1	Understanding Development as it Relates to Assessment Kimberly P. Ray, Ph.D. Licensed Psychologist Board Certified Behavior Analyst TCLC Mississippi Behavior Clinic
2	"Recent studies estimate that 19.5" Recent studies estimate that 19.5% of U.S. children between ages 3 and 17 have one of the following: A developmental delay A learning disability An emotional disorder
3	Number of Children Being Served under IDEA (B) Mississippi (fall 2005) 3 – 5 years: 8,319 6 – 11 years 28,895 12 – 17 years 27,887 18 – 21 years 2,998 Total ages 3 – 21 68,089
4	Number of Children Being Served under IDEA (B) 50 states and D.C. (fall 2005) 3 – 5 years: 698,938 6 – 11 years: 2,729,822 12 – 17 years: 2,979,095 18 – 21 years: 312,545 Total ages 3 – 21: 6,720,400
5	Teachers employed to provide special education and related services to children ages 3 through 5 under IDEA, Part B, by certification status and state: Fall 2004 Total Certified Non-certified Mississippi 651 564 88 50 states 32,866 29,121 3,745 (and D.C.) *number of children served 3-5 MS- 8,319 US- 698,938
6	Stages of the Assessment Process Child Find Developmental Screening Diagnosis Individual Planning and Intervention Program Monitoring Program Evaluation
7	Child Find Procedures designed to locate children who need early intervention services and programs many parents do not know that services are available for young children, parents may not realize that their child has a developmental problem, or family may deny that a problem exists
8	Developmental Screening Developmental screening is a cursory method for obtaining general information about a child's development and detecting any potential problems
9	Diagnosis Diagnosis is a more intensive evaluation than screening. Information is obtained through observation, interviews, case history, and informal and standardized tests.
10	Individual Planning and Intervention Areas typically considered in the planning process for children: Sensory/physical development Language and communication abilities Fine and gross motor development Cognitive abilities Adaptive or self-help skills Social-emotional development
11	Program Monitoring Multiple checks include observations, developmental checklists, and rating scales Collect data on a regular basis and analyze to determine mastery of targeted skills Note progress in meeting goals and objects on the child's Individualized Education Plan (IEP) or Individualized Family Service Plan (IFSP) Determine the effectiveness of the invention and changes that are needed in the intervention plan
12	Program Evaluation Program evaluation is objective, systematic procedure for determining progress of the child and the effectiveness of the total intervention program. It may be necessary to make needed changes and modifications in the intervention program.
13	Developmental Screening Recall?? Developmental Screening is a method for obtaining general information about a child's development and detecting any potential problems
14	Normal Developmental Milestones Language 6-months turn to voice nonspecific words like “dada”, “mama” imitate speech sounds Shows interest in sounds Plays peek-a-boo Smells different things Looks for members of family or pets when present
15	Normal Developmental Milestones 12-months specific words -- “Dada”, “Mama” Uses single word sentences Vocalizes or gestures wants and needs Greets with verbal cues Uses exclamatory expressions “uh-oh”
16	Normal Developmental Milestones Language - II 2 years Uses 2 word sentences Tells experience using jargon and words Uses intelligible words about 65% of the time Imitates spontaneously or requests new words Uses past tense Imitates 4 word phrases
17	Normal Developmental Milestones Language - III 3 - 4 years comprehends cold, tired, & hungry feelings comprehends prepositions comprehends opposite analogies gives first and last names Uses expressive vocabulary of about 1300 words Asks questions using “where” “what” “when” and “WHY”
18	Normal Developmental Milestones Language - IV 5 - 6 years defines words Composes Ideas
19	Normal Developmental Milestones Personal & Social Behavior 15 months Imitates housework Expresses affection Shows jealousy at attention to others 18 months Engages in parallel play Enjoys solitary play Attempts to comfort others in distress DEFENDS POSSESSIONS
20	Normal Developmental Milestones Personal & Social Behavior 2 years refers to self by name says “no” to mother separation anxiety begins to diminish (started 10 - 18 months) Displays shyness with strangers Will tend to be physically aggressive Begins to obey and respect simple rules Begins to develop awareness of gender differences
21	Normal Developmental Milestones Personal & Social Behavior - III 3 years puts on shoes unbuttons buttons feeds self well understands taking turns 4 years washes & dries own face brushes teeth associative or joint play/cooperative with other children
22	Normal Developmental Milestones Personal & Social Behavior - IV 5 years dresses & undresses self prints a few letters plays competitive exercise games 6 years ties shoelaces separates from mom easily
