, really truly know your students skills realistically.  Perhaps they complete a puzzle for you, repeat a variety of words, imitate block designs, and follow your instructions but if they are just doing this with you it is a problem, I think an important part of bridging the gap is to teach for generalization.  Ensure each skill your students master is solid.  If they are asked to perform the skill from whomever in whatever setting they will comply or complete the activity.

Best Practices

I thought it was interesting viewing the presentation from one of our book author's because I felt that a lot of the topics covered in this presentation were things we have discussed during class discussions. First, I think that a FBA fits into an assessment profile of a student as a good tool to see the social and emotional development of a student. I feel that most often an FBA is used to teach or deal with a behavior that is exhibited when the child is frustrated or upset. Having said that, the behaviors and the triggers identified in the FBA can tell you many things about the child. If the student exhibits these behaviors at a great deal of frequency, they might have a very difficult time with change, communication, and sensory issues. Perhaps these behaviors are occur at such a high rate of frequency because the student has a great difficulty with dealing with these factors. I also think the opposite could be true as well. Using what you know of the student from assessments should guide you as to what behaviors you are going to introduce as replacements. 


Clinical assessments can be very valuable in classroom practice. For example, currently I have 6 out of 7 students who use AAC devices to communicate. However, each of them needs a different level of modeling or prompting in order to further their development of communication using the AAC devices. Having viewed some of their clinical assessments, I can get a better idea of what their receptive communication skills are like. For those students who have a greater base of receptive communication skills, I can use more verbal prompts verse visual prompts. Also in the classroom, it is good to know the students sensory needs as well. Some students are extremely sensitive to noise while others need music to alert them and prepare them for transitions. 


I think when having a classroom for students with autism spectrum disorders it is so important to value your team's input. I think that by using assessments when presenting to your team your ideas will be more readily accepted. If you have data and research that backs your interpretation and plan for the student, it is more likely to be implemented. I think another best practice is to inform your team of what school of thought your practices come from. For example, my occupation therapist comes from a Sensory Integration background where I might come more from a Floortime and ABA background. However, having everyone on the team being well informed about current research and best practices insures the best result for the students. 

This presentation by Dr. Ozonoff I feel serves as a pretty good summary of everything that we have discussed in class up to date.  Just as we have done in previous classes, Dr. Ozonoff has touched upon many different tools used for assessment and the ways in which they can help any given assessment.  It is very important to recognize that she points out the great importance in having a very well rounded team in order to complete a thorough assessment of a child.  It would make no sense for a BCBA to provide an assessment on medical needs just as it would make no sense for a teacher to complete the assessment on the speech and language skills of the child.  It is key that the child's different areas of assessment be completed by those who know the field best, the ones that have the most formal training.  


In regards to how the FBA fits into the assessment picture, I believe that it serves as yet another useful tool.  Without having the proper behavior protocol in place for a child, one cannot hope to complete a more thorough assessment of a child's skills and abilities, especially when one or more problem behaviors are present.


I think the best way for educator's to bridge clinical assessments and classroom practices is to use what the assessments have provided and play up a student's strengths.  When you can recognize a student's strengths you can use those to your advantage to help further a student in other areas which they might be struggling in.  It can also help you build momentum in regards to simple matters such as compliance if the student has difficulty with such things.

Best Practices

Dr. Ozonoff talks right away about the screening process: should occur at checkups at 18, 24, 36 months; if a child fails: hearing tested, check for PICA and lead screening, screened for autism; if a child fails one of those tests: referred to early intervention and formal diagnosis (level two assessment)
Screening Red Flags:
·         Does not respond to name
·         Acts as if deaf
·         Does not smile at others
·         Does not point or use other gestures by twelve months
·         No babbling by 12 months or words by 16 months
·         Talks but does not try to communicate
·         Loss of any social or communication skill

I thought that these screening red flags were important to mention because first time parents could be seeing things like this and not thinking anything of it because they don’t have any other children to compare the development to.  I also thought it was important that she distinguished between screeing and assessments.  The screenings are used as a tool to determine whether a formal diagnosis is needed, and I think sometimes that even the word "screening" might be scary for parents.

