The California School Psychologist - CASPOnline4 The California School Psychologist, 2006, Vol. 11...

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The California School Psychologist2006, Volume 11

The California School Psychologist Provides ValuableInformation Regarding Autism Spectrum Disorders

Editorial

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Special Topic Articles

Natacha AkshoomoffChristina CorselloHeather Schmidt

The Role of the Autism Diagnostic Observation Schedulein the Assessment of Autism Spectrum Disordersin School and Community Settings

Shane R. Jimerson

John S. CarlsonTara BrinkmanAmy Majewicz-Hefley

Medication Treatment Outcomes for School-Aged ChildrenDiagnosed with Autism

Stephen E. Brock An Examination of the Changing Rates of Autism in SpecialEducation

Bridging the Transition to Kindergarten: SchoolReadiness Case Studies from California’s First 5 Initiative

Michael P. BatesAlyce MastrianniCarole MintzerWilliam NicholasMichael J. FurlongJenne SimentalJennifer Greif Green

Using Sociograms to Identify Social Status in theClassroom

Brian P. LeungJessica Silberling

School Crisis Teams within an Incident CommandSystem

Amanda B. NickersonStephen E. BrockMelissa A. Reeves

Projective Assessment and School Psychology:Contemporary Validity Issues and Implications for Practice

David N. MillerAmanda B. Nickerson

CONTENTS

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73

General Articles

Natasha HenleyMichael Furlong

Using Curriculum-Derived Progress Monitoring Data asPart of a Response-to-Intervention Strategy: A CaseStudy

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The California School PsychologistContributes Valuable Knowledge to

Promote Student Success

Shane R. JimersonUniversity of California, Santa Barbara

This volume of The California School Psychologist includes several articles regarding “autismspectrum disorder” as well as other informative articles on topics ranging from California’s First 5Initiative, to school crisis teams, classroom sociograms, and projective assessments. These articlesprovide valuable information for school psychologists and other professionals working in the schools,and also contribute to the literature and scholarship that aims to promote the educational success of allstudents. Previous articles published in The California School Psychologist, including the recent vol-umes addressing a) school engagement, b) strength-based assessment, and c) response to intervention(RTI), are available on-line at www.education.ucsb.edu/school-psychology.

The first article (Akshoomoff, Corsello, & Schmidt, 2006) reports the results of a national surveyexamining autism diagnosis practices among school and clinical psychologists. The role of the AutismDiagnostic Observation Schedule (ADOS) was a particular focus of this study. The results of this studyrevealed that both school psychologists and clinical psychologists were similar in following best prac-tice guidelines for screening, diagnosis, and assessment. Both school psychologists and clinical psy-chologists were found to typically include a parent interview and a developmental history in theirassessment. It was also found that school psychologists were more likely to include a home observa-tion or teacher report, relative to clinical psychologists. Perceived merits of the ADOS included thestandardized structure for observation and capturing behaviors specific to autism spectrum disorder.The authors emphasize that more research is needed on how practitioners interpret the various diag-nostic criteria and the impact of different practices and level of expertise on classification and serviceutilization.

The second article (Carlson, Brinkman, & Majawicz-Hefley, 2006) provides valuable informationregarding the use of biomedical treatments with school-aged children diagnosed with autism. Notingthe increasing prevalence of autism and the increased frequency of pharmacological interventions, thisarticle provides a synthesis of research informing the outcomes and risks associated with psychotropicmedications. No medications are currently FDA-approved for treating autism; however, such inter-ventions are often implemented as an adjunct to behavioral, social, and educational interventions. Theauthors identify specific domains where pharmacological treatments demonstrate promise in treatingspecific symptoms commonly associated with autism, including aggression, anxiety, agitation, cogni-tive inflexibility, overactivity, self-injury, and stereotypic behaviors. School psychologists are in acritical position to monitor the effects of various interventions, including medications. Moreover, it isimportant that school psychologists be knowledgeable of the effects of pharmacological interventions.

The third article (Brock, 2006) examines the changing rates of autism in special education usingdata from the U.S. Department of Education. The U.S. Department of Education included “Autism” asa specific special education eligibility category beginning in 1991, whereas previously students withASD who required special education assistance were identified as eligible by meeting other eligibilitycategory criteria (e.g., mental retardation, speech/language impairment). This article explores whetherclassification substitution may be an explanation for increases in the number of students found eligible

The California School Psychologist, Vol. 11, pp. 3-5, 2006

Copyright 2006 California Association of School Psychologists

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for special education using the autism criteria. The trends illustrate that as the rates of autism classifi-cation have gone up, the classification rates of mental retardation (MR), emotional disturbance (ED),and specific learning disability (SLD) have gone down. The author concludes that it is possible that theincreased numbers of students found eligible for special education using autism criteria are at least inpart a function of IEP teams being increasingly more willing and able to use autism criteria instead ofMR, ED, and SLD criteria.

The fourth article (Bates, Mastrianni, Mintzer, Nicholas, Furlong, Simental, & Greif-Green, 2006)presents information regarding bridging the transition to kindergarten. The first five years of develop-ment have been increasingly recognized as establishing a critical foundation for later success in schooland life. Moreover, early interventions that combine child-focused educational activities with parent-child relationship building can positively influence children’s readiness for school, particularly forthose at-risk for poor developmental outcomes. The authors present an overview of one such initia-tive—California’s First 5—and provide three Southern California case studies of how it is being imple-mented at the county level. Noting that the California Pupil Personnel Services Credential trainingstandards added preschool as one of the primary fieldwork settings for school psychologists, and theInfants and Toddlers with Disabilities Act (ITDA) Part C of IDEA (2004) was developed to improvethe identification of infants and toddlers (ages birth to 2 years) with disabilities and to provide earlyintervention and family support services, the authors emphasize that the convergence of developmen-tal research, prevention science, and public policy initiatives are increasing efforts to enhance earlyeducational experiences for all children in order to increase their chances of entering school fullyready to learn.

The fifth article (Leung & Silbering, 2006) offers a review of literature regarding the use ofsociograms to identify social status in the classroom. Emphasizing the importance of peer relationsand the classroom context on learning,, the authors discuss the sociogram as a tool that may be used byschool psychologists to explore the social climate and peer status in the classroom. The working defi-nition of sociometry is — a methodology for tracking the energy vectors of interpersonal relationshipsin a group. The process includes asking members of a group to choose others in the group based on aspecific criteria, everyone in the group can make choices and describe why the choices were made.From this information a description emerges of the networks inside the group. An illustration of thosenetworks is referred to as a sociogram. The sociogram represents the patterns of how individualsassociate with each other. The authors advocate that the results of a class sociogram may be helpful inidentifying the need for individual and/or classroom-wide intervention, and the information can alsobe used to assess effects of such interventions.

The sixth article (Nickerson, Brock, & Reeves, 2006) provides a thoughtful and cogent discussionof school crisis teams within an incident command system infrastructure. Recognizing the lack ofinformation regarding how to coordinate with multiple agencies involved following a crisis, this ar-ticle describes the U. S. Department of Homeland Security’s (2004) National Incident ManagementSystem and its Incident Command System (ICS), which provides a common set of concepts, prin-ciples, terminology, and organizational processes to facilitate crisis response activities. The authorscompare the traditional school crisis team structure to the ICS structure and discuss the overlap andintegration of the two. Two case scenarios help to illustrate how the school crisis team may operate incompliance with the ICS in different crisis situations.

The seventh article (Miller & Nickerson, 2006) explores the use of projective assessments in theprofession of school psychology, emphasizing contemporary validity issues such as incremental valid-ity and treatment validity. The use of projective assessments with children and adolescents has been

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controversial. Based on their review of the extant literature, the authors emphasize that projectivetechniques will generally not be useful for identifying (a) significant variables that are causing, sup-porting, or maintaining the problem; or (b) interventions that will effectively and efficiently resolvethe problem or the variables causing or maintaining it. The authors conclude that despite the wide useof projective techniques by school psychologists with children and adolescents, the continued use ofthese techniques would appear inconsistent with best practices in school psychology assessment.

The eighth article (Henley & Furlong, 2006) discusses the school psychologist’s role in monitor-ing student progress. The authors emphasize that the revised Individuals with Disabilities Improve-ment Education Act (2004) and subsequent Federal Regulations promote the use of alternative processof identifying students with specific learning disabilities based on how well a student responds toresearched-based interventions. The authors highlight that as these strategies are implemented, schoolpsychologists have the opportunity to expand their roles and to assume leadership positions in imple-menting a response-to-intervention (RtI) model. This article includes a case study demonstrating howa school psychologist took the first steps to implement a continuous progress monitoring procedure inone urban school, using data readily available at the school site (reading probes included with thedistrict reading curriculum) to develop a systematic way to monitor progress by creating local schoolnorms and using existing reading benchmarks.

This collection of articles provides valuable information that may be used by educational profes-sionals working with children, families, and colleagues to enhance the academic success and promotepositive developmental trajectories of students. The authors of the manuscripts in this volume providevaluable information and insights that advance our understanding of numerous important topics. TheCalifornia School Psychologist contributes important information regarding promoting the social andcognitive competence of all students.

REFERENCES

Akshoomoff, N., Corsello, C., & Schmidt, H. (2006). The role of the Austism Diagnostic Observation Schedule inthe assessment of autism spectrum disorders in school and community settings. The California SchoolPsychologist, 11, 7-19.

Bates, M. P., Mastrianni, A., Mintzer, C., Nicholas, W., Furlong, M. J., Simental, J. & Greif-Green, J. (2006).Bridging the transition to Kindergarten: School readiness case studies from California’s First 5 initiative. TheCalifornia School Psychologist, 11, 41-56.

Brock, S. E. (2006). An examination of the changing rates of autism in special education. The California SchoolPsychologist, 11, 31-40.

Carlson, J. S., Brinkman, T. & Majawicz-Hefley, A. (2006). Medication treatment outcomes for school-agedchildren diagnosed with autism. The California School Psychologist, 11, 21-30.

Henley, N. & Furlong, M. J. (2006). Using curriculum-derived progress monitoring data as part of a response-to-intervention strategy: A case study. The California School Psychologist, 11, 85-99.

Leung, B. P., & Silbering, J. (2006). Using sociograms to identify social status in the classroom. The CaliforniaSchool Psychologist, 11, 57-61.

Miller, D. N., & Nickerson, A. B. (2006). Projective assessment and school psychology: Contemporary validityissues and implications for practice. The California School Psychologist, 11, 73-84.

Nickerson, A. B., Brock, S. E., & Reeves, M. A. (2006). School crisis teams within an incident command system.The California School Psychologist, 11, 63-72.

The California School Psychologist

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The Role of the Autism Diagnostic Observation Schedulein the Assessment of Autism Spectrum Disorders

in School and Community Settings

Natacha Akshoomoff, Christina Corsello, and Heather SchmidtUniversity of California, San Diego

Child and Adolescent Services Research CenterChildren’s Hospital and Health Center San Diego

Autism diagnostic practices among school and clinical psychologists, particularly those using theAutism Diagnostic Observation Schedule (ADOS), were examined using national survey results(N=132). School and clinical psychologists were similar in following the Best Practice Guide-lines for screening, diagnosis and assessment. School psychologists were more likely to includea school or home observation and teacher report than clinical psychologists but evaluated signifi-cantly fewer children with autism spectrum disorders per year compared to clinical psycholo-gists. School psychologists who were ADOS users were more likely to consider themselves au-tism experts and include a review of records than ADOS non-users. Perceived advantages of theADOS included its strength in capturing ASD-specific behaviors and the standardized structureprovided for observation, while diagnostic discrimination and required resources were the mostcommonly identified disadvantages.

The “autism spectrum disorders” (ASD) include the DSM-IV diagnoses of Autistic Disorder,Asperger’s Disorder, and Pervasive Developmental Disorder-Not Otherwise Specified (Lord & Bailey,2002). According to DSM-IV criteria (American Psychiatric Association, 2000), Autistic Disorder ischaracterized by difficulties in the areas of communication, reciprocal social interaction, and restricted/repetitive behaviors and interests, with an onset prior to three years of age. While children with Asperger’sDisorder also have significant difficulties in reciprocal social interaction and exhibit restricted/repeti-tive behaviors and interests, they do not have cognitive delays or significant delays in early languagedevelopment, and exhibit less severe communication problems. Children with Pervasive Develop-mental Disorder-Not Otherwise Specified (PDD-NOS) exhibit symptoms associated with Autistic Dis-order but do not meet the full diagnostic criteria.

The prevalence of ASD has been estimated to be approximately 60 per 10,000 (Fombonne, 2003).Better identification, broader categorization, and the growth of available services have contributed tothe increased number of children being identified with ASD and requiring specific educational inter-ventions (Akshoomoff & Stahmer, 2006; Croen, Grether, Hoogstrate, & Selvin, 2002; Fombonne,2003). While ASD is relatively rare compared to other developmental disorders, it is more commonthan previously thought and quite significant in terms of impact and resource needs.

With the introduction of IDEA in 1990 (P.L. 101–476), the “Autism” category and its definitionwas added to the previous list of disability categories and definitions. School psychologists and otherschool professionals have thus been placed in the role of identifying and assessing children for specialeducation eligibility under this educational disability category. However, there are significant differ-ences in how states define and assess children for eligibility (Conderman & Katsiyannis, 1996). Theadministrative prevalence of children in the “Autism” special education category varies across states,across school districts within a state, and appears to be significantly associated with education-relatedspending as well as availability of health-related resources (Mandell & Palmer, 2005; Palmer, Blanchard,

Address correspondence to Natacha Akshoomoff, Ph.D.; Child and Adolescent Services Research Center; 3020Children’s Way; MC 5033; San Diego, CA 92123-4282. E-mail: [email protected].

The California School Psychologist, Vol. 11, pp. 7-19, 2006Copyright 2006 California Association of School Psychologists

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Jean, & Mandell, 2005). Although it appears to be more common for children with Autistic Disorder tobe identified during the preschool period, many children are first identified by their local school sys-tem, not their local health care system (Yeargin-Allsopp et al., 2003). Given that epidemiologicalstudies frequently utilize special education administrative data to estimate the national prevalence ofautism (Mandell & Palmer, 2005; Newschaffer, Falb, & Gurney, 2005; Shattuck, 2006), making thepractices followed by school psychologists in the classification of ASD of particular interest to epide-miologists and policy makers.

There is a general consensus that appropriately targeted early intervention improves outcome forchildren with ASD (National Research Council, 2001). Increased diagnostic accuracy is thereforeexpected to have a greater impact on the success of individualized early intervention and educationprograms (National Research Council, 2001). It is recommended that a diagnostic evaluation for ASDshould include a formal multidisciplinary evaluation of social behavior, language and nonverbal com-munication, adaptive behavior, motor skills, atypical behaviors, and cognitive status by a team ofprofessionals experienced with ASD (Charman & Baird, 2002; Filipek et al., 2000; National ResearchCouncil, 2001; Shriver, Allen, & Matthews, 1999). With regard to specific diagnostic information, it isrecommended that the diagnostic process include measures of parental report, child observation andinteraction, and the use of clinical judgment (Filipek et al., 1999). The large number of behaviors thatdefine ASD and the variability seen between individual children, even within the same diagnosticcategory, increases the likelihood that inaccurate decisions about diagnosis and classification may bemade by those with less training and experience.

In 2002, the California Department of Developmental Services published the “Best Practice Guide-lines for Screening, Diagnosis, and Assessment of Autistic Spectrum Disorders” (California Depart-ment of Developmental Services, 2002). These guidelines were developed under the direction of theCalifornia State Legislature, who passed a bill in 2001 acknowledging the need for the use of diagnos-tic tools and methods to ensure consistent and accurate diagnosis of ASD throughout California. It isnot clear how these guidelines have been adopted across the state at this point. For example, whilespecialty clinics, regional centers, and some school districts may have “resident ASD experts” who fitthe recommendations regarding training and experience outlined in the Best Practice Guidelines, it isnot known what proportion of children identified as eligible for school and state funded services arediagnosed by those with the recommended expertise. Data regarding the methods and accuracy ofdiagnostic and functional assessment for children with ASD being served by school and public agen-cies are lacking. Due to the limited availability of standardized tools, diagnostic interviews and obser-vations are typically unstructured, and the format can vary according to theoretical orientation andtraining of the psychologist. The use of standardized diagnostic instruments among professionals andthe relative advantages of these instruments are not known.

A number of standardized autism diagnostic instruments that rely on parent or teacher report areavailable, including the Gilliam Autism Rating Scale (GARS; Gilliam, 1995). These measures areappealing because they require limited training and time to administer. However, recent studies havereported that the GARS may miss as many as 58% of children with Autistic Disorder (Lecavalier,2005; South et al., 2002). The Childhood Autism Rating Scale (CARS; Schopler, Reichler, & RochenRenner, 1988) is a diagnostic measure that involves an experienced professional rating the child’sbehavior after direct observation. Scoring this measure requires some training. However, the CARS isbased on DSM-III-R criteria and tends to miss children diagnosed with PDD-NOS and over-identifychildren with mental retardation (Perry, Condillac, Freeman, Dunn-Geier, & Belair, 2005; Pilowsky,Yirmiya, Shulman, & Dover, 1998).

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The Autism Diagnostic Observation Schedule (ADOS) is one of the few standardized diagnosticmeasures that involves scoring direct observations of the child’s interactions and that accounts for thedevelopmental level and age of the child. The ADOS is recommended in several Best Practice Guide-lines as an appropriate standardized diagnostic observation tool (California Department of Develop-mental Services, 2002; Filipek et al., 1999; Filipek et al., 2000; National Research Council, 2001). Itincludes a standardized administration of interactive activities introduced by the examiner, designed toelicit social interactions, communication and repetitive behaviors for the purpose of diagnosing anASD (Lord et al., 2000; Lord, Rutter, DiLavore, & Risi, 2001). The measure takes 30 to 60 minutes toadminister and consists of four different modules for use with individuals of different developmentaland language levels. Activities vary based on the language level and chronological age of the child. Forexample, Modules 1 and 2, which are designed for use with children with a language level of less than48 months, include playing with bubbles, the release of an inflated balloon, and a pretend birthdayparty. Modules 3 and 4, which are designed for older children, adolescents, and adults who have theability to use complex sentences and talk about things that are not immediately present, include ques-tions about emotions and relationships as well as retelling a story from a book and demonstrating aroutine activity. For each task, a hierarchy of “presses” or social structures is provided. During the firstadministration of a task a child is able to take as much initiative as possible; if this does not occur, theexaminer gradually makes the tasks more specific and increasingly structures the situation to observethe child’s response (Lord & Risi, 2000; Lord, Rutter, DiLavore, & Risi, 2001) The ADOS is standard-ized in terms of the materials used, the activities presented, the examiner’s introduction of activities,the hierarchical sequence of social presses provided by the examiner, and the way behaviors are codedor scored. Following the administration of the ADOS, behaviors are coded using a “0” to “3” pointcoding system, with a “0” indicating that the behavior is not abnormal in the way specified in thecoding description and a “3” indicating that a behavior is abnormal and interferes in some way with thechild’s functioning.