23	Normal Developmental Milestones Adaptive Behavior - I 18 months build a tower of 3 - 4 cubes Shows understanding of color and size scribbles spontaneously & imitates stroke Solves simple problems using tools Points to distant objects outdoors Sorts objects Recognizes self in photograph
24	Adaptive Behavior 2 years builds a tower of 6 - 7 cubes aligns cubes -- imitating train imitates vertical & circular strokes Remembers where objects belong Pastes on appropriate side Identifies rooms in the home Engages in simple make-believe activities
25	Normal Developmental Milestones Adaptive Behavior - II 3 years imitates a 3-cube bridge copies a circle Points to larger of 2 items Points to at least 6 body parts Understands the concept of 2 Understands most adjectives Identifies longer
26	Normal Milestones 4 years copies a cross and other figures repeats 4-digits Demonstrates one to one correspondence Understands all common verbs
27	Normal Developmental Milestones Adaptive Behavior - III 5 years copies a square draws a recognizable man with a head, body, and limbs (stick man) counts objects accurately 6 years prints name copies triangle and most letters and numbers
28	Normal Developmental Milestones Motor & Sensory Behavior - I 15 months toddles creeps upstairs 18 months coordinated walking, seldom falls hurls ball walks upstairs with one hand held
29	Normal Developmental Milestones Motor & Sensory Behavior - II 2 years runs well, no falling kicks large ball goes up & down stairs alone fine motor skills increase 3 years rides tricycle jumps from the bottom steps alternates feet going up stairs
30	Normal Developmental Milestones Motor & Sensory Behavior - III 4 years walks down stairs one step to a tread stands on one foot for 5 - 8 seconds 5 years skips, using feet alternately usually has complete sphincter control fine coordination improves 6 years rides bicycle
31	Red Flags for Developmental Problems Language Problems Do not speak at all or speaks in rhyme Echolalia - repeating a person’s words like an echo Refer to themselves in the third person (he/she) Uses peculiar language Does not speak at expected developmental level
32	Red Flags for Developmental Problems Language Problems - II Language problems limited vocabulary errors in tense difficulty recalling words difficulty producing sentences
33	Red Flags for Developmental Problems Language Problems - III Speech problems broken words audible or silent blocking word substitution to avoid word problems sound & syllable repetition or sound prolongation
34	Red Flags for Developmental Problems Motor Problems Peculiar behavior Delays in walking, crawling, sitting Dropping things Clumsiness Poor handwriting Poor performance in sports Loss of bladder or bowel control Loss of previously acquired motor skills
35	Red Flags for Developmental Problems Adaptive Problems Repetitive routines Odd/ritualistic behavior like rocking, hand waving or an obsessive need to maintain order Spends hours each day preoccupied with specific tasks (e.g., counting cars on the street or watching only the weather channel on the TV)
36	Red Flags for Developmental Problems Personal/Social Problems - I Problems in communication Total lack of social awareness or interest in others Parents become concerned that their child may be deaf, not yet talking, resists cuddling, avoids interactions with others
37	Red Flags for Developmental Problems Personal/Social Problems - II Preschool kids - withdrawn aloof fails to respond to other people not making eye contact Eccentric/odd behavior Unable to take care of self
38	Red Flags for Developmental Problems Other Problems Decrease head size between 5 - 48 months Hearing problems Vision problems
39	Diagnostic Process Interview multiple sources (child, parent, teacher, etc.) Gather additional information (medical records, school) Careful assessment (time, severity, observation) Preliminary diagnosis – apply DSM criteria Few perfect fits Observation over time to sharpen diagnosis
40	Multiaxial Evaluation Axis I: Clinical Disorders Axis II: Mental Retardation, Personality Disorders Axis III: General Medical Condition Axis IV: Psychosocial and Environmental Problems Axis V: Global Assessment of Functioning Scale
41	Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence Limited Intellectual Functioning Pervasive Developmental Disorders Learning Disorders Communication Disorders Movement and Tic Disorders Disorders of Intake and Elimination Attention-Deficit and Disruptive Behavior Disorders Disorders of Relationship
42	Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence Mental Retardation Below intellectual functioning Onset before 18 years Deficits in adaptive functioning Mild Moderate Severe Profound
43	Learning Disorders Academic functioning that is substantially below that expected given chronological age, measured intelligence and education Diagnoses made based on standardized, individualized tests Reading disorder Math disorder Disorder of written expression Estimates of the prevalence of LD range from 2% to 10%. It is thought that around 5% of students in public schools in the US are identified as having a LD.
