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Assessing ELL Students Suspected of Autism

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Nikki Breeden

on 10 April 2014

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Transcript of Assessing ELL Students Suspected of Autism

Assessing ELL Students Suspected of Autism
Definitional Criteria for Autism
Preventing misplacement in SPLED
Assess in the student’s primary or home language when possible
Ensure that accurate info regarding primary and English language skills are accounted for when evaluating assessment results
A psychologist who is bilingual is not the same as a bilingual psychologist who is trained to assess ELLs and understand linguistic, academic, cultural, and social needs
(Sainz de la Peña, 2012)
ELL? Autism? Both?
Demonstrates difficulties relating to his peers
Appears to demonstrate a lack of interest or interaction during group discussions.
Student is isolated or alienated in the classroom and outside of the classroom.
Appears to have difficulty:
Comprehending instructional directions
Understanding behavioral directions
Establishing connections between class materials and the student’s personal life
Keeping up with the pace of learning
Parental input/interview
African American, Latino, Asian, and other race children were diagnosed with ASDs at older ages than white children (Zuckerman et al., 2013).

Children from non-English speaking families were less likely to be identified for screening or evaluation.

Cultural, racial, or ethnic differences in parents’ beliefs about normal development is likely to impact why and when children are referred for an evaluation.
Developmental milestones
Appropriate behaviors
Importance of socioemotional development
Beliefs about mental health and developmental disorders
Comprehensive Assessment of ASD
Review records
Assessment of ASD characteristics from multiple sources
Testing
Observation
Structured - ADOS
Unstructured - functioning in educational setting
Input from parents, teachers, and other professionals and individuals who are significant in the child’s life
Rating forms
Interviews
Assessment of need for services (achievement)
Rule-outs that (may) apply specifically to ELLs
Cultural factors
Environmental or economic disadvantage
Limited English
Lack of appropriate instruction
Observations
Observations in various context help to determine the existence of communication problems
Need to determine if communication difficulties are due to cultural differences or deficits
Need to address:
Vocabulary
Home language
Ability to converse
Developmental appropriateness
Impairments in all languages spoken
Sufficient exposure in L2
Testing and Structured Observation
Three Components to look for specifically when suspect ASD:
Communication (nonverbal and verbal)
Social interaction
Behavior
Other areas
Achievement
IQ
Others determined as necessary on case-by-case basis
Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history
Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history
Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).
Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
DSM-5 Diagnostic Criteria
Autism Spectrum Disorder
Considerations in assessing these areas given cultural and language diversity
Child’s language proficiency in English and native language
Child’s culture and how norms affect social interaction styles and nonverbal communication
What interests and behaviors are considered typical for the culture and family
Cultural Considerations and the ADOS
Although the overall algorithms used in the ADOS do robustly work to differentiate individuals with ASD from those without, there are still individual differences for what is considered “normal” for individual behaviors examined in the ADOS
Eye contact and pointing with the index finger
Interactions with adults for Chinese cultural background
Weighted heavily in ADOS algorithm
Exposure to and play with toys
Perceptions of pictures and story books in ADOS
Research needed to identify normative developmental data
Norbury & Sparks, 2013
Diverse parental perspectives on symptoms of autism
http://www.asha.org/uploadedFiles/ASHA/Publications/leader/2011/110118/Autism-Symptoms-Diverse-Perspectives.pdf
Parent input/interview
Parents are the main source for information about the child’s developmental and behavioral history.
Provide questionnaires in parents’ native language if English is not proficient.
Information gathered from norm-referenced questionnaires can be used qualitatively
Follow up questions
Obtain information about child’s L1 development.
Ask about the family’s understanding of and expectations for child development.
Clarify if an Interpreter is needed before the visit.
Parent input/interview
Modified Checklist for Autism in Toddlers (M-CHAT; Robins, Fein, & Barton, 1999)
Children 16-48 months
Follow-up interview schedule
6th grade English level
42 translationed versions
23 yes/no questions

