National Trends in Autism Diagnostic and Intervention Service ...
Published on: Mar 3, 2016
Transcripts - National Trends in Autism Diagnostic and Intervention Service ...
National Trends in Autism Diagnostic and Intervention Service Provision
Poster Session presented at the 2010 NASP Annual Meeting
Lopa M. Paul, Allison Landry, and Ramona M. Noland
SAM HOUSTON STATE UNIVERSITY
Prevalence rates of the broader Pervasive Developmental Disorder (PDD) spectrum, also referred
to as Autism Spectrum Disorders (ASD), have been steadily increasing in recent years, with a
convergence at approximately 60 per 10,000 children (Brock, 2006). Along with the rising PDD
diagnoses, we are also seeing an increased use of the educational disability category of Autism, as initially
outlined in the 1990 Individuals with Disabilities Education Act (IDEA), and Brock (2006) found that this
increase has coincided with a decrease in the use of diagnostic categories for emotional disturbance,
specific learning disability, and mental retardation. School psychologists are now required to be more
involved in both the diagnosis and treatment of the PDD spectrum disorders (Volker & Lopata, 2008).
It is likely, yet unclear, that states are differing with regard to special education service provision
for students who range from mild to severe impairment as a result of their disability. Just as states are
likely to vary with regard to required and/or supported assessment practices, there is also likely variation
between school districts within states. There are also likely to be a number of differences with regard to
adequate treatment implementation and types of evidenced-based educational interventions utilized.
School psychologists are uniquely suited to provide information related to such questions about services
for children diagnosed with a PDD.
This study was developed to gain a better understanding of regional differences in autism
diagnostic and intervention services. Information was gathered through the use of a confidential internet
survey. Potential participants were randomly selected from each state in the NASP Membership Directory
and contacted via email. The email briefly described the purpose of the study, including the topic, assured
potential participants of confidentiality protection, and included a link to a brief online survey. The survey
was designed specifically for this study and included a total of 44 questions. Potential participants were
contacted during the 2008-2009 school year. Only individuals who were practicing on at least a part-time
basis in the schools were encouraged to respond. A total of 1,622 total emails were sent in an effort to
contact potential participants. Of these, 182 were returned as nonfunctioning email addresses. In addition,
37 individuals contacted the researchers stating that they were unable to participate, most often citing not
working in the field as the reason (see Table 1).
Table 1. Participant contact information
Emails sent 1662
Invalid addresses 182
Unable to participate 37
Total potential participants 1480
Participation rate 19.8%
Participants included 278 school psychologists who initiated survey responses, yielding a
participation rate of 19.8%. Initial analysis revealed that a large number of willing participants (n = 78;
28%) began the survey but lacked the working knowledge of school-based practices needed to respond to
survey questions. Participants who completed surveys were primarily female (n = 162; 81%) and of
European American descent (n = 173; 86.5%). The age of participants was relatively equally distributed
between the ten year intervals of 21-30 (n = 43; 21.5%), 31-40 (n = 52; 26.0%), 41-50 (n = 36; 18.0%),
and 51-60 (n = 53; 26.5%), with only 8% (n = 16) citing an age of 61 or older. Respondents reported
working an average of 11.5 years in their current state of employment, with the largest group working in
the Northeast (n = 90; 32.8%), followed by the Midwest (n = 80; 29.2%), Southwest (n = 47; 17.2),
Southeast (n = 40; 14.6%), and Northwest (n = 15; 5.5%) regions (see Table 2).
Participants indicated 11.3 years of work experience on average (SD = 10.0; range 0 – 35) and
were spread relatively evenly across the professional educational levels, with 104 (37.4%) trained at the
Master’s degree level, 92 (33.1%) at the Specialist level, and 82 (29.5%) at the Doctoral level. Most
indicated working full-time as a school district employee (n = 193; 69.4%), with “other” employment
settings (n=42; 15.1%) and part-time school district employment (n = 19; 6.8%) indicated far less
frequently. Roughly half of the participants worked in suburban communities (n = 140; 50.4%), with 77
(27.7%) working in urban and 61 (21.9%) working in rural settings.
