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Eligibility and School-Aged Children

Brookman-Frazee, L.I., Drahota, A., & Stadnick, N. (2011). Training community mental health therapists to deliver a package of evidence-based practice strategies for school-age children with autism spectrum disorders: A pilot study. Journal of Autism and Developmental Disorders, 42, 1651-61.

This study examined the feasibility of training community mental health providers to deliver an evidence-based practice intervention for children with ASD. Community mental health providers traditionally have not played a significant role in therapeutic interventions for children with ASD and their families. Because there are often gaps in services for school-aged children, the Interagency Autism Coordinating Committee calls for more research on ways to improve implementation of evidence-based services in various community settings and agencies. Since some children with ASD often have a co-morbid psychological disorder, many children are already being treated by community mental health therapists. However, many of these therapists do not have ASD specific training and often hold outdated beliefs about ASD.

In order to improve upon community services, this study examined the outcomes when 13 community therapists were trained to deliver evidence-based practices to 13 male school-aged children with ASD through a program called AIM HI. These therapists had no previous experience with ASD. AIM HI is an evidence-based clinical intervention based on the principles of Applied Behavioral Analysis (ABA) that includes the use of functional behavior assessment, behavior intervention plans, antecedent and reinforcement strategies, schedules, priming, visual cues, modeling, self-management skills, prompt fading, and evaluation. The AMI HI program is designed to reduce behavioral challenges in children with ASD and provide parents with the skills they need to improve behavior across all routines and environments. Initial sessions began with a collaboration between parents, children, and therapists to determine functions of behaviors, develop a treatment plan, and identify alternative, more adaptive behaviors. Further sessions included a review of what the family did the previous week at home, a time for the therapist to teach or review a skill with the parent and/or child, a summarization of the session and assignment of the homework for the week, and ended with a motivating activity.

Before beginning AIM HI sessions, participating therapists were provided with specific training, including a 6 hour introductory workshop, web-based self-study course materials, printed materials, and ongoing feedback and supervision from AIM HI developers. Multiple methods were used to measure fidelity to the program including observation, outside ratings, and self-reporting. Additional measures included: therapists were provided with a survey at the end of the training period, child and family attendance was reported, ratings of parental involvement were included, scales to determine changes in child behavior were utilized, and paired sample t-tests were used. Overall, the results indicated that therapists perceive the evidence-based strategies used in AIM HI as helpful for their clients with ASD, and for their clients with other disorders such as ADHD, behavioral disorders, and anxiety as well. Results also indicated that the use of these strategies statistically and significantly reduced challenging behaviors, specifically hyperactivity. The authors note that the limitations of the study include the small sample size and a lack of a control group and suggestions for future study included another more comprehensive, large-scale study into the use of EBPs in community settings.

Cardon, T.A., Wilcox, M.J., & Campbell, P.H. (2011). Caregiver perspectives about assistive technology use with their young children with autism spectrum disorders. Infants and Young Children, 24(2), 153-173.

The types and uses of assistive technology can be confusing for parents and professionals alike. Many people currently think only about iPads and smartphones or voice output systems when they hear the words assistive technology but AT actually includes a wide variety of techniques and supports from low tech to high tech. Assistive technology is meant to support an individual throughout the entire day, not with just communication. Low tech supports might include Velcro, pencil grips, bath mats, or photographs while high tech supports might include computers or augmentative communication systems with voice output. While we often see school age children with autism and adults enjoying more access to different types of assistive technology, the same cannot be said for very young children with ASD.

This study examined how families perceive and use all types of assistive technology with their young children with autism. Questions asked for this study included: Are there activities or routines that are challenging for your child? Were any AT strategies utilized for these challenging situations and if so, what type? How much training, information, and support did you have in regards to using assistive technology? The results from 134 families raising children with ASD ages 12 months to 36 months suggest that bathing was the most challenging routine followed by morning routine, evening routine, mealtime, and play. Mealtime and play were the only activities that were not reported to be more difficult than children with any other type of disabilities. Less than half of the families surveyed indicated they were able to find and implement assistive technology solutions for these challenging activities; however, when families were asked about what type of AT they were using, only 1/4 of these families were actually using a form of assistive technology. Of the 1/4 families surveyed who had been using assistive technology, photographs were the most commonly used AT followed by grips, mats, Velcro and one family used a high tech communication system. When families were asked about how they learned about assistive technology, families were almost just as likely to learn about AT from other parents as they were from EI providers. Previous studies suggest that EI providers may not be adequately trained in assistive technology strategies and supports. The authors suggest that future research focus on training activities for parents of young children with ASD and EI providers in regards to understanding what AT is and how it can support daily routines for children with ASD.

Leach, D., & Duffy. M.L. (2009). Supporting students with autism spectrum disorders in inclusive settings. Intervention in School and Clinic, 45, 31-37.

With ongoing collaboration among general education teachers, special education teachers, related service professionals, and parents, students with autism spectrum disorders (ASD) can receive a quality education alongside their typically developing peers. This article provides strategies to promote the successful inclusion of students with ASD in general education classrooms. The suggestions provided are categorized by preventative, supportive, and corrective strategies and techniques. These strategies can provide general education teachers with a set of tools that enable them to be proactive in preventing and addressing problem behavior and academic and social isues, while enhancing instruction and enabling students to reach their full potential. Special emphasis is given to strategies to increase active engagement in instructional activities.

Leaf, J.B., Tsuji, K.H., Griggs, B., Edwards, A., Taubman, M., McEachin, J., Leaf, R., & Oppenheim-Leaf, M.L. (2012). Teaching Social Skills to Children with Autism Using the Cool versus Not Cool Procedure. Education and Training in Autism and Developmental Disabilities, 47(2), 165-175.

