School-based identification of ASD may come under scrutiny in some circles in light of the fact that school teams may not have been clinically trained to conduct evaluations. Many school districts have not been provided with the comprehensive training necessary to reliably administer the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) or the Autism Diagnostic Interview-Revised (ADI-R) . However, as this chapter will point out, not only is it legally required that school teams conduct evaluations, the school environment may be one of the best opportunities for children with ASDs to be identified. Notice, the term “identified” is not considered equivalent to “diagnosed” and will not be used synonymously in this chapter. Rather, this discussion seeks to empower and instruct school teams to collect and analyze readily available data within the school environment to conduct a comprehensive evaluation. Further, the process provided here allows school teams to collect data, implement evidence-based interventions, and evaluate and identify students with ASD as a part of an RtI framework . Although the school identification process is much different than the clinical evaluation process, neither is considered inferior. School evaluation serves a different purpose in terms of both identification and provision of services, and schools are uniquely positioned to do just that.

So, how then is the school environment such a unique opportunity? During an assessment, it is necessary to look at each symptom, not only to understand whether or not it is pathologic, but also the impact of this symptom on the child’s life. That is, in respecting a client’s differences and autonomy, there are times where a certain trait or behavior, although atypical, is not really “getting in the way” of his or her life, dreams, or ambitions. In that case, it is not necessarily to be perceived as a symptom, but rather a difference, sometimes referred to as a “quirk”; other times as a “gift.” In the home environment, it may be that the child’s personality trait is seen more as a quirk; whereas in the school system when placed in context with social and academic demands, it is possible to see whether or not this trait occurs in the context of a disability.

For example, some children are very shy. Could shyness be a symptom of autism? Indeed it may be. The child is shy because he lacks the skills to socialize, communicate, and make friends. In this case, shyness could be a sign of ASD. However, shyness could also signal an introverted personality; someone who is happy spending time alone. In this case, shyness is not a symptom at all, but a personality trait which may actually contribute to his or her life. Perhaps, this introverted child may be highly productive; enjoying time reading, writing, drawing, or learning, in lieu of socializing.

The question becomes, when does a trait or behavior become a symptom or major concern? The answer generally comes down to this, to what degree is this trait or behavior interfering with the client’s occupation, relationships, goals, and pursuit of happiness? If the symptom interferes, it is worthy of consideration for identification and treatment.

So what is a child’s occupation then and how do we know if a symptom is interfering with it? “Student” is a child’s occupation, or certainly one of them. Children spend much of their waking hours in a school building, where they live, learn, work, and grow. This is why school is referred to in this section as The First Frontier. School is the place where children choose a path for their lives, make potentially lifelong friends, and navigate some of the decisions regarding career endeavors. Although earlier is always considered better, symptoms are likely to show up when the child first enters the academic world, perhaps in Kindergarten and First Grade. School professionals are wise to take a close look at early elementary school students to see if they are able to integrate and socialize with peers, initiate and maintain conversations, play with others at recess, follow classroom instructions, and access the learning environment. Particularly in the case where a child has never attended preschool, kindergarten and first grade may be the primary place where signs and symptoms are identified.

As this chapter will clearly delineate, the law requires that children from age birth to 21 are to be identified, evaluated, and provided with early intervention or special education services commensurate with their needs. The law does not require that the children solely be provided with academic supports (Colorado Department of Education (CDE) et al., 2014); school teams are to teach the life skills needed for participation in future endeavors such as college and career . Thus, these school-based evaluations are essential and critical such that individuals with ASD can obtain an accurate identification and begin the path for intervention and services. In order to provide a framework for understanding the requirements for school-based teams, the next section delineates the mandates from the IDEA and Child-Find. Also included later in this chapter is the RtI requirements for schools and the Appendix provides more specific information about Independent Educational Evaluations, IEP’s and 504 Plans.

The purpose of this section is to examine federal statutes, regulations, and legal administrative guidelines involving the identification, assessment, and evaluation of students with Autism Spectrum Disorders for determination of eligibility for special education.

It is often the case that school-based professionals are put into a bit of a bind when they suspect a child may have autism. School teams often have a plethora of helpful information for families regarding the potential that a child has autism and then be cautioned against using it; either by administrators, or as a matter of policy. Families and community members might believe that the reason school teams will not even utter the word “autism” to parents is because the school does not want to be burdened with the cost of an evaluation or sued for that cost if the child is later found to not have autism. Although these risks exist in some cases; generally, the decision to steer clear of diagnostic terms is made with integrity and sound ethics. That is, School Psychologists and other members of the support services teams are not qualified to diagnose and absolutely must keep all discussions with families centered around observable behaviors and symptoms that may interfere with school performance. Now couple that ethical responsibility to avoid diagnostic labels with the mandate to find and identify children with disabilities, and school professionals are placed in an awkward position.

