Background and Acknowledgement

1. Documentation and Accommodation for Students on the Autism SpectrumLoring Brinkerhoff, Ph.DLorraine Wolf, Ph.DJane Thierfeld Brown, Ed.D

2. Background and Acknowledgement • ETS Policy Statement for Documentation of Autism Spectrum Disorders (ASD) in Adolescents and Adults is a work in progress. • Being developed collaboratively by the College Board and ETS • Projected publication date: September 1, 2013 • Grateful acknowledgement to Dr. Lorraine Wolf

3. What is ASD? • A neuro-developmental disorder ranging from mild to severe that is characterized by core features of social/communication deficits, repetitive/restrictive behaviors, and a lack of emotional reciprocity

4. Banerjee and Brinckerhoff, June 2013 DSM-5 Changes to ASD • The four previously separate disorders (e.g, Asperger’s disorder, childhood disintegrative disorder, and PDD- NOS) are now viewed as a single condition with different levels of symptom severity in two core domains: • deficits in social communication and social interaction • restricted, repetitive behaviors, interests & activities

5. College Students With ASD Are on the Rise • ASD affects 1 to 1.5 million Americans. • The CDC (2013) estimates that 1:88 individuals have ASD. • 3-4 times more prevalent in males • Number of test takers with ASD requesting accommodations on ETS tests is increasing each year. • A recent study by SRI International (2012) noted that “STEM related majors were more common among college students with ASD than students with any other type of disability.”

6. College Students with ASD Despite intellectual and academic gifts, persons with AS have a decreased ability to decipher the intentions and actions of others, to integrate multiple streams of incoming information, and to navigate an increasingly complex social world. They may be rigid and perfectionistic and resist changing to meet the demands of their environment.” (Wolf, Thierfeld Brown & Bork, 2009)

7. Why Develop Documentation Guidelines for ASD? • ETS Policy Statements for LD, ADHD, and Psychiatric don’t fit this population. • Need to move away from the LD discrepancy model review mindset • ASD documentation typically does not show test scores with significant deficits in cognitive profiles or in achievement areas. • The key is an in-depth discussion by the evaluator of symptomatology. • Documentation may involve multiple professionals.

8. Documentation Considerations • ASD is often picked up at school age and misdiagnosed as ADHD. • ASD should spill over into two or more settings. • Look for relevant information regarding current treatment. • Individuals with ASD may experience difficulties with major life activities such as learning, reading, concentration, and/or thinking.

9. Documentation Considerations (cont’d): • The use of psychotropic drugs is becoming increasingly common, so there may be side effects of medication to consider. • Both the positive and negative effects of medication should be noted.

10. Banerjee and Brinckerhoff, June 2013 Concerns about AHEAD’s Position on Documentation • Medical and scientific evidence is viewed in the Guidance Document as "inappropriate and burdensome" • Dependence on past history alone, without current documentation can create an unfair advantage

11. Banerjee and Brinckerhoff, June 2013 Concerns about AHEAD’s Position on Documentation • Testing agencies and many postsecondary institutions depend on normed psychometric and/or medical evidence from a qualified third party for accommodation decisions. • Assumes that the student is able to articulate his/her needs, discuss functional impact of the disability, recall accommodation history and accurately provide information about the diagnosis

12. Banerjee and Brinckerhoff, June 2013 ETS Policy Statement for Documentation of Autism Spectrum Disorder in Adolescents and Adults (in press), cont. I. A qualified professional must conduct the evaluation: • Licensed psychologist/neuropsychologist • Psychiatrist • Relevantly trained medical doctors, developmental pediatricians, child neurologists, clinical social workers, • School psychologists, speech and language therapists, occupational therapists. Documentation from more than one source, often involving a multi-disciplinary approach.