**May not be as sensitive to borderline cases of ASD as we would like.
Role of the ESL teacher
Administer English proficiency assessments
Observe classroom behaviors and consider within context of knowledge of second language acquisition and acculturation
The ESL teacher is an important team member for interpreting evaluation results and instructional implications
(Sainz de la Peña, 2012)
Other general strategies
Underdiagnosis of ASD in ethnic minorities
"SLPs have the expertise to distinguish a language disorder from 'something else.' That 'something else' might include cultural and linguistic differences, socioeconomic factors, lack of adequate prior instruction, and the process of acquiring the dialect of English used in the schools" (ASHA, 2010, p. 2).
Conclusions should be based on the convergence of data from multiple indicators (Sainz de la Peña, 2012)
Something to consider...
“If these children are succeeding in
mainstream schools and are not causing concern, should we diagnose
them with a disorder? What would the advantages and disadvantages
be of labeling more children with ASD?”
Resources
Autism Consortium
http://www.autismconsortium.org/
Autism information available in 7 different languages.
Autism Speaks
http://www.autismspeaks.org/what-autism
Autism and Bilingualism - Blog
http://autismsupportnetwork.leveragesoftware.com/blog_post_view.aspx?BlogPostID=c87ffa795dca45bc8b07047ad14a5e8c
Pennsylvania Specific Resources
ASERT - http://www.paautism.org/
Case Studies
and discussion
Anton
6 years old, transition to kindergarten
Jin
Emigrated from Japan with his parents and grandparents.
None of his family speaks any English.
Family is middle class.
School interactions have only been with his mother, but she is very reserved.
She demonstrates limited eye contact when interacting with the school.
She is willing to provide the school with information about Jin but once expressed worry about shame relating to possible outcomes.
When queried, mom did not elaborate further.
Jin’s previous school records exhibit below average grades and there is no evidence of prior psychoeducational testing
Family speaks Russian and English at home
School interactions are always with dad
Lot of extended family in the area
Head Start screenings: concerns about social and communication skills, attending to and following directions, peer interactions, tantrum behaviors
Previously administered Battelle Developmental Inventory-II: significant delays in all areas
Early Academic Skills: knows some letters and colors, can count to 10, can write his name
PK teacher feels language barrier and lack of focus impedes skill development
Anton
ESL teacher observation: used only English words
English proficiency screenings in K; no records
SLP observation and testing:
Answered yes/no questions quickly and correctly but speech difficult to understand without context (picture)
Not clear if attempting to speak Russian or combination of Russian and English
Preschool SLP didn’t believe difficulties are result of influence of another language
Could not complete standardized testing (no basals)
Anton
K readiness: Bracken Basic Concepts Scale
Social/Emotional/Behavioral: BASC, Autism Spectrum Rating Scale (ASRS)
ADOS - Module 1 because pre-verbal or mostly single words
Communication scores met criteria for ASD
Reciprocal social interaction did not meet criteria (but social overtures were limited)
Stereotyped behavior seen 1x, preferred functional toys over imaginative toys but did engage in symbolic play
Convergence of evidence support eligibility of ASD
Teacher input, classroom observations, teacher ratings on ASRS and BASC (atypicality) and some of ADOS
Found eligible for Emotional Disturbance because parents did not want identified under ASD
10 years old, recent legal immigrant
Jin
Jin has been in ESL for 6 months, but is demonstrating continued delays and deficits in communication and social interaction.
He is able to communicate using short English sentences, typically consisting of subject, verb, object.
Demonstrates decreased emotional expression.
Lives in the Japanese community in the area.
Parents want the children to learn English and support their use of English
Family is trying to assimilate, but is getting push-back from child’s grandparents and neighbors.
At home, Jin’s parents note that he will often avoid them and experiences similar communication delays
Jin’s grandparents believe that this is out of respect for his elders and maintain the belief that there is nothing wrong with him.
They feel this assessment is a waste of time and often make Jin's parents aware of their opinion.
Jin
ESL teacher notes some “oddities” in the way communicating, particularly with others
Has more difficulties picking up social communication
Jin evidences pauses when speaking.
He also has difficulty producing some English sounds (short A sound), and at times, would have a monotonic intonation when speaking.
Both ELL and general ed teachers stated lack of eye contact
During recess, Jin prefers to play alone engaging in sensory-motor play
The school is a small school with some resources.
ELL teacher is bilingual (Japanese and English) and often is the interpreter.
There is two other Japanese children at the school who are 8 and 12, who are both Japanese Americans and speak both Japanese and English and live in the same community as Jin.
Jin
Parent interview with interpreter
ADOS Module 2 (any age with phrase speech)
Teacher input - ESL and general education teacher
Classroom observation
Recess observation to see peer relations
Planned peer interaction observation with other Japanese students
Assess communication and peer relationships regardless of language
What we would do...
References
Begeer, S., El Bouk, S., Boussaid, W., Terwogt, M.M., Koot, H.M. (2009). Underdiagnosis and referral bias of autism in ethnic minorities. Journal of Autism and Developmental Disorders, 39, 142-148.
http://www.asha.org/Publications/leader/2011/110118/Assessing-Diverse-Students-With-Autism-Spectrum-Disorders/
Guo, Y. (2006). “Why didn’t they show up?”: Rethinking ESL parent involvement in K–12 education. TESL Canada Journal, 24, 80–95.
Hebert, E. (2010). Parental beliefs about cause and course of their child’s autism and outcomes of their beliefs: A review of the literature. Issues in Comprehensive Nursing, 33, 149-163.
Norbury, C. F. & Sparks, A. (2013). Difference or disorder? Cultural issues in understanding neurodevelopmental disorders. Developmental Psychology, 49, 45-58. doi: 10.1037/a0027446
Sainz de la Peña, A. (2012, October). English language learners in special education: Evidence and practice. Association of School Psychologists of Pennsylvania Annual Conference Presentation at State College, PA.
Zuckerman, K. E., Mattox, K. M., Sinche, B. K., Blaschke, G. S., & Bethell, C. (2013). Racial, ethnic, and language disparities in early childhood developmental/behavioral evaluations: A narrative review. Journal of Clinical Pediatrics, XX, 1-13.
Prevalence Rates of
Autism
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