Dr. Ozonoff talks about the Level Two Assessments and the fact that these should be done by interdisciplinary team because it touches on the following aspects:
·         Diagnosis
·         Intellectual
·         Adaptive
·         Speech-language
·         Medication
·         Functional
·         Psychiatric
·         Educational/academic
·         Neuropsychological
·         Motor, OT
As you can see from the above list, no one person can accurately touch on all of these areas, it is imperative that the Psychologist works with the Pediatrician and the SLP and the OT and so on.  This is the same approach that we talked about with our FBAs; utilizing an interdisciplinary team approach so you can get a more accurate picture of what exactly is going on with the child, what their skill defecits and strengths might be. 

Dr. Ozonoff touched on how to diagnosis: DSM-IV Criteria; developmental history from parents; direct interaction with child; review of records – I think the most important thing here that Dr. Ozonoff touched on was the direct interaction with the child.  I feel like records and getting a history can only take you so far, in order to get an accurate assessment of what is going on with the child you need to come into direct contact with them; how else would you try to get a handle on the different skills they have strengths or weaknesses in, to me this just seems like common sense but it also seems important to point out to everyone in the field who maybe doesn’t feel this way.

Developmental Red Flags are included in the table recreated below; again something that I felt was necessary for everyone to be aware of.

First Year of Life	Second Year of Life	Third Year of Life
General (regulatory) difficulties	Slow language development	Lack of interactive peer play
Less looking at faces and eyes	Lack of imitation	Poor language development (echolalia)
Lack of interest in social games	Lack of joint attention behaviors	Rituals, stereotyped behaviors in some
Poor response to name	Lack of social interest and social play	General delays in some

 At my workplace, we bridge the gap by having team meetings every week with the Head Teacher of the classroom, the Head Teacher of the residence, the nurse, the Behavior Education Team Supervisor, the BCBA (if not the same as the BETS), as well as other staff attend where we discuss each of the students in our unit (usually 6-8 kids) and we talk about any medication changes or issues, upcoming assessments, results of assessments, behavior programs and examine data to see if effective.  In addition to these weekly meetings, we provide quarterly reports to the parents and we keep them updated as to the changes in their child’s life (because we are residential).  Every 6 months, we have a meeting with the school district, the parents, the primary nurse, the head teacher of both the classroom and residence, the BETS, our family services personnel, and we discuss the progress the student has made over the past 6 months towards their IEP goals, we discuss any concerns that anyone at the table has about the child, and we talk about the goals or vision that we have for the child.  It seems to work to keep everyone on the same page while allowing an open atmosphere to really discuss what is going on with the child.

Best Practices

I very much enjoyed how Dr. Ozonoff talked about not only various tools to use with children during screenings and assessments, but she also discussed the assessment process itself.  Assessment with any child can be difficult, but especially with a child on the spectrum.  As with any situation, a child with Autism needs the testing environment and procedure to be organized and structured.  Dr. Ozonoff recommended using visual schedules, reinforces, teaching the give and take of testing, testing in multiple settings, and ending testing on a good note before exhaustion sets in.  So often educators can get wrapped up in completing countless assessments it's easy to forget that the testing environment should be set up very carefully.  She also mentioned that it is extremely important to use various modes of assessment as testing is a social skill and kids with Autism do not usually test well.  They do not have the ability to sit and focus on a test for a pro-longed period of time which is why including direct observations of the child in a natural setting and parent/teacher interviews (from those who have directly observed the child) are so crucial.

An FBA fits into the assessment procedure as it is an assessment itself.  As we discussed, an FBA determines the function of a behavior by looking closely at antecedents, specific behaviors, and consequences through direct observation of a child.  In my program, if a child with a possible behavior issue is assessed to determine eligibility and possibly placement, an FBA is done at this time as well to have a behavior plan set if and when the child begins in their new special education classroom.

The overall assessment process, including clinical and educational assessment, should help inform classroom practice.  In my program, these assessments are the first thing the classroom teacher gets when he or she discovers a child is coming to their classroom.  Because it's all they really know of the child, it should guide what is being taught in the classroom and how information is presented to the child.  Then, of course, as time goes on meetings and updated assessments/observations will occur to ensure that the most up-to-date and accurate information is known about the child at hand.

