School thinks DS has ASD, dev ped does not agree. Now what?

[Anonymous]

Anonymous wrote:I haven't read this thread. We had a similar issue when DS was in K. He hated school that year often saying his teacher was mean. He also takes some time to warm up and took a long time to make friends. We had him evualated and he was found to be borderline ADHD and the recommendation was not to treat him at that time, just to keep our eyes on him. DCUM all weighed in that DS sounded like he was on the spectrum and he must have issues if the school was telling us so.

We requested a certain teacher for 1st grade who is very patient, loving and kind. DS flouished in her class, hasn't had any issues since and has made many friends.

None of us can diagnose over the internet, though some of us try. Glad your kid is doing well.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I haven't read this thread. We had a similar issue when DS was in K. He hated school that year often saying his teacher was mean. He also takes some time to warm up and took a long time to make friends. We had him evualated and he was found to be borderline ADHD and the recommendation was not to treat him at that time, just to keep our eyes on him. DCUM all weighed in that DS sounded like he was on the spectrum and he must have issues if the school was telling us so.

We requested a certain teacher for 1st grade who is very patient, loving and kind. DS flouished in her class, hasn't had any issues since and has made many friends.

None of us can diagnose over the internet, though some of us try. Glad your kid is doing well.

No one is trying to diagnose the OP's kid, but some of us trying to help her get an appropriate iep.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Get the ADOS done independently. Rookie mistake not to include it in the first place. The schools are supposed to consider outside reports, but the often don't, so it may not change their stance. Iep labels are incredibly general. Focus on the supports your kid needs no matter what label it comes under.

Total blergh.

Interestingly, dev ped thinks it's not worth doing—doesn't think it will show much in his case.

PP is wrong. BTDT. ADOS is not a standard part of a neuropsych. It's a matter of professional judgement whether to do it, not a rookie mistake. You may want one anyway for the school or for your own peace of mind. If you do want an ADOS, go to David Black, he's a neuropsych specializing in autism.

In our situation, the tester decided not to do the ADOS after doing a bunch of other testing and spending hours with my son. He said it wasn't even close -- my DS didn't have autism, and wasn't going to test in the autistic range on the ADOS. He'd done hundreds of ADOS testing through the years.

See the difference? He's done hundreds of the tests and followed the kids through adulthood. He knows the difference. Elementary school teachers do not have this training and should not be using it to diagnose kids. I think they like it because it's a checklist and it looks easy but it's not.

I am not sure what you are talking about. The ADOS is not a checklist and it is not administered by teachers. There ARE checklists a teacher might fill out as part of an evaluation, which is totally appropriate. While I understand it might be distressing to have a teacher think they know the diagnosis, try to focus more on what your child needs.

Sorry, I think that it was CARS checklists that I used to see teachers following kids around with at my daughter's school. Photocopied autism checklists when honestly I'm pretty sure these teachers had never seen an autistic kid in their life were filling out.


This is CARS-2 but there was a first/original CARS too.
http://www.proedinc.com/customer/productView.aspx?ID=4754

Just to expand, the actual CARS scoring tests can only be scored by a clinician who has been trained and observes the child in person. The tested is calibrated and each item has definite criteria.

There are CARS checklists for teachers and parents, but those only inform the clinician. The actual test has to be done by someone who is trained. My son had the original CARS twice, once by someone the school brought in to do behind our back, and the second by Dr. Stephen Camarata of Vanderbilt; the scores were within a half-point of each other in the non-autistic range. Dr. Camarata didn't see the first result before he did his CARS assessment; that's how controlled the process is, scoring wise.


https://www.chadis.com/site/content/childhood-autism-rating-scale-second-edition-cars2-hf

The Childhood Autism Rating Scale (CARS) helps to identify children (2 years and older with Autism, specifically, distinguishing them from developmentally handicapped children who are not Autistic. In addition, it distinguishes between mid-to-moderate and severe Autism. Its brevity makes it a very useful tool to help recognize and classify Autistic children. The CARS was developed over a 15-year period with more than 1,500 cases, the CARS includes items drawn from five prominent systems for diagnosing Autism, and provides quantifiable ratings based on direct behavior observation. Each item covers a particular characteristic, ability of behavior. Note that this is a strictly a clinician rating tool and is not to be administered directly to parents but can be used in conjunction with the CARS parent questionnaire (QPC) which is an unscored data collection tool. CHADIS, with guidance from the authors, has created a way for relevant parent data for each CARS item to be viewed above each clinician item. This should greatly facilitate the clinical process when meeting with parent and child.

