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REL Midwest Ask A REL Response

January 2019

Question:

What does the research say about the process of implementing universal autism screeners in schools (K–12) and long-term outcomes related to universal autism screening in schools?



Response:

Following an established Regional Educational Laboratory (REL) Midwest protocol, we conducted a search for research reports and descriptive studies on implementing universal autism screeners in schools (K–12). In particular, we focused on identifying resources related to the process of implementing universal autism screeners and long-term outcomes related to universal autism screening in schools. For details on the databases and sources, keywords, and selection criteria used to create this response, please see the Methods section at the end of this memo.

Below, we share a sampling of the publicly accessible resources on this topic. References are listed in alphabetical order, not necessarily in order of relevance. The search conducted is not comprehensive; other relevant references and resources may exist. For each reference, we provide an abstract, excerpt, or summary written by the study’s author or publisher. We have not evaluated the quality of these references, but provide them for your information only.

Research References

Barton, E. E., Harris, B., Leech, N., Stiff, L., Choi, G., & Joel, T. (2016). An analysis of state autism educational assessment practices and requirements. Journal of Autism and Developmental Disorders, 46(3), 737–748. Retrieved from https://eric.ed.gov/?id=EJ1090341

From the ERIC abstract: “States differ in the procedures and criteria used to identify ASD. These differences are likely to impact the prevalence and age of identification for children with ASD. The purpose of the current study was to examine the specific state variations in ASD identification and eligibility criteria requirements. We examined variations by state in autism assessment practices and the proportion of children eligible for special education services under the autism category. Overall, our findings suggest that ASD identification practices vary across states, but most states use federal guidelines, at least in part, to set their requirements. Implications and recommendations for policy and practice are discussed.”

Note: REL Midwest was unable to locate a link to the full-text version of this resource. Although REL Midwest tries to provide publicly available resources whenever possible, it was determined that this resource may be of interest to you. It may be found through university or public library systems.

Campbell, J. M., Scheil, K. A., & Hammond, R. K. (2016). Screening methods. In Handbook of assessment and diagnosis of autism spectrum disorder (pp. 65–86). Switzerland: Springer. Retrieved from https://link.springer.com/book/10.1007%2F978-3-319-27171-2

From the abstract: “Identifying who is at risk for autism as early as possible and identifying collateral problems is the focus of screening. Unlike diagnosis, the emphasis is on assessing broader populations and narrowing a group who will receive more in depth, precise assessments leading to a final diagnosis. This chapter will review strategies and methodologies for screening.”

Note: REL Midwest was unable to locate a link to the full-text version of this resource. Although REL Midwest tries to provide publicly available resources whenever possible, it was determined that this resource may be of interest to you. It may be found through university or public library systems.

Dilly, L., & Hall, C. (2018). Autism spectrum disorder assessment in schools. New York, NY: Routledge. Retrieved from https://www.taylorfrancis.com/books/9781351242448

From the abstract:Autism Spectrum Disorder Assessment in Schools serves as a guide on how to assess children for autism spectrum disorders (ASD), specifically in school settings. Dilly and Hall offer a general overview of ASD, describe ASD assessment best practices, and explain the process of identifying ASD in schools. Current research and up-to-date science is incorporated in a practitioner-friendly manner, and short case vignettes will increase the accessibility of the book content and illustrate principles. As the rates of ASD reach 1/59 children, and school psychologists are increasingly expected to possess expertise in the assessment of ASD, this book serves as a must have for school psychologists, school social workers, and other practitioners.”

Note: REL Midwest was unable to locate a link to the full-text version of this resource. Although REL Midwest tries to provide publicly available resources whenever possible, it was determined that this resource may be of interest to you. It may be found through university or public library systems.