Good Assessments

Dr. Ozonoff had many good ideas about how to assess a child with autism.  It is not surprising that sometimes children with autism make it through the first round of screening without being diagnosed.  Some tests are can diagnose up to three months but those test are not always accurate.  It is important to continue to monitor a child if you suspect them of having ASD or Aspergers.  I also agree that it is up to knowledgeable health care professionals, such as pediatrics to provide a questioner to the parents about how their child is developing.  First time parents may not know the symptoms or think there is nothing wrong with their child at all.  That is another reason why it is important for pediatrics to have assessments that are easy for parents to fill out and understand.

Dr. Ozonoff also was on the right track about having FBA done.  They are always a great place to start and should be done with all students who have ASD.  Each FBA should be conducted by a team of individuals who have interaction with the student.  Taking in all information that each person provides is a great way to paint a whole picture of the individual who is being assessed.  Although some information should be taken with a grain of salt, some parents and other caregivers can have bias opinions about the student and although it is a valuable information can cause an in accurate portrayal of the student.  It is important that each individual have some sort of interaction with the student.  I enjoyed the fact that Dr. Ozonoff touched on the fact that some professionals will conduct assessments based on interviews or other secondary information and not direct observation or interaction with the patient.  These meetings are very important to have especially as the student grows and should happen on a regular basis so the needs of the student can be addressed and understood by the entire team.

Best Practices

Dr. Ozonoff made some very informative observations regarding the assessment of a child.  Some of the points she made are important for any type of assessment.  I think it is very important for educators to keep in mind that they should prepare themselves and the environment before they conduct an educational assessment.  Assessors should also be persistent, and not give up on the child if they don’t seem to understand what is being asked of them at first.  Assessors should also learn how the child processes things, and follow their pace.  One very important thing to keep in mind is to end on a good note.  If a child is assessed, and things end on a bad note, the next time someone assesses the child their testing may be affected by the history with testing.

An FBA is an important part of the assessment picture.  An FBA will help determine the antecedents and consequences for behavior, and the behavior plan that is then developed has the potential to improve the quality of life for not only the child, but the family as well.  There are several similarities in how we approach conducting an FBA and the assessments that are conducted to determine a diagnosis.  A BCBA conducting an FBA will interview parents and teachers to get a history of the behavior.  We will also ask the family what their concerns are, and find out which behaviors they are most concerned about and should be addressed first.  We also make sure to directly observe the child.  Direct observation is a very important aspect of conducting an FBA.

I also thought it was very interesting that Dr. Ozonoff said that when an examiner feels that a child is “untestable”, that usually means that the examiner is inexperienced.  I would agree with that completely.  That may mean that the examiner did not collect enough data on the history of the child.  Some children will need motivation during testing.  This could be earning tokens to exchange for a preferred item.  A few years ago a nueropsychiatrist asked me (the behavior therapist for the child at the time) to attend the testing sessions and follow the child’s reinforcement system during the testing.  This particular child was very bright, but had a lot of maladaptive behavior when working with people that did not know him.  This would be an example of a child that may be called “untestable”, when really he just needed the examiner to keep him engaged at all times, and reinforce his good behavior.

I think that clinical assessments, educational assessments, and classroom practice should all be approached in the same way.  The person working with the child should take the time to get to know the child, prepare themselves and the environment for the child, and strive for maximum results.  I also feel very strongly that everyone in the child’s life should have high expectations.  Children will only perform as well as they are expected to.  If a teacher, parent, or examiner expects a child to fail, it is more likely that they will.  We have to expect that a child will give everything that they can, and in turn they will succeed. 

Best Practices

Dr. Ozonoff made some very good points in this video about interactions with the child during assessments.  I think for many professionals assessing a child, who potentially may have autism, they need to have some form of interactions with the child.  By interacting with the child, they can direct the interactions for specific abilities and interactions that might indicate an autism diagnosis.  Professionals should be well informed of all assessments, so they know what to look for when interacting with the child.  I think it was also important that doctors provide the parents at 12, 18, and 36 months a questionnaire about the development of their child.  The early a child is diagnosed the early they can receive services and it also will assist parents, especially first time parents in observing their child’s development throughout the early years.

