Monterey Bay Forum » autistic spectrum disorder

Aptos, CA psychologist: How best to measure autism? Caveats about use of the ADOS? What happened to the toddler version of the ADOS? Is there a way to accurately used standardized scores when measuring autism?

jaj48 — Fri, 22 Oct 2010 22:37:33 +0000

Cameron Jackson DrCameronJackson@gmail.com

Some caveats concerning the use of the ADOS in the assessment of autism.

One caveat: The ADOS measures autistic spectrum disorders but does not distinguish between the severity of autistic symptoms. That is, it does not distinguish between 299.0 Autistic Disorder (most severe), PDD-NOS (less severe) and Asperger’s Disorder (normal IQ and normal adaptive functioning).

A second caveat: The ADOS only picks up information between the interaction of an adult (psychologist, therapist) with a child. Unfortunately, there is no sampling of the child’s behaviors with same age peers. And, needless to say, how a child interacts with same age peers is crucial information. Frequently persons with an autistic spectrum disorder (ASD) do fine with persons older or younger. How the ASD functions in relation to persons fairly close in age is highly important. Why? In America, we educate children that are the same age. In many states, including California, once a child has been held back one time they cannot be held back again. So if a child cannot readily function with same age peers that is highly significant for that child’s educational experience.

The ADOS, a measure of autistic spectrum disorders, is a very different kind of measure compared to measures of intelligence.

We have lots of measures of intelligence and they all do a fairly good job. Most of the well known measures of intelligence result in standard scores and persons can be classified in a range: Average range, Superior range, Deficient range. A person who scores in the Average range on one measure typically and usually will score in the Average range on other measures of intelligence. For example, the Test of Nonverbal Intelligence (TONI) will give a standard score in the Average range that is fairly close to the Performance I.Q. of a Wechsler IQ test.

In contrast to measures of intelligence (I.Q.), the measurement of autistic spectrum disorders with an ADOS does not result in a standard scores. Scores are not spread out along the bell curve. Thus it is mot possible to talk about Average range, Superior range, Deficient range.

Hence, because there are no standard scores there is no way to compare performance on the ADOS with all the hundreds of tests that exist which use standard scores.

Instead of providing standard score information, the ADOS has a “cut-off” score. If the person scores above then they supposedly have an autistic spectrum disorder. The ADOS does include Category 3 (repetitive behaviors, unusually strong, limited interests) items in determining the overall scores.

So what happened to the ADOS for toddlers that was coming soon — but not here yet?

How did the new ADOS Module T perform?

1.The sensitivity of the ADOS Toddler module was 91%. That is, the test was able to correctly identify 91% of the cases of ASD (based on a cut off score of 12).

2.The specificity of the ADOS-Module T when tested against non-ASD disorders was also 91%. This means that only in 9% of the cases, the test suggested a diagnosis when the child had been previously identified as not having an ASD.

3.The specificity of the ADOS-Module T when tested against typically developing cases was 94%. That is, only in 6% of the cases, the test suggested a diagnosis in children who were actually typically developing kids.
What happened to the ADOS Toddler Module? Not happening?

One of the authors writes:

“These are actually excellent numbers and indicate that the ADOS Toddler Module has excellent sensitivity and specificity. However, the authors also described some general concerns and limitations.

The ADOS, although it is the most reliable and valid diagnostic instrument available, it is still only a clinical tool that must be used in the context of a comprehensive clinical evaluation and it is subservient to clinical judgment.

Specifically, a diagnosis of autism is provided only when the person meets the DSM-IV diagnostic criteria. Therefore, clinicians must use their judgments in interpreting and applying the results from the ADOS. There will be cases when the ADOS suggests a diagnosis but the clinician will not provide the diagnosis because the child doesn’t meet full diagnostic criteria based on the DSM-IV.

So you may ask, what is the point? Why do we have the ADOS if all a clinician has to do is go down the list of the DSM-IV criteria and add up the check marks? The ADOS provides for a reliable and valid tool to assess for the specific symptoms included in the DSM-IV criteria and it helps the clinician interpret the child’s clinical presentation as it applies to the DSM-IV criteria. The ADOS standardizes this process so that diagnoses are less dependent upon other factors, such as biases in parental reporting of symptoms, or the skills or training of the clinician in properly indentifying such symptoms. Therefore, the ADOS greatly improves the validity and accuracy of our ‘clinical judgment’.

