Department of Education WA

The Diagnosis of Autism Spectrum Disorder

In Western Australia

Andrea BuchananConsulting Teacher – Autism Education ServicesSchool of Special Educational Needs Disability

Autism Spectrum Disorder (ASD) is a neurologically-based pervasive developmental disorder characterised by 1. persistent deficits in social communication and social interaction 2. restricted or repetitive patterns of interests, behaviour and activities.

Neurological means it affects the brain and pervasive means that it affects many areas of development. At this time, there is no medical/blood test available to determine if a person has Autism. Autism is currently diagnosed by the presence or absence of certain behaviours and developmental history.

Who is involved in Autism Assessments? In Western Australia, an experienced multidisciplinary team is required to carry out an assessment for Autism Spectrum Disorder for individuals:

DSM-5 Autism Spectrum Disorder

A. Clinically significant, persistent deficits in social communication and interactions.1. Deficits in social-emotional reciprocity (i.e.: failure to initiate or respond to

social interactions)2. Deficits in nonverbal and verbal communication used for social interaction;3. Deficits in developing, maintaining and understanding relationships

B. Restricted, repetitive patterns of behavior, interests, and activities

1. Stereotyped or repetitive motor movements, use of objects, or speech2. Insistence of sameness, inflexible adherence to routines and ritualized

patterns of verbal or non-verbal behavior3. Highly restricted, fixated interests of abnormal intensity or focus4. Hypo- or hyper-reactivity to sensory stimuli, or unusual sensory behaviors

DSM-5 Autism Spectrum DisorderC. Symptoms must be present in early childhood (may manifest only when social

demands exceed capacities)

D. Symptoms must have a marked effect on ability to function

E. Severity must be specified: Level 1, 2, or 3

Severity• Level 3

– Requires very substantial support– Severe deficits in verbal and non-verbal social communication, very limited

initiation, minimal response to others(e.g. few words of intelligible speech)

• Level 2– Requires substantial support– Marked deficits in verbal and non-verbal social communication, limited

initiation, reduced or abnormal response to others (e.g. speaks a few sentences)

• Level 1– Requiring support– Without support, has deficits in verbal and non-verbal social communication,

deficits in initiation and clear examples of unsuccessful overtures and responses to others

New Diagnosis: Social Communication Disorder (SCD)• Impairment of pragmatics

• Diagnosed based on difficulty in the social uses of verbal & nonverbal communication in naturalistic contexts

• Must affect the development of social relationships & discourse comprehension and

• Cannot be explained by low abilities in the domains of word structure & grammar or general cognitive ability

• Must first rule out ASD. By definition ASD encompasses pragmatic communication problems

• The low social communication abilities result in functional limitations in effective communication, social participation, academic achievement or occupational performance, alone or in any combination.

Once a new diagnosis is confirmed, referral to support and therapy services is advised.

-Speech Language Therapy-Occupational Therapy-Clinical Psychologist

For students with a diagnosis arriving in WA from other states or countries, DSC is responsible for confirming the diagnosis to be valid for educational and service purposes.

Challenging BehaviourHow to do a student referral for

Behaviour

Kimberley School Psychology Service

Behaviour Vs. Risk Is there a potential risk of harm? If Yes:

◦Immediately report to line manager◦School Psychologist can support on a

priority bases◦Risk Management Plans will be put in

place to support staff and students If No: ◦Follow school process for behaviour

support

Before a referral?

There should be:

Whole class behaviour management program in place

Consultation with school leaders Behaviour data collected Individual Behaviour Plan written

and trialed

In School Support

Each school has a wealth of knowledge and experience. Seek support through:◦Colleagues◦SAER Coordinator ◦Principals/Deputy Principal ◦Senior staff member◦Learning support coordinator

Collecting Data

In order to change the behaviour we need to understand the behaviour

Data needs to be collected to inform your IBP

Data allows you to gather evidence of target behaviour and monitor progress

Types of Data Collection

Relevant classroom/playground observations

Behaviour Records Frequency counts A(ntecedent) B(ehaviour)

C(onsequence) Observations

What is an Individual Behaviour Plan (IBP)

An IBP is a written plan that identifies the behavioural needs of a student.