A functional behavior analysis is a very important part to the assessment process.  During the analysis, professionals conduct direct observations along with interviewing parents and other individuals that are in close contact with the child, to gain as much information as possible.  It also allows interacting and consulting with other professionals in other related service areas where the child might have needs.

When it comes to best practices in bridging the clinical, educational and classroom practices, it is important for all parties to plan a meeting or clinic every 6 weeks or so to discuss the progression of the child and address any questions that might be arising in their daily encounters.  These clinics should be also at the convenience of the parents as well.  Some children display different behaviors and difficulties in different environments and sometimes with different people.  These clinics will provided everyone with the same information and paint a big picture of the child’s strengths and weaknesses and hopefully address any problems and possible solutions to help the child.

When determining whether a child might have high functioning autism or Asperger’s syndrome, I think it is very important to pay attention to the little differentiations that Dr. Ozonoff pointed out.  This is where the observations and interviews with parents become very important especially because of the little differences among the two groups.  High functioning autism has a communication delay where children with Asperger’s have normal language development and also do not meet the standards in the DSM for autism.

Best Practices

One point Dr. Ozonoff made that I found particuluary interesting was when she talked about children that she labeled "untestable".  She described untestable children as very young children with autism who've had little or no intervention, and therefore lack the basic skills necessary to engage in most assessments.  Some of these prerequesite skills described by Ozonoff included sitting down or the ability to receive an item and then hand it back to the instructor.  She also emphasized the importance of the assessor being trained and prepared to work with this type of child.

Dr. Ozonoff provided some guidelines as to how to run an assessment with a child who could be considered "untestable".  First, she emphasized the importance of reinforcement.  Establish a work-reward pattern and reinforce any attempt by the child- whether it is correct or incorrect.  Second, use visual schedules as needed.  Third, teach "test-taking skills" under which Ozonoff listed "sitting" and "establish a give-and-take, accept and relinquish pattern".  Fourth, the assessor should test in multiple, short sessions.  And fifth, the assessor should "end on a good note, before exhaustion occurs".

I find this advice very relevant to my work because I commonly work with children who lack these basic pre-attending skills.  We would try to work on pre-academic programs with them such as visual matching, picture discrimination, or one-step instructions, but it is difficult to run these programs when the child lacks the very basic pre-attending skills necessary to be successful.  In this case, we often put the other programs on hold in order to focus on teaching these skills such as sitting and establishing a basic give-and-take pattern. 

I think the role of an FBA enters into this situation because usually when a child has difficulty performing these basic pre-attneding skills, it's sometimes because they have problematic behavior(s) that are interfering with their acquisition of these skills.  Therefore, a functional behavioral assessment would be necessary to identify potential maladaptive behaviors interfering with their success in academic programs- and even in their ability to successfully engage in assessments.

Best practices/assessment

Dr. Sally Ozonoff comments on a variety of informal information on the overall assessment process. She explains what is crucial when assessing a child, how we screen for autism, the many red flags to be aware of, and the diagnosis process.

How We Screen forAutism:

It is recommended that the child’s pediatrician screens for autism at 18 month, 24 month and 36 month intervals. It is interesting, and important to note, that if the child passes the screening, they still need to be tested again following these month intervals. This is due to the fact that a child screening may show symptoms initially, but as the child develops symptoms may become evident.

There were many “red flags” mentioned in the video that I found helpful for educators, and especially parents who may have concerns with a child’s development.  Some of the red flags to consider when screening a child include:

1.       Does not respond to his or her own name;
2.       Acts like they are hard of hearing;
3.       Does not smile at others;
4.       Does not point or use gestures by 12 month;
5.       May talk, but cannot communicate with others;
6.       Sudden loss of social and communication skills.

There are other reasons to referral a child for autism screening, including hearing tests and lead tests. After being referred, if the child fails any of the indicators, they may be eligible for early intervention, which involves other comprehensive assessments.

 I found it interesting when Dr. Ozonoff mentioned that one may notice red flags in an infant as young as 6 months.  I find this beneficial to know, especially for new parents who may not be aware of a child’s “typical” developmental stages.  However, having information that explains the meaning of these indicators will be very informative and helpful for new parents.