On a personal note and disclaimer. Dr. Luyster (lead author of the study), Dr. Richler, and Dr. Oti were all my classmates in graduate school and I congratulate them for their wonderful work. In addition Dr. Lord, creator of the ADOS and founder of the University of Michigan Autism and Communication Disorders Clinic, will be my collague this Fall when I join the University of Michigan faculty.

The Reference: Luyster, R., Gotham, K., Guthrie, W., Coffing, M., Petrak, R., Pierce, K., Bishop, S., Esler, A., Hus, V., Oti, R., Richler, J., Risi, S., & Lord, C. (2009). The Autism Diagnostic Observation Schedule—Toddler Module: A New Module of a Standardized Diagnostic Measure for Autism Spectrum Disorders Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-009-0746-z

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Aptos, CA psychologist: stories of courage and faith are all around us.

jaj48 — Thu, 11 Mar 2010 07:21:45 +0000

Diploma earned by CA youth with autism

There are stories of courage and faith all around us. This one is about a Catholic family with a special needs child. Recently, now age 18, I had the opportunity to assess their son.

This young person has substantial, multiple difficulties. To protect the family’s privacy, some information has been changed.

I will call their son Thomas. Not Thomas the Doubter but Thomas the Tenacious.

Early on, Thomas’ family knew that their middle child was very different. Though not a problem at home, he got kicked out of a private pre-school for behavior issues. By age four, assessment suggested that he had substantial communication and social delays. Other assessment suggested an array of delays.

In Kindergarten, Thomas’ parents turned down an SDC placement (more than 50% in special ed setting) and insisted on mainstreaming him. His family wanted and got a regular ed placement. He had an aide.

Assessment in second grade showed that Thomas had normal, average cognitive IQ abilities and quite low other abilities. However, thereafter when Thomas’ cognitive IQ abilities were tested his scores were in the bottom 5 out of 100.

“No, we are not going to use the mental retardation label,” the parents said to themselves and to professionals. To Thomas they said, “You can and will graduate from high school”.

The parents set the bar high for Thomas. The parents helped him every night at home and negotiated with the schools for support services to assist Thomas. At times he had an aide. He had Occupational Therapy and Speech services. Throughout high school he had RSP support.

Outside school, Thomas was able to complete religious classes and in high school was confirmed in his church. But he never had any friends.

“If Thomas misses 1 class it is as though he missed 3″ said his mother to me when I tried to set up an appointment to assess him. ” And absolutely don’t take him out of History …” And I did set up appointment times that did not conflict with any of his academic subjects.

And guess what — this June Thomas age 18 will graduate with a high school diploma. True — he has not been able to pass the California exit exams. However, he has completed all the work and taken all the necessary classes. Thomas has worked hard and long to get a diploma.

It has been a hard road for Thomas. It takes him 2-3 times as long to finish his homework compared to fellow students. Though he would like friends — he has no friends. And he cannot drive a car. And except for work experience through Special Education, he has had no part time jobs.

Thomas has a disability called Autistic Spectrum Disorder. It substantially affects his communication and social abilities. Sometimes he mumbles and sometimes he nearly shuts down in his abilities to communicate with people.

When assessing Thomas, one thing shined through — Thomas has sold, normal, average cognitive intelligence. That Thomas has normal, average intelligence is a real strength that will help him in all of life’s situations.

All of us have strengths and relative weaknesses. Thomas has strong intelligence and incredible tenacity. Once he knows what to do and how to do it, he persists and keeps on trying until the task is done. And that willingness to persist and keep on trying was passed along to Thomas by the faith and courage of his parents.

Heal autism? A lot of the symptoms can clear …Here’s one story…

jaj48 — Wed, 03 Mar 2010 22:45:37 +0000

This is a true story with some information changed to protect privacy.

The boy, I will call him Mark, is nearly seven years old. He was diagnosed with Autistic Disorder a year ago.

The diagnosis was given after a thorough assessment by a licensed California psychologist up in the Bay Area. Mark and his parents live in the Monterey Bay area. Mark goes to a public school kindergarten.

In the course of just one year, Mark’s functional abilities have improved considerably. He no longer meets criteria for a diagnosis of Autistic Disorder.

Since the diagnosis , Father, a computer type, now spends much more time engaged with Mark has an Individual Education Plan (IEP) which provides a full time aide and public school speech services. Mother also takes him to private social learning classes and to horseback riding classes for children with disabilities. And there is a normally developing same age boy who lives close. The parents put in an outside hot tub and child oriented playground to encourage other children to come visit.