44	Communication disorders Difficulties in speech or language Expressive language disorder Mixed receptive-expressive language disorder Phonological disorder Stuttering
45	Communication Disorders Expressive Language Disorder: Estimates suggest that the developmental type of Expressive Disorder may affect 3%-5% of school-aged children. There are two subtypes (acquired and developmental) and the acquired type is less common. Mixed Receptive-Expressive Language Disorder (MRELD): It is estimated that the developmental type of MRELD may occur in up to 3% of school-age children
46	Pervasive Developmental Disorders Autistic Disorder Severe and pervasive impairment in several areas of development Communication skills Social interaction skills Presence of stereotyped behavior, interests, and activities Sensory dysfunction In epidemiological studies of Autistic Disorder, it is estimated that between 2 to 20 of every 1,000 children will be afflicted.
47	Pervasive Developmental Disorders Asperger’s Disorder Impairment in social interaction Restricted repetitive and stereotyped patterns of behavior, interests, and activities Causes clinically significant impairment in social, occupational or other areas of functioning No clinically significant general delay in language No clinically significant delay in cognitive development or adaptive behavior
48	Attention-Deficit Hyperactivity Disorder (ADHD) Predominantly Inattentive Type Predominantly Hyperactive-Impulsive Type Combined Type The prevalence of ADHD in school-aged children is estimated variably at 3%-9%
49	Oppositional Defiant Disorder Pattern of negative, hostile and defiant behavior lasting a period of time Causes significant impairment in social, academic or occupational functioning Rates of ODD range from 2% to 16%
50	Conduct Disorder Repetitive and persistent pattern of behavior in which the basic rights of others or societal norms or rules are violated Aggression to people and animals Destruction of property Deceitfulness or theft Serious violations of rules
51	Conduct Disorder Prevalence (or at least the diagnosis) of CD seems to have increased Rates vary widely from 6%-10% for males and 2% to 9% for females. CD is one of the most frequently diagnosed conditions in all mental health facilities for children.
52	Tourette’s Disorder Tourette syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. Presence of multiple motor and vocal tics Onset before the age of 18 4% of children in regular education meet diagnostic criteria for Tourette's Syndrome, while over 7% of children in special education have TS
53	Elimination Disorders Encopresis frequently is associated with constipation and fecal impaction Accidentally or on purpose, the patient repeatedly passes feces into inappropriate places (clothing, the floor). Duration is for at least 3 months, at least once per month. Onset after 4 years old
54	Elimination Disorders Enuresis Accidentally or on purpose, the patient repeatedly urinates into clothing or the bed The clinical importance of this behavior is shown by either: It occurs at least twice a week for at least 3 consecutive months or It causes clinically important distress or impairs work (scholastic), social or personal functioning The patient is at least 4 years old (or the developmental equivalent). This behavior is not directly caused by a general medical condition (such as diabetes, seizures, spina bifida) or by the use of a substance (such as a diuretic). Specify type: Nocturnal Only, Diurnal Only Nocturnal and Diurnal
55	Elimination Disorders Enuresis: The prevalence of Enuresis decreases as children age. At age 5 years the prevalence is 7% for males and 3% for females; at 10 years the prevalence is 3% for males and 2% for females. At 18 years, the prevalence is 1% for males and less among females. Encopresis: Approximately 1% of 5 year olds have Encorpresis, and the disorder is more common in males than in females.
56	Selective Mutism Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations. The disturbance interferes with educational or occupational achievement or with social communication. The duration of the disturbance is at least 1 month (not limited to the first month of school). The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation. The disturbance is not better accounted for by a Communication Disorder (e.g., Stuttering) and does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder.