FBA/ Assessment:
When using a FBA, and other assessment tools, I strongly believe, it is essential to interact with the child on a one on one basis. As mentioned in the video, some assessments are based on parent review questionnaires or video monitoring, where little or no interaction occurs. The down fall for this type of assessment is the assessor may only have a short time with the child in his/her environment, and therefore will be limited with fully determining the child’s behavior.

Another strong connection on how FBA fits into an assessment picture is having access to knowledgeable team members that can work collaboratively in describing the behavior. This team may include persons who have daily interaction with the child, such as a speech therapist, doctor, teachers, daycare provider, psychologist, family members, as well as parents.

Diagnosis Procedure and History:

Dr. Ozonoff explained the diagnostic approach to be very straightforward and clear. Determining if the child meets all requirements for the DSM-4, it is important to collect as much as information as possible from the parents, teachers, and caregivers.  One important question to consider involves what the child’s behavior was like before the parents noticed an issue. It is also essential to determine what the parents’ main concerns are as well.

Some red flags that may be noticeable during the child’s first six months include:

Lack of sleep, not eating, level of activity, as well as appearing irritated and hard to settle down. By the first birthday the child may have difficulty making eye contact, not responding to one’s own name, not pointing or imitating, and demonstrating little interest when playing with others. By three years of age, the behaviors of autism seem more clear and noticeable. The child is usually behind in a variety of developmental milestones, desire to play alone, not respond to other children, not talk, but will exhibit some echolalia, or automatic repetition of sounds made by another person. I believe the best practice for bridging clinical assessment, educational assessment, and classroom practice involves having a scheduled meeting with the assessment team who should meet at least once a month, or more frequently, to discuss the child’s progress and/or concerns. This will enable the team to collaborate with each other about different positive outputs, or new issues, involving the child’s progress.

Identifying autism involves many steps and procedures with each assessment. However, a key factor with this is to recognize the importance of team meetings, and the meaningful impact such a collaboration will have on not only the child, but the family as well.

Autism and Childhood Schizophrenia

I am not as familiar with childhood schizophrenia as I am with autism, and prior to viewing this video I wasn’t aware how similar they can present.  In the opening of the video we see Jani engaging in a form of hand flapping or what we would assume to be self-stimulatory behavior, and this topography is something that I have in fact seen with some of the students that I work with that have a diagnosis of autism.  Watching the home videos of Jani in her early years, I don’t think that childhood schizophrenia would have entered my mind.  Staring off at things, not engaging in joint attention, engaging in self-stimulatory behavior, these are all things that would have said autism to me.  The behaviors that she exhibited as she got older, engaging in conversation, displaying social skills that are quite usually far beyond individuals with ASD would have raised a red flag that this might not be autism.  However, the fact that when her little brother got upset and she wanted to hurt him might be a sign for either autism or childhood schizophrenia; I have seen many children with ASD who do not like loud noises, or other people getting upset.  However, her hallucinations, the number and quality of them growing over the years, are definite cause for concern.  The fact that she has hallucinations that talk to her repeatedly, that tell her to do things like hit her brother, and that do things to her that she says she can feel in her brain would clearly lead me to think of something more along the lines of schizophrenia.  I think that it is possible that her diagnosis could have been made prior to age seven, as these symptoms were presenting at a very early age.  By observing her behavior, completing assessments with her parents and others who know her, I think the diagnosis of childhood schizophrenia could have been reached earlier.   I also thought it was interesting to note the difference in paranoid schizophrenia in a child and childhood schizophrenia.  The girl with paranoid schizophrenia seemed to exhibit many of the same symptoms that an adult with paranoid schizophrenia would exhibit, and perhaps this fact would help to aid in her diagnosis or in her getting a diagnosis sooner than perhaps Jani would have.  