It outlines a continuing plan of action to meet these needs, often utilising incentive programs and hierarchy of consequences, and states that resources are needed and who is involved.

It is a way of establishing behaviour goals and recognising specific strategies to put in place to meet those goals.

How does an IBP work?An IBP gives the classroom teacher ways and

means by which to help a student experiencing behavioural difficulties.

It also provides a record of students progress.Parents/ Guardians should be informed and

involved in this process

What to include in an IBP

What behaviours should be focused on next?◦How will this be achieved?◦Who will provide

instruction/reinforcement?◦Where it will take place?◦For how long?◦What resources will be used?

Objectives and Goals

Objectives Strategies Who/How Evaluation

Should be Specific Measurable Achievable Realistic Time-based

How will the objectives be achieved?

Who is involved?

How will each member be involved?

How will each objective be measured to ensure objectives have been met?

Implementation

Monitor, evaluate

and review

Assessment and Planning

Process

Monitor, Evaluate and Review IBP

Monitor student’s progressCollect data using a range of toolsEvaluate effectiveness of strategiesMeet with parents, student and other

key participants to discuss current progress

Plan for further action – Request for external support?

External Support School Psychologist Kimberley Behaviour Support

Consultant Lead School Psychologist

School Psychologist - Request for assistance form

◦Need to complete form◦Return to SAER Coordinator (case manager)

◦SAER Coordinator will consult with School Psychologist

◦School Psych will either accept request or recommend another pathway

◦If accepted a Case Conference will be arranged by SAER coordinator

Case Conference People who may attend

include:

SAER LSC School Psychologists School Nurse Deputy Principal Parents / carers Teacher

EA Speech Therapists Occupational

Therapists DPFS (Department

for Child Protection and Family Support) *After School Care

Informed Consent The client has the right to know and school psychologists have the obligation to: inform parents/ guardians what they can and cannot do as professionals, the kinds of involvement and interventions they are likely to provide and the implications of such intervention, BEFORE a Case Conference record can be signed and BEFORE ANY involvement is undertaken by the psychologist. The following should be made explicit:

The client has the right to withdraw consent at any time. The consent for an intervention must come from the

legal guardian responsible for the student until they reach the age of consent.

In certain cases the student can be deemed to be a Mature Minor and is then able to make his/her own decision. 

Kimberley Behaviour Support A consultant Psychologist

specialising in supporting with challenging behaviour

Can support on a ◦whole school level – training and

management◦Individual case level – teacher

consults and planning support

There is a problem with student behaviour…

Is someone getting hurt?

YES – urgent referral to Lead School Psychologist

Restraint RAC - emergency training for staff and Risk Management Plan provided by KBSC within 3 school days

No – but learning is being disrupted

Behaviour Management plans written, implemented and data collected as per

school processes

Yes – but it didn’t work

Follow school process for School Psychologist referral, behaviour assessment and

implement intervention

One case Multiple cases across the school

Whole school training is available for free – Principal and contact School Psychologist contact the lead school psychologist to make a request

The KBSC will attend site and conduct whole school training as soon as is practicable

Kimberley Behaviour Support Consultancy (KBSC) Referral process 2015

Follow school process for School Psychologist referral, behaviour assessment and

implement intervention

Joint referral – School Principal and contact School psychologist send an email to the Lead School Psychologists requesting more assistance from the KBSC.

KBSC will attend school and conduct

Parent discussion to gain informed consent (at case conference) Assessment interview with school staff and parents Intervention planning with school staff and parents

as soon as is practicable

The KBSC will attend site and conduct whole school training as soon as is practicable

Yes – but it still didn’t work

Kimberley Behaviour Support Consultancy (KBSC) Referral process 2015

Support is always available If you are unsure about the

process at your school talk to your Principal or School Psychologist

Questions?