Hammond, R. K., Campbell, J. M., & Ruble, L. A. (2013). Considering identification and service provision for students with autism spectrum disorders within the context of Response to Intervention. Exceptionality, 21(1), 34–50. Retrieved from https://eric.ed.gov/?id=EJ994719

From the ERIC abstract: “The Response to Intervention (RTI) framework, a preventive model of universal screening, tiered interventions, and ongoing progress monitoring, poses an interesting consideration for identification and service delivery for children with autism spectrum disorders (ASD). Upon examination of the existing literature, paucity exists regarding how RTI might guide identification and service delivery for students with ASD; however, the authors consider core tenets of RTI and how they are relevant for students with ASD given what is known about this unique population. Due to the importance of early identification and interventions for individuals with ASD, the RTI framework could be problematic if used to delay education eligibility. Thus, two routes of identification are outlined by the authors, one of which expedites evaluation based on pervasive symptomatology, while the other route uses a form of universal screening to assist in moving toward evaluation for those suspected of ASD. The use of tiered interventions for prevention or service delivery could cause potential complications given the need for early identification and individualized intensive programming. However, there is a clear match for several instructional RTI components and ASD, specifically for evidence-based interventions that are implemented with fidelity and monitored frequently, and other aspects such as family involvement, which could improve programming for students with ASD.”

Note: REL Midwest was unable to locate a link to the full-text version of this resource. Although REL Midwest tries to provide publicly available resources whenever possible, it was determined that this resource may be of interest to you. It may be found through university or public library systems.

Hepburn, S. L., DiGuiseppi, C., Rosenberg, S., Kaparich, K., Robinson, C., & Miller, L. (2008). Use of a teacher nomination strategy to screen for autism spectrum disorders in general education classrooms: A pilot study. Journal of Autism and Developmental Disorders, 38(2), 373–382. Retrieved from https://eric.ed.gov/?id=EJ783912

From the ERIC abstract: “Given a rising prevalence of autism spectrum disorders (ASD), this project aimed to develop and pilot test various teacher nomination strategies to identify children at risk for ASD in a timely, reliable, cost-effective manner. Sixty participating elementary school teachers evaluated 1323 children in total. Each teacher nominated students who most fit a description of ASD-associated characteristics, and completed the Autism Syndrome Screening Questionnaire (ASSQ) on every child in the classroom. The proportion of overall agreement between teacher nomination and ASSQ was 93-95%, depending upon the nomination parameters. Nomination required 15 min per class versus 3.5-5.5 h per class for the ASSQ. These results support the need for further study of teacher nomination strategies to identify children at risk for ASD.”

Note: REL Midwest was unable to locate a link to the full-text version of this resource. Although REL Midwest tries to provide publicly available resources whenever possible, it was determined that this resource may be of interest to you. It may be found through university or public library systems.

Kroncke, A. P., Willard, M., & Huckabee, H. (2016). Assessment of autism spectrum disorder: Critical issues in clinical, forensic and school settings. Switzerland: Springer. Retrieved from https://www.springer.com/us/book/9783319255026?utm_campaign=3_pier05_buy_print&utm_content=en_08082017&utm_medium=referral&utm_source=google_books#otherversion=9783319255040

From the About This Book section: “This book offers clear best-practice guidelines for the assessment of Autism Spectrum Disorder. It discusses both the rising rates of autism and the growing need for appropriate, effective treatments and services. The book examines measures and methods used in assessing for core symptoms of ASD as well as memory, attention, visual and spatial skills, and other areas relevant to autism assessment. In-depth material on differential diagnosis and a range of comorbid conditions depict the complexities of the assessment process and the necessity of accurate identification. The book’s case vignettes and sample recommendations add practical and personal dimensions to issues and challenges surrounding diagnosis. Topics featured include:

  • A practical guide to the comprehensive assessment process.
  • Discussion of the assessment process from referral to recommendation.
  • Diagnostic framework for ASD and other disorders
  • School-based ASD eligibility evaluation.
  • Assessment across the lifespan.

Assessment of Autism Spectrum Disorder is an important tool for clinicians, practitioners, researchers and graduate students in the fields of child and school psychology, behavioral therapy, and social work as well as the related areas of psychiatry, pediatrics, forensic psychology, and educational and healthcare policy.”

Note: REL Midwest was unable to locate a link to the full-text version of this resource. Although REL Midwest tries to provide publicly available resources whenever possible, it was determined that this resource may be of interest to you. It may be found through university or public library systems.

