ASD Identification

Even though public school programs are mandated by state and federal law to quickly and accurately identify children with ASD and other conditions, ASD continues to be under- and mis-identified in many places across the United States. When I assumed the leadership of DAP, the combination of a cursory protocol, combined with an incomplete and outdated definition of autism in state regulations, made it difficult to differentiate autism from related conditions or to confidently identify ASD in very young children, and impossible to capture the entire spectrum.  As a result, the rapid increase in rates of identification in Delaware threatened to overwhelm existing services and lead to a dramatic decrease in program quality.

You can only generalize the outcomes reported for a specific intervention or program to other populations if the initial evaluations are comprehensive and accurate

As we established research-based protocols for ASD classification, I gained a greater appreciation for the critical role that accurate identification plays in evaluating claims of effectiveness, especially when considered along with the presence of significant, co-occurring intellectual disabilities and behavioral or mental health conditions.  My colleagues and I analyzed ASD outcome research published in 3 different journals, and found wide variations in the likelihood that background information about the level of co-occurring intellectual disability might be reported, or whether an identification protocol was described (Abel et al, 2008): this led us to be more discerning when considering the potential fit between a new practice, and the needs of a particular group of students.

Reported rates of successful outcomes are skewed when programs exclude students with co-occurring intellectual disability or problem behavior.

The requests I received to consider adopting other programs prompted me to look closely at the students served by these programs, and I discovered that advocates of these programs did not recognize that they only served a subset of the overall population. Sometimes the exclusion of certain kinds of students was quite explicit; other times it was the consequence of other policies; some programs specifically excluded students with significantly challenging behaviors; some programs adopted curricula that presumed a certain level of ability, and so perhaps unintentionally excluded students with more significant intellectual disabilities.  These were important considerations in any recommendation to adopt a program, because they helped us to estimate the proportion of our student population that might benefit.  I also found that program advocates did not always recognize that the exclusion of these students should temper the program's claims of success, and so I learned to pay careful attention to these explicit and implicit exclusion criteria.