ADOS classifications are based on specific coded behaviors that are included in a scoring algo-rithm using the DSM-IV diagnostic criteria, resulting in a Communication score, a Reciprocal SocialInteraction score, and a Total score (a sum of the Communication and Reciprocal Social Interactionsscores). Scores are compared with an algorithm cut-off score for Autism or the more broadly definedASD in each of these areas. If the child’s score meets or exceeds cut-offs in all three areas, they areconsidered to meet criteria for that classification on the measure. The authors reported good inter-raterreliability estimates on the Communication, Reciprocal Social Interaction, Total, and Stereotyped Be-haviors and Restricted Interests domains, with intraclass correlations ranging from .82 to .93 (Lord,Rutter, DiLavore, & Risi, 2001). Test-retest reliability was also good, with intraclass correlations rang-ing from .73 to .82 on the Communication and Reciprocal Social Interaction domains, and .59 to .86 onthe Stereotyped Behaviors and Restricted Interests domain. Published validity studies also suggestgood predictive validity, with sensitivities ranging from 90% to 97%, and specificities ranging from87% to 94% for autism/ASD versus other clinical diagnoses (Lord, Rutter, DiLavore, & Risi, 2001).

The ADOS has been widely used in research and academic centers for approximately 15 years toclassify children with an ASD diagnosis for research studies and to assist in making clinical diagnoses.A five-day training workshop has been developed to train those using the ADOS in research studies toadminister the ADOS and establish reliability in scoring, defined as 80% agreement or better on theprotocol and algorithm. Supporting information from a developmental history, additional observa-tional information or a detailed parent interview are needed for a comprehensive diagnosis (Lord et al.,2000; Lord et al., 2001). The approach used in the majority of research studies of ASD includesadministration of the ADOS and the Autism Diagnostic Interview-Revised (ADI-R) by a trained pro-

ADOS in School and Community Settings

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fessional, with the clinician using a best estimate approach to diagnosis. The ADI-R is a semi-struc-tured interview that is conducted with the parents or primary caregiver and is designed to elicit the fullrange of information needed to verify a diagnosis of autistic disorder or an ASD diagnosis (Lord,Rutter, & Le Couteur, 1994; Rutter, Le Couteur, & Lord, 2003). Diagnostic decisions are based onalgorithm items. Both the ADI-R and the ADOS operationally define current DSM-IV criteria, andquantify separately the three domains that define ASD: social reciprocity, communication, and re-stricted, repetitive behaviors and interests. This can be very helpful in increasing parents’ understand-ing of their children’s disabilities and setting goals.

Since the ADOS became commercially available through Western Psychological Services (WPS)in 2001, it has become more familiar to practitioners and purchased widely for use within school andcommunity settings. The authors of the ADOS indicate that it should be used by experienced clinicianswho have received appropriate training (Lord et al., 2001). In an effort to meet these criteria, WPSoffers a two-day workshop, which includes live demonstration of two ADOS administrations, a dem-onstration videotape, and discussion of coding and administration issues. For individuals who areunable to attend the workshop or want additional training in ADOS administration and coding, WPSalso sells a guidebook and training videotapes developed for professionals working in clinical settings.

While interest in the ADOS has increased, little is known about the use of the ADOS in commu-nity and school settings, practitioners’ opinions about the ADOS, and how they follow the trainingguidelines outlined by the test developers. These issues were examined in the present survey study.Two comparisons were of primary interest: 1) differences in ASD diagnostic practices and ADOS useamong school and clinical psychologists who use the ADOS, and 2) differences in ASD diagnosticpractices among school psychologists who do and do not use the ADOS.

METHOD

Participants

The participants were 44 clinical psychologists who reported that they use the ADOS and 88school psychologists (44 ADOS users, 44 ADOS non-users). The majority of the respondents werefemale (77.3%) and white (87%). A Chi Square analysis revealed there were significantly more doc-toral degrees among the clinical psychologists (100%) than the school psychologists (29.5%), x2 (1, N= 132) = 58.46, p < .001. The majority of the respondents were from California (52%). Manyrespondents did not provide contact information (32%). Twenty-one other states were represented,with the most surveys received from Texas (4%), Illinois (4%), Georgia (3%), Indiana (3%), and NorthCarolina (3%).

Pilot Survey

In collaboration with Bobbie Kohrt (former President of the California Association of SchoolPsychologists (CASP)), a brief pilot survey was posted to the CASP members’ website in October2003. Results obtained at the end of November 2003 were presented in the January 2004 CASP TodayNewsletter. The results of the CASP survey were used to develop additional questions to include abroader array of topics and to allow for more specific responses beyond the yes/no format.

Survey Development and Description

The survey was initially administered in the form of a telephone interview. Based on the partici-pants’ responses, a small number of questions were modified to allow for more specific responses. Thefinal written survey consisted of over 50 questions printed on 15 pages. Some suggestions from Dillman’s

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Total Design Method of mail and telephone surveying (Bernard, 2002) were utilized in an effort toimprove the response rate. For example, the surveys were professionally printed on light green paper,a cover letter was included, and the recommended formatting techniques were used. It was estimatedthat the survey would take approximately 30 to 45 minutes to complete. A subset of the questions hadrestricted responses while a number of more open-ended questions were included to allow for furtherqualitative analyses. Six restricted questions pertained to the respondent’s current position and train-ing. In another section, a list of over 20 tools and standardized tests were provided and respondentswere asked to indicate how often they administer these instruments (never, sometimes, most of thetime, or always). In the analyses, “most of the time” and “always” were collapsed into one categoryand “sometimes” and “never” were collapsed into a second category. A series of 20 questions regard-ing training and experience, current work placement, and the diagnostic process were included withspace provided for written responses.

Respondents were also asked if they used the ADOS and if they had received training on theADOS. Those who responded yes were asked to complete an additional set of 16 questions, all ofwhich required a written response. These questions focused on the nature and quality of training re-ceived, specific questions regarding opinions about the ADOS, and how the ADOS is used in therespondent’s placement. An identical section and list of questions were included regarding the use ofthe ADI-R.

Recruitment Procedures

Initial surveys were completed in the form of a telephone interview with 6 clinical psychologistsand 11 school psychologists, recruited through local contacts. The majority of the written surveys wereobtained through a mass mailing in collaboration with WPS (N =84). Survey packets were mailedusing a confidential list of individuals who had purchased the ADOS or ADI-R from WPS or who hadattended an ADOS training workshop sponsored by WPS. A cover letter indicated that individualsinterested in completing the survey should submit a signed consent form along with the completedsurvey in the stamped self-addressed envelope. Those individuals who agreed to further contact wereasked to complete a contact information sheet. Respondents were informed that their responses wouldbe kept confidential. The surveys were mailed out in August 2005. Responses received through De-cember 2005 were included in the present study. In addition, 10 participants were attendees at localprofessional presentations on autism who were asked to volunteer to complete the survey, and 21school psychologists volunteered to complete the survey prior to participating in a two-day ADOSworkshop conducted by the first author. Of the 44 school psychologists who reported that they did notuse the ADOS, 21 were from this group, 6 were recruited in response to the WPS mailing, 8 weretelephone interviews, and 9 volunteered to complete the survey after attending local professional pre-sentations on autism.

RESULTS

Assessment Practices Among School and Clinical Psychologists Who Use the ADOS

In considering the components included in an ASD assessment “always” or “most of the time”, 2x 2 Chi Square analyses revealed there were no significant differences between clinical (N = 44) andschool psychologists (N = 44) in the inclusion of a parent interview, χ2(1, N = 88) = 1.01, p = .32, adevelopmental history, χ2(1, N = 88) = 1.01, p = .32, or review of records, χ2(1, N = 82) = 1.95, p = .16(see Figure 1). However, school psychologists were significantly more likely than clinical psycholo-gists to indicate that they include a teacher questionnaire, χ2(1, N = 87) = 5.44, p = .02, interview with


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the teacher, χ2(1, N = 88) = 13.41, p < .001, or school or home observation, χ2(1, N = 88) = 45.52, p <.001 (see Figure 1).

Figure 1.Percentage of Survey Respondents in Each Group Rating Each Assessment Component as “Most ofthe Time” or “Always” Used

The majority of participants in both groups of ADOS users reported that they use standardizeddiagnostic measures in their assessment always or most of the time (clinical = 96%; school = 93%). AChi Square analysis revealed no group differences (χ2(1, N = 88) = .35, p = .56). There were nodifferences between the groups in their use of the most frequently administered diagnostic measures:the ADOS, χ2(1, N = 88) =.10, p = .75, the CARS, χ2(1, N = 88) =1.14, p = .29, or the GARS, χ2(1, N= 88) = 2.44, p = .12 (see Figure 2).

Figure 2.Percentage of Survey Respondents in Each Group Rating Each Diagnostic Measure as “Most ofthe Time” or “Always” Used

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In terms of experience, a t-test revealed that there was not a significant difference between theschool (M = 10.56, SD = 7.55) and clinical psychologists (M = 11.23, SD = 7.81) in years worked in asetting where ASD assessments were conducted, t (86) = .41, p = .68. The number of initial evaluationsconducted per year was compared between clinical and school psychologists. Two clinical psycholo-gists reported completing more than 500 ASD assessments per year and were considered to be signifi-cant outliers, and therefore dropped from this analysis. Clinical psychologists reported conductingsignificantly more evaluations per year (M = 64.0, SD = 74.83) than school psychologists (M = 27.8,SD = 42.9), t (84) = 2.77, p < .007, Cohen’s d = .59). The percentage of clinical psychologists whocompleted 30 or more initial ASD assessments per year (50%) was higher than the school psycholo-gists (only 15.9%).

Assessment Practices Among School Psychologists

The assessment practices of the 44 school psychologists who are ADOS users and the 44 schoolpsychologists who are not ADOS users were compared. Among the ADOS users, 63.6% consideredthemselves ASD specialists while only 11.4% of the ADOS non-users considered themselves ASDspecialists. A t-test revealed there was not a significant difference in terms of years worked in a settingwhere ASD assessments were conducted between the ADOS users (M =10.56, SD = 7.55) and theADOS non-users (M = 9.53, SD = 8.69), t (86) = .59, p = .55. There was not a significant differencebetween these two groups in terms of how many initial ASD evaluations were conducted per year(ADOS users: M = 27.80, SD = 42.9; ADOS non-users: M = 17.28, SD = 29.40; t (86) = 1.34, p = .18),with 88% of each group conducting 36 or fewer initial evaluations per year.

When considering components included in an ASD assessment, 100% of the ADOS users andADOS non-users reported that they include a parent interview and a developmental history. Bothgroups were as likely to include an interview with the teacher (χ2(1, N = 87) = 1.04, p = .31) or a schoolor home observation (χ2(1, N= 85) = 2.2, p < .14). ADOS users were significantly more likely thanADOS non-users to include a review of records (χ2(1, N = 79) = 4.32, p = .04; see Figure 1).

The majority of both groups indicated that they included standardized measures in their assess-ment most of the time or always (ADOS users = 95%; ADOS non-users = 88%) and there were nodifferences between the groups (χ2(1, N = 87) = 1.47, p = .23). There were no significant differencesbetween the groups in their use of the most frequently administered diagnostic measures: CARS, χ2(1,N = 86) = 1.85, p = .17, or the GARS, χ2(1, N = 84) =1.17, p = .28. ADOS users were significantlymore likely than ADOS non-users to use the ADI-R, χ2(1, N = 72) = 8.16, p = .004. Very few respon-dents reported using the PDD-ST, but this was significantly more common among ADOS non-usersthan ADOS users, χ2(1, N = 76) = 6.61, p = .01.

Training Among ADOS Users

Of the 88 clinical and school psychologists who indicated that they used the ADOS, the majorityhad attended a clinical training (clinical psychologists = 81.4%; school psychologists = 81.8%) orwatched training videotapes (clinical psychologists= 88.6%; school psychologists = 90.9%). Only16% of the sample reported that they had only watched the WPS training videotapes and only 2%reported that they had not attended a workshop or watched training videotapes. Very few of the respon-dents had attended research training (clinical psychologists = 22.7%; school psychologists = 6.8%).Only 7 of the 13 respondents who indicated that they had attended research training indicated that theyhad met the research reliability criteria on the ADOS. Almost all of the 13 respondents who attended aresearch training worked in a setting that also conducted research (N=8), or trained students (N=4),

ADOS is School and Community Settings

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Perceived Advantages and Disadvantages of the ADOS

The 88 survey respondents who use the ADOS were asked to answer questions about the advan-tages and disadvantages of the ADOS. Within this group, 92% (N = 81) listed one (N = 40) or morethan one (N = 41) advantage of using the ADOS. This resulted in a total of 131 advantages that weregrouped into 7 categories: resources, scoring/reliability, diagnostic discrimination, test materials/items/organization, capturing behaviors of ASD, administration, and other benefits. Chi-square analyses (ps> .05) indicated that there were no significant differences between the number of school and clinicalpsychologists indicating advantages in any category, with the exception of diagnostic discrimination,χ2(1, N = 88) = 3.94, p = .05. For this reason the groups were collapsed.

The most common responses fell in the categories of capturing behaviors of ASD and administra-tion. Of the 46 respondents (57%) listing advantages associated with capturing behaviors of ASD,33% indicated that it captured ASD behaviors generally, 29% specifically indicated that it capturedsocial and communication behaviors, and 20% indicated that it was a good measure for capturingbehaviors that are difficult to observe or probe for in other situations. Examples of respondents’ re-sponses to this question included: “It gets at the reciprocal social communication data and the ability tounderstand social nuances better than any test I’ve used before”, “Shows strengths and weakness ofthe child’s social interactions, pragmatic, and communication skills”, and “Captures social behavior”.Others indicated that the ADOS elicits behaviors that might not otherwise be observed. For example:“The ADOS does a nice job of pulling out characteristics of ASD that you wouldn’t necessarily see ina routine battery of tests”, “The ADOS provides specific presses in several ways to elicit specificbehaviors that I may not otherwise remember to probe”. Of the 45 respondents (56%) that listed anadvantage in the administration category, 60% specifically listed the standardization or the structurethe measure provides, 20% listed the presses designed to elicit ASD behaviors, 16% listed the directobservation of the child, and 8% listed that the children enjoyed the ADOS. Responses to this questionincluded: “Gives specific probes/presses to elicit responses which are often delayed/impaired in chil-dren with autism”, “It provides stimuli/presses which tend to bring out some of those behaviors asso-ciated with ASD that may not be obvious (or observed) under the more structured circumstances of acognitive or educational assessment”.

Among ADOS users, 80% (N = 70) listed one (N = 43) or more (N=27) disadvantages of using theADOS, resulting in a total of 100 disadvantages that were grouped into 6 categories: resources, scor-ing/reliability, diagnostic discrimination, test materials/items/organization, scope of evaluation, andadministration. As with advantages, Chi Square analyses did not indicate any significant differencesbetween the number of school and clinical psychologists indicating disadvantages in any category (ps>.05). For this reason the groups were collapsed.

The most common responses fell into the diagnostic discrimination (41%) and resources (37%)categories. Within the diagnostic discrimination category, the majority of respondents (59%) indicatedthat the ADOS tends to over classify other diagnostic groups as ASD. The second most commonlycited disadvantage was that the evaluator tends to rely on the tool for a diagnosis (28%). Approxi-mately 10% of this group were concerned that the measure does not discriminate well within ASDsubgroups. Of those that indicated resources as a disadvantage, almost all (96%) indicated time ofadministration as a disadvantage. Interestingly, 58% of this group indicated that they spend more than13 hours on an evaluation. Some participants also indicated that expense (19%) was a disadvantage.

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DISCUSSION

Among these select groups of clinical and school psychologists, ASD assessment practices werequite similar. The majority of the psychologists reported that they typically include a parent interviewand a developmental history in their assessment. The most commonly endorsed standardized diagnos-tic measures were also similar for both groups. School psychologists were more likely to report thatthey include teacher input and a school or home observation, probably due to greater accessibility toteachers and students within the school setting. It is also possible that clinical psychologists may bemore likely to evaluate very young children who are not yet in a school setting. For those children whoare in a school setting, it is important to obtain information from the teacher, particularly if a schoolvisit is not practical or not covered by insurance companies. Clinical psychologists reported that theyevaluate more children with ASD for an initial evaluation per year than school psychologists. Thismay reflect relative differences in assessment practices across professions, or a bias in the surveyrespondents who indicated they are ADOS users.

The assessment practices were also fairly similar between the two groups of school psychologists,regardless of whether or not they are ADOS users. There was a tendency for those who used the ADOSto be more likely to review records, otherwise there were no differences in the components included inan assessment. The school psychologists who reported using the ADOS were more likely to considerthemselves ASD experts, but they did not necessarily complete more initial ASD assessments per yearthan the ADOS non-users. It is therefore unclear what criteria the participants used in response to thisquestion. Additional information is needed to determine if school districts utilize any specific criteriawhen selecting school psychologists to attend ADOS training and begin using the ADOS routinely fordiagnostic evaluations. The nature of the ADOS requires routine use to remain efficient in administra-tion and coding and therefore those practitioners who have limited opportunities to assess childrenwith ASD may not necessarily be the best candidates to learn the ADOS and be identified as an ASDexpert.

It is possible that the results of this study are not necessarily representative of school and clinicalpsychologists who conduct diagnostic evaluations for ASD. The majority of participants were re-cruited from the WPS mailing list, which represents those individuals who had purchased ADOS orADI-R materials and/or had attended an ADOS clinical workshop. These individuals also volunteeredto complete a rather lengthy written survey, which may indicate greater than expected experience withASD, enthusiasm for the ADOS, or confidence in diagnostic expertise. A small portion (12%) of thedata was obtained in the form of a telephone interview rather than a written survey. Although theresponses obtained over the telephone did not appear qualitatively different from those obtained in thesurvey format, the results from this study may have been slightly different if all participants had agreedto a telephone interview and the data had been obtained in that format. Additional research with abroader sample of school and clinical psychologists is needed to gain an understanding of diagnosticpractices in school and community settings. Independent validation of practice is also needed, in theform of record review and diagnostic confirmation of cases. For example, a recent examination ofdiagnostic records from 115 children diagnosed with ASD through the Metropolitan DevelopmentalDisabilities Surveillance Program of the CDC found that professionals assigning an initial ASD diag-nosis used a standardized diagnostic tool in only 30% of evaluations (Wiggins, Baio, & Rice, 2006).This stands in stark contrast to the practices reported in the present study.