Thus, the goal of this section is to “remove the fog” about autism identification. It is not only legally required for school teams to identify ASDs, but also it is the right thing to do to help the child, support the teacher, and maximize the child’s potential for optimal outcomes . School teams should feel empowered to conduct these evaluations as they have the skills, access, and the most natural environment to do so. It will be clearly advanced in this chapter that school teams are legally required to identify children who are suspected of having an Autism Spectrum Disorder and that it is possible to do so while still maintaining the ethical requirement not to diagnose; as well as, enacting a comprehensive evaluation process which is very much in line with the IEP assessment process used for other disabilities such as Specific Learning Disabilities .

A paucity of research exists regarding the implications of RtI, Positive Behavioral Intervention and Supports (PBIS), and Multi-Tiered Systems of Support (MTSS) approaches in determining eligibility of services for students with ASD. This section presents information regarding the implications of RtI/MTSS in determining eligibility and providing services for students with ASD. Additionally, a tiered approach to interventions is utilized in the Best Practices model put forth in this chapter.

There is a current debate as to whether or not school teams should be administering the ADOS-2, or other clinical diagnostic measures. The ADOS-2 is a gold standard instrument and is critical to clinical evaluations; however, may not be as useful or effective in school evaluations (Hepburn, personal communications, 2015). That is, although these clinical instruments are ideal in clinical settings, sometimes school teams are hard-pressed to provide and maintain the training, and logistically, to assign school clinicians to do the evaluations, when they generally have another position within the school district. If school districts fail to provide the time for both training and the assessment time needed, school professionals are likely to quickly burn out and vacate their roles within the ASD assessment process. When this happens, school teams are taxed twice: first the cost of the training to the school teams, and second when the Autism Team is yet again left without qualified evaluators.

The authors of this book make no clear statement as to whether school teams should administer the ADOS-2; although it is optimal, the process advanced in this book does not require it. However, should school teams be provided with such clinical instruments, it is recommended that they become adequately trained. School professionals administering the ADOS should at least attend the 2-day WPS ADOS training and attend sessions locally with a clinically trained and well-versed clinician to assess for one’s reliability of scoring and accuracy. Generally, although in clinical settings the ADOS-2 is administered by psychologists, in school evaluations an interdisciplinary team may conduct the instrument together, similarly to a play-based approach such as the Transdisciplinary Play-Based Assessment model (Linder, 2008). In that case, the team may be comprised of psychologists, speech-language pathologists, occupational therapists, audiologists, and special education teachers. Often, as in the case in Colorado, local agencies are willing to provide supervision or training on obtaining clinical reliability on the ADOS-2. It is important to be clear here that knowing how to give the measure is only a small part of the training needed for the ADOS-2, because the scoring and assessment of symptoms is perhaps the most nuanced and challenging part of giving the ADOS-2. For example, the clinician needs to be able to assess the quality of the rapport, the child’s eye-contact, emotional awareness, response to joint attention, gesture use, social response, social overtures, flexibility or rigidity, repetitive speech and behaviors, restricted interests, reporting of events and a host of other symptoms, in the moment as the ADOS-2 is meant to be scored immediately following administration.

Given all of the above considerations, it may seem that the school should always err on the side of caution and complete an evaluation, just in case the child may have an ASD if a referral has been made. The authors want to make a clear and firm point that this is absolutely not the approach recommended here. Rather, these authors support autism identification, as with other disabilities, should only occur when the school team has considered whether or not the child can receive reasonable benefit from general education alone, and only after evidence-based interventions have been employed with fidelity . The child must always be placed in the Least Restrictive Environment (LRE) , and as such, school teams are charged with providing a supportive educational environment with first-best instruction provided by teachers in the education classroom, within consultation with support services (as needed). It is time to look closely at what most ASD evaluations in schools will entail. Every state looks a bit different but the process is similar in terms of the primary elements from some sort of referral process to an eligibility determination and initiation of services.

In Colorado, a collaborative relationship was established between the Colorado Department of Education and JFK Partners, Center of Excellence for Autism and Neurodevelopmental Disabilities in collaboration between The Children’s Hospital and the University of Colorado Medical School. Through this partnership, a guidebook was written which describes a best-practice approach for doing an autism evaluation in Colorado schools. This guidebook describes the process thusly (interested readers are invited to read the guidebook in detail—the reference is provided):

The final phase then is (G) Activate where the IEP program is put into place and services begin (with parental consent). (Process taken directly from CDE et al., 2014, p. 15).

In addition to the process presented above in Colorado, there are multiple similar models throughout the country that include most of the same elements in somewhat different configurations. One approach is offered and well-articulated by an excellent online resource called Ohio Center for Autism and Low Incidence (OCALI) , which includes a free training module called, “Educational Evaluation of Autism: A team approach.” This approach flows thusly: Referral, Evaluation Plan, Observation, Evaluation, Collaboration Team Reports, Meeting with team and family, Follow up.” As shown here, there are multiple approaches that can be considered. For this study, Colorado, Ohio, California, and Oregon’s processes were studied. Although these processes are certainly all aligned with legal guidelines and would generally be considered appropriate, the authors did not find a process that comprehensively included the RtI or Multi-Tiered System of Supports structures. As such, the procedures and Best-Practice Approach for Screening and Assessment of ASDs in schools are provided here to aide schools in developing a process that aligns with universal screenings and evidence-based intervention procedures that are in place in most schools across the country (Fig. 18.1).