That is all true in theory, but some people photocopy away and try to diagnose themselves or as a school. I doubt that happens outright at the public schools but it may happen privately (private opinions held by teachers that don’t get put in a report but do get included in the attitudes directed towards a child).
If public schools want to diagnose so much why don’t they have their own certified clinicians? I’m sure they don’t have the budget so they should stop pushing unofficial opinions.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Get the ADOS done independently. Rookie mistake not to include it in the first place. The schools are supposed to consider outside reports, but the often don't, so it may not change their stance. Iep labels are incredibly general. Focus on the supports your kid needs no matter what label it comes under.

Total blergh.

Interestingly, dev ped thinks it's not worth doing—doesn't think it will show much in his case.

PP is wrong. BTDT. ADOS is not a standard part of a neuropsych. It's a matter of professional judgement whether to do it, not a rookie mistake. You may want one anyway for the school or for your own peace of mind. If you do want an ADOS, go to David Black, he's a neuropsych specializing in autism.

In our situation, the tester decided not to do the ADOS after doing a bunch of other testing and spending hours with my son. He said it wasn't even close -- my DS didn't have autism, and wasn't going to test in the autistic range on the ADOS. He'd done hundreds of ADOS testing through the years.

See the difference? He's done hundreds of the tests and followed the kids through adulthood. He knows the difference. Elementary school teachers do not have this training and should not be using it to diagnose kids. I think they like it because it's a checklist and it looks easy but it's not.

I am not sure what you are talking about. The ADOS is not a checklist and it is not administered by teachers. There ARE checklists a teacher might fill out as part of an evaluation, which is totally appropriate. While I understand it might be distressing to have a teacher think they know the diagnosis, try to focus more on what your child needs.

Sorry, I think that it was CARS checklists that I used to see teachers following kids around with at my daughter's school. Photocopied autism checklists when honestly I'm pretty sure these teachers had never seen an autistic kid in their life were filling out.


This is CARS-2 but there was a first/original CARS too.
http://www.proedinc.com/customer/productView.aspx?ID=4754

Just to expand, the actual CARS scoring tests can only be scored by a clinician who has been trained and observes the child in person. The tested is calibrated and each item has definite criteria.

There are CARS checklists for teachers and parents, but those only inform the clinician. The actual test has to be done by someone who is trained. My son had the original CARS twice, once by someone the school brought in to do behind our back, and the second by Dr. Stephen Camarata of Vanderbilt; the scores were within a half-point of each other in the non-autistic range. Dr. Camarata didn't see the first result before he did his CARS assessment; that's how controlled the process is, scoring wise.


https://www.chadis.com/site/content/childhood-autism-rating-scale-second-edition-cars2-hf

The Childhood Autism Rating Scale (CARS) helps to identify children (2 years and older with Autism, specifically, distinguishing them from developmentally handicapped children who are not Autistic. In addition, it distinguishes between mid-to-moderate and severe Autism. Its brevity makes it a very useful tool to help recognize and classify Autistic children. The CARS was developed over a 15-year period with more than 1,500 cases, the CARS includes items drawn from five prominent systems for diagnosing Autism, and provides quantifiable ratings based on direct behavior observation. Each item covers a particular characteristic, ability of behavior. Note that this is a strictly a clinician rating tool and is not to be administered directly to parents but can be used in conjunction with the CARS parent questionnaire (QPC) which is an unscored data collection tool. CHADIS, with guidance from the authors, has created a way for relevant parent data for each CARS item to be viewed above each clinician item. This should greatly facilitate the clinical process when meeting with parent and child.