The majority of ADOS users attended a clinical training on the measure. Very few respondentsfrom either group attended the research training. The majority of respondents who had attended the


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research training were most likely involved in training and research as well as clinical work becausethey indicated that they worked in a setting that was actively involved in research and/or training ofgraduate students and post-doctoral fellows. At this point, little is known about the accuracy of admin-istration and coding of those who have only attended a clinical training, which is currently the trainingrecommendation for those using the measure clinically. This is an important issue, particularly giventhat the ADOS is commercially available but the two-day clinical workshop training is limited inavailability and most practitioners and administrators assume attendance of a two-day clinical work-shop will be adequate preparation for implementation of the ADOS. We are currently examining thismore directly in a series of ADOS training studies in school and community settings.

The ADOS is one of the few standardized measures administered to a child by a trained profes-sional that allows for direct observation of behaviors characteristic of an ASD. Of those who use theADOS as part of their assessments, many consider the administration and the ability to capture behav-iors of ASD to be advantages of the measure. The most commonly reported disadvantages of themeasure was the tendency to over classify children who have other clinical disorders, the cost of thetest kit, and the time it takes to administer the measure. As with any clinical assessment, the pros andcons and priorities must be considered when making a decision about which measures to include.Certainly, if time and money are issues, it is less expensive and takes less time to have parents com-plete a rating scale or questionnaire. Most test kits are fairly expensive but offer the advantage ofproviding the clinician with a way of directly assessing development and behavior. In contrast, ques-tionnaires do not typically allow the clinician to directly observe and rate the child’s behavior, a fre-quently reported advantage of the ADOS. In addition, many questionnaires have resulted in low sensi-tivity or a tendency to miss children who have a clinical diagnosis of ASD. While diagnostic classifi-cation is also a concern for the ADOS, it is important to remember that this is a limitation of anystandardized diagnostic measure. Any measure will result in missing some children with an ASD andincluding some children who do not have an ASD. Ultimately, the clinician makes a diagnosis, incor-porating all relevant information from the assessment, including, but not limited to scores on a stan-dardized measure. The goal is to choose a standardized measure that minimizes classification errorsand is practical to use, given the training and time necessary to use it properly.

As expected, those who used the ADOS were also more likely to use the ADI–R, although use ofthe ADI-R was fairly rare and use of the ADI-R outside of research settings appears to be very limited.Additional research is needed to develop a parent interview or parent report measure that provides thereliability and validity of the ADI-R with a shorter administration time and training requirements.

Additional studies are needed to examine how best to assess the issue of “expertise” among clini-cians who evaluate children for a possible ASD diagnosis, particularly because adequate experienceand training are important components of the Best Practice Guidelines (California Department ofDevelopmental Services, 2002) and for proper administration of the ADOS (Lord, Rutter, DiLavore,& Risi, 2001). It is important for school districts to provide training for all school psychologists on theBest Practice Guidelines for screening, diagnosis and assessment of ASD. School districts may alsoconsider implementing common protocols for the assessment of ASD. Although there are no datacurrently available on the advantages of “resident ASD experts” within school districts, our experienceindicates this can be helpful for proper identification as well as program planning for a variety ofstudents with ASD. It is also our experience that there is better coordination of services and improvedparental satisfaction when school districts have close connections with ASD experts and service pro-viders in the community. It is important for clinical and school psychologists to provide parents with

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information about the potential differences between the DSM-IV categories of ASD and the “autism”educational disability category. More research is needed on how practitioners interpret the variousdiagnostic criteria and the impact of different practices and level of expertise on classification andservice utilization.

REFERENCES

Akshoomoff, N. A., & Stahmer, A. (2006). Early intervention programs and policies for children with autisticspectrum disorders. In H. E. Fitzgerald, B. M. Lester & B. Zuckerman (Eds.), The Crisis in Youth MentalHealth: Critical Issues and Effective Programs (Vol. 1: Childhood Disorders, pp. 109-131). Westport, CT:Praeger.

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th Ed, TextRevision. Washington, DC: American Psychiatric Association.

Bernard, H. R. (2002). Research methods in anthropology (Third ed.). Walnut Creek, CA: Alta Mira Press.California Department of Developmental Services. (2002). Autistic Spectrum Disorders: Best Practice Guidelines

for Screening, Diagnosis and Assessment. Sacramento.Charman, T., & Baird, G. (2002). Practitioner review: Diagnosis of autism spectrum disorder in 2- and 3-year-old

children. Journal of Child Psychology & Psychiatry, 43(3), 289-305.Conderman, G., & Katsiyannis, A. (1996). State practices in serving individuals with autism. Focus on Autism &

Other Developmental Disabilities, 11, 29-36.Croen, L. A., Grether, J. K., Hoogstrate, J., & Selvin, S. (2002). The changing prevalence of autism in California.

Journal of Autism and Developmental Disorders, 32(3), 207-215.Filipek, P. A., Accardo, P. J., Ashwal, S., Baranek, G. T., Cook, E. H., Jr., Dawson, G., et al. (2000). Practice

parameter: screening and diagnosis of autism: report of the Quality Standards Subcommittee of the AmericanAcademy of Neurology and the Child Neurology Society. Neurology, 55(4), 468-479.

Filipek, P. A., Accardo, P. J., Baranek, G. T., Cook, E. H., Jr., Dawson, G., Gordon, B., et al. (1999). The screeningand diagnosis of autistic spectrum disorders. Journal of Autism and Developmental Disorders, 29(6), 439-484.

Fombonne, E. (2003). The prevalence of autism. Journal of the American Medical Association, 289(1), 87-89.Gilliam, J. E. (1995). Gilliam Autism Rating Scales. Austin, TX: PRO-ED.Lecavalier, L. (2005). An evaluation of the Gilliam Autism Rating Scale. Journal of Autism and Developmental

Disorders, 35, 795-805.Lord, C. (1995). Follow-up of two-year-olds referred for possible autism. Journal of Child Psychology and

Psychiatry, 36(8), 1365-1382.Lord, C., & Bailey, A. (2002). Autism Spectrum Disorders. In M. Rutter & E. Taylor (Eds.), Child and Adolescent

Psychiatry: Modern Approaches, Fourth Edition. (pp. 636-663). Oxford: Blackwell Publications.Lord, C., & Risi, S. (2000). Diagnosis of autism spectrum disorders in young children. In A. Wetherby & B.

Prizant (Eds.), Autism spectrum disorders: A transactional developmental perspective (pp. 167-190). Baltimore:Paul H. Brookes Publishing Co.

Lord, C., Risi, S., Lambrecht, L., Cook Jr., E. H., Leventhal, B. L., DiLavore, P. C., et al. (2000). The AutismDiagnostic Observation Schedule—Generic: A standard measure of social and communication deficits associatedwith the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205-223.

Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2001). Autism Diagnostic Observation Schedule. Los Angeles:Western Psychological Services.

Mandell, D. S., & Palmer, R. (2005). Differences among states in the identification of autistic spectrum disorders.Archives of Pediatric and Adolescent Medicine, 159, 266-269.

National Research Council. (2001). Educating children with autism. Washington, DC: National Academy Press.Newschaffer, C. J., Falb, M. D., & Gurney, J. G. (2005). National autism prevalence trends from United States

special education data. Pediatrics, 115, e277-e282.Palmer, R. F., Blanchard, S., Jean, C. R., & Mandell, D. S. (2005). School district resources and identification of

children with autistic disorder. American Journal of Public Health, 95(1), 125-130.Perry, A., Condillac, R., Freeman, N., Dunn-Geier, J., & Belair, J. (2005). Multi-site study of the Childhood

Autism Rating Scale (CARS) in five clinical groups of young children. Journal of Autism and DevelopmentalDisorders, 35, 625-634.

Pilowsky, T., Yirmiya, N., Shulman, C., & Dover, R. (1998). The Autism Diagnostic Interview-Revised and theChildhood Autism Rating Scale: differences between diagnostic systems and comparison between genders.Journal of Autism and Developmental Disorders, 28, 143-151.


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Rutter, M., Le Couteur, A., & Lord, C. (2003). ADI-R. Autism Diagnostic Interview-Revised. WPS Edition. LosAngeles: Western Psychological Services.

Schopler, E., Reichler, R. J., & Rochen Renner, B. (1988). The Childhood Autism Rating Scale: WesternPsychological Services.

Shattuck, P. T. (2006). The contribution of diagnostic substitution to the growing administrative prevalence ofautism in US special education. Pediatrics, 117, 1028-1037.

Shriver, M. D., Allen, K. D., & Matthews, J. R. (1999). Effective assessment of the shared and unique characteristicsof children with autism. School Psychology Review, 28(4), 538-558.

South, M., Williams, B. J., McMahon, W. M., Owley, T., Filipek, P. A., Shernoff, E., et al. (2002). Utility of theGilliam Autism Rating Scale in research and clinical populations. Journal of Autism and DevelopmentalDisorders, 32(6), 593-599.

Wiggins, L.D., Baio, J., & Rice, C. (2006). Examination of the time between first evaluation and first autismspectrum diagnosis in a population-based sample. Journal of Developmental and Behavioral Pediatrics, 27,79-87.

Yeargin-Allsopp, M., Rice, C., Karapurkar, T., Doernberg, N., Boyle, C., & Murphy, C. (2003). Prevalence ofautism in a US metropolitan area. Journal of the American Medical Association, 289, 49-55.

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Author Note

Supported by NIMH K23MH071796. We thank Barbara Deggelman and Melissa Connolly for assistance

with data coding, and Drs. Larry Palinkas, Catherine Lord, Amy Esler, and John Landsverk for their support of

this project. Dr. Christopher Gruber assisted in survey distribution through Western Psychological Services. Bobbie

Kohrt shared the CASP survey results.


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Medication Treatment Outcomes for School-AgedChildren Diagnosed with Autism

John S. Carlson, Tara Brinkman, and Amy Majewicz-HefleyMichigan State University

Recent studies on the prevalence of autism indicate that approximately 1 in 200 children meetdiagnostic criteria, significantly greater than rates reported just a decade ago (Blanchard, Gurka,& Blackman, 2006). Concurrently, biomedical treatments including psychotropic medication havebeen used with increased frequency to treat children diagnosed with autism spectrum disorders(Aman, Lam, & Van Bourgondien, 2005). Medication treatments are often sought as an adjunct tosocial, behavioral, and educational interventions in an attempt to improve children’s academic,social, behavioral, and emotional functioning. Anticipated and unanticipated effects of medica-tions commonly used to treat behaviors associated with autism are reviewed. Knowledge aboutthe types and evidence-based support for different medication treatments used within this popu-lation of children is essential to integrating medical, educational, and psychosocial treatmentswithin the school context. Finally, a simple and efficient means by which school psychologistsmay contribute to the evaluation of treatment services to those with autism is provided.


Address correspondence to John S. Carlson, PhD; NCSP Associate Professor of School Psychology; Director ofClinical Training; Licensed Psychologist; Michigan State University; 431 Erickson Hall; East Lansing, MI 48823.Email: [email protected].

A dramatic rise in the prevalence rates of autism and the increased provision of special educationservices to students served under this diagnostic category in schools has significant implications forschool psychologists’ assessment and treatment practices (Blanchard, Gurka, & Blackman, 2006; Brock,Jimerson, & Hansen, 2006). With current estimates ranging from 6.7 cases per 1000 children in NewJersey (Bertrand et al., 2001), 3.4 cases per 1000 children in Atlanta (Yeargin-Allsopp et al., 2003),and 5 cases per 1000 children based on a national sample, rates of autism spectrum disorders appear tohave increased since the 1980s and 1990s when estimates indicated 1 case per 1000 children. Irrespec-tive of concerns about how these studies have defined “autistic disorder criteria,” current rates indi-cate that schools and communities have an increased need to provide early intervention and treatmentservices to children exhibiting social, communication, and behavioral challenges. Recognizing andutilizing approaches with demonstrated empirical support is an important first step to developing thetype of comprehensive treatment plan that is essential when working to alleviate these difficulties(Williams, Johnson, & Sukhodolsky, 2005).

One treatment that is being utilized with an increasing number of children is psychopharmaco-logical interventions. Survey responses from parents in Ohio and North Carolina indicate that be-tween 45% and 55% of children diagnosed with autism have been treated with one or more psychop-harmacological agents (Aman, Lam, et al., 2005; Langworthy-Lam, Aman, & VanBourgondien, 2002;Witwer & Lecavalier, 2005). When considering the use of any biomedical treatment, these ratesappear to be even higher (up to 65%) indicating that a wide variety of medical treatments are beingsought. The overall rate of medication use within autistic populations appears to be slowly increasing(Martin, Scahill, Klin, & Volkmar, 1999), and the specific medications being used have shifted to agreater reliance on antidepressant, antipsychotic, and stimulant medications (Aman, Lam, et al., 2005).A survey study from an Autism Society chapter in North Carolina indicated that antidepressants (21%),antipsychotics (17%), and stimulants (13.9%) were the most commonly prescribed medications(Langworthy-Lam, Aman, & Van Bourgondien, 2002). Specifically, risperidone, fluoxetine, meth-ylphenidate, clonidine, and carbamazepine were the five most reported medications utilized.

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No medications currently hold approval by the Food and Drug Administration for the treatment ofautism, and educational and behavioral supports are most commonly recommended as the most appro-priate first-line treatment for childhood autism (Simpson, 2004; Towbin, 2003; Volkmar, Cook, Pomeroy,Realmuto, & Tanguay, 1999). In contrast to medication efficacy for schizophrenia, attention-deficit/hyperactivity disorder, and depression, some researchers have hypothesized that the basis of autismmay not lie in neurotransmitter dysfunction (Rutter, 2005). Others suggest that autism features such asrepetitive and compulsive behaviors point to serotonin dysregulation and point to the use of multiplemedications that target the neurotransmitter, serotonin (Martin et al., 1999). Despite this etiologicaluncertainty, it is common to see a variety of medication treatment practices being used for the primarypurpose of symptom reduction (e.g., self-injury, stereotypies, aggression, anxiety, depression, behav-ioral rigidity, cognitive inflexibility) or in an attempt to help facilitate skill promotion (e.g., socialinteraction, nonverbal/verbal communication, attention to task) via psychosocial treatment approaches.

The predominant focus of this article is on the role and use of medications within the treatment ofschool-aged children diagnosed with autism. When combined with an increased focus on a response-to-intervention approach to school psychological service delivery (i.e., accountability and evidencedbased practices), knowledge of biomedical treatments for autism and the means to assess how theunique needs of an individual child may be impacted by a particular treatment selected by his/herparents are essential. Readers are encouraged to review recent literature appearing within the field thatlooks more exclusively at the current evidence-base psychosocial/ecological interventions (Williamset al., 2005) for managing disruptive behaviors, promoting learning, and facilitating social integrationcommonly associated with autism. In addition, a comprehensive review of emerging research onautism spectrum disorders can be found at www.nimh.nih.gov (National Institute of Mental Health,2004).

Behavioral Outcomes and Side Effects of Psychopharmacological Treatment

Some of the most frequently targeted symptoms of pharmacological treatments for autism includeinattention, hyperactivity, aggression, anxiety, irritability, obsessions/repetitive behavior, disruptivebehavior, affective instability, and social withdrawal (des Portes, Hagerman, & Hendren, 2003; Handen,Johnson, & Lubetsky, 2000; Martin et al., 1999). Psychostimulants, antidepressants, and atypicalantipsychotics are among the most common medications utilized to address these behaviors and re-spectively address inattention/hyperactivity/impulsivity, repetitive behaviors/anxiety, and highly irri-table behavior such as tantrums, aggression, and self-injury (Aman, Lam, & Van Bourgondien, 2005).A review of recent studies examining behavioral outcomes associated with pharmacological interven-tions for children with autism and other pervasive developmental disorders (PDDs) is presented inTable 1 and provides a comprehensive link between medications and symptom reduction or improve-ment in children treated for autism.

Despite the frequency of their use, a dearth of well-controlled studies exists examining the effi-cacy and safety of these medications. One exception is the methodologically-strong research that hasbeen done on risperidone, an atypical antipsychotic. Converging evidence from a series of studiesmay ultimately lead to the future approval of this antipsychotic for the treatment of behavioral distur-bance (e.g., irritability, aggression, tantrums) in autism (King & Bostic, 2006). The impact of risperidoneon adaptive behavior has also been suggested within a recently published study of a subset of partici-pants from the McCracken et al. study (Williams et al., 2006). Additional evidence exists that demon-strates fluoxetine, a Selective Serotonin Reuptake Inhibitor (SSRI) antidepressant, to be effective intreating repetitive behavior in children with autism (Posey, Erickson, Stigler, & McDougle, 2006).

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Specifically, one research group is reporting nearly a 70% response rate to fluoxetine treatment withinyoung children diagnosed with autism (DeLong, Ritch, & Burch, 2002). Yet, a similarly acting drug,fluvoxamine, has resulted in minimal benefit and substantial cost in terms of side effects within pedi-atric populations (McDougle, Kresch, & Posey, 2000). Large-scale, controlled trials of fluoxetine andcitalopram are currently under development and likely will shed further light on the role of SSRIs inthe treatment of autism (King & Bostic, 2006). Moreover, studies using a combined psychosocial andpharmacological treatment approach are also under way. Numerous other medications in addition tothose reviewed have been used to treat children with autism (see Handen & Lubetsky, 2005) and futuregrowth and investigation of “new” and combined pharmacological treatments for autism are likely toincrease significantly in the next ten years (Wilens, 2004).