Table 2. Respondent demographic information
Sex (primarily female) n = 162 81.0%
Race (primarily European descent) n = 173 86.5%
Setting (primarily full-time, school) n = 193 69.4%
Master’s degree n = 104 37.4%
Specialist degree n = 92 33.1%
Doctoral degree n = 82 29.5%
Northeast n = 90 32.8%
Midwest n = 80 29.2%
Southwest n = 47 17.2%
Southeast n = 40 14.6%
Northwest n = 15 5.5%
Suburban n = 140 50.4%
Urban n = 77 27.7%
Rural n = 61 21.9%
Following a brief review of the Individuals with Disabilities Education Act (IDEA) definition of
Autism and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision
(DSM-IV-TR; APA, 2000) definition of Autism, participants indicated that their state’s definition of
Autism was more closely aligned with the IDEA definition (n = 125; 57.6%) than the DSM-IV-TR
definition (n = 52; 24.0%), with 18.4% (n = 40) unsure of which definition was more applicable to their
state’s Autism definition. More states were reported by respondents to not specify which Pervasive
Developmental Disorder (PDD) diagnostic categories were eligible for special education services (n =
114; 52.3%) than to specify which diagnostic categories met eligibility requirements (n = 71; 32.6%),
with a surprising 15.1% (n = 33) of respondents being unsure if the state clearly identified special
education eligibility (see Table 3). This trend remained consistent across all regions of the country.
Additionally, only a small percentage of respondents indicated that their state specified disability
categories necessary to meet Special Education eligibility as part of the Autism disability definition (see
Table 3. My state clearly indicates which diagnostic categories are eligible to receive Special Education services (N=218)
n % Response
71 32.6 Yes
114 52.3 No
33 15.1 I don’t know
Table 4. Diagnostic categories specified within respondent’s state disability definition (N=218)
n % Response
52 15.9 Pervasive Developmental Disorders
61 18.7 Autism Spectrum Disorders
71 21.7 Autism
55 16.8 Asperger’s Disorder
42 12.8 PDDNOS
Participants were asked to read several descriptions of a child’s level of impairment resulting from
an identified Autism disability and then indicate if they believed, based on the description, that the child
would meet the criteria of “adverse impact on educational performance” for eligibility to receive Special
Education services (see Table 5). Children who were described as having a clear academic need along
with autism-specific skill deficits (e.g., social interaction, behavior, or adaptive behavior) were most
likely to be viewed as meeting the “adverse impact” criteria. Once a child demonstrated no clear academic
need for intervention services, the likelihood that they might qualify for special education decreased.
Children described as having only mild impairment (e.g., only social interaction skill deficits) were
deemed likely to qualify for special education services by only one quarter of participants.
Table 5. Student level of impairment descriptions identified as meeting the criteria for “adverse impact,” and thus eligible
for Special Education services (N=217)
n % Level of Impairment Description
199 91.7 Child demonstrates clear academic need with social interaction, behavioral, and/or adaptive behavior deficits.
173 79.7 Child demonstrates mild academic need with social interaction, behavioral, and/oradaptive behavior deficits.
125 57.6 Child has no academic need, but demonstrates social interaction, behavioral, and adaptive behavior deficits.
84 38.7 Child has no academic need and no behavioral need, but demonstrates deficits in social interaction and adaptive
89 41.0 Child has no academic need and no social interaction deficits, but demonstrates deficits in behavior and adaptive
90 41.5 Child has no academic need and no adaptive behavior deficits, but demonstrates deficits in social interaction and
58 26.7 Child has no academic need and only demonstrates deficits with social interaction.
76 35.0 Child has no academic need and only demonstrates deficits with behavior.
63 29.0 Child has no academic need and only demonstrates deficits with adaptive behavior.
Only 15 participants (6.9%) indicated their states required certain assessment instruments to be
used in making a diagnosis of Autism, while 167 (77.0%) indicated that their states had no such
requirements and 35 (16.1%) were unsure. The Autism Diagnostic Observation Schedule (ADOS),
commonly referred to as the “gold standard” diagnostic instrument for Autism-related evaluations, was
the most frequently cited recommended instrument or assessment practice (see Table 6). It is interesting to
note, however, that many individuals reported using the “ADOS or an adaptive behavior measure”
(commonly the ABAS), with these instruments being extremely different in design as well as function.
Also, while a large number of respondents indicated the need to conduct a parent interview, very few
individuals reported using the Autism Diagnostic Interview-Revised (ADI-R), a semi-structured interview
instrument designed specifically for use as part of an Autism evaluation.