13. Banerjee and Brinckerhoff, June 2013 ETS Policy Statement for Documentation of ASD, cont. II. Documentation Necessary Must be Comprehensive: • Specific diagnosis or diagnoses • Description of current symptoms in the testing environment and across settings • Relevant information regarding the test taker’s prescribed use of medications and side effects • Relevant information regarding current treatment • A narrative discussion of all relevant information including results of standardized assessment measures. • Specific recommendations for accommodations

14. Banerjee and Brinckerhoff, June 2013 ETS Policy Statement for Documentation of ASD, cont. III. Relevant Testing Domains: “ETS acknowledges that a clinical discussion of symptoms may be more valuable than a standardized score.” • Cognitive • Executive functioning • Expressive and receptive language and communication • Psychiatric, personality, and behavioral • Sensory-motor integration • Attention/Memory/Learning • Visual-perceptual motor skills • Academic achievement

15. Banerjee and Brinckerhoff, June 2013 ETS Policy Statement for Documentation of ASD, cont. IV. Interpretive Summary “Many of the core features of ASD are not captured in test scores.” V. Alternative Diagnoses should be ruled out VI. Currency Requirements of the Documentation “ASD is an enduring disorder that exists across the lifespan. Functional limitations of the disorder, however, may change depending upon the test taker’s age as well as environmental demands.” Documentation must be from the last 5 years.

16. Banerjee and Brinckerhoff, June 2013 ETS Policy Statement for Documentation of ASD, cont. VII. Rationale for each requested accommodation must be provided “A link must be established between the requested accommodations and the manifested symptomatology of the disorder that is pertinent to the anticipated testing situation.”

17. Banerjee and Brinckerhoff, June 2013 ETS Policy Statement for Documentation of ASD, cont. VIII. Additional sources of information: • IEP, 504, SOP, prior evaluations, evidence of accommodations, a detailed letter from the college disability provider, vocational rehab counselor, or a human services professional describing current limitations and use of accommodations. • A personal letter from the test taker in his/her own words • Appendix I- DSM-5 • Appendix II- Recommendations for Consumers • Appendix III- Testing instruments • Appendix IV-Social Cognition

18. A Rationale for Each Requested Accommodation Must Be Provided • Why grant accommodations to ASD students? • Co-occurring disabilities • Perfectionistic tendencies • May fixate on the wording of test questions • May over-analyze content in test questions • Testing environment may warrant modifications.

19. Academic Accommodations for AS There are no clear cut guidelines Accommodations flow from understanding: Nature of student’s functional impairment Domains where having difficulty Fundamental requirements Wolf ETS 2012 do not reproduce

20. In theory… Academic difficulties in ASD are directly related to the student’s core deficits If we understand why, we can figure out when and how to best accommodate Wolf ETS 2012 do not reproduce

21. For example… Some are quite common Distraction reduction Extra time Computer Some need considerably more analysis: Alternate means of demonstrating mastery without compromising fundamentals Alternative to essay exams which require taking another perspective Sensory adjustments SOCIAL ACCOMMODATIONS? Wolf ETS 2012 do not reproduce

22. Wolf ETS 2012 do not reproduce Exam Accommodations • Papers instead of exams (to be used sparingly) • Stop the clock breaks • Distraction reduced setting • Extended time • Computer (possibly voice input) • No “scantron” forms • Sensory modifications • Clarification of questions or answers (written or oral) • Space apart sections • Oral supplement to essay exams

23. Wolf ETS 2012 do not reproduce Writing • Writing synthetically vs. stating “the obvious” • Plots & character motivation • Compare & contrast • Personal perspectives • Initiate and sustain • Some students excel at writing though • SOCIAL CONTEXT OF STEMS

24. Wolf ETS 2012 do not reproduce Math Disability • Analyzing spatial information • Spatial reasoning • Non-quant questions which tap into this • Charts and graphs • Math fluency and computation

25. Wolf ETS 2012 do not reproduce Why extra time? • Stickiness • Slow processing • Anxiety • EF dysfunction • Overanalyzing • Overwriting • Figuring out relationships • Context analysis

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27. Wolf ETS 2012 do not reproduce A Favorable Prognosis • The older, the better • The smarter, the better • The less symptomatic, the better • Take home: Young adults with ASD who go to college and enter the workforce may have the best prognosis • Can we extrapolate to grad school grads?

28. Leave with a challenge… The student is not the only locus of change Wolf ETS 2012 do not reproduce

29. Wolf ETS 2012 do not reproduce New views? • Is ASD a psychiatric diagnostic? • What about DSM-V? • Should ADAAA influence diagnostic practice? • Is ASD a per se diagnoses? • And what about AHEAD?

30. Wolf ETS 2012 do not reproduce Concluding Thought • “If you've met one person with ASD, you've met one person with ASD” • Stephen Shore, Ph.D., professor, author, person with AS

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