McClain, M. B., Otero, T. L., Haverkamp, C. R., & Molsberry, F. (2018). Autism spectrum disorder assessment and evaluation research in 10 school psychology journals from 2007 to 2017. Psychology in the Schools, 55(6), 661–679. Retrieved from https://eric.ed.gov/?id=EJ1181818

From the ERIC abstract: “School psychologists are increasingly engaged in service provisions for students eligible for special education services under the eligibility category of autism, including conducting school-based assessments and evaluations. Evaluations occur for a variety of reasons such as special education eligibility decision-making, treatment and intervention planning, and progress monitoring. Publications in school psychology journals emphasizing autism spectrum disorder (ASD) assessment and evaluation are vital to quality training and practitioner utilization of quality practices. In the current study, researchers conducted a systematic review of publications in 10 school psychology journals from 2007 to 2017 to assess the current state of ASD assessment and evaluation research in the field of school psychology. Implications for researchers, trainers, and practitioners are discussed.”

Note: REL Midwest was unable to locate a link to the full-text version of this resource. Although REL Midwest tries to provide publicly available resources whenever possible, it was determined that this resource may be of interest to you. It may be found through university or public library systems.

McPheeters, M. L., Weitlauf, A., Vehorn, A., Taylor, C., Sathe, N. A., Krishnaswami, M. S., et al. (2015). Screening for autism spectrum disorder in young children. A systematic evidence review for the U.S. Preventitive Services Task Force (Evidence Synthesis No. 129). Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK349703/

From the abstract: “Context: The U.S. Centers for Disease Control and Prevention estimates that one in 68 children has an autism spectrum disorder (ASD) and the majority of children are not diagnosed until after 4 years of age. Current approaches rely on developmental surveillance, general developmental screening, and/or parental concerns. Systematic screening has been advocated for identifying ASD at earlier ages. Objective: We systematically reviewed the evidence about benefits and harms of routine screening for ASD in primary care settings.

Methods: We explicitly focused on studies of screening instruments for use in young (≤36 months of age), unselected populations (e.g., universal screening approaches). Results: We identified 17 unique screening studies reported in 22 papers. The most commonly studied tool was the Modified Checklist for Autism in Toddlers (M-CHAT) including the most recently available variant (M-CHAT-Revised with Follow-Up [M-CHAT-R/F]), which has a positive predictive value of 48 percent in diverse populations of children ages 16 to 30 months. Forty-two studies of good and fair quality addressed interventions for young children. Among these, 17 involved direct provision of intervention to children. Fifteen of these 17 studies assessed cognitive outcomes, and outcomes were significantly more improved in the treatment arm vs. comparison arm in 10. Sixteen of these 17 studies assessed language outcomes, and outcomes were significantly improved in the treatment vs. comparison group in 10 studies. Thirteen studies involved parent training. Five of these thirteen studies addressed cognitive outcomes, and outcomes were significantly improved in the treatment vs. comparison group in one study. Twelve of the 13 studies addressed language outcomes, and outcomes were significantly improved in the treatment vs. comparison group in three studies. Thus, 20 studies overall measured cognitive outcomes and 11 reported greater benefit for the intervention group compared with control groups, and language outcomes were significantly improved in treatment vs. comparison arms in 13 of 28 studies assessing language. Twelve studies focused on play and interaction and typically measured joint attention as the outcome. Nine out of 10 studies evaluating joint attention outcomes reported greater benefit in the treatment arm compared with the control arm. None of the studies focused on screen detected children.

Conclusions: Both the M-CHAT and the M-CHAT-R/F, when including the follow-up interview procedure, have PPVs of around 50 percent in community practices, for children between 16 and 30 months of age. Screening tools are widely available. Multiple treatments are available to young children with ASD. Early intensive interventions demonstrate statistically significant improvements in cognitive and language outcomes in children, compared with eclectic treatments obtained in the community or other comparison groups, although the studies are generally small, and within the studies, some children benefit while others do not. We found no studies that directly compared long-term outcomes of screened versus non-screened children. More research is needed to determine the benefits and harms of screening the general population.”

Noland, R. M., & Gabriels, R. L. (2004). Screening and identifying children with autism spectrum disorders in the public school system: The development of a model process. Journal of Autism and Developmental Disorders, 34(3), 265–277. Retrieved from https://eric.ed.gov/?id=EJ735450

From the ERIC abstract: “Heightened public awareness of autism and increased prevalence estimates of autism spectrum disorders (ASDs) has generated a sense of urgency within the public school system to identify children with these disorders for targeted intervention. Two multidisciplinary groups of professionals, one each from two separate school districts, were identified and trained to provide diagnostic and consultative services. This paper outlines a model process for school personnel to develop a basic level of training and competence in recognizing and serving students who have an ASD by (1) providing an overview of the legal and clinical issues involved in screening for children with ASD within the school system, (2) defining a school-based professional training process and (3) outlining a school-based ASD screening process.”