Of note: There was no Applied Behavioral Analysis (ABA) services in place. Mother appears to use a soft, developmentally oriented approach. And it IS working! So, YES, children can dramatically improve in one year. Instead of having 6 out of 9 functional areas quite low, now there are only three. What more improvements will happen over the next year? I expect more great, positive changes ….
written by Cameron Jackson DrCameronJackson@gmail.com

Aptos psychologist: Even MORE people will be diagnosed “austistic spectrum disorder”

jaj48 — Thu, 11 Feb 2010 23:17:14 +0000

The next version of the Diagnostic and Statistical Manual (DSM-V) more than likely will collapse Asperger’s Disorder and PDD-NOS into “Autistic Spectrum Disorder” (ASD). If you want to comment go to the following web site.

I think the new definition of ASD is cleaner and well written. It still needs something in the diagnostic criteria that addresses how substantially handicapped the person is by his/her particular symptoms.

The flip side of diagnosis is treatment. A diangosis of “Autistic Spectrum Disorder” should include the specific deficits — and degree of deficit — so as to suggest appropriate, individual interventions.

Aptos psychologist: Easter Seals offers P.L.A.Y. autism therapy in Santa Cruz & Monterey Counties www.freedomOK.net/wordpress

jaj48 — Sun, 24 May 2009 17:46:33 +0000

written by Dr. Cameron Jackson, Ph.D.. L.D. Licensed Psychologist 831 688-6002

Children with a diagnosis of Autistic Spectrum Disorder (ASD) (Autistic Disorder, Asperger’s Disorder, Pervasive Developmental Disorder, NOS) have major social and communication difficulties.

Families need to be given the TOOLS how to have fun and be spontaneous with their children as they teach them. It is very hard on families to be social and engaging with ASDD children who seem to be in their own world, who seem to ignore their parents, who seem unaware of brothers and sisters.

The P.L.A.Y. project’s goal is to teach parents to PLAY in a fun way in developmentally appropriate ways. Not only the child – the whole family can benefit. Currently available in Monterey County, P.L.A.Y. is also available to Santa Cruz County parents. P.L.A.Y. is a vendor of San Andreas Regional Center which covers the four counties of Santa Cruz, Monterey, San Benito and Santa Clara. Pl.L.A.Y. is a regional center vendor for under 3 children. It is appropriate for children before attending school.

The following information comes from the Easter Seals site. There is a link to the site at the bottom.

“Easter Seals P.L.A.Y. Project (Play and Language for Autistic Youngsters) program started in 2006. The mission of the project is to help young children (up to age 6) with autism spectrum disorders and their families obtain interventions that consist of 2-3 hours of intensive, individualized therapy per day, and are integrated with other therapies saving the parents time and money.

“The P.L.A.Y. Project is unique in that it provides training for the parents of children with autism so they can implement therapy at home. Easter Seals has home consultants, including specially trained occupational therapists and speech pathologists, to implement the P.L.A.Y. Project, enabling them to teach parents how to initiate therapy in the home setting. A child with autism needs 20-30 hours per week of therapy to learn and grow as quickly as possible. This project is highly cost effective for families and enables the child to receive a continuum of service throughout their day.

“The P.L.A.Y. Project was founded by Dr. Rick Solomon, who has diagnosed and treated children with autism for over 15 years. Dr. Solomon’s initial study of 70 children with autism demonstrated that 65% of the children in the P.L.A.Y. Project made good to excellent progress. Solomon’s study has been given tremendous credibility with its recent acceptance for publication in the Journal of Autism and receipt of a National Institute of Health grant.

Goals of the P.L.A.Y. Project include:

Improving parent/child relationships.
Improving behavior of the child reducing stress within the home.
Including siblings in coaching and training.
Creating strong families including improved spousal relationships
Improving child development so children are ready for school.
Improving systems for families so services are integrated, accessible, culturally-appropriate and of high quality.The P.L.A.Y. Project is partially funded by First 5 Monterey County, First 5 Fresno County and the Fansler Foundation.

“If you or someone you know would like information regarding the P.L.A.Y. Project, please contact Drea Martinez at 559-267-3952 in Fresno and Mark Wenzler at 831-684-2166 in Monterey.

“For more information about the P.L.A.Y. Project, you can also visit www.playproject.org.

Above comes from Easter Seals