That is all true in theory, but some people photocopy away and try to diagnose themselves or as a school. I doubt that happens outright at the public schools but it may happen privately (private opinions held by teachers that don’t get put in a report but do get included in the attitudes directed towards a child).
If public schools want to diagnose so much why don’t they have their own certified clinicians? I’m sure they don’t have the budget so they should stop pushing unofficial opinions.

Schools and school systems have the money for what is important to them, like everyone else. They do have some certified clinicians but not enough. They certainly have enough money to pay expensive attorneys to fight parents over private placements and services, they certainly have the money to pay for good assessments for our kids.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:An ADOS that doesn't show ASD won't make the school believe a child doesn't have autism. They like the ADOS because the test doesn't differentiate well between autism and other special needs. Studies have shown it captures all the kids with autism, and then many more who have other learning challenges. So they are playing the odds.

Can you point us to these studies?

here's one:

http://bestpracticeautism.blogspot.com/2012/01/best-practice-review-autism-diagnostic.html

A current study also investigated the diagnostic validity of the ADOS in a clinical sample (Molloy, Murray, Akers, Mitchell, & Manning-Courtney, 2011). ADOS classifications were compared to final diagnoses given to 584 children referred for evaluation for a possible ASD in a children’s medical center. Sensitivities were moderate to high on the algorithms, while specificities were substantially lower than reported in the original ADOS validity sample. The authors concluded that the higher number of false positives was likely attributable to the composition of their clinical sample which included many children with a broad range of developmental and behavioral disorders. The results of this study also suggest that clinical populations for which the ADOS is regularly used may be substantially different from the research samples on which it was normed. As a result, it is especially important that the ADOS not be used as a “stand-alone” assessment so as to minimize misclassification in clinical settings where there are children with many other developmental or behavioral disorders.

Step away from your cherry picking google skills.

One, this study was already cited in this link already posted:
http://www.pearsonclinical.co.uk/Psychology/ChildMentalHealth/ChildMentalHealth/ADOS-2/Resources/autism-diagnosis-evidence-update.pdf

See page 23.

Two, learn how to evaluate health information on the internet:
https://ods.od.nih.gov/Health_Information/How_To_Evaluate_Health_Information_on_the_Internet_Questions_and_Answers.aspx

From the link:
Accuracy of autism diagnostic tools
NICE CG128 states: do not rely on any autism-specific diagnostic tool alone to diagnose
autism.

[Anonymous]

From page 23:

Information on final diagnosis was available for 584 children (97% of included children, 87%
male) on electronic medical records. For detection of autism versus non-spectrum disorders,
the sensitivity was 67–91% for communication and social domain scores and 82–94% for
social affective and repetitive restricted behaviour domain scores. Specificity was 65–95%
and 55–81% respectively. For detection of autism spectrum disorders other than autism
versus non-spectrum disorders the sensitivity was 75–94% for communication and social
domain scores and 72–100% for social affective and repetitive restricted behaviour domain
scores. Specificity was 29–81% and 29–60% respectively.


Look at those low ranges, and tell me this is the be-all, end-all test.

[Anonymous]

Anonymous wrote:From page 23:

Information on final diagnosis was available for 584 children (97% of included children, 87%
male) on electronic medical records. For detection of autism versus non-spectrum disorders,
the sensitivity was 67–91% for communication and social domain scores and 82–94% for
social affective and repetitive restricted behaviour domain scores. Specificity was 65–95%
and 55–81% respectively. For detection of autism spectrum disorders other than autism
versus non-spectrum disorders the sensitivity was 75–94% for communication and social
domain scores and 72–100% for social affective and repetitive restricted behaviour domain
scores. Specificity was 29–81% and 29–60% respectively.


Look at those low ranges, and tell me this is the be-all, end-all test.

And right below the previous graph is this reminder:

This evidence is consistent with the recommendation in NICE CG128 that diagnosis should
not rely solely on 1 tool.