There are numerous interventions available to improve social communication skills for those with ASD, including behavioral training and teaching interaction strategies. This study evaluated the effectiveness of another possible approach—the cool versus not cool procedure. In this approach, individuals are taught to discriminate between appropriate, or "cool," behaviors and inappropriate, or "not cool," behaviors. Once the individual identifies whether or not the behavior is cool or not cool, the participant must then explain why the behavior is appropriate or inappropriate. This approach does not describe the behavior or why the behavior should happen through social narratives, and it also does not provide any cues for the individual about when to use the behavior as is seen in behavioral and teaching strategies. This study followed three case studies as several behaviors were targeted such as interrupting, changing games, greetings, joint attention, changing conversations, abduction prevention (stranger dager), and eye contact. Four of the skills achieved mastery criterion using the cool versus not cool procedure, three other skills required role-playing to reach mastery criterion, and finally, one skill—eye contact—did not achieve mastery criterion. The results of this study suggest that the cool versus not cool approach might be an effective intervention for teaching social communication skills. The benefit to using this approach is that it requires little preparation time, little to no materials, and can be implemented in a flexible and spontaneous manner. Future research is necessary to understand more about the use of role-playing in this intervention and the effectiveness of this intervention when used in conjunction with other approaches.

MacFarlane, J.R., & Kanaya, T. (2009). What does it mean to be autistic? Inter-state variation in special education criteria for autism services. Journal of Child and Family Studies, 18, 662-669.

The rapid increase in the number of individuals being diagnosed with ASD has spurred public interest into the specifics of who is being diagnosed, what services are being provided, and the cause(s) of ASD. While we still know very little about why the prevalence rate continues to increase, one area of concern among professionals is the discrepancy between a clinical diagnosis of ASD and school-based eligibility for special educational services. Some epidemiological studies include special education data to monitor diagnostic trends; however, a clinical diagnosis of ASD can be very different from a finding of special education eligibility.

A clinical diagnosis of ASD is based on the Diagnostic and Statistical Manual of Mental Disorders, now in its 5th edition (DSM-5), while eligibility for services under the federal category of Autism is based on an individual state's definition of autism (which must meet or exceed the requirements of the CFR—Code of Federal Regulations). Therefore, an individual can meet the clinical criteria for a medical diagnosis of autism while not meeting the educational requirements for eligibility of autism services in special education because that eligibility is based on educational need not on clinical criteria. The literature suggests that one-third of those with an ASD diagnosis are not eligible for special education services.

This study analyzed the legal definitions of special education in each state to examine the variability of autism services eligibility criteria from state to state. According to the authors of the study, 17 states and Washington D.C. relied on the wording from the Code of Federal Regulations, while the other 33 states expanded on the definition. The report indicated that there was a significant amount of variability among those states that expanded the definition. The authors of the study recommend: more consistency between states in terms of eligibility criteria, that each state publish this criteria in a parent-friendly format on the web, and that future epidemiological studies carefully note and document data from clinical and educational sources.

Morrier, M.J., & Hess, K.L. (2012). Ethnic differences in autism eligibility in the United States public schools. The Journal of Special Education, 46, 49-63.

Because of the dramatic rise in autism diagnosis and eligibility, many professionals have begun to look at the specifics of the numbers to determine whether any racial or ethnic disparities exist. Although autism knows no cultural, ethnic, or socioeconomic boundaries, not all groups of individuals are being diagnosed or identified at the same rate. Research suggests that many ethnicities are either under- or over-reported. Research suggests that there will be some variation in the representation of various groups due to state to state differences in how students are identified for eligibility of special education services under the autism category. This study specifically examines the ethnic differences of those receiving special education services under the category of autism from 2007 to 2008. The results of this study suggest that there are ethnic disparities and that 80% of states are under-reporting all ethnicities—most especially those of Hispanic background. From the results, 95% of states are under-representing children from Hispanic backgrounds. There are several limitations of the study, including the individual ways that states are allowed to define the autism eligibility criteria, availability of qualified staff to administer diagnostic measures such as the ADOS or ADI-R, and limited access to protected data such as gender, medical diagnosis and medical co-morbidity, and immigration status. The authors suggest that future studies should consider socioeconomic status and eligibility, as well as representation over time and urban versus rural statistics.

Rowley, E., Chandler, S., Baird, G., Simonoff, E., Pickles, A., Loucas, T., Charman, T. (2012). The Experience of Friendship, Victimization and Bullying in Children with an Autism Spectrum Disorder: Associations with Child Characteristics and School Placement. Research in Autism Spectrum Disorders, 6, 1126-1134.

Developing and maintaining friendships is important for everyone, especially individuals with ASD. However, the primary and secondary characteristics of ASD often prevent individuals from developing relationships with others. Many people mistakenly assume that individuals with ASD do not want to develop friendships, and yet, the opposite is generally true. Individuals with ASD often feel lonely and want friendships, but the social experience of being with others can be incredibly stressful. As this study suggests, the more students with ASD seek out friendships, the more often they may experience bullying and peer victimization due to literal language, narrow range of interests, and repetitive behaviors. From a sample of 56,946 children involved in the Special Needs and Autism Project (SNAP), 100 children ages 10-12, their parents, and their teachers were interviewed about friendships, bullying, and victimization. Parents often rated fewer friendships and more cases of bullying than students and their teachers. Overall, results suggest that friendship quality was lower and that bullying and victimization was higher.

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