Table 6. Most frequently recommended assessmentinstruments or measurement methods
Number of Reports Instrument name or type of measure
35 Autism Diagnostic Observation Schedule
26 Gilliam Autism Rating Scale
22 Childhood AutismRating Scale
22 Standardized adaptive behavior measure
20 Standardized cognitive measure
12 Standardized achievement measure
4 Autism Diagnostic Interview-Revised
Many states were reported by participants to be encouraging educational personnel to work in
teams for both evaluation purposes (n=116; 53.7%) and consultation and intervention purposes (n=106;
49.1%). Participants reported that their school districts were more likely to maintain an Autism team for
consultation and intervention services (n=88; 40.7%) than for evaluation purposes (n=70; 32.4%), with a
majority of districts either not maintaining an Autism team or not promoting the team such that school
psychologists working in that district were aware of the services (see Table 7).
Table 7. Reported state- and district-level practices regarding Autism teams
State-level Practices: n %
Encourage educational personnelto work in teams for evaluation purposes 116 53.7
Encourage educational personnelto work in teams for consultation and intervention purposes 106 49.1
Autism team maintained for consultation and intervention services 88 40.7
Autism team maintained for evaluation purposes 70 32.4
Participants were asked to rate, based on their typical experience, the qualifications of different
educational personnel to work with children who have been given an educational diagnosis of Autism
(See Table 8). School psychologists thought, on average, that professionals in their field were adequately
qualified and prepared to make an educational diagnosis of Autism. Unfortunately, respondents viewed
special education teachers as minimally prepared and general educators as minimally to not at all prepared
to work with children diagnosed with Autism.
Table 8. Ratings of personnel preparation to adequately work with children diagnosed with Autism Spectrum
Preparation of Personnel
School Psychologists, n = 213
Qualified to make Autism/ASD educationaldiagnosis 0 42 84 70 17 3.3
Prepared to make Autism/ASD educational diagnosis 0 63 88 49 13 3.1
Special Educators, n = 213
Prepared to work with children who have Autism/ASD diagnosis 3 105 72 30 3 2.7
General Educators, n = 213
Prepared to work with children who have Autism/ASD diagnosis 89 105 17 2 0 1.7
Participants were also asked to rate, based on their typical experience, the ability of special
educators and general educators to effectively implement evidence-based interventions and programming
for children diagnosed with Autism (see Table 9). As with the ratings for level of preparation, special
educators were rated to be minimally implementing evidence-based programming while general educators
were rated to be minimally to not at all able to implement evidence-based programming. Special
educators were viewed as more capable of implementing programming following a training workshop.
Table 9. Ratings of personnel implementation of evidence-based educational programming and practices for
children diagnosed with Autism Spectrum Disorders
Implementation of Evidence-Based
Special Educators, n = 205
Based on typical performance, evidenced-based programming is implemented 9 85 65 39 7 2.8
Following participation in training for children diagnosed with Autism/ASD,
evidenced-based programming is implemented
9 70 83 37 6 2.8
General Educators, n = 205
Based on typical performance, evidenced-based programming is implemented 64 104 30 7 0 1.9
Following participation in training for children diagnosed with Autism/ASD,
evidence-based programming is implemented
30 121 40 14 0 2.2
While more diagnoses remain to be conducted, the initial findings from this study indicate
tremendous variation among school districts as well as states with regard to diagnostic evaluation of and
intervention practices for children diagnosed with an Autism Spectrum Disorder. More than half of the
state definitions of Autism align with the IDEA definition of Autism, but a substantial subset of states’
Autism disability definition aligned with the much more detailed DSM-IV-TR definition. More than half
of the states are reported to not clearly identify which diagnostic categories from the DSM-IV-TR would
make a child eligible to receive special education services, and there is variability among respondents as
to what level of impairment resulting from an Autism Spectrum Disorder would meet the “adverse
impact” special education qualification. There also appears to be little consensus on the types of
assessment practices and/or the assessment instruments to be used when conducting an evaluation for
Autism. Roughly half of states were reported to be encouraging the use of Autism teams for evaluation
and consultation purposes, but reported district implementation of Autism teams for these purposes was
lower. School psychologists report adequate preparation and qualification to make an educational
diagnosis of Autism, but they report both general and special educators as minimally prepared to work
with children who have the diagnosis.
Brock, S.E. (2006). An examination of the changing rates of autism in special education. The California
School Psychologist, 11, 31-40.
Volker, M.A., & Lopata, C. (2008). Autism: A review of biological bases, assessment, and intervention.
School Psychology Quarterly, 23(2), 258-270.