And from page 25:

The authors noted that the best strategy was using the ADI-R clinical cut-off score and the
ADOS together, which had sensitivity of 90–98% and specificity of 80–92% across the groups
of children analysed. Sensitivity for detecting autism was best when either ADI-R or ADOS
were used with sensitivity of 99–100%, but specificity was lower at 45–85%. If a child’s ADI-R
and ADOS scores were both judged to be in the range of concern, the odds ratio of having a
best estimate clinical diagnosis of autism was 56.19 (p<0.001).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I haven't read this thread. We had a similar issue when DS was in K. He hated school that year often saying his teacher was mean. He also takes some time to warm up and took a long time to make friends. We had him evualated and he was found to be borderline ADHD and the recommendation was not to treat him at that time, just to keep our eyes on him. DCUM all weighed in that DS sounded like he was on the spectrum and he must have issues if the school was telling us so.

We requested a certain teacher for 1st grade who is very patient, loving and kind. DS flouished in her class, hasn't had any issues since and has made many friends.

None of us can diagnose over the internet, though some of us try. Glad your kid is doing well.

No one is trying to diagnose the OP's kid, but some of us trying to help her get an appropriate iep.

This comment was directed to pp, although I will note that one poster actually diagnosed all the kids of all the parents who disagreed with her, based solely on the fact that they disagreed with her.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:An ADOS that doesn't show ASD won't make the school believe a child doesn't have autism. They like the ADOS because the test doesn't differentiate well between autism and other special needs. Studies have shown it captures all the kids with autism, and then many more who have other learning challenges. So they are playing the odds.

Can you point us to these studies?

here's one:

http://bestpracticeautism.blogspot.com/2012/01/best-practice-review-autism-diagnostic.html

A current study also investigated the diagnostic validity of the ADOS in a clinical sample (Molloy, Murray, Akers, Mitchell, & Manning-Courtney, 2011). ADOS classifications were compared to final diagnoses given to 584 children referred for evaluation for a possible ASD in a children’s medical center. Sensitivities were moderate to high on the algorithms, while specificities were substantially lower than reported in the original ADOS validity sample. The authors concluded that the higher number of false positives was likely attributable to the composition of their clinical sample which included many children with a broad range of developmental and behavioral disorders. The results of this study also suggest that clinical populations for which the ADOS is regularly used may be substantially different from the research samples on which it was normed. As a result, it is especially important that the ADOS not be used as a “stand-alone” assessment so as to minimize misclassification in clinical settings where there are children with many other developmental or behavioral disorders.

Step away from your cherry picking google skills.

One, this study was already cited in this link already posted:
http://www.pearsonclinical.co.uk/Psychology/ChildMentalHealth/ChildMentalHealth/ADOS-2/Resources/autism-diagnosis-evidence-update.pdf

See page 23.

Two, learn how to evaluate health information on the internet:
https://ods.od.nih.gov/Health_Information/How_To_Evaluate_Health_Information_on_the_Internet_Questions_and_Answers.aspx

From the link:
Accuracy of autism diagnostic tools
NICE CG128 states: do not rely on any autism-specific diagnostic tool alone to diagnose
autism.

No one is trying to diagnose autism. Go back and get the ADOS added to the neuropsch that the op already did to get an appropriate iep. Why is this so hard?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:An ADOS that doesn't show ASD won't make the school believe a child doesn't have autism. They like the ADOS because the test doesn't differentiate well between autism and other special needs. Studies have shown it captures all the kids with autism, and then many more who have other learning challenges. So they are playing the odds.