57	Selective Mutism Selective Mutism (SM): SM is thought to be rare and seen in fewer than 1% of individuals assessed in the mental health settings
58	Reactive Attachment Disorder Markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before five years of age and is associated with grossly pathological care. This pathological care-giving behavior may consist of any form of neglect, abuse, mistreatment or abandonment
59	Other conditions Relational problems Parent-child Problems related to abuse or neglect Physical abuse of child Sexual abuse of child Neglect of child Additional conditions
60	Mood disorders Bipolar disorder Less than 1 % incidence in children (< 13 yo) Emotional lability, irritability, episodic hyperactivity, minor depressive symptoms, grandiosity About 1 % incidence in adolescents (> 13 yo) Elevated mood, rapid speech, flight of ideas, hyperactive, insomnia, hypersexual, delusions of grandeur
61	Anxiety Disorders Generalized Anxiety Disorder (GAD): In community samples, the 1-year prevalence rate for GAD was approximately 12% Posttraumatic Stress Disorder (PTSD): The lifetime prevalence for PTSD ranges from 1% to 14% It should be noted that PTSD is often related to child abuse which is thought to be under-reported .16% of all women are estimated to suffer from some form of attempted or completed sexual abuse prior to their 18th birthday and that a considerable proportion of them will develop PTSD prior to adulthood. Obsessive-Compulsive Disorder (OCD) OCD was previously thought to be rare in the general population but studies have estimated a lifetime prevalence of 2.5% The average age of onset ranges from early adolescence to the mid-twenties.
62	Now They are Yours… How do you decide WHAT to teach? How do you decide HOW to teach? How do you know when to move on?
63	From Diagnosis to Treatment
64	Examples of Assessments Vineland Adaptive Behavior Scales Developmental Profile II Bayley Infant Development Scale K-BIT, (Kaufman Brief Intelligence Test) PPVT-3, (Peabody Picture Vocabulary Test ) WRAT-3, (Wide Range Achievement Test) Wechsler Intelligence Scale for Children Woodcock-Johnson Tests of Cognitive Ability Test of Visual-Perceptual Skills ADHD Rating Scale Behavior Assessment System for Children
65	Where to begin: Case example Ana is a 3 year, 7 month old female referred for a comprehensive evaluation by her parents due to speech delay and behavior problems. The parents are seeking diagnostic clarifications of her problems and recommendations for intervention.
66	Example Psychological Measures included: Standford-Binet Bayley Scales of Infant development Receptive/Expressive Emergent Language Scale Autism Behavior Checklist Childhood Autism Rating Scale Vineland Adaptive Behavior Scale Parent Interview Behavioral Observation
67	Example Diagnosis included: Autism Non-verbal skills in the mild mental retardation range Mixed Receptive/Expressive Language Disorder Pica Psychosocial stressors
68	Example Recommendations: Referred to their local school district to “request a meeting to arrange appropriate placement for children with Autism with a teacher trained in the education of children with autism. The curriculum will need to be highly individualized to her current skills and needs, and targeted at her developmental level”.
69	Example Outpatient Behavioral Psychology services with a therapist experienced in the principles of Applied Behavior Analysis. Referred to the Autism Society of America Continue to monitor progress so that appropriate school placement and arrangement can occur Return for evaluation in 1 year.
70	Suggested Objectives Goals were presented: Stop script echolalia Stop aggression toward siblings Join in quality family time Learn how to initiate, maintain and end play with other children Understand the difference between a mistake and a purposeful action Control anger when people make honest mistakes Understand metaphors and figures of speech Initiate and allow affection with family members
71	Breakdown in Curriculum Planning Occurs when: Based on minimal exposure to learner Based on psychological testing data alone Goals are not broken down into smallest teaching unit Goals are not chosen on the basis of solid assessment measures Goals are not based on highest priority needs
72	What I WOULD do Conduct a comprehensive skills assessment Determine skill deficits Develop target list for behavior reduction Determine behavioral excesses Conduct a preference assessment activities and food Conduct a Functional Assessment Interview for problem behaviors Parents Caregivers Teachers Immediately begin instructor pairing procedures
73	What Goals I WOULD focus on On the basis of the presented information: Intensive, focused intervention to teaching verbal communication skills Teaching developmentally appropriate play skills Reduce interfering maladaptive behaviors Increase independence skills
74	Goal Setting- Ana Domains Communication Behavioral Social Preacademic Self-help
75	Goal Planning Goal Setting School Home Transition Community During parent training
76	Goal Planning (example) Reduction of maladaptive behaviors Communication Attentive skills Speech Receptive Language Expressive Language Self-Help Skills Daily Living skills
77	Example Goal in Self-Help Domain GOAL: Ana will increase use of appropriate self-feeding skills When provided with a spoon and food in a bowl, Ana will use the spoon to eat the contents of the bowl without spilling contents by: a Rotates forearm when bringing food to mouth b Uses spoon to eat semisolid foods c Uses spoon to eat liquids When given a cup ½ full of liquid, Ana will dring from the cup unassisted without spilling the liquid or throwing the cup. Replacing the cup on the table after taking a sip, as well as taking one sip at a time. Ana will sit appropriately at the table for the duration of the meal, with feet on the floor, buttocks on the chair, with proper orientation, and absence of physical interference with her peers meal.