Note: REL Midwest was unable to locate a link to the full-text version of this resource. Although REL Midwest tries to provide publicly available resources whenever possible, it was determined that this resource may be of interest to you. It may be found through university or public library systems.

Smith, C. J., Pollard, E., Stein, A. J., Ober-Reynolds, S., Kirwan, J., Malligo, A., et al. (2015). A method for universal screening of elementary school students: Development of the Social Challenges Screening Questionnaire. Journal of Applied School Psychology, 31(2), 115–140. Retrieved from https://eric.ed.gov/?id=EJ1061878

From the ERIC abstract: “Schools regularly screen students for hearing and vision impairments because they present impediments to academic progress. For the same reason, schools should consider adding a universal screening for social challenges, which may also impede the learning process. This study reports on the development of the Social Challenges Screening Questionnaire (SCSQ), an efficient teacher-report screening questionnaire that identifies students with challenges who may benefit from a psychological evaluation. Further, the questionnaire may help identify students with Autism Spectrum Disorder who were previously undiagnosed. The SCSQ was administered to 549 general education students in the third and fourth grades. Internal consistency was 0.85. A smaller sample of students (n = 50) was selected for additional follow up assessment using the Social Responsiveness Questionnaire, Second Edition. Scores on the two instruments were strongly correlated (r = 0.87, p < 0.01), and sensitivity (0.94) and specificity (0.88) indicate the SCSQ can efficiently detect students with social challenges in need of a formal evaluation.”

Note: REL Midwest was unable to locate a link to the full-text version of this resource. Although REL Midwest tries to provide publicly available resources whenever possible, it was determined that this resource may be of interest to you. It may be found through university or public library systems.

So, P., Greaves-Lord, K., van der Ende, J., Verhulst, F. C., Rescorla, L., & de Nijs, P. F. A. (2013). Using the Child Behavior Checklist and the Teacher’s Report Form for identification of children with autism spectrum disorders. Autism, 17(5), 595–607. Retrieved from https://eric.ed.gov/?id=EJ1018976

From the ERIC abstract: “This study evaluated the ability of the Child Behavior Checklist and the Teacher’s Report Form to identify children with autism spectrum disorders (ASD), using a sample of children with ASD (n = 458), referred children without ASD (n = 1109) and children from the general population (n = 999). A ten items ASD scale was constructed using half of the sample and the ability of this scale to discriminate between children with ASD and the other children was tested for the CBCL and the TRF separately and together in the other half of the sample. Using a cut-off score of 8 the combined CBCL/TRF ASD scale demonstrated high predictive values (NPV 95%, PPV 73%) in identifying children with ASD and children in the general population sample. This might be an acceptable percentage of false positives in general screening, considering the chance that these children might have other behavioural, emotional, and developmental problems which also need psychiatric evaluation. In the referred population, using a cut-off of 13, PPV was 49% and NPV was 85%. The high NPV indicates that in a referred population the scale is especially good at identifying children who do not need evaluation with a more ASD-specific instrument.”

Note: REL Midwest was unable to locate a link to the full-text version of this resource. Although REL Midwest tries to provide publicly available resources whenever possible, it was determined that this resource may be of interest to you. It may be found through university or public library systems.

Wallace, I. F. (2018). Universal screening of young children for developmental disorders: Unpacking the controversies (RTI Press Publication No. OP-0048-1802). Research Triangle Park, NC: RTI International. Retrieved from https://eric.ed.gov/?id=ED582380

From the ERIC abstract: “In the past decade, American and Canadian pediatric societies have recommended that pediatric care clinicians follow a schedule of routine surveillance and screening for young children to detect conditions such as developmental delay, speech and language delays and disorders, and autism spectrum disorder. The goal of these recommendations is to ensure that children with these developmental issues receive appropriate referrals for evaluation and intervention. However, in 2015 and 2016, the US Preventive Services Task Force (USPSTF) and the Canadian Task Force on Preventive Health Care issued recommendations that did not support universal screening for these conditions. This occasional paper is designed to help make sense of the discrepancy between Task Force recommendations and those of the pediatric community in light of research and practice. To clarify the issues, in this paper I review the distinction between screening and surveillance; the benefits of screening and early identification; how the USPSTF makes its recommendations; and what the implications of not supporting screening are for research, clinical practice, and families.”