Can you point us to these studies?

here's one:

http://bestpracticeautism.blogspot.com/2012/01/best-practice-review-autism-diagnostic.html

A current study also investigated the diagnostic validity of the ADOS in a clinical sample (Molloy, Murray, Akers, Mitchell, & Manning-Courtney, 2011). ADOS classifications were compared to final diagnoses given to 584 children referred for evaluation for a possible ASD in a children’s medical center. Sensitivities were moderate to high on the algorithms, while specificities were substantially lower than reported in the original ADOS validity sample. The authors concluded that the higher number of false positives was likely attributable to the composition of their clinical sample which included many children with a broad range of developmental and behavioral disorders. The results of this study also suggest that clinical populations for which the ADOS is regularly used may be substantially different from the research samples on which it was normed. As a result, it is especially important that the ADOS not be used as a “stand-alone” assessment so as to minimize misclassification in clinical settings where there are children with many other developmental or behavioral disorders.

Step away from your cherry picking google skills.

One, this study was already cited in this link already posted:
http://www.pearsonclinical.co.uk/Psychology/ChildMentalHealth/ChildMentalHealth/ADOS-2/Resources/autism-diagnosis-evidence-update.pdf

See page 23.

Two, learn how to evaluate health information on the internet:
https://ods.od.nih.gov/Health_Information/How_To_Evaluate_Health_Information_on_the_Internet_Questions_and_Answers.aspx

From the link:
Accuracy of autism diagnostic tools
NICE CG128 states: do not rely on any autism-specific diagnostic tool alone to diagnose
autism.

No one is trying to diagnose autism. Go back and get the ADOS added to the neuropsch that the op already did to get an appropriate iep. Why is this so hard?

Again, look at the specificity of the ADOS. Look at the recommendations - you aren't supposed to use one test to diagnose. So why force the ADOS?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:An ADOS that doesn't show ASD won't make the school believe a child doesn't have autism. They like the ADOS because the test doesn't differentiate well between autism and other special needs. Studies have shown it captures all the kids with autism, and then many more who have other learning challenges. So they are playing the odds.

Can you point us to these studies?

here's one:

http://bestpracticeautism.blogspot.com/2012/01/best-practice-review-autism-diagnostic.html

A current study also investigated the diagnostic validity of the ADOS in a clinical sample (Molloy, Murray, Akers, Mitchell, & Manning-Courtney, 2011). ADOS classifications were compared to final diagnoses given to 584 children referred for evaluation for a possible ASD in a children’s medical center. Sensitivities were moderate to high on the algorithms, while specificities were substantially lower than reported in the original ADOS validity sample. The authors concluded that the higher number of false positives was likely attributable to the composition of their clinical sample which included many children with a broad range of developmental and behavioral disorders. The results of this study also suggest that clinical populations for which the ADOS is regularly used may be substantially different from the research samples on which it was normed. As a result, it is especially important that the ADOS not be used as a “stand-alone” assessment so as to minimize misclassification in clinical settings where there are children with many other developmental or behavioral disorders.

Step away from your cherry picking google skills.

One, this study was already cited in this link already posted:
http://www.pearsonclinical.co.uk/Psychology/ChildMentalHealth/ChildMentalHealth/ADOS-2/Resources/autism-diagnosis-evidence-update.pdf

See page 23.

Two, learn how to evaluate health information on the internet:
https://ods.od.nih.gov/Health_Information/How_To_Evaluate_Health_Information_on_the_Internet_Questions_and_Answers.aspx

From the link:
Accuracy of autism diagnostic tools
NICE CG128 states: do not rely on any autism-specific diagnostic tool alone to diagnose
autism.

No one is trying to diagnose autism. Go back and get the ADOS added to the neuropsch that the op already did to get an appropriate iep. Why is this so hard?

You seem very rigid. Have you had the ADOS yourself?

If you both are going to insult each other, please do it properly. Both are giving poor information. The ADOS has been updated and its the ADOS-2 now. If someone is still using the first version, be concerned.

[Anonymous]

Op, you asked for advice and I'm sorry this conversation has gone down the rabbit hole. Feel free to ask for the thread to be locked or deleted in website feedback forum.

If you go back to the evaluator who did your neuropsch, they will know what you mean and which version of ADOS to use, just like you need to specify to use the latest version of the DSM. I've been where you are in the iep process. GL

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Get the ADOS done independently. Rookie mistake not to include it in the first place. The schools are supposed to consider outside reports, but the often don't, so it may not change their stance. Iep labels are incredibly general. Focus on the supports your kid needs no matter what label it comes under.