One of the major drawbacks of pharmacological treatments to consider is the possibility of devel-oping side effects and the long-term impact of medication on a developing brain and body. While theseare concerns for all individuals taking psychotropic medications, there appear to be an increased levelof risk for children with autism. In regards to psychostimulants, children and adolescents with autismmay be at greater risk for developing side effects (i.e., social withdrawal, dullness, sadness, irritability)associated with psychostimulants than typically developing children with Attention-Deficit/Hyperac-tivity Disorder (ADHD) (Handen, Johnson, & Lubetsky, 2000). Individuals with autism experience ahigh rate of seizure disorders (Kerbeshian, Burd, & Avery, 2001). Because of this, the tricyclic antide-pressants (TCAs) pose a concern since they have been associated with decreased seizure threshold(Handen & Lubetsky, 2005). Issues with the SSRIs have also been raised concerning the tolerabilityand appropriate dosing of these medications for children with autism (Posey et al., 2006). In addition,issues related to behavioral activation and suicidal ideation are at the forefront of public skepticismabout the merits of these drugs (FDA Public Health Advisory, 2004). A serious concern with the antip-sychotic medications is the possibility of developing extrapyramidal (i.e., involuntary body move-ments) side effects (Campbell, Rapoport, & Simpson, 1999). Extrapyramidal side effects that canoccur include pseudo-parkinsonism (i.e., tremors, shakiness), akathisia (i.e., uncontrollable motor rest-lessness) and acute dystonic reactions (i.e., marked arching of the back or eye rolling) (Handen &Lubetsky, 2005). Further difficulties arise because the extrapyramidal side effects that individualsusing this drug may experience may mimic motor symptoms that are associated with autism such asrestlessness, rigidity, and posturing (Kerbeshian et al., 2001). These concerns have been limited withinrisperidone studies, yet issues associated with sleep problems, weight gain, heart rate, and blood pres-sure have been raised and are important to consider within treatment cost-benefit analysis (Aman,Arnold, et al., 2005; King & Bostic, 2006; Troost et al., 2005).

Polypharmacy and Autism

Polypharmacy refers to the concurrent use of two or more medications for the treatment of psychi-atric or medical conditions (Duffy et al., 2005). Children with autism typically present with severalassociated behavioral symptoms in addition to the core features of the disorder. These children mayalso have one or more co-morbid psychiatric and medical diagnoses which may necessitate the needfor multiple medications in order to effectively treat distinct disorders and symptoms. While the prac-tice of polypharmacy appears to be relatively common among children with autism (Aman, Lam, &Van Bourgondien, 2005), empirical evidence regarding the effects of polypharmacy in this populationis virtually nonexistent (des Portes et al., 2003). A study conducted by Martin et al. (1999) found thatnearly 30% of 109 subjects with high functioning pervasive developmental disorders were taking 2 ormore psychotropic medications simultaneously. The most common combination was an SSRI with an

Medication Treatment Outcomes

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atypical neuroleptic. Stigler et al. (2004) reported that in 18% of the stimulant trials they reviewed,subjects received one or more concomitant psychotropic medications. Potential benefits of polyphar-macy include increasing the likelihood of response to treatment, treatment of adverse medication sideeffects, and utilizing lower doses of two agents to reduce adverse side effects associated with a higherdose of one psychotropic agent (Wilens, Spencer, Biederman, Wozniak, & Connor, 1995). Risks asso-ciated with polypharmacy include deleterious drug interactions and lack of medication compliancedue to complicated treatment regimens (Duffy et al., 2005). The ability to establish a link between anobserved behavioral outcome and the effect of a single medication is a challenging task within thecontext polypharmacy.

Alternative Biomedical Treatments for Autism

A gap between the lack of scientific support for the pharmacological treatment of autism and theactual practices that appear within communities widens further when you take into consideration theuse of other biomedical treatments commonly found within popular internet resources such as theDefeat Autism Now (DAN; www.autismwebsite.com/ari) Treatment Guidelines for Autism (i.e., vita-min therapy, chelation treatment, digestive enzymes, casein/gluten-free diets, probiotics, antifungals,thyroid hormones, amino acids, mega-B6 with Magnesium, antibiotics). The rate of autism supple-ment use has been estimated to be as high as 10-17% in recent studies (Aman, Lam, & Van Bourgondien,2005; Witwer & Lecavalier, 2005), while others estimate their use at less than 10% (Langworthy-Lamet al., 2001). The most commonly used supplements (usually in megadose) reported were vitamin B6,dimethylglycine, Super Nu-Thera, and dimethylaminoethanol (DMAE). Secretin, composed of aminoacids and reportedly used by 3% of children (Witwer & Lecavalier), is one of the only biomedicaltreatments, outside of the traditional pychotropics, to have been studied under multi-site, randomized,and placebo-controlled conditions. The intended effects of this treatment on social and communica-tion deficits within children with autism (N=56) was found to be minimal and limited work is nowbeing done to develop this treatment for use within childhood autism populations (Owley et al., 2001).Finally, with respect to other alternative treatments, an estimated 15% of children are on modifieddiets which can be very expensive and time-consuming and little data exists beyond anecdotal reportto support their use (Witwer & Lecavalier, 2005). This research also is limited due to methodologicalconcerns and small sample sizes (Nye & Brice, 2005).

Alternative treatment approaches for autism will continue to be sought out by parents until aspecific intervention approach demonstrates significant benefits across this population, which clearlyoutweighs the potential costs (e.g., side effects, availability, resources needed, training) associatedwith each. This becomes especially challenging in the context of some current etiological explana-tions for this condition (e.g., immunization-related) given the focus on curing this disorder rather thantreating the core symptoms. Uncertainty within the treatment literature combined with the frequent useof alternative approaches provides support for the collaborative involvement of children’s mental healthproviders (e.g., school psychologists) within physician/parent treatment decision-making. In addition,the unique biological sensitivities of this population of children, more variable response rates to medi-cation treatment, and a greater frequency of emergent side effects result in the need to closely monitorthe behavioral response of those children being treated pharmacologically (Handen & Lubetsky, 2005).

CONCLUSIONS AND IMPLICATIONS

No medications are currently FDA-approved for treating autism and other treatment approaches(i.e., behavioral and educational) are considered first line treatments. However, many children withautism are prescribed medications in an attempt to improve academic, behavioral, and social function-

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ing. In addition, many parents are providing supplements and vitamins as a part of an adjunctivetreatment program (Aman, Lam, & Van Bourgondin, 2005; Witwer & Lecavalier, 2005). The com-plexity of the individual symptom picture of children diagnosed with autism results in the need for aclose examination and prioritization of treatment target behaviors. School psychologists are in theunique position of having the training and knowledge necessary to consult with teachers, parents, andphysicians to establish treatment goals and to monitor treatment progress (DuPaul & Carlson, 2005). Ithas been recommended that the priority of every multimodal treatment plan for children with autismshould be on communication and social enhancement (Towbin, 2003). Thus, a comprehensive treat-ment plan involving pharmacological, behavioral, and educational approaches may be typical for chil-dren with autism (Simpson, 2004). To effectively monitor the impact of these treatments, specificgoals should be established and linked to the various treatment modalities that are initiated. This isespecially essential when multiple medications are prescribed.

Utilizing narrow-band assessment measures that are efficient and cost-effective (e.g., GAS rat-ings) combined with a problem solving approach to service delivery are important skills to bring to acollaborative approach to treating autism. The spectrum nature of this condition and the resultingvarying levels of dysfunction that may be experienced, presents school psychologists with a need to beknowledgeable about a wide array of potentially effective biopsychosocial treatment approaches. Schoolpsychologists report receiving minimal training in child psychopharmacology and indicate a desire fora greater level of training in this area (Carlson, Demaray, & Hunter-Oehmke, 2006). The same mightalso be said for evidenced-based interventions training in general (Shernoff, Kratochwill, & Stoiber,2003). An absence of this knowledge base limits the role that school psychologists may play in evalu-ating medication outcomes and presents a set of ethical challenges to providing services to those whomay benefit from such an approach (Carlson, Thaler, & Hirsch, 2005).

Pharmacological treatments demonstrate promise in treating specific symptoms commonly asso-ciated with autism including aggression, anxiety, agitation, cognitive inflexibility, overactivity, self-injury, and stereotypic behavior (Handen & Lubetsky, 2005). This same level of evidenced-basedsupport has not been found within alternative treatment approaches for autism [e.g., secretin (i.e., ahormone that helps to control digestion); Handen & Hofkosh, 2005; Owley et al., 2001)], yet schoolpsychologists need to understand both why parents seek out these treatments and what each is hypoth-esized to address. The availability of biomedical treatments for autism is likely to increase in the yearsto come especially in light of the growing prevalence of this condition within the school-aged popula-tion. Training in child psychopharmacology within the larger context of evidenced-based interven-tions is essential to school psychologists’ ability to monitor the unique response that children have toparent-determined treatment plans.

IMPLICATIONS FOR SCHOOL PSYCHOLOGISTS

School psychologists are highly skilled to engage in consultation and assessment. These compe-tencies can be used to identify the appropriate behavioral targets for any biopsychosocial treatment(DuPaul & Carlson, 2005). Simple questions including: “What does your child need to be success-ful?” or “What concerns you most about your child’s behavior” or “How can we at school help you tobetter understand if your child’s current educational programming is effective” are often all it takes towork toward operationalizing behaviors that will ultimately serve as a catalyst to monitor a child’streatment/educational progress. More elaborate approaches via best practices in functional assess-ment (identifying antecedents and consequences), behavioral intervention plans (managing anteced-ents and rethinking consequences), conjoint behavioral consultation (the process by which one canengage consultees in working toward behavior change) and progress monitoring (a response to inter-


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vention approach) may also be sought and utilized when working with children with autism spectrumdisorders.

Using behavioral rating scales [e.g., Behavioral Assessment System for Children- Monitor (BASC-Monitor), Kamphaus & Reynolds, 1998] at the beginning of the year with all children receiving ser-vices under the autism special education category is one efficient and effective means to prepare andbe ready to engage in monitoring treatment progress within the classroom and at home. Such anapproach can also then be used repeatedly across time (i.e., monthly). Specifically, the BASC ParentMonitor ratings allows for an easy way to learn about a child’s treatment history including the use ofany biomedical treatments, as it specifically asks questions about past treatment. It also provides someconcrete ways to uncover recent behavioral improvements and to keep teachers and parents focused onwhich specific behaviors are of greatest concern within the home or school setting. This initial datacollection effort via rating scales can then be followed up using the core structure of the ProblemIdentification Interview, used to validate a problem that a parent or teacher has raised regarding a childwithin a behavioral consultation approach (Bergan & Kratochwill, 1990). When working with parentswho are not proactive in seeking outside treatment services or those who may be misinformed aboutthe efficacy of certain treatments, the importance of working to educate parents of the nature of vari-ous intervention approaches including their empirical support is essential to treatment consultation.Communication with physicians or other treatment providers is also an essential role to play whenfocusing school psychological service delivery on a set of comprehensive interventions that work(Williams et al., 2005).

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Malone, R. P., Cater, J., Sheikh, R. M., Choudhury, M. S., & Delaney, M. A. (2001). Olanzapine versus haloperidolin children with autistic disorder: An open pilot study. Journal of the American Academy of Child and AdolescentPsychiatry, 40, 887-894.

Malone, R. P., Maislin, G., Choudhury, M. S., Gifford, C., & Delaney, M. A. (2002). Risperidone treatment inchildren and adolescents with autism: Short- and long-term safety and effectiveness. Journal of the AmericanAcademy of Child and Adolescent Psychiatry, 41, 140-147.

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Martin, A., Scahill, L., Klin, A., & Volkmar, F. (1999). Higher-functioning pervasive developmental disorders:Rates and patterns of psychotropic drug use. Journal of the American Academy of Child and AdolescentPsychiatry, 38, 923-931.

McCracken, J. T., McGough, J., Shah, B., Cronin, P., Hong, D., Aman, M. G., et al. (2002). Risperidone inchildren with autism and serious behavioral problems. The New England Journal of Medicine, 347, 314-321.

McDougle, C. J., Kem, D. L., & Posey, D. J. (2002). Case series: Use of ziprasidone for m a l a d a p t i v esymptoms in youths with autism. Journal of the American Academy of Child and Adolescent Psychiatry, 41,921-927.

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McDougle, C. J., Scahill, L., Aman, M. G., McCracken, J. T., Tierney, E., Davies, M., et al. (2005). Risperidonefor the core symptom domains of autism: Results from the study by the autism network of the research unitson pediatric psychopharmacology. American Journal of Psychiatry, 162, 1142-1148.

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An Examination of the Changing Ratesof Autism in Special Education

Stephen E. BrockCalifornia State University Sacramento

Using U.S. Department of Education data, the current study examined changes in the rates ofspecial education eligibility classifications. This was done to determine if classification substitu-tion might be an explanation for increases in the number of students being found eligible forspecial education using the Autism criteria. Results reveal that as the rates of Autism have goneup, the rates of mental retardation (MR), emotional disturbance (ED), and specific learning dis-ability (SLD) have gone down. From these data it was concluded that it is possible that the in-creased numbers of students found eligible for special education using Autism criteria, is at leastin part a function of IEP teams being increasingly more willing and able to use autism criteriainstead of MR, ED, and SLD criteria.

Recently there has been study of the increased rate of autism spectrum disorders (ASD). Forexample, Fombonne (2003a) reviewed ASD prevalence studies and noted that several of the mostrecent studies (published since 2000) generated prevalence rates converging at approximately 60 per10,000 (up from 10 per 10,000). Given these data, it has been suggested that the number of childrenidentified with ASD has significantly increased. Similar trends have been reported in the number ofstudents served within special education programs. For example, in a recent electronic survey of schoolpsychologist Kohrt (2004) reported that 95% of respondents indicated an increase in the number ofstudents with ASD on their caseloads.

Although students with ASD have always been found in the special education population, it wasnot until 1991 that the U.S. Department of Education added “Autism” as a specific special educationeligibility category. Prior to 1991, students with ASD, who required special education assistance, wereidentified as eligible by meeting other eligibility category criteria (e.g., mental retardation, speech/language impairment). Since its inclusion as an eligibility category, the number of children classifiedfor special education purposes as students with Autism has steadily increased. While in 1991 therewere only 2,896 students in this category, by 2004 there were 165,552 school-aged students (6 to 21years of age) falling within this Individuals with Disabilities Education Act (IDEA) eligibility cat-egory. The vast majority of these students (96,799) fall in the 6- to 11-year-old age group (U.S. Depart-ment of Education, 2005). The changes in the prevalence of students classified as eligible for specialeducation in the Autism category is illustrated in Figure 1.

The purpose of the current study is to investigate the changing rates of Autism special educationeligibility in comparison to other eligibility categories. It is hypothesized that because Autism is arelatively new category, the increasing rates of students classified as falling within this category is due,at least in part, to classification substitution. In other words, students with ASD who prior to 1991would have been classified as eligible for special education in another category are today classified inthe Autism category. Support for this hypothesis would be found in data indicating increases in Autismeligibility being associated with decreases in other eligibility category rates.

Address correspondence to Stephen E. Brock; Department of Special Education, Rehabilitation and School Psy-chology; College of Education; California State University Sacramento; 6000 J Street; Sacramento, CA 95819-6079. E-mail: [email protected].


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Figure 1.Changes in the Rate of Students Eligible for Special Education in the Autism Category

METHOD

Population

The data presented in this study reflects the population of children enrolled in special educationduring the years 1991 to 2004 who reside in the 50 states, the District of Columbia, and who attendBureau of Indian Affairs schools. These data include the period of time during which ASD has had itsown separate special education eligibility category (i.e., “Autism”).

This study analyzed data for students within the 6- to 11-year-old age group. The rationale forfocusing on this age group is that it included more students who would have been initially foundeligible for special education during the time period being considered (1991 to 2004). It was judgedthat older students, already found eligible for special education before there was an Autism category,would be less likely to have their eligibility category changed upon re-evaluation. In other words, theeffect of any possible classification substitution was judged to be most likely observed among thestudents who had become initially eligible for special education when ASD had its own specific eligi-bility category. Since 1996, all students within this age group would have been evaluated by IEP teamswho had Autism as an eligibility category option.

Measurement

Data were obtained from the IDEAdata.org web site (www.ideadata.org/index.html). This website provides public access to data collected annually by the U.S. Department of Education’s Office ofSpecial Education Programs for its Annual Reports to Congress. This report provides data tables ad-dressing students with disabilities served under IDEA. The specific data used in this study was found

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in Table B2A (www.ideadata.org/docs/PartBTrendData/B1.xls), which provided the number, percentof population, and IDEA disability distribution, by disability and age group.

Procedures

First, Table B2A from the IDEAdata.org web site was downloaded in Excel spreadsheet form.Then to adjust for population size changes, the number of students in each eligibility category wastransformed to a rate per 1,000 students. This was accomplished by dividing the total number of stu-dents in the given eligibility category for a given year, by the total “resident population” (i.e., thenumber of enrolled students as reported in the IDEAdata.org data) for the given year, and then multi-plying the result by 1,000 [i.e., (number of students with a disability ÷ student population) x 1,000)].

Next, from the author’s applied school psychology experiences, reviews of diagnostic and eligi-bility categories, and consultations with colleagues1 the following IDEA eligibility categories wereselected as having some likelihood of being substituted in place of the Autism category: EmotionalDisturbance (ED), Mental Retardation (MR), Specific Learning Disability (SLD), and Speech/Lan-guage Impaired (SLI). Then obtained school population rates for Autism and the selected eligibilitycategories (from one year to the next) were compared; Pearson correlation coefficients were obtainedand year to year changes in rates computed (by subtracting a current year’s rate from that of theprevious year).

RESULTS

As indicated in Table 1, over the 14-year time frame covered by these data, there have beenchanges in the rates of students found eligible for special education. Overall, when all eligibility cat-egories are combined, it is observed that since 1991 the rate of students found eligible has increased by7.65 per 1,000 students. The two specific eligibility categories with the largest increases during thistime period have been the Other Health Impaired (OHI, +7.59) and Autism (+3.91) categories. Con-versely, the categories with the largest declines have been ED (-0.69), MR (-2.25) and SLD (-4.89).When the four categories judged by the author as having some likelihood of being substituted in placeof the Autism category (ED, MR, SLD, and SLI) are combined the rate change is -7.14. The correlationbetween changes in Autism rates and the rate of these four categories is significant (r = -.929, p < .01).This result indicates that as Autism rates have increased, the rates for these four categories combinedhave declined.

Figures 2, 3, 4, and 5, provide year-by-year comparisons (from 1991 to 2004) of changes in therates of Autism to changes in the rates of specific eligibility categories judged to have some likelihoodof being substituted for Autism. As illustrated in Figure 2, with the exception of the years 1993, 1994,and 1995 (11 out of the 14 years), every year since 1991 has seen an increase in Autism rates and acorresponding decrease in MR rates. The correlation between Autism rates and MR rates is significant(r = -.928, p < .01). This result indicates that as Autism rates have increased, MR rates have declined.