Best Practice in the Assessment of Autism

The video was refreshing because I had some encounter with most of the main points Dr. Ozonoff discussed. It is important to have early screening at 18, 24 and 36 months.   According to Dr.Ozonoff  something may not show in the first screening and hopefully it will during level 2.  These are some of the red flags the assessor should be aware of : child does not respond to name, act as if deaf, does not smile at others, does not point or use other gestures by 12 months, no babbling by 12 months or no words by 16months, talk but does not try to communicate, loss or social or communication skill. Anyone who is familiar with ASD will definitely thinks the child is on the spectrum.  If a child fail at least 2 of the screening it is likely he/she has autism.  I was surprised that Dr. Ozonoff had difficulty distinguished if a child is high function autism or Asperger unless she reads their charts. they have many things in common and only a few differences.

It is crucial to involve everyone who has encounter with the child daily in the assessment process.  Parents are very important because they spend the most time with the child and there are time the kid will display a behavior at home but never at school.  Also the teacher, OT, PT, nurse, bus monitor, para professional, lunch aid, recess aid, classmates, sibling etc. Dr. Ozonoff mentioned the assessor should have direct interaction with the child before writing a report.  I find it funny that someone  will write a report solely on secondary information.  I understand getting the information from the team is important but one should not write a report without observation.

I think creating an FBA is important when dealing with the unknown. it is a great place to start, once the FBA is in place hopefully it will give the team a better understand if the plan is working or need to make some adjustment.  I think many specialist make that mistake without being aware of it. When working with a child on the spectrum we tend to write note while the kid is waiting on us. sometimes we  forget to take out a toy to keep the child engage so he or she does not get bored and wonder around. If the child is working on waiting that will be a good time to practice.  Dr. Ozonoff mentioned establishing sitting, use reinforcement, use visual schedule as needed and establishing give and take, begin with the easiest item and always alternate from easy to hard items and avoid making pattern. It is common sense to get a child to attend before presenting any material otherwise the score will not show the child real ability.  Clearing out the room is extremely important if you don't want the child to be distracted while being assess.  Sometimes I feel like the assessor does not know if they should correct certain thing while the child is in the middle of a test and  he or she does not want to make a mistake. Dr. Ozonoff  believes the session should end on a good note before exhaustion occurs.  I agree because you want to child to end the session on a positive note by answering the last question correctly and cashing in.  I always start out my session with an easy program or something the child has mastered because it will built up his or her confident.

We used to have a team meeting at my previous job every 3 months with the entire team.  If someone was not able to attend the meeting due to conflict of schedule the person will send in a report. During the meeting the parents will have an opportunity to voice their opinion and concern.  and let the team know if they would like to work on particular skill at home.  Each team member will have the opportunity to go over the child progress and what concern they may still have. I found these meeting helpful because I got to hear from the team.  We are extremely busy so it is great to have the opportunity to bounce ideas of each other. I wished we could have the meeting more often .

   

Best Practices

I think the point that Dr. Ozonoff makes that one person cannot pull off an assessment is very important.  In completing an FBA or any assessment, it is necessary to get input from the entire team.  Parents can often provide valuable insight on a child’s behavior and their skills, and often one member of the team may have information that another does not.  For example, a classroom teacher who generally sees a student in an environment with a multitude of other students may report disruptive attention seeking behavior that a speech and language pathologist working with a child in a 1:1 setting never sees, suggesting that attention from peers could potentially be a maintaining consequence.

I also liked the fact that she discussed the importance of reinforcing desirable behaviors such as sitting in a chair and complying with instructions during the assessment process.  Often I think evaluators forget to do this or think they are not supposed to do this and get faulty information as a result.  I also think this can be useful to do across the board in educational settings, as opposed to just during the process of assessment.

The comment Dr. Ozonoff made about interacting with the child was great.  I agree with her that this almost seems like common sense, but the scary fact is that often professionals will use parent reports and other forms of indirect assessment as a base for their results.  It is crucial, during a FBA and other assessments such as the ABLLs and VB-Mapp to both directly observe the individual and interact with them and their environment.  Often it is necessary for evaluators to facilitate an opportunity to interact with a peer to observe an individual’s response, and in regards to FBA, systematically manipulate the environment to evaluate effects on behavior. 

At my organization we seek to “bridge the gap” between clinical and educational assessments and classroom practice is by having monthly “clinics” with the parent, teacher, and other relevant members of the team.  This is just an informal meeting to discuss current findings, problems, and progress.  I find them to be a great way to keep everyone on the same page, give an open opportunity to address questions and concerns, and serve as a proactive approach to problem solving.