78	Example Skill- Self help Domain Specific toileting skills Remains dry and unsoiled between scheduled toileting Walks to bathroom Removes clothing Sits / stands in the toilet area Voids in the toilet Indicates when done with a reminder Uses toilet paper appropriately Replaces clothing Washes hands Dries hands Wipes up sink area Demonstrates other toileting skills
79	Example Skill- Preacademic Domain Attentive Skills- Levels Basic Attentive Skills Group Attentive Skills Sustained Attention Independent Attentive skills
80	Independent Attentive Skills On task behavior on independent work in individual setting Assembles simple puzzles independently Works independently on matching/sorting task Traces independently Completes simple readiness worksheets independently Maintains attention on preacademic/academic worksheets for a lesson period Reestablishes attention after an interruption Remains in instructional area
81	Independent Attentive Skills (cont.) On task behavior on independent work in group setting Assembles puzzles independently when working in a small group Works independently on matching/sorting task when working in a small group Traces independently when presented with a tracing task in a group…..
82	Example Goal: Academic Domain Reading Skills Basic Skills Sight Vocabulary & Vocabulary Development Word Attack Skills Comprehension Spelling
83	Reading Skills - Basic Basic Skills Visual discrimination Task 1. Identifies letters of the alphabet Task 2. Identifies letter sounds Task 3. Discriminates same-different words Task 4. Identifies target word in text
84	Reading Skills- Basic Auditory discrimination Task 1. Identifies rhyming words Task 2. Identifies words that are same-different Task 3. Identifies words with the same initial or final consonant sound Task 4. Identifies words with the same vowel sounds
85	Reading Skills- Basic Visual memory Task 1. Recalls missing objects Task 2. Recreates block design from memory Task 3. Reproduces a sequence of letters presented visually Task 4. Reproduces a sequence of letters presented visually
86	Reading Skills- Basic Auditory memory Task 1. Repeats a series of digits presented orally Task 2. Repeats a series of letters presented orally Task 3. Repeats a series of words presented orally Task 4. Repeats phrases presented orally Task 5. Repeats a story presented orally in the proper sequence
87	Reading Skills-Basic Generalized visual recognition Task 1. Recognizes same words written in different sizes as identical Task 2. Recognizes same words printed in different type faces as identical Task 3. Recognizes same words presented in various medium (book, flashcard, computer screen) as identical
88	Reading Skills- Basic Identification skills Task 1. Identifies front and back of book Task 2. Identifies top and bottom of page Task 3. Turns pages individually Task 4. Demonstrates understanding of reading sequence (left to right, top to bottom) Task 5. Locates target word on a page Task 6. Locates sentences on a page Task 7. Locates page numbers Task 8. Locates title page Task 9. Locates title Task 10. Locates author Task 11. Identifies paragraphs by indention Task 12. Identifies chapters in a book
89	Checklist for Developing a Curriculum Identify broad developmental domains Identify relevant sub-domains Identify specific skill sequences and student specific deficits Task analyze each skill using a combination of behavioral, developmental, and educational methods Identify behavioral techniques specific to teaching the skill
90	Checklist for Developing a Curriculum Probe the student for entry level teaching point Determine how to evaluate progress Evaluate progress Revise as necessary Once master, MOVE ON to the next skill in sequence
91	Components of a Behavioral Analytic Educational Program Curriculum must be comprehensive Programming should involve all care givers and peers across settings Programming should allow for and consider maximization of learning opportunities Programming should make use of data based instructional procedures