As illustrated in Figure 3, with the exception of the years 1991, 1992, 1994, and 1995 (10 out ofthe 14 years), every year since 1991 has seen an increase in Autism rates and a corresponding decreasein SLD. The correlation between Autism rates and SLD rates is significant (r = -.885, p < .01). Thisresult indicates that as Autism rates have increased, SLD rates have declined.

As illustrated in Figure 4, with the exception of the years 1993, 1994, 1995, 1996, 1998, and 1999(8 out of the 14 years), every year since 1991 has seen an increase in Autism rates and a correspondingdecrease in ED. The correlation between Autism rates and the ED rates is significant (r = -.740, p <.01). This result indicates that as Autism rates have increased, ED rates have declined.

Changing Rates of Autism

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Table 1.Changes in Special Education Classification Rates and Percentages (1991 to 2004; for ChildrenAges 6 to 11)

Finally, as illustrated in Figure 5, with the exception of the years 1993, 2002, 2003, and 2004 (11out of the 14 years), every year since 1991 has seen an increase in Autism rates and a correspondingdecrease in SLI. However, the correlation between Autism rates and SLI rates is not significant (r = -.086). Further, the use of a nonparametric sign test suggest the odds of SLI rate declines in 11 of 14years being due to chance (while low) fall short of statistical significance (p = .092). This result wouldnot appear to support the hypothesis that as Autism rates have increased SLI rates have declined.

DISCUSSION

Since 1991, the two eligibility categories to have had substantially increased numbers are the OHIand Autism categories. Comprehensive explanations of the increased rate of OHI are beyond the scopeof this paper. However, it is of note that these increases took place subsequent to the Office of SpecialEducation and Rehabilitative Services’ Joint Policy Memorandum (Davila, Williams, & MacDonald,1991) on ADD, which specified that the OHI category was an option to consider when determining ifa student with an attention deficit was eligible for special education. As for ASD, these data are consis-tent with reports that the number of children being identified as persons with autism is increasing(Tidmarsh & Volkmar, 2003). However, further analysis of special education classification rates yieldsdata consistent with the classification substitution hypothesis. Specifically, during the period follow-ing ASD having its own special education eligibility classification ED, MR, and SLD rates have de-clined. As was previously stated, ED, MR., SLD, and SLI were the categories that the author specu-lated as being the ones within which students with ASD (who required special education) would have

Category 1991 Rate 2004 Rate Rate Change

All eligibilities categories combined 106.65 114.30 +7.65

Other Health Impairments 1.32 8.91 +7.59

Autism 0.13 4.04 +3.91

Speech/Language Impairments (SLI) 40.10 40.79 +0.69

Traumatic Brain Injury 0.00 0.33 +0.33

Orthopedic Impairments 1.25 1.31 +0.06

Deaf-Blindness 0.03 0.03 0.00

Hearing Impairments 1.34 1.33 -0.01

Visual Impairments 0.52 0.48 -0.04

Multiple Disabilities 2.26 2.14 -0.12

Emotional Disturbance (ED) 6.43 5.74 -0.69

Mental Retardation (MR) 9.71 7.46 -2.25

Specific Learning Disabilities (SLD) 43.56 38.67 -4.89

MR+SLD+ED+SLI 99.80 92.66 -7.14

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Figure 2.Annual Changes in Autism and Mental Retardation IDEA Special Education Eligibility CategoryRates (Children Ages 6-11, 50 States, D.C., BIA Schools): 1991 to 2004

Figure 3.Annual Changes in Autism and Specific Learning Disability IDEA Special Education EligibilityCategory Rates (Children Ages 6-11, 50 States, D.C., BIA Schools): 1991 to 2004


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Figure 4.Annual Changes in Autism and Emotional Disturbance IDEA Special Education EligibilityCategory Rates (Children Ages 6-11, 50 States, D.C., BIA Schools): 1991 to 2004

Figure 5.Annual Changes in Autism and Speech/Language Impaired IDEA Special Education EligibilityCategory Rates (Children Ages 6-11, 50 States, D.C., BIA Schools): 1991 to 2004

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previously been classified. Thus, it is suggested that these eligibility trends are consistent with thehypothesis that the increased incidence of students classified using Autism criteria, is at least in part anartifact of IEP teams substituting the Autism category for the ED, MR, or SLD categories.

Additional inspection of Figures 2, 4, and 5, during the first two years that ASD had its owneligibility category, reveals relatively large jumps in Autism rates (relative to that seen in subsequentyears), corresponding to relatively large declines in MR, ED, and SLI rates (relative to that seen insubsequent years). The author speculates that this may be a consequence of children with classic au-tism, previously placed in other eligibility categories (due to the fact that Autism was not a classifica-tion option), being moved into the new Autism category. Further analysis of Figure 3 finds the greatestyear-to-year declines in SLD rates to have occurred in the most recent years, which corresponds to themost dramatic increases in the rates of Autism. The author speculates that this may reflect that IEPteams have become increasingly sensitive to the broader autism spectrum (and skilled at identifyingsuch), and thus may have begun to place students with high functioning autism and Asperger’s Disor-der in the Autism category (instead of the SLD category). Research by Powell and colleagues (2000)may support this speculation. These researchers studied the changing incidence rates of both classicalchildhood autism (most similar to what is now referred to as Autistic Disorder) and other autismspectrum disorders between 1991 and 1996. Results suggested rates for classical autism increased by18% per year, whereas rates for other autism spectrum disorders increased by 55% per year. Theauthors concluded that clinicians are becoming increasingly willing and able to diagnose the broaderautism spectrum among young children.

Reasons for Classification Substitution

These eligibility trends suggest the possibility that the increased number of students found eli-gible for special education using Autism criteria is, at least in part, a consequence of classificationsubstitution. Potential causes of this phenomenon have been suggested by Brock, Jimerson, and Hansen(2006) to include: (a) an increased public awareness of ASD, (b) an increased willingness and abilityto classify students as children with ASD, and (c) awareness of increased resources for children withASD.

Heightened public awareness of ASD. One explanation for the increasing number of studentsclassified using Autism criteria, is that there is a heightened public awareness (and related mediacoverage) of ASD. Consequently, today’s educators are more likely to recognize and refer childrenwith ASD (Barbaresi, Katusic, Colligan, Weaver, & Jacobsen, 2005; Chakrabarti & Fombonne, 2001;Gernsbacher, Dawson, & Goldsmith, 2005; Yeargin-Allsopp et al., 2003). For example, Gillberg andWing (1999), have suggested that the prevalence of ASD has always been higher than earlier studieshad reported.

Increased willingness and ability to diagnose ASD. A second explanation for classification substi-tution might be found in the author’s observation that the diagnosis of ASD is more acceptable intoday’s schools. The author’s experiences suggest that today’s IEP teams view ASD as having thepotential for relatively positive outcomes (especially in comparison to MR). Another explanation forincreased Autism classification rates is that today’s educational professionals (such as school psy-chologists) are better prepared to identify these disorders (American Academy of Pediatrics, 2001;Chakrabarti & Fombonne, 2001; Gernsbacher et al., 2005; National Research Council, 2001; Yeargin-Allsopp et al., 2003). Thus, it may be that IEP teams are simply doing a better job of identifyingchildren with ASD (Fombonne, 2003, September).


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Availability of resources for children with ASD. A third explanation for classification substitutionis the increased availability of resources for children with ASD. The intensive early intervention ser-vices often made available to students classified for special education using Autism criteria are nottypically offered to the child whose primary eligibility classification is MR, SLD, or ED. In otherwords, educators and parents alike may be increasingly motivated to identify students as eligible forIDEA services using Autism criteria (Brock et al., 2006). In addition, the mandate for early interven-tion services for children with developmental disabilities (such as ASD), combined with the fact thatchildren with ASD respond well to early and intensive intervention (National Research Council, 2001),has likely served to further increase motivation to use Autism eligibility criteria (Barbaresi et al.,2005;Yeargin-Allsopp, 2003).

Limitations

Although associations between Autism and other special education classification category rateshave been identified, these data cannot be considered definitive proof that ASD rates in the generalpopulation are not increasing. While suggestive of such, these special education classification data areinfluenced by a number of factors; thus, the possibility that yet to be identified environmental factorsmay be playing a role in the increased prevalence of ASD cannot be ruled out (Fombonne, 2003b;2003; 2003, September). Supporting this hypothesis is the Report to the Legislature (2002). This re-search project investigated reports of a 273 % increase in reported cases of autism in California from1987 to 1998. To study this increase, a statewide sample of children from two birth-year cohorts (1983-1985 and 1993-1995) were identified and data collected from the families of 375 children with adiagnosis of autism and 309 children with a diagnosis of mental retardation without autism. Fromthese data the authors concluded that there was no evidence that the increased numbers of childrenidentified as persons with autism could be attributed completely to artificial factors (i.e., loosening ofdiagnostic criteria for autism, more misclassification of autism, or increased migration of childrenwith autism to California). Without evidence of an artificial increase in autism cases, it was concludedthat “some, if not all, of the observed increase represents a true increase in cases of autism in Califor-nia” (p. 42). Interestingly, however, analysis of the same data by Croen, Grether, Hoogstrate, andSelvin (2002) suggested that “diagnostic substitution” of autism for mental retardation explains theincrease in autism rates. Their interpretation of the data suggested that to a significant extent the in-crease in autism rates might be explained by a decrease in the use of the diagnosis of mental retarda-tion.

CONCLUSION

These data can be used by school psychologist to generate one possible answer to questions askedof them, by parents and IEP teams, regarding the apparent increase in the number of students withASD. While it is possible that yet to be identified environmental factors have resulted in a true increasein this population, it is also possible that artificial factors, such as classification substitution, explainthis increase.

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REFERENCES

American Academy of Pediatrics. (2001). Counseling families who choose complementary and alternative medicinefor their child with chronic illness and disability. Pediatrics, 107, 598-601.

Barbaresi, W. J., Katusic, S. K., Colligan, R. C., Weaver, A. L., & Jacobsen, S. J. (2005). Incidence of autism inOlmsted County, Minnesota, 1976-1997: Results from a population-based study. Archives of Pediatrics &Adolescent Medicine, 159, 37-44.

Brock, S. E., Jimerson, S. R., & Hansen, R. L. (2006). Identifying, assessing, and treating autism at school. NewYork: Springer.

Chakrabarti, S., & Fombonne, E. (2001). Pervasive developmental disorders in preschool children. JAMA, 285,3093-3099.

Croen, L. A., Grether, J. K., Hoogstrate, J., & Selvin, S. (2002). The changing prevalence of autism in California.Journal of Autism and Developmental Disorders, 32, 207-215.

Davila, R. R., Williams, M. L., & MacDonald, J. T. (1991, September 16). Joint policy memorandum (ADD).Washington, DC: Office of Special Education and Rehabilitative Services. Retrieved May 18, 2006, fromhttp://www.wrightslaw.com/law/code_regs/OSEP_Memorandum_ADD_1991.html

Fombonne, E. (2003a). Epidemiology of pervasive developmental disorders. Trends in Evidence-BasedNeuropsychiatry, 5, 29-36.

Fombonne, E. (2003b). The prevalence of autism. JAMA, 289, 87-89.Fombonne, E. (2003, September). Modern views of autism. The Canadian Journal of Psychiatry, 48, 503-505.Gernsbacher, M. A., Dawson, M., & Goldsmith, H. H. (2005). Three reason not to believe in an autism epidemic.

Current Directions in Psychological Science, 14, 55-58.Gillberg, C., & Wing, L. (1999). Autism: Not an extremely rare disorder. Acta Psychiatrica Scandinavica, 99,

399-406.Kohrt, B. (2004, Winter). School psychologists respond to ASD survey. CASP Today, 53(1), 4.National Research Council, Committee on Educational Interventions for Children with Autism. (2001). Educating

children with autism. Washington, DC: National Academy Press.Powell, J. E., Edwards, A., Edwards, M., Pandit, B. S., Sungum-Paliwal, S. R., & Whitehouse, W. (2000). Changes

in incidence of childhood autism and other autistic spectrum disorders from two areas of the West Midlands,UK. Developmental Medicine & Child Neurology, 42, 624-628.

Report to the legislature on the principle findings from the epidemiology of Autism in California (2002, October17). A comprehensive pilot study. Davis, CA: University of California, Davis, M.I.N.D. Institute.

Tidmarsh, L., & Volkmar, F. R. (2003). Diagnosis and empidemiology of autism spectrum disorders. CanadianJournal of Psychiatry, 48, 517-525.

U.S. Department of Education, Office of Special Education Programs. (2005). Annual report tables [Data file].Available from IDEAdata.org Web site, retrieved May 17, 2006, http://www.ideadata.org/AnnualTables.asp

Yeargin-Allsopp, M., Rice, C., Karapukar, T., Doernberg, N., Boyle, C., & Murphy, C. (2003). Prevalence ofautism in a US metropolitan area. JAMA, 289, 49-55.


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Author Note The author wishes to thank Cathi Christo and Dorothy Marshall, both from California State University Sac-ramento, and Michael Slone, Irvine Unified School District; Irvine, CA, for their guidance regarding eligibilitycategories likely to be substituted for autism.

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The California School Psychologist, Vol. 11, pp 41-56, 2006Copyright 2006 California Association of School Psychologists

Bridging the Transition to Kindergarten:School Readiness Case Studies from

California’s First 5 Initiative

Michael P. BatesUniversity of California, Santa Barbara

Alyce Mastrianni, Carole MintzerOrange County Children and Families Commission, Irvine, California

William NicholasFirst 5 LA, Los Angeles, California

Michael J. Furlong, Jenne Simental, Jennifer Greif GreenUniversity of California, Santa Barbara

Recent advances in science have underscored how critical children’s first five years of life are totheir later success in school and life. It has also been recently recognized that early childhoodinterventions, particularly those that combine child-focused educational activities with parent-child relationship building, can positively influence children’s readiness for school, particularlyfor those at-risk for poor developmental outcomes. Though early childhood services have tradi-tionally received fewer resources than those for school-aged children or adults, many states havetried to address this inequity by sponsoring early childhood initiatives aimed at providing com-prehensive health and social services to children ages 0 to 5 and their families. The current articlepresents an overview of one such initiative—California’s First 5—and provides three SouthernCalifornia case studies of how it is being implemented at the county level. Implications for policymakers, school psychologists, and other educational stakeholders are discussed.

Importance of Early Childhood Development

It has long been widely accepted that children’s early development and experiences—prenatallythrough age 5—contribute greatly to their chances to succeed in elementary school and in later life. Ithas only been in recent years, however, that the scientific, professional, political, and public communi-ties have come together to make early childhood development a fundamental priority. In their compre-hensive review of the literature—Neurons to Neighborhoods—the National Research Council andInstitute of Medicine (NRCIM, 2000) summarized the critical importance of early childhood develop-ment with some of the following conclusions:

1. From birth to age of five is the period of the most rapid growth in children’s linguistic, cogni-tive, emotional, social, regulatory, and moral abilities, and it is during this time that the foundation forfuture development is laid.

2. While development in the early years is extremely robust, it is also quite vulnerable and canbe seriously compromised by emotional trauma, such as loss and early personal rejection; and environ-mental threats, such as poor nutrition, specific infections, environmental toxins, drug exposure, andchronic stress due to abuse or neglect.

Address correspondence to Michael P. Bates; Center for School-Based Youth Development; Gevirtz GraduateSchool of Education; University of California, Santa Barbara, CA, 93106. Email: [email protected].

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3. Wide differences in children’s abilities, noticeable well before kindergarten, are associatedwith multiple risk factors, as well as disparities in social and economic circumstances, and are predic-tive of later academic performance.

4. Children’s relationships to their parents and other caregivers, including those outside thehome, play a critical role in strengthening nearly every aspect of their development by providingstable, nurturing, and secure attachments upon which exploration, learning, and self-regulation arebased.Given these conclusions, the importance of childhood development to early school success cannot beunderestimated.

The NRCIM report (2000) also found that early childhood interventions, particularly those thatcombine child-focused educational activities with parent-child relationship building, positively affectchildren’s developmental trajectories. For example, numerous studies have shown that well-designed,child-focused early interventions lead to immediate improvements in standardized test scores, particu-larly on measures of intelligence (NRCIM, 2000). In addition, children who attend high-quality pre-school programs or early child care centers are more cognitively advanced (by at least two months)than similar children who did not attend programs, a trend that seems particularly strong for childrenfrom disadvantaged families (Bridges, Fuller, Rumberger, & Tran, 2004). Family-focused interventionprograms directed at parent and caregiver education have also been shown to have strong, positiveinfluences on child growth and school readiness (Zigler, Finn-Stevenson, & Hall, 2002). Early inter-vention not only has a positive impact on school readiness, but also promotes long-term improvementsin reading and math, decreases the likelihood that students will be retained in grade school, and in-creases the chances that children will attend a four-year college and maintain a skilled (non-entrylevel) job as an adult (Ramey & Ramey, 2004).

The recent surge in research on early physical and social-emotional development, as well as theeffectiveness of child- and family-focused early interventions, has demonstrated the importance thatearly childhood and family support services have in facilitating the optimal development of youngchildren—particularly those who may be at-risk for poorer developmental trajectories. Yet, tradition-ally, early childhood services have been undervalued by society and have received relatively fewerresources than services for school-aged children and adults (NRCIM, 2000). Increasingly, however,parent advocacy groups, practitioners and policy makers have recognized and supported the criticalimportance of the first years of life. Over the past decade, early care and education (ECE) providersand other early health and social providers have developed systems of assessment and diagnosis (e.g.,National Education Goals Panel [NEGP], 1998; Zero to Three, 1994), created standards of quality care(e.g., Casamassimo & Holt, 2004; National Association for the Education of Young Children, 1997),and advocated for funding and policy improvements (e.g., Hayes, 2004; National Governor’s Associa-tion Center for Best Practices, 2001; NRCIM, 2000; Parent Advocacy Center for Educational Rights,2004). Several states have responded by implementing early childhood initiatives aimed at providingcomprehensive health and social services to children ages 0 to 5 and their families, including SmartStart in North Carolina and First 5 in California.

The California Children and Families Act

First 5 was created by the California Children and Families Act (“the Act”), when Proposition 10was passed by California voters in November 1998 and implemented beginning January 1999. Thefour primary goals of the Act are to promote: (a) improved child health: healthy children; (b) improvedchild development: children learning and ready for school; (c) improved family functioning: strong

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families; and (d) improved systems for families: integrated, accessible, inclusive, and culturally appro-priate services. Funding for the Act, generated from a 50-cent excise tax increase on tobacco products,provides approximately $600 to 700 million annually, 20% of which is distributed to the state, and80% of which is distributed proportionately to each of California’s 58 counties based on live birth rate.The California Children and Families Commission—recently rebranded to First 5 California—handlesstate-level administration of the Act and allocates funds to statewide initiatives in mandated propor-tions in the following areas: mass media communications (30%), parent and provider education (25%),child care (15%), research (15%), administration (5%), and unallocated (10%).