Total blergh.

Interestingly, dev ped thinks it's not worth doing—doesn't think it will show much in his case.

PP is wrong. BTDT. ADOS is not a standard part of a neuropsych. It's a matter of professional judgement whether to do it, not a rookie mistake. You may want one anyway for the school or for your own peace of mind. If you do want an ADOS, go to David Black, he's a neuropsych specializing in autism.

In our situation, the tester decided not to do the ADOS after doing a bunch of other testing and spending hours with my son. He said it wasn't even close -- my DS didn't have autism, and wasn't going to test in the autistic range on the ADOS. He'd done hundreds of ADOS testing through the years.

See the difference? He's done hundreds of the tests and followed the kids through adulthood. He knows the difference. Elementary school teachers do not have this training and should not be using it to diagnose kids. I think they like it because it's a checklist and it looks easy but it's not.

I am not sure what you are talking about. The ADOS is not a checklist and it is not administered by teachers. There ARE checklists a teacher might fill out as part of an evaluation, which is totally appropriate. While I understand it might be distressing to have a teacher think they know the diagnosis, try to focus more on what your child needs.

Sorry, I think that it was CARS checklists that I used to see teachers following kids around with at my daughter's school. Photocopied autism checklists when honestly I'm pretty sure these teachers had never seen an autistic kid in their life were filling out.


This is CARS-2 but there was a first/original CARS too.
http://www.proedinc.com/customer/productView.aspx?ID=4754

Just to expand, the actual CARS scoring tests can only be scored by a clinician who has been trained and observes the child in person. The tested is calibrated and each item has definite criteria.

There are CARS checklists for teachers and parents, but those only inform the clinician. The actual test has to be done by someone who is trained. My son had the original CARS twice, once by someone the school brought in to do behind our back, and the second by Dr. Stephen Camarata of Vanderbilt; the scores were within a half-point of each other in the non-autistic range. Dr. Camarata didn't see the first result before he did his CARS assessment; that's how controlled the process is, scoring wise.


https://www.chadis.com/site/content/childhood-autism-rating-scale-second-edition-cars2-hf

The Childhood Autism Rating Scale (CARS) helps to identify children (2 years and older with Autism, specifically, distinguishing them from developmentally handicapped children who are not Autistic. In addition, it distinguishes between mid-to-moderate and severe Autism. Its brevity makes it a very useful tool to help recognize and classify Autistic children. The CARS was developed over a 15-year period with more than 1,500 cases, the CARS includes items drawn from five prominent systems for diagnosing Autism, and provides quantifiable ratings based on direct behavior observation. Each item covers a particular characteristic, ability of behavior. Note that this is a strictly a clinician rating tool and is not to be administered directly to parents but can be used in conjunction with the CARS parent questionnaire (QPC) which is an unscored data collection tool. CHADIS, with guidance from the authors, has created a way for relevant parent data for each CARS item to be viewed above each clinician item. This should greatly facilitate the clinical process when meeting with parent and child.

That is all true in theory, but some people photocopy away and try to diagnose themselves or as a school. I doubt that happens outright at the public schools but it may happen privately (private opinions held by teachers that don’t get put in a report but do get included in the attitudes directed towards a child).
If public schools want to diagnose so much why don’t they have their own certified clinicians? I’m sure they don’t have the budget so they should stop pushing unofficial opinions.

I think school psychologists are certified to use CARS.

[Anonymous]

Anonymous wrote:Op, you asked for advice and I'm sorry this conversation has gone down the rabbit hole. Feel free to ask for the thread to be locked or deleted in website feedback forum.

If you go back to the evaluator who did your neuropsch, they will know what you mean and which version of ADOS to use, just like you need to specify to use the latest version of the DSM. I've been where you are in the iep process. GL

How is the ADOS helpful when its not ASD, is ADHD and there has been a neuropsych. Maybe target the behaviors at this point and look at the classroom setting.