Best Practices

I think it’s funny that she comments on actually interacting with the child when assessing them. This seems like common sense to me especially since that’s how you can get a greater perspective on what’s going on with the child. I like the information she gave on the developmental history. It’s interesting that they are starting to assess autism in children as young as one year old. The presenter showed on one of her slides that towards the child’s first birthday they are developing the not looking at faces or eyes, lack of interest in social games and poor response to name. Researchers are finding out that during the second year of life there are signs of lack of imitation, lack of joint attention behaviors and lack of social interest and social play. In addition researchers are now saying that at the third year of life it’s much clearer that the child is developing autism. The children lack interactive play, have poor language development, they have rituals and stereotyped behaviors and just general delays.

An FBA fits into this assessment picture because it requires the assessor to interact with the child that s/he is assessing. FBA helps describe the behavior that everyone should be looking at and assessing. FBA require input from the parents, the school, clinical setting and anyone who interacts with the child. It helps create a vivid picture of the specific child.

Because these individuals are unable to fully explain why they were displaying certain inappropriate behaviors, methods were developed to determine why they demonstrated such actions. By gathering data and conducting experiments that evaluated the effects of environmental variables on the behavior, concerned staff members could usually decipher the meaning of the behaviors (i.e., what emotion or message was being communicated through the actions), determine why they were occurring, and develop behavior change programs to help the disabled individual display more appropriate behavior in meeting his or her needs.

One way we bridge the gap between clinical assessment, educational assessment, and classroom practice is by having what we call wrap around meetings. These meetings can happen as often as once a month to as little as once every six months. At these meetings the clinical staff that works with the child, the school staff, and families all come together to talk about the progress and positive things that are happening. At the end of the meeting people can list some concerns they have between the end of the meeting and the next one that they all work on and improve upon. The whole point of the meeting is that it is positive and there is no blame. These meetings look at the strengths of the students and it’s a great way to have all services meet and talk about the great things that are happening. These types of meetings should happen all the time everywhere because it helps bridge the gap.

Best Practices in the Assessment of Autism

It was great to read last week's posts and see how much you learned from watching the video on schizophrenia in young children. For those of you who are interested, here is a link to a Q&A with Jani's parents:

http://health.discovery.com/tv/psych-week/articles/born-schizophrenic.html

The Discovery Health Channel aired a full documentary on Jani. More video clips about her case can be found here:

http://health.discovery.com/videos/psych-week-2010-jannys-world.html

Best Practices in Assessment

This week you will be viewing a lecture by Dr. Sally Ozonoff on Best Practices in the Assessment of Autism. The video is below:

http://www.youtube.com/watch?v=0dpiVa8RTg8&feature=relmfu

The video is one hour long, so we will take time off of next week's class, which will end at 8:30 PM. As you listen to Dr. Ozonoff, you will see that she addresses topics we have discussed in class, such as distinctions between autism and Aspergers. It is really great to hear this presentation from one of our textbook authors and a leading scholar in the field of autism.


After listening to Dr. Ozonoff's presentation, reflect and comment on how the information she presents informs the  overall assessment process for you as an educator. How does a FBA fit into the assessment picture?  How do educator's bridge clinical assessments and classroom practice? What do best practices can you recommend for bridging clinical assessment, educational assessment and classroom practice?

Autism and Schizophrenia

One of the first behaviors I noticed in this video was Jani's stereotypic movements/flapping at her birthday gathering.  These movements, particularly in a large-group setting that could be somewhat exciting for Jani, immediately struck me as being very similar to a child with Autism.  Jani's parents reported that she never slept as an infant and was up often screaming for no particular reason.  She had invisible companions, which is also comparable to a child with Autism.  However, Jani's list of invisible companions was extremely expansive and it was very evident that she was not in control of these imaginary friends as there were many times she felt threatened by them.  I have worked with many pre-school age children with Autism who also have imaginary friends; however, they present much differently and are very much in control of their companions.  Jani also demonstrated aggressive behaviors towards her younger brother, particularly when he was crying.  While this may be true for a child with Autism, much of the cause here would be due to shifts in attention from the parents or sensory overload due to the noise.  This was definitely not true for Jani; it seemed as though she had a strong urge to actually hurt her brother.  They were also both socially withdrawn and made poor eye contact throughout the video.