Wilkinson, L. A. (2016). A best practice guide to assessment and intervention for autism spectrum disorder in schools. Philadelphia, PA: Jessica Kingsley Publishers. Retrieved from https://eric.ed.gov/?id=ED573510

From the ERIC abstract: “Fully updated to reflect DSM-5 and current assessment tools, procedures and research, this award-winning book provides a practical and scientifically-based approach to identifying, assessing, and treating children and adolescents with an Autism Spectrum Disorder (ASD) in school settings. Integrating current research evidence with theory and best-practice, the book will support school-based professionals in a number of key areas including: (1) screening and assessing children and youth with high-functioning autism spectrum conditions; (2) identifying evidence-based interventions and practices; (3) developing and implementing comprehensive educational programs; (4) providing family support and accessing community resources; and (4) promoting special needs advocacy. Illustrative case examples, a glossary of terms and helpful checklists and forms make this the definitive resource for identifying and implementing interventions for pupils with ASD.”

Note: REL Midwest was unable to locate a link to the full-text version of this resource. Although REL Midwest tries to provide publicly available resources whenever possible, it was determined that this resource may be of interest to you. It may be found through university or public library systems.

Yuen, T., Carter, M. T., Szatmari, P., & Ungar, W. J. (2018). Cost-effectiveness of universal or high-risk screening compared to surveillance monitoring in autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(9), 2968–2979. Retrieved from https://eric.ed.gov/?id=EJ1187306

From the ERIC abstract: “The American Academy of Pediatrics recommends universal screening for autism spectrum disorder at 18 and 24 months. This study compared the cost-effectiveness of universal or high-risk screening to surveillance monitoring. Simulation models estimated the costs and outcomes from birth to age 6 years. The incremental cost per child diagnosed by 36 months was $41,651.6 for high-risk screening and $757,116.9 for universal screening from the societal perspective. Universal screening may not be a cost-effective approach to increase earlier treatment initiation, as most children initiated treatment after age 60 months. Eliminating wait times resulted in more children initiated treatment by 48 months, but at a high initial cost that may be offset by future cost-savings related to better outcomes.”

Note: REL Midwest was unable to locate a link to the full-text version of this resource. Although REL Midwest tries to provide publicly available resources whenever possible, it was determined that this resource may be of interest to you. It may be found through university or public library systems.

Methods

Keywords and Search Strings

The following keywords and search strings were used to search the reference databases and other sources:

  • autism “educational diagnosis”

  • autism “state policy”

  • “screening tests” assq

  • “screening tests” autism

  • universal autism screening kindergarten;

  • “universal screening” autism

Databases and Search Engines

We searched ERIC for relevant resources. ERIC is a free online library of more than 1.6 million citations of education research sponsored by the Institute of Education Sciences (IES). Additionally, we searched IES and Google Scholar.

Reference Search and Selection Criteria

When we were searching and reviewing resources, we considered the following criteria:

  • Date of the publication: References and resources published over the last 15 years, from 2002 to present, were included in the search and review.

  • Search priorities of reference sources: Search priority is given to study reports, briefs, and other documents that are published or reviewed by IES and other federal or federally funded organizations.

  • Methodology: We used the following methodological priorities/considerations in the review and selection of the references: (a) study types—randomized control trials, quasi-experiments, surveys, descriptive data analyses, literature reviews, policy briefs, and so forth, generally in this order, (b) target population, samples (e.g., representativeness of the target population, sample size, volunteered or randomly selected), study duration, and so forth, and (c) limitations, generalizability of the findings and conclusions, and so forth.
This memorandum is one in a series of quick-turnaround responses to specific questions posed by educational stakeholders in the Midwest Region (Illinois, Indiana, Iowa, Michigan, Minnesota, Ohio, Wisconsin), which is served by the Regional Educational Laboratory (REL Midwest) at American Institutes for Research. This memorandum was prepared by REL Midwest under a contract with the U.S. Department of Education’s Institute of Education Sciences (IES), Contract ED-IES-17-C-0007, administered by American Institutes for Research. Its content does not necessarily reflect the views or policies of IES or the U.S. Department of Education nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.