At the county level, funds are overseen by local Children and Families Commissions, many ofwhich recently adopted the First 5 moniker as well, consisting of 5 to 9 members (plus alternates). TheCommissions are comprised of at least 1 County Supervisor, 2 directors of public departments servingchildren and families (e.g., Mental Health, Juvenile Justice, Public Health, Social Services, or Drug/Alcohol Services), and remaining members representing the fields listed above and/or (a) early careand education (ECE) educators, (b) ECE planning council/resource and referral, (c) families-at-riskcoordinating/planning groups, (d) community-based organizations focusing on early childhood devel-opment, (e) local school districts, and (f) health boards/medical associations. County Commissionshave the choice of operating as an independent body or under the structure of county services. One ofthe primary conditions of the Act is that funds are to be used to create new services and enhanceexisting services, but cannot be used to supplant existing funding sources.

To receive funding, each county Commission must create and periodically update a strategic planoutlining their goals and objectives, funding priorities, and implementation strategies as to how theywill achieve the desired results of the Act. The Act also specifies that each county Commission must(a) establish advisory committees to provide professional, technical, and community input; and (b)evaluate the outcomes of their work using a results-based accountability framework. Most countyCommissions have opted to distribute funds to local service providers (including public, private, andnon-profit organizations) through a competitive bidding process, whereas a few have augmented thispractice by becoming direct service providers themselves. The types of services counties have funded/provided comprise a wide array of strategies, including newborn home visiting, health and dentalscreening and treatment, family literacy and parenting education programs, family resource centers,ECE quality and capacity enhancements, and a variety of family support programs such as case man-agement and counseling interventions. Many of these strategies have been built upon the infrastructureof existing programs, such as Head Start, Healthy Start, family resource centers, ECE Resource andReferral, and Public Heath programs; but in many cases, First 5 has funded the planning and develop-ment of entirely new programs. In fact, for school psychologists in California working with at-riskyoung children, there is a good chance that they or their families have been touched by First 5 in someway over the past six years.

The First 5 Approach to School Readiness

First 5 has worked for several years at the state level in partnership with the California Depart-ment of Education to develop an early childhood component of the Master Plan for Education. Theyestablished a collaborative School Readiness Working Group, which developed a consensus definitionof school readiness that consisted of five essential and coordinated elements: (a) early care and educa-tion; (b) parenting education and family support services; (c) health and social services; (d) schools’readiness for children/school capacity; and (e) program infrastructure, administration, and evaluation.They also worked to identify policies, systemic reforms, and legislative options to promote school

School Readiness Case Studies

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readiness for every child in the state. In 2001, the State’s First 5 Commission developed and imple-mented the School Readiness Initiative, awarding $206.5 million in incentive matching funds to localcounty Commissions to support school readiness centers at high-priority schools (≤ 30th percentile onthe California Academic Performance Index). To qualify for the four-year projects, each program mustprovide at least a one-to-one local funding match and address each of the five essential and coordi-nated elements of school readiness. As of June 30, 2003, the School Readiness Initiative included 110school readiness centers representing 461 schools in 44 counties (First 5 California, 2003).

Another by-product of the School Readiness Working Group was the recommendation to build astatewide system of early childhood education. Towards this aim, First 5 California developed thePreschool for All program. This included funds and tools to help counties investigate how to developshort-term plans for the development and sustainability of a universal system of preschool programsavailable to all children. In November 2005, First 5 California changed the name of this program toPower of Preschool to avoid confusion with a separate and distinct Preschool for All Initiative antici-pated to appear on the state ballot in 2006. Similar to Proposition 10, this state initiative, if passed,would provide an ongoing funding stream for the planning and implementation of universally avail-able early care and education services for California’s young children. In 2005, 10 counties werefunded to conduct Power of Preschool planning, with the opportunity to apply for state implementa-tion funds in the near future. Finally, the state Commission has funded numerous media outreach andeducation activities, local demonstration projects, stipend programs, and research and evaluation ac-tivities aimed at general topics (e.g., school readiness, ECE, and health care); and targeted groups,such as children with special needs, families of migrant farm workers, and informal care providers(First 5 California, 2003).

CASE STUDIES

Activities funded by First 5 California are numerous and far-reaching, but perhaps the greatestimpact of First 5 funding comes at the county level through local implementation strategies. Often,counties face demographic, geographic, social, economic, and/or political realities that present uniquechallenges and require creative, individualized solutions. One of the greatest advantages of First 5funds is that they are highly leverageable and must be used to enhance existing or develop new ser-vices. The culture of supporting new approaches and building collaboration within a system of earlychildhood services can best be seen at the local level, as illustrated by the following case studies.

Los Angeles County

Demographic/economic profile and challenges. With approximately 10 million people, includingalmost one million children ages 0 to 5; Los Angeles (LA) County’s population is the largest of anycounty in the nation and exceeds all but eight states. Each year, approximately 160,000 children areborn in LA County. Almost half of these children ages 0 to 5 live in families earning below 200% of theFederal Poverty Level ($36,489 for a family of four in 2002) and more than half speak a languageother than English at home (Los Angeles County School Readiness Indicators Workgroup [LASRIW],2004). Despite ample evidence that preschool helps children succeed in school and in life, only abouthalf of LA County’s 160,000 four-year-olds are currently enrolled in any kind of preschool experience.Of these, only about 8,000 are enrolled in high-quality programs taught by a credentialed teacher (Hill-Scott, 2004). In 2002, nearly 1 of every 20 children ages 0 to 5 was referred to the County Departmentof Children and Family Services and subsequently received emergency response services based onreports of child abuse and neglect (LASRIW).

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Strategic approach to school readiness. First 5 LA’s mission is to increase the number of childrenfrom the prenatal stage through age 5 who are physically and emotionally healthy, safe, and ready tolearn. To that end, the Commission funds programs and initiatives under three strategic goal areas: (a)early learning, (b) health, and (c) safe children and families. The Commission’s major initiatives ineach of the goal areas include a Universal Access to Preschool Initiative, a Healthy Births Initiative, aHealthy Kids health insurance initiative and a community based child abuse prevention initiative calledPartnerships for Families. In addition to these local initiatives, the Commission provides matchingfunds for the statewide School Readiness Initiative and currently funds 43 School Readiness Centersunder this program.

Program spotlight. In addition to these large-scale initiatives, the Commission funds program-matic grants based on local needs. One such programmatic grant is particularly noteworthy because itsactivities cut across all strategic plan goal areas described above. Child Health Works (CHW), a five-year project currently in its third year, is a special needs health resource collaborative led by Children’sHospital Los Angeles that also includes the Los Angeles County Department of Mental Health, theFamily Resource Network of Los Angeles County, and the Los Angeles Unified School District(LAUSD). CHW is designed to improve services and school readiness for children with special healthcare needs in 20 LAUSD Early Education Centers (EEC) located in high need areas. The EECs areoperated by the LAUSD Early Childhood Education Division and provide preschool programs on ornear LAUSD elementary school campuses. CHW staff members—including mental health providers,pediatricians, nurses and nutritionists—provide health, developmental/behavioral health, and nutri-tion screenings to all children attending the EECs. Children identified through screenings receiveinterdisciplinary assessments, integrated service delivery and family consultations through the net-work of collaborative partners. In addition, CHW provides specialized trainings and ongoing supportto EEC staff on early childhood health, mental health and nutrition, as well as education for parents onsimilar topics.

After a planning phase, CHW launched its activities in an initial group of eight EECs. By the endof the second year of the grant, CHW had screened 1,433 children, had educated 1,101 parents; andhad provided training to 133 early childhood educators, 600 LAUSD nurses, 4 LAUSD administra-tors, and 45 classroom volunteers. Of the mental health consultations provided at the EECs, the mostfrequent mental health concerns voiced during consultations with CHW staff were impulsivity, inat-tention, and aggressive behavior. Parents sought consultations most often about aggressive behaviorand impulsivity; teachers sought consultations most often about inattention and impulsivity.

In addition, more than 40% of children screened had a Body Mass Index–for-age (BMI) over85%, and at the EECs where dental screenings were performed, more than 50% of children were inneed of dental care. A program evaluation is underway that includes electronic reporting of screeningdata via a web portal, focus groups, and participant surveys. Preliminary data from the evaluationdemonstrate the high level of need for CHW services at the targeted EECs. The program model iseffectively reaching young children and families at the preschool setting. Data on school readinessoutcomes are forthcoming.

Orange County

Demographic/economic profile and challenges. Orange County is the second largest county inCalifornia by population ages 0 to 5 years old, and the second most densely populated. In June 2003,only 21% of households could afford to buy the median priced home. Rental affordability is equallydismal, with the fastest growing occupations (service jobs, manufacturing, and retail jobs) paying less


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than half the amount needed for rent (Orange County Community Indicators Project, 2004). Low- andmoderate-income earners have difficulty finding affordable housing, which leads to overcrowding andpotentially negative affects on their children’s health and social, emotional, and cognitive develop-ment.

Although the media glamorizes the wealthy communities in Orange County, there are vast areasof poverty that are not widely known beyond the county borders. Approximately 43,800 children ages0 to 5 live in families earning less than $25,000 per year (Orange County Health Needs AssessmentProject, 2002). Almost half of the young children in the county rely on publicly funded health careprograms. In comparison to the county as a whole, Orange County’s preschool population (ages 0 to 5)represents a disproportionate number of children in low-income families, and families with limitedEnglish proficiency. Orange County children 5 years and under are more likely to be Hispanic/Latinothan Caucasian, and there is a sizable and growing Asian and multi-racial population (Children’s Ser-vices Coordination Committee, 2003).

Strategic approach to school readiness. The Commission’s strategic plan is based on a holisticview of school readiness, modeled after the National Education Goals Panel (NEGP) definition, whichincludes supportive families and communities, good health, and appropriate preschool experiences.The Commission funds community and specialty clinics to promote good health, family resource cen-ters to strengthen families, birthing hospitals to identify and refer those newborns most at risk, andschool readiness programs that provide young children with comprehensive preschool services, in-cluding strategies to enhance early literacy and language development.

The Commission also funds School Readiness Coordinators and School Readiness Nurses at eachof the 25 elementary school districts in the county who create a network among districts, early careproviders, health service providers, and family support services, so that families with children ages 0to 5 are aware of and can access all available resources. With the addition of school nurses, moreyoung children will be able to receive services, including general health and early developmentalscreenings, to start addressing unidentified issues prior to the first day of school.

Program spotlight. One of the strategies that the Commission funds to enhance early literacy andlanguage development is the Home-based Activities Building Language Acquisition (HABLA) SchoolReadiness program. The HABLA program is a broad-spectrum, Latino-focused educational outreachprogram based at the University of California at Irvine (UCI), and is an accredited replication site ofthe National Parent-Child Home Program.1 Focusing on improved child development and improvedfamily functioning through parenting skills, HABLA is a home visitation program that seeks to in-crease the school readiness of disadvantaged children ages 2 to 4 through a collaboration of faculty andstudents at UCI, the Santa Ana Unified School District, local Family Resource Centers, AmeriCorps/VISTA, as well as state and federal funding. Because HABLA focuses on Latino families, home visi-tors are recruited who know the language and the culture of the parents.

HABLA clients are Latino children from low-income, low socioeconomic status families. Theaverage parental education is eighth grade and the average annual income is $20,000. HABLA empha-sizes that parents are the first and most important teachers for their children and that they need toassume this role whatever their native language. Home visitors use toys and books to model and coachparenting techniques intended to increase verbal interaction and promote child learning and expressivelanguage. Since the majority of the parents are monolingual speakers of Spanish, all HABLA homevisitors typically deliver their visits in Spanish and distribute Spanish language books and activities.Home visitors also coach parents on reading to their children, talking to them and asking them ques-tions to engage them in conversation, and other strategies to help prepare children to enter school.

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Some of these activities focus on health and hygiene, whereas others focus on cognitive developmentand pre-academic skills in science, math, and reading. All of the toys and books stay in the home forcontinued use and often become the only books that the family owns and the first books that thechildren learn to read.

HABLA helps ensure that children enter kindergarten with the language and cognitive skills neededto succeed in school. In order to measure these outcomes, home visitors conduct weekly assessments,and more in-depth testing at program entry and annual follow-ups to assess parent-child engagement,and child oral and receptive language development. More than 450 children have been enrolled to dateand the results indicate that HABLA participants demonstrate significant improvements on the Pre-school Language Scale–3, Spanish Edition (Zimmerman, Steiner, & Pond, 1993). Whereas untreatedchildren have standard scores that tend to fall to substandard levels between ages 2 and 4, HABLAclients move from standards scores of 90 at entry to 95 after one year of treatment and 100 after twoyears (see Figure 1). Kindergarteners who have participated in HABLA maintain this advantage andtend to have a greater awareness of language and greater potential for phonics-based instruction.

95.3100.1

89.5

96.0

85.0

79.0

70

85

100

115

130

Entry One Year Two Years

Stan

dard

Sco

re

Participants

Non-Participants

Figure 1.Comparison of Scores on the Preschool Language Scale-III, Spanish Edition for Participantsand Non-Participants of the Home-Based Activities Building Language Acquisition (HABLA)School Readiness ProgramNote. Participants’ mean ages were as follows: 31 months at entry (n = 401), 39 months at one year(n = 413), and 50 months at two years (n = 175). Non-participant controls were grouped as followsfor age comparisons: 30 months or less for entry, 31-42 months for one year, and 42 months orgreater for two years.


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Parents have responded positively to HABLA. Many have expressed that they had not realizedhow they could help their children and that subsequently their children have overcome their shynessand language barriers. Parents are also able to sustain verbal interactions with their children; they growin perceived competence and in the quality of attention that they give to their children. Where parentsin the community-at-large tend to have a passive view of their role in their children’s education, HABLAparents seem to realize their role as their children’s first and most important teachers and are ready toform a responsive partnership with the educational system.

Santa Barbara County

Demographic/economic profile and challenges. Santa Barbara is a geographically and sociallydiverse county located on the central coast of California. Its total population—estimated at 414,800 for2003—includes approximately 26,000 children under age 5 (Damery, Furlong, Graydon, Greif, &Bates, 2005). The county is divided along geographical and economic lines by the Santa Ynez Moun-tain range, with approximately half of the population residing in the relatively affluent south coastcities of Santa Barbara, Goleta, and Carpinteria, with the other half residing in the central and northernportions of the counties, particularly in the cities of Santa Maria and Lompoc, and in the Santa YnezValley. Interspersed are a number of geographically and socially isolated communities with very fewor no services.

The southern coast has a much higher cost of living than the northern portions of the county, asreflected by the estimated median home prices for August 2004 rising to more than $1 million, com-pared to $390,000 for the north county region and $627,000 for neighboring Ventura County (Dameryet al., 2005). Yet, only 12.3% of entry-level jobs pay enough to meet the conservative standard of200% poverty level for a family of four. Thus, there are a large number of very wealthy families and alarge number of families in poverty, with very few middle-income families. Countywide, an estimated22.7% of children ages 0 to 4 live in poverty, most of them Hispanic/Latino. Most of the familiesreceiving public assistance reside in the Santa Maria (56%) and Lompoc (21%) regions and are His-panic/Latino (67%, Damery et al.). Santa Barbara County also has the highest rate of uninsured chil-dren ages 0 to 17 in the state (Inkelas et al., 2003).

Strategic approach to school readiness. Since 2000, the First 5 Commission of Santa BarbaraCounty has made a significant investment in supporting and expanding existing programs for youngchildren and creating new services. Over the years, the Commission’s funding priorities have evolvedto focus on core initiatives that will have a long-term impact on building integrated systems of com-prehensive services and support for children and families in the community. Beginning in 2004, theCommission funded programs that provided core and/or supportive services under the following sixinitiatives: (a) Early Care and Education Infrastructure—improving the quality of ECE programs andproviders; (b) Early Childhood Oral Health—screening and treating preschool children with oral healthproblems; (c) Early Childhood Mental Health and Other Special Needs—building a system of care foryoung children with special needs; (d) Family Support—providing family support services such ascase management, basic needs assistance, resource and referral, parent education, and family counsel-ing; (e) Newborn Home Visiting—providing early screening, developmental support, and parentingeducation to families of newborns through age 9 months; and (f) School Readiness—providing match-ing funds for the state School Readiness Initiative. Santa Barbara is also one of the state-funded coun-ties for Power of Preschool planning, and First 5 is an active partner in Healthy Kids, a state and localinitiative aimed at providing universal health coverage to all children ages 0 to 5.

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The Commission’s approach to ensuring and evaluating the success of these initiatives has been tofacilitate system integration through: (a) collaboration among and between initiatives by encouragingintegration and coordination of services; (b) strategic planning for long-term sustainability for bothfunded programs and non-funded agencies with similar foci, services, and target populations; (c) de-velopment of common evaluation plans and data collection tools; (d) implementation of a softwaresystem for data entry, tracking, reporting, and transfer; and (e) provision of technical support for datamanagement, analysis, reporting, and communication.

Program spotlight. The Santa Barbara County School Readiness Initiative is fully operational in14 targeted school sites within all five eligible districts. School readiness programs focus on earlyliteracy and socialization skills for children ages 0 to 5 through a combination of strategies that includehome-based education, twilight preschool, and summer pre-kindergarten (pre-K) classes. All programstarget services to children who are not enrolled in any other structured pre-K environment. Parents area vital component of all school readiness programs due to the common core value that a parent is achild’s first and most important teacher. They are served in a variety of modalities, such as one-on-onehome visitation with a structured literacy curriculum, and evening parenting workshops paired withpre-K classes for children (i.e., twilight preschool). The program also features an innovative AdultEducation and Community College course focusing on school readiness issues for ECE providers.

Each of the readiness programs is working collaboratively with the ECE community in conjunc-tion with kindergarten teachers and school administrators to smooth the transition into kindergarten.As of October 2003, more than 150 professionals had attended kindergarten-transition articulationworkshops. Some of the positive outcomes include (a) the transfer of early care records and assess-ments to kindergarten prior to classroom placement, (b) the adoption of common screening tools amongpreschool and kindergarten teachers, and (c) the redesign of kindergarten orientation programs by aworkgroup of multiple community stakeholders to better reflect family needs.