However, there were  some noticeable distinctions between Schizophrenia and Autism as well.  I found the video clip of Jani as an infant tracking something she saw very interesting.  It was so clear that she was actually seeing something that was not a part of reality.  The part I found most fascinating is how both of these girls, so young in age, could describe so vividly what they were seeing and feeling.  Because of this, communication does not seem to be as much of a factor when looking at Schizophrenia.  A child with Autism would never be able to look outside of themselves enough to explain their thoughts and feelings to another individual.  Children with Autism, at least those with whom I have worked, also do not seem as dissatisfied with their lives.  You could tell in the video that both Jani and Becca were very unhappy with their lives, they hated people, and were very much in pain.  They are looking to escape their imaginary companions and voices, which a child with Autism seemingly enjoys being a part of another world.


Constant observation of these children and looking back on old videos like they did, in conjunction with extensive research on symptoms across settings, would help with differential diagnosis between Autism and Schizophrenia.

autism and schizophrenia

This video was definitely a very interesting one to view this week.  Never having experienced a child with schizophrenia I never really understood how it was that people could consider schizophrenia and autism to be similar.  After watching this video of Jani and Rebecca it has become very clear to me why at a very young age it can be difficult to tell the difference.  When the child is a baby, the lack of sleep and the staring off at things, not making eye contact are symptoms which can also be found in autism.  And as the child gets older, things such as the stereotyped movements such as hand flapping are also similar to that of a child with autism.  Upon closer examination of these symptoms however, I think that it is very clear that these symptoms present very differently in topography and function than they would for a child with autism.

Another thing which I found very interesting was how distinctly different childhood schizophrenia and paranoid schizophrenia actually are.  Paranoid schizophrenia in children presents very much the same way that it would in an adult.  The childhood schizophrenia I believe would be a bit harder to diagnose and that is why it took so long for Jani's diagnosis.  Her hallucinations seem very much like imaginary friends at first which all children usually go through as a part of development. Overall this video was definitely interesting to watch and certainly provided some insight.

Autism and Schizophrenia

When I first compared schizophrenia and autism, I thought both would have very different characteristics. As I watched the video on childhood schizophrenia, and did some research, it was quite obvious some of the symptoms are similar, especially in childhood years.

As an example, here are some resembling characteristics of autism and schizophrenia:

AUTISM:  little eye contact or none at all, difficulty reading facial expressions and body language, not being able to understand ones feelings, difficulty sleeping, obsessions with objects and certain ideas, speech impairments, poor social skills, and difficulty staying focused.

SCHIZOPHRENIA: seeing and hearing things that do not exist, difficulty paying attention, speech impairments, inappropriate expression or emotion, poor social skills, poor eye contact, and difficulty sleeping.

While watching the video of Jani as an infant, she demonstrated more than one sign of autism. For example, Jani was not sleeping through the night, and was waking up every 20 to 30 minutes.   Jani would also stare in a daze for several minutes.  As Jani became older, she started to show self-stimulations, such as hand flapping. These are all symptoms of autism.

What led me in a different direction of schizophrenia was the intense invisible appearances Jani was experiencing, which became more intense as she developed. Another reason why I thought Jani was schizophrenic was the relationship with her younger brother, wanting nothing to do with him. Jani’s parents also mentioned the “dozens of characters” in her head were telling her to do hurtful things to her brother, such as hitting him for no apparent reason.

I do not think Jani’s diagnosis of schizophrenia could have occurred earlier than seven years old because she did not show many signs of schizophrenia until she was older. And though Jani had invisible friends and characters that she would talk to on a daily basis, this is not uncommon for young children to experience, and are viewed as one of the normal developmental phases of childhood.

If I had to approach diffential diagnosis of an infant to making of the video I would consider both diagnosis’s and keep track of the symptoms the child is experiencing. Though medication can be beneficial, there can be many side effects. Subsequently, medication should not be viewed as the main cure until the diagnosis can be accurately determined.