Early results suggest that these school readiness programs are having a positive impact on partici-pating families. Some of the preliminary findings, for example, are: (a) an increased percentage ofparents regularly reading to their children, (b) an increased number of children who have been enrolledin health insurance and who are receiving primary health care, and (c) an increase in children’s earlyliteracy skills. As a specific example of the latter, the Santa Maria School Readiness Program—com-prising 7 of the 14 eligible schools in the county—assessed the progress of 197 children who attendedtheir four-week summer pre-K camps using the Santa Barbara Healthy Start Teacher Scale, a locallydeveloped teacher rating of children’s school readiness skills.2 The scale includes 15 items with threesubscales: Social-Emotional Development, Language Development, and Approaches Toward Learn-ing. Results of pretest and posttest comparisons showed improvements in mastery of skills on eachdomain and for the total score (from 39.6% at pretest to 77.3% at posttest; see Figure 2).

DISCUSSION

Lessons Learned from First 5

Designing early childhood services. First 5 is a unique opportunity that has generated numerousbenefits for young children and their families through the development of systems of early childhoodservices. Some of the common strategies that are being implemented across the state are helping (a)children get off to the right start at birth (e.g., through pre- and perinatal health and support programsfor families of newborns); (b) children grow up in safe, supportive, and nurturing environments (e.g.,


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46.8%

39.6%

13.6%

3.7%

19.0%

77.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Not Yet Emerging Developed

Pre-Test

Post-Test

Total Score

43.0% 46.3%

10.7%

2.0%13.6%

84.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%


Pre-Test

Post-Test

Social-Emotional Items

47.6%

29.7%22.7%

8.0% 27.7%

64.3%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%


Pre-Test

Post-Test

Language Development Items

53.7%

36.0%

10.4%

2.9%

21.0%

76.1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%


Pre-Test

Post-Test

Approaches Toward Learning Items

Figure 2. Pretest to Posttest Comparisons for Participants in the Santa Maria School ReadinessProgram’s Summer Pre-Kindergarten Camps (n = 197)Note. Paired comparison t-tests showed significant pre-to-post improvement as follows: (a) Total Score,t (196) = 17.835; (b) Social-Emotional Development, t (196) = 15.437; (c) Language Development,t (196) = 15.368; and (d) Approaches Toward Learning, t (196) = 15.672. All p < .001.

through a variety of family resource and support programs); (c) parents gain and/or maintain the skillsand confidence to be their children’s first teachers (e.g., through parenting education programs); and(d) children enhance early learning, language, cognitive, and social-emotional development (e.g., throughimprovement in the availability of high quality ECE programs). Together, these strategies are layingthe foundation for an infrastructure of coordinated early childhood services in California. All of theseefforts are intended to ensure that young children enter kindergarten with the best possible chance tosucceed.

Transition to kindergarten. In this paper, we have highlighted some innovative programs that cutacross many of the strategies identified above. Some common elements of the three case studies werea focus on multiagency collaboration and breaking down barriers between systems that traditionallyoperate independently, such as the early care and education community and public schools. In theeffort to ensure the smoothest possible transition to kindergarten, the highlighted programs have eachfocused on identifying and supporting children most at risk to encounter difficulties in kindergarten—

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such as those with special health care needs, those without previous preschool experiences, and thosefrom linguistically diverse backgrounds—and involved the family as a key partner in ensuring thatboth children are ready for school and schools are ready for children. Perhaps the most critical elementto ensuring smooth kindergarten transition, however, has been the process of creating communitysupport among and between the various stakeholders—parents, ECE and kindergarten teachers, healthcare providers, administrators, and policy makers. Each of the programs described in these case stud-ies has been created and sustained through countless meetings, luncheons, workshops, tours, mailings,newsletters, parent education, newspaper and television advertisements, and other support processes.Based on reports from First 5 Commissions and funded programs, this work appears to have beenmade possible, not just from First 5 funds, but from an infusion of collaborative spirit and innova-tion—the knowledge of having the opportunity to improve systems for children and families.

Relevance to School Psychologists

The work of First 5 at both the state and local levels should be of particular interest to schoolpsychologists, special educators, and other education professionals for a variety of reasons, includingits shared goals on several federal and state fronts. For example, Goal #1 of the NEGP (1998) statesthat, “all American children will start school ready to learn” (p. 1). NEGP defines school readiness ascomprising three components:

1. Children will receive the nutrition, physical activity experiences, and health care needed toarrive at school with healthy minds and bodies, and to maintain the mental alertness necessary to beprepared to learn, and the number of low-birth weight babies will be significantly reduced throughenhanced prenatal health systems;

2. Every parent in the United States will be a child’s first teacher and devote time each day tohelping such parent’s preschool child learn, and parents will have access to the training and supportparents need;

3. All children will have access to high-quality and developmentally appropriate preschool pro-grams that help prepare children for school.

In February 2005, the National School Readiness Indicators Initiative—a collaborative partner-ship of 17 states, including California—expanded upon this definition to create the Ready Child Equa-tion, comprising ready families, ready communities, ready services, and ready schools (Rhode IslandKids Count, 2005). First 5 California was one of the organizations contributing to the project, servingas the coordinator for California. Clearly, there is growing consensus at the state and national levels asto the scope of family, community, and school involvement needed to prepare young children to suc-ceed in kindergarten and beyond, and this relates directly to the professional interests of school psy-chologists.

School psychologists are natural partners to help children and families make a smooth transitionto elementary school and ensure that children are ready to learn. School psychologists in Californiacan also become involved with the First 5 initiative on a number of different levels.

Awareness and knowledge. School psychologists can become more aware of First 5 activities intheir community and around the state by contacting their local Commission, including School Readi-ness programs. Most county First 5 Commissions host websites with information about the programsthey fund, as well as the other services and activities in which they may be involved. Links to countywebsites can be found on the First 5 California website (http://www.ccfc.ca.gov/countyinfo.htm). Thestate website also contains information about state-funded programs such as the School ReadinessInitiative.


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Receiving a referral. School psychologists are in an ideal position to receive referrals from localFirst 5 programs and gain a head start with young children who may benefit from additional attentionand services. In particular, school psychologists working in elementary schools will likely run acrossfamilies and children who have already benefited from First 5 services. Information about assistanceprovided by First 5 can be used to determine which services will best serve children. Furthermore, thisimportant information about participation in First 5 programs can be communicated to teachers andother school staff working directly with children and families.

Making a referral. In addition to receiving referrals, school psychologists may be in a position torefer children and their families to First 5-funded programs and services. Not only would this beappropriate for those working with preschool-aged children and their families, but families with olderchildren often have younger siblings in the 0 to 5 age group who would benefit from First 5 services.School psychologists in secondary schools may work with pregnant and parenting teenagers whocould receive support from First 5 programs as well.

Monitoring the progress of young children. One of the most important ways school psychologistscan participate in First 5 is by understanding its ramifications on the assessment and monitoring ofchildren who may be at-risk for developing academic, behavioral, and emotional problems. Increas-ingly, research findings and other evidence has highlighted the importance and potential benefits ofearly identification and treatment for children with developmental problems. In many California coun-ties, First 5-funded programs are a common milieu where this early identification and treatment oc-curs. School psychologists can contribute to these efforts by applying their expertise in child develop-ment and assessment in a variety of roles, such as program development, child advocacy, and programevaluation. In a more central role, they can serve as a critical partner in helping children with identifiedneeds transition to the Kindergarten setting and monitoring their progress through early elementaryand beyond.

Participating in First 5 programs. There are many opportunities for school psychologists to be-come involved with First 5-funded programs themselves. For example, in Santa Barbara County theChild Assistance Team Creating Hope (CATCH) program employs a multidisciplinary team, includinga school psychologist, to provide early intervention for young children with emotional and behavioralproblems. Across the state, there are opportunities for school psychologists to become involved inFirst 5 programs, with activities ranging from school readiness articulation and developmental assess-ment, to parent education. School psychologists can also become involved in First 5 advisory groups,volunteer for program evaluation projects, or, potentially, even serve as a commissioner.

Professional development. Serving young children is one of the credentialing skills required ofCalifornia school psychologists, and it is essential for school psychology programs to consider how tomeet these training needs. With the widespread investment in early childhood services that First 5 hasprovided, there is a resulting need for a professional workforce that is well-trained in early develop-ment and related issues. As such, school psychology training programs may feel increasing pressure toensure that their students are well-educated in areas such as early childhood assessment, programdesign for young children, and continuous program monitoring. Trainers of school psychologists maybenefit from First 5 by cultivating student fieldwork placements and internships in settings servingchildren ages 0 to 5, including early care and education, school readiness, and early intervention pro-grams. In general, there is a need for the field of school psychology to pay more attention to the earlystages of development. Given the broad range of competencies required of school psychologists, it isworth considering whether some school psychologists could develop a special skill set to serve pre-school students and target this age group for service delivery.

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CONCLUSIONS

Overall, the work of First 5 has critical implications for the way that early disabilities and devel-opmental delays are identified and approached. Early identification and treatment will likely haveprofound impacts on the special education system. It is unknown whether this model would reducecertain types of Student Study Team and special education referrals, and change the problems identi-fied in IEPs. For example, early identification and parent education might facilitate early parentalinvolvement, increasing the potential for positive parent-psychologist-teacher relationships (and in-creased parent buy-in for working with the school system). Furthermore, early parent education canmake it possible for interventions to be implemented simultaneously in the home and school. There isstill much to learn about the impacts of effective school readiness programs on youth in the long term;however, based on the preliminary results presented above, early findings look extremely promising.

The convergence of developmental research, prevention science, and public policy initiatives areincreasing efforts to provide stimulating, nurturing educational experiences for all children in order toincrease their chances of entering school fully ready to learn and respond to a challenging curriculum.Among school psychologists, similarly there has been increasing interest in early childhood education.The California Pupil Personnel Services Credential training standards added preschool as one of theprimary fieldwork settings for school psychologists. Furthermore, the Infants and Toddlers with Dis-abilities Act (ITDA) Part C of IDEA (2004) was developed to improve the identification of infants andtoddlers (ages birth to 2 years) with disabilities and to provide early intervention and family supportservices, strategies that are commonly employed by First 5 funded programs. As efforts to implementresponse-to-intervention strategies become more common in grades K-3, it is inevitable that efforts tobuild children’s competencies will continue to be pushed into the preschool years. These efforts affirmthe recognition that no developmental opportunities for any child should be wasted. By becomingaware of and joining with the First 5 initiatives in each of California’s counties, school psychologistscan support the early development of all children and help promote community-school collaborationsthat have the potential to significantly increase the odds that each child will experience early andsustained school success.

REFERENCES

Bridges, M., Fuller, B., Rumberger, R., & Tran, L. ( 2004, September). Preschool for California’s children: Promisingbenefits, unequal access (Policy Brief 04-3). Berkeley, CA: Policy Analysis for California Education.

Casamassimo, P., & Holt, K. (Eds.). (2004). Bright futures in practice: Oral health—pocket guide. Washington,DC: National Maternal and Child Oral Health Resource Center.

Children’s Services Coordination Committee. (2003). The 9th annual report on the conditions of children inOrange County. Santa Ana, CA: Author.

Damery, H., Furlong, M., Graydon, K., Greif, J., & Bates, M. (2005). Santa Barbara County Children’s Scorecard2004. Santa Barbara, CA: KIDS Network.

First 5 California Children and Families Commission. (2003). Annual report: Fiscal year 2002-2003. Sacramento,CA: Author.

Hayes, C. (2004). Strategic financing: Making the most of the state early childhood comprehensive systems-building initiative. In N. Halfon, T. Rice, & M. Inkelas (Eds.), Building state early childhood comprehensivesystems series (no. 5, pp #-#). Los Angeles: National Center for Infant and Early Childhood Health Policy.

Hill-Scott, K. (2004). Los Angeles Universal Preschool Master Plan. Los Angeles, Retrieved February 27, 2005,from http://www.laup.net/images/Proj_UPK_MasterPlanFinalDraft.pdf

IDEA (Individuals with Disabilities Education Act). (2004). IDEA 2004 (P.L. 108-446). Retrieved March 15,2004, from http://www.nectac.org/idea/Idea2004.asp

Inkelas, M., Halfon, N., Uyeda, K., Stevens, G., Wright, J., Holby, S., & Brown, E. R. (2003). The health of youngchildren in California: Findings from the 2001 California Health Interview Survey. Los Angeles: Center forHealth Policy Research.


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Los Angeles County School Readiness Indicators Workgroup. (2004). Shaping the future: Help children in yourcommunity get the best possible start in life. Los Angeles: Author. Retrieved February 27, 2005, from http://www.first5.org/docs/Community/ShapeFuture_r10.pdf

National Association for the Education of Young Children. (1997). Developmentally appropriate practice in earlychildhood programs serving children from birth through age 8. Washington, DC: Author.

National Education Goals Panel. (1998). Principles and recommendations for early childhood assessments—Goal 1 Early Childhood Assessments Resource Group. L. Shepard, S. L. Kagan, & E. Wurtz (Eds.). Washington,DC: Author.

National Governor’s Association Center for Best Practices. (2001). Where there’s a will: Promising ways to promoteearly childhood development. Retrieved February 21, 2005, from http://www.nga.org/center/divisions/1,1188,C_ISSUE_BRIEF^D_2405,00.html

National Research Council and Institute of Medicine. (2000). From neurons to neighborhoods: The science ofearly childhood development. Washington, DC: National Academy Press.

Orange County Community Indicators Project. (2004). The Orange County community indicators report, 2004.Santa Ana, CA: Author.

Orange County Health Needs Assessment Project. (2002). The Orange County health needs assessment, Springreport, 2002. Santa Ana, CA: Author.

Parent Advocacy Center for Educational Rights. (2004, Winter). Early childhood connection. Minneapolis, MN:Author.

Ramey, C. T., & Ramey, S. L. (2004). Early learning and school readiness: Can early intervention make a difference?Merrill-Palmer Quarterly, 50, 471-491.

Rhode Island Kids Count. (2005). Findings from the National School Readiness Indicators Initiative: A 17 statepartnership. Providence, RI: Author. Retrieved March 3, 2005, from http://www.gettingready.org/matriarch/

Zero to Three. (1994). Diagnostic classification of mental health and developmental disorders of infancy andearly childhood (DC:0-3). Zero to Three’s Diagnostic Classification Task Force, S. I. Greenspan and S. Wieder(Eds.). Washington, DC: Author.

Zigler, E. F., Finn-Stevenson, M., & Hall, N. W. (2002). The first three years and beyond: Brain development andsocial policy. New Haven, CT: Yale University Press.

Zimmerman, I. L., Steiner, V. G., & Pond, R. E. (1993). Preschool Language Scale-3: Spanish Edition. SanAntonio, TX: Psychological Corporation.

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Author Note Michael P. Bates, Michael J. Furlong, Jennifer Simental, and Jennifer Greif Green, Center for School-BasedYouth Development, Gevirtz Graduate School of Education, University of California at Santa Barbara, Califor-nia. Alyce Mastrianni and Carole Mintzer, Children and Families Commission of Orange County, Irvine, Califor-nia. William Nicholas, First 5 LA, Los Angeles, California. The authors wish to acknowledge the staff and funded partners of First 5 LA, the Children and FamiliesCommission of Orange County, and the First 5 Santa Barbara County Children and Families Commission. Thisresearch was funded in part by the First 5 Santa Barbara County Children and Families Commission. The researchreported does not necessarily reflect the views of First 5 LA, the Children and Families Commission of OrangeCounty, the First 5 Santa Barbara County Children and Families Commission, nor any of the specific organiza-tions and programs identified herein.


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Footnotes

1 The local Parent-Child Home Program was launched four years ago by Virginia Mann Ph.D., Professor of Cognitive Sciences and

director of the NSF-MSP FOCUS project at the University of California, Irvine. Located in the School of Social Sciences, HABLA is the first

University sponsored site. The extensive evaluation research on the Parent Child Home Program has been published in peer reviewed

professional journals and includes the demonstrated success of the program in achieving sustained high verbal responsiveness of parents to

their children, along with reading and math standardized test scores of participating children that are above national elementary school norms.

2 The Santa Barbara Healthy Start Teacher Scale is a 15-item scale that was developed using responses from a sample of 249 Latino

children attending a similar type of pre-kindergarten immersion program, and yielded 3 factors accounting for 67.7% of item variance: Social-

Emotional Development (48.6%), Language Development (10.3%), and Approaches Toward Learning (8.5%). For more information on this

scale, please contact the lead author.

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57

Using Sociograms to IdentifySocial Status in the Classroom

Brian P. Leung and Jessica SilberlingLoyola Marymount University

Classroom climate, though difficult to define and assess, affects student learning especially in theelementary schools. Much of the current research focuses on the primary architect of classroomclimate – the teacher. There is little doubt that teacher behaviors determine the overall climate ofthe classroom, but peer actions and reactions also significantly affect classroom climate for indi-vidual students. This article briefly highlights peer relationship’s impact on student motivationand performance. An informal method, sociogram, is described for use by school psychologistsin collaboration with teachers to confirm social peer status and hierarchy in the classroom. Re-sults of a class sociogram help to identify the need for individual and/or classroom-wide inter-vention; and the data can also be used to assess effects of such interventions. Sociograms cansupplement teacher observations to promote a positive learning environment for all students.

Classroom climate remains an interesting and intriguing concept in understanding how the art ofteaching and learning occur. Although classroom climate also encompasses the physical environmentof a classroom, it is the “emotional” climate that is typically of high interest. Beattie and Olley (2001)called it a phenomenon that is difficult to dissect and analyze but can be felt. Classroom climatedescribes the interactive emotional environment in which teachers teach and children learn, but it mayalso reflect subjective feelings of individual students. Alternately defined as a sense of belongingness,learning community, etc, the concept refers to the notion of an overall comfort level that children feelin class, the extent they feel connected and cared for, and whether they can be accepted as part of thecommunity of learners. Though research on this topic is not definitive, it seems reasonable to believethat the overall emotional environment can have a significant impact on children’s motivation to learnand subsequent achievement.

Much research on the topic of classroom climate focuses on the teacher, the primary architect ofevery aspect of the classroom, especially its climate. For example, Shapiro (1993) explains that inorder to develop a classroom environment in which learning can take place it is the teacher that needsto establish a positive social climate. Additionally, she states that if the classroom climate is support-ive, students will succeed. Although Shapiro does consider the role students interactions may have onthe classroom climate, her primary focus is on the teacher. With most emphasis and resources directedat teacher behaviors to promote classroom climate, this article considers the role of peer interactions,which also affect the emotional learning environment for an individual child.

UNDERSTANDING THE IMPACT OF PEERS

Most teachers and parents would readily agree that peers play an important role in children’s lives.Children interact with their peers on a regular basis, and they are also the individuals with whom achild forms friendships. At school, friendship promotes shared activities, both academic and non-academic. Within these friendships at school, children become aware of the broader social status hier-archy that exists within the classroom, and they know the children that are sought out and the childrenthat are probably not invited to birthday parties. Popularity plays an important role in the social statushierarchy that exists within a school setting. Interestingly, children often hold similar opinions regard-


Address correspondence to Brian P. Leung, Ph.D.; Loyola Marymount University; School of Education; SchoolPsychology Program; One LMU Drive; Los Angeles, CA 90045. E-mail: [email protected].

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ing social acceptance as their friends so, together, friends accept or reject the same students (Haselager,Hartup, van Lieshout, & Riksen-Walraven, 1998). Thus, children who have few friends or are rejectedby a more popular student are at risk for high levels of rejection from many of their classmates. Chil-dren rejected by peers not only have fewer friends but increased levels of loneliness and isolation.Without friendships, the child’s sense of confidence and competence is compromised, and this percep-tion has wide-ranging consequences (Vandell & Hembree, 1994). These are issues that affect the over-all comfort and engagement (i.e. learning climate) for individual children.

THE IMPACT OF FRIENDSHIPS ON THE CLIMATE FOR ACHIEVEMENT

Friends create a support group or buffer zone within which kids adjust socially and academicallyto school and the classroom environment. It would be helpful for teachers to be aware of the impact offriendships within their classrooms, and the role that friendships may play in students’ academic mo-tivation and achievement, each of which is an important component in contributing to the sense ofbelongingness that is part of classroom climate. Rejection seems to play an important role in achieve-ment and motivation for students because students who are rejected by their peers are often found tohave more problematic academic and socioemotional adjustment (Vandell & Hembree, 1994). Further,peer rejection has been linked with violations of classroom rules and has been considered to be apredictor of academic dysfunction (Hundley & Cohen, 1999). Consistent with the above findings,Yugar and Shapiro (2001) reported that students who were viewed negatively by peers were also ratedby their teacher as having academic and social difficulties.

MEASURING SOCIAL STATUS

So just how do we assess social status? A method for this purpose from social psychology is calledSociometry. A useful working definition of sociometry is that it is a methodology for tracking theenergy vectors of interpersonal relationships in a group. It shows the patterns of how individualsassociate with each other when acting as a group toward a specified end or goal (Criswell cited inMoreno, 1960, p. 140). This technique was developed by psychiatrist Jacob Levi Moreno in 1934 toanalyze interpersonal emotive relationships within a group. His methods have been used to identifyinformal leaders, social rankings and isolated individuals. Sociometry is a way of measuring the de-gree of relatedness among people. Measurements of relatedness can be useful not only in the assess-ment of behavior within groups, but also for interventions to bring about positive change and fordetermining the extent of change. Sociometry is based on the fact that people make choices in interper-sonal relationships. Whenever people gather, they make choices—where to sit or stand; choices aboutwho is perceived as friendly and who is not, who is central to the group, who is rejected, who isisolated. As Moreno says, “Choices are fundamental facts in all ongoing human relations, choices ofpeople and choices of things. It is immaterial whether the motivations are known to the chooser or not;it is immaterial whether [the choices] are inarticulate or highly expressive, whether rational or irratio-nal. They do not require any special justification as long as they are spontaneous and true to the self ofthe chooser. They are facts of the first existential order.” (Moreno, as cited in Hoffman, 2001).

Jacob Levy Moreno coined the term sociometry and conducted the first long-term sociometricstudy from 1932-38 at the New York State Training School for Girls in Hudson, New York. As part ofthis study, Moreno used sociometric techniques to assign residents to various residential cottages. Hefound that assignments on the basis of sociometry substantially reduced the number of runaways fromthe facility (Moreno, as cited in Hoffman, 2001). Many more sociometric studies have been conductedsince, by Moreno and others, in settings including other schools, the military, therapy groups, and

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59Using Sociograms in the Classroom

business corporations. Sociometry can be used to measure the degree to which a child is liked ordisliked by peers or to assess a child’s social standing within a peer group (Wu, Hart, Draper, & Olsen,2001).

Sociometric Criteria

Social choices are always made on some basis or criterion. The criterion could be subjective, suchas an intuitive feeling of liking or disliking a person on first impression. The criterion may be moreobjective and conscious, such as knowing that a person does or does not have certain skills needed forthe group task.

When members of a group are asked to choose others in the group based on a specific criteria,everyone in the group can make choices and describe why the choices were made. From these choicesa description emerges of the networks inside the group. A drawing, like a map, of those networks iscalled a sociogram. The data for the sociogram may also be displayed as a table or matrix of eachperson’s choices. Such a table is called a sociomatrix. Used in the classroom, this type of social map-ping would allow teachers and educators to gain perspective on how students view each other, andwould be especially helpful to identify those students who are in need of additional intervention eitherat school or from external sources. Typically, sociometric measures are based on student and, occa-sionally, teacher reports. Wu et al. (2001) found a high level of reliability between teachers’ and peers’perceptions thus allowing one to measure popularity and friendship from two perspectives. Yugar andShapiro (2001) also found that students were readily able to identify students they hung around as wellas to identify students with whom no one hung out with. Sociometric measures are simple to use andcan be easily utilized to better grasp social status within classrooms. This information is particularlyuseful in classrooms where there is a high turnover of students or when new students are introduced(e.g. inclusion of special needs students), to determine how well these students are fitting in with therest of the class.

Using a Sociogram

The use of a sociogram is very straightforward and involves asking students questions regardingtheir preferences in hypothetical activities with their classmates. Results are tallied to identify 4 typesof children:

(a) Popular = high level of acceptance,(b) Rejected = high level of rejection,(c) Controversial = both acceptance and rejection, and(d) Neglected = students name appears infrequently or not at allThe following are typical steps in conducting a sociogram:Step 1. An adult individually meets with each student in a classroom and ask the student both

positive and negative questions regarding their classmates (e.g. Name two students who you wouldlike to sit next to in this class or Name two students who you would not pick to be your partner forP.E.). The adult can be the teacher, although a “neutral” third party such as a school psychologist (nota parent volunteer or instructional aide) is the best choice to ensure objectivity and professionalism.Alternately, this procedure can be conducted on paper (i.e. a class-wide survey) as long as every stu-dent understands what is being asked and puts down an answer.

Step 2. After the questions are given to students and results collected; on a sheet of paper, theschool psychologist can simply tally the number of votes each student receives for each question (seeTable 1), then tabulate the results by giving the student one point for tallies relating to positive ques-

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tions and minus one point for tallies relating to negative questions. Interpretations are based on therelative numerical values can be interpreted to identify 4 types of children: (a) Popular = high numberof points from positive question, (b) Rejected = high level of points from negative question, (c) Con-troversial = positive points – negative points, and (d) Neglected = students name appears infrequentlyor not at all.

Step 3. Once results are tabulated, the school psychologist reviews the chart with the classroomteacher to determine which student’s score stands out. In Table 1, some possible social status is indi-cated. Note that students’ status are based not only on the Total Points, but also the combination or ratioof positive (+) and negative (-) points.

Table 1.Sample Sociogram Results

Acceptance Rejection Total PossibleName Gender Points Points Points Status

E.B. F 0 0 0 NeglectedG.B. M 8 0 8 PopularL.B. F 0 3 -3 RejectedS.C. M 6 5 1 ControversialR.C. F 1 1 0 NeglectedJ.E. M 4 1 3 PopularE.E. M 1 11 -10 RejectedP.H. M 7 4 3 Controversial

Some fairly clear indications are: E.B is a neglected student, as the name never came up in conver-sation. G.B is a popular student, with many (+) and no (-). S.C is controversial because of high pointsin both (+) and (-). E.E. is rejected with lots of (-), and L.B. is also likely to be rejected with fewer (-)but no (+). Some other indications are considered based on the combination of scores: Even though J.Eand P.H both have “3” as the Total Points, the unique combination of points suggest that their socialstatus might be different in the classroom. The actual status of these students can best be determinedthrough observations or teacher reports. Lastly, R.C might be neglected since the name was not men-tioned very often. Again, additional observations and teacher comments would help to verify a student’ssocial standing among his peers.

Additional Issues for Consideration

It is likely that younger children (i.e. kindergarten, first grade) tend to have more transient friend-ships (Meyerhoff, 1999); thus, sociogram results may not be as reliable. By second or third grade,children form more stable relationships and are cognitively able to make social comparisons and judg-ments (Sneed, 2002). For upper grades (i.e. middle school), sociogram can still be effective if it’s mademore “game-like”, and the teacher/adult do not put too much emphasis when presenting the idea.Another issue concerns negative questions. Using negative questions may be uncomfortable for some,but using indirect disassociative-type negative questions (e.g. If the class had a party, who might not beinvited?) seem to buffer against unintended negative consequences. Negative questions provide a clearerindication of rejection and can identify controversial students, but can be eliminated if needed.

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61Using Sociograms in the Classroom

CONCLUSION

Friendships are crucial to a child’s emotional development not only because they provide socialreinforcement but because they provide a buffer for handling stressors. Friendships also affect thelearning climate for individual students that impact the child’s overall sense of self-efficacy and ulti-mately classroom achievement and motivation.

This paper discussed a tool for school psychologists, in collaboration with teachers, that can beused to assess friendship status in the classroom — an aspect of classroom climate. This informationcould be invaluable to identify children in need of additional support and attention for in-classroominterventions or referrals outside the classroom. Reviewing the overall patterns can provide teacherswith a view of the classroom’s social climate for possible classroom-wide interventions by the schoolpsychologist. Moreover, sociograms can be used to assess effectiveness of interventions (i.e. as preand post measures). Since sociograms are quick and simple to use, it can be used regularly to assess aclassroom’s social climate. It is particularly useful in classrooms where there is a high turnover ofstudents or when new students are introduced (e.g. inclusion of special needs students), to determinehow well new students are fitting in. Ultimately, we believe that sociogram data can supplementteacher observations to help establish the type of classrooms that maximally supports student learning.

REFERENCES

Beattie, I., & Olley, P. (2001). Non-instructional factors relating to classroom climate: An exploratory study.Education, 98(2), 180-184.

Haselager, G. J. T., Hartup, W. W., van Lieshout, C. F. M., & Riksen-Walraven, J. M. A. (1998). Similaritiesbetween friends and nonfriends in middle childhood. Child Development, 69, 1198-1208.

Hoffman, C. (2001). Introduction to Sociometry. Retrieved February 1, 2005 from http://www.hoopandtree.org/sociometry.htm.

Hundley, R. J., & Cohen, R. (1999). Children’s relationships with classmates: A comprehensive analysis of friendshipnominations and liking. Child Study Journal, 29, 233-240.

Meyerhoff, M. (1999). Friendship. Pediatrics for Parents, 18(9). 8-10.Moreno, J.L. (1960). The Sociometry Reader. Ill: The Free Press.Shapiro, S. (1993). Strategies that create a positive classroom climate. The Clearing House, 67, 91-98.Sneed, C. D. (2002). Correlates and implications for agreeableness in children. The Journal of Psychology, 136,

59-68.Vandell, D. L., Hembree, S. B. (1994). Peer social status and friendship. Merrill-Palmer Quarterly, 40, 461-477.Wu, X., Hart, C. H., Draper, T. W., & Olsen, J. A. (2001). Peer and teacher sociometrics for preschool children:

cross-informant concordance, temporal stability, and reliability. Merrill-Palmer Quarterly, 47, 416.Yugar, J. M., & Shapiro, E. S. (2001). Elementary children’s school friendships: a comparison of peer assessment

methodologies. School Psychology Review, 30, 568-586.

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63

School Crisis Teams within an Incident Command System

Amanda B. NickersonUniversity at Albany, State University of New York

Stephen E. BrockCalifornia State University Sacramento

Melissa A. ReevesCherry Creek School District, Greenwood Village, CO

Despite the increasing attention given to the need for schools to be prepared to respond in avariety of crisis situations, there is a lack of information about how to coordinate with multipleagencies following a crisis. This article describes the U. S. Department of Homeland Security’s(2004) National Incident Management System and its Incident Command System (ICS), whichprovides a common set of concepts, principles, terminology, and organizational processes to fa-cilitate crisis response activities. The traditional school crisis team structure is compared to theICS structure and the overlap and integration of the two are highlighted. Two case scenarios arepresented to illustrate how the school crisis team may operate in compliance with the ICS indifferent crisis situations.

Crises are sudden, uncontrollable, and extremely negative events that have the potential to impactan entire school community (Brock, 2002). Thus, they require an organized and carefully coordinatedresponse to meet the needs of the affected individuals. During the past two decades, there has beenincreased public, professional, and legislative interest in school crisis prevention and intervention. Ithas been recommended that comprehensive crisis teams be established at the school, district, andregional or community levels (Brock, Sandoval, & Lewis, 2001), of which school psychologists areoften active members (Allen et al., 2002; Nickerson & Zhe, 2004). Whereas recommendations havebeen made about the structure and function of these teams, there is a notable absence of literature onhow these teams coordinate with other emergency personnel. In particular, guidance regarding howthe school crisis team fits within the federal government’s National Incident Management System(NIMS) has been scarce.

The U. S. Department of Homeland Security (2004) developed the NIMS to help facilitate astandardized response to emergencies. A central component of NIMS is the Incident Command Sys-tem (ICS). Consistent with guidance offered by Brock, Jimerson, and Hart (2006) and required insome states (e.g., California), it is important that school crisis teams conform to the NIMS and its ICSso that these teams can communicate in a common language with the many other agencies and re-sponse personnel that may be involved in responding to a crisis at school. Despite the use of the ICS byagencies such as the American Red Cross, electric companies, emergency management, fire, law en-forcement, public health, and public works/highway departments (Landesman, 2005), a review of theliterature indicates that school crisis teams are rarely described within this infrastructure and whenthey are, the ICS is mentioned only briefly (e.g., U.S. Department of Education, 2003). However, thisissue has received attention recently. For instance, the Federal Emergency Management Agency (FEMA)offers an independent study course on Multi-Hazard Emergency Planning for Schools (http://www.training.fema.gov/EMIWeb/IS/is362.asp). In addition, Brock et al. (2006) have offered an in-depth description of how the ICS can provide the infrastructure for delineating the roles and duties of

Address correspondence to: Amanda B. Nickerson; University at Albany, State University of New York; 1400Washington Avenue; ED 232; Albany, NY 12222. E-mail: [email protected].


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school crisis team members, specifically with regard to the prevention, preparation, response, andrecovery from school violence. The following provides a description of the ICS, reviews the currentstatus of school crisis teams, proposes how school crisis teams can comply with the ICS, and providestwo examples of how the school crisis team may operate within the ICS in different emergenciesaffecting schools.

School Crisis Teams

Recent surveys of school psychologists provide evidence that crisis response teams are prevalentin schools, with 93% of respondents in Nickerson and Zhe’s (2004) study indicating that their schoolsused these teams and 76% of respondents in Allen et al.’s (2002) study reporting that their districts hadthese teams. However, Graham, Shirm, Liggen, Aitken, and Dick’s (2006) recent study of schoolsuperintendents revealed deficiencies in school emergency/disaster planning. Of school superinten-dents who responded, 86% had a crisis plan but only 57% had a prevention plan. Although 95% had anevacuation plan, almost 30% had never conducted a drill and 43% had never met with local ambulanceofficials to discuss emergency planning.

Experts in school crisis prevention and intervention have emphasized the importance of having acomprehensive school crisis team to address the safety and mental health needs of students, staff, andfamilies through prevention, response, and recovery (e.g., Brock et al., 2001; Poland, Pitcher, & Lazarus,2002). Although it is important to have building-level crisis teams and ensure that local school re-sources are the primary providers of crisis team assistance, district, regional, or community-level teams,consisting of members with more advanced crisis knowledge, expertise, and access to additional re-sources, are also important. Multiple hierarchical teams are necessary given that some crisis events areso severe that they can quickly overwhelm local resources. School crisis situations are also uniquebecause they often impact the school caregiver(s), either physically or psychologically, which maycomplicate crisis response. Depending upon the nature of the school crisis event the district-level and/or regional or community-level team may provide consultation to school teams or offer direct services(Brock et al., 2001).

A hallmark of school crisis teams is multidisciplinary membership. Some have recommended thatteams be comprised of specific staff members, such as the principal, guidance counselor, nurse, psy-chologist, and teachers (e.g., Peterson & Straub, 1992). Others, however, have advocated a functional,rather than a discipline-specific, approach to team formation (Brock et al., 2001; James & Gilliland,2001; Pitcher & Poland, 1992). These functions include a crisis response coordinator, counseling coor-dinator, media liaison, security/law enforcement liaison, medical liaison, and parent liaison (Brock etal., 2001; Pitcher & Poland, 1992; Poland et al., 2002). Organizing teams according to function, in-stead of being discipline specific, also allows back-up trained personnel to assume duties if a particularindividual is not available.

The crisis response coordinator is typically a school administrator who is responsible for coordi-nating the development of the school crisis plan, overseeing the response to an actual crisis, and evalu-ating the response (Brock et al., 2001). Most school teams also designate a person to coordinate theschool’s response to the psychological needs of students and staff. This role has been referred to as thecrisis intervention coordinator (Brock et al., 2001), counseling coordinator, or counseling liaison (Pitcher& Poland, 1992). This coordinator is responsible for ensuring that mental health and/ or supportiveservices are provided to the affected individuals through triage, direct intervention, and referrals. Mostoften, this person is a trained mental health provider such as a school psychologist, school socialworker, or school counselor. The media liaison, often the school or district public information officer,

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works with broadcast and print journalists prior to a crisis to establish good working relationships andduring an event to provide concise and accurate information to be shared with the public. The securityor law enforcement liaison is typically an administrator, a school resource officer (Brock et al., 2001),or a school security staff member that has ongoing contact with local law enforcement personnel.Because crises often affect the physical health of students, a medical liaison, who may be a nurse ordistrict health administrator, provides training to school personnel in emergency first aid, coordinatescommunication between the paramedics and school crisis team, and, in some cases, manages medicaltriage of victims (Brock et al., 2001). Recognizing parents’ need for information and assurance abouttheir children’s safety, Pitcher and Poland (1992) recommended including a parent liaison as part ofthe school crisis team. This person is responsible for establishing a system to respond to phone callsand to reunite parents with students.

It is essential that comprehensive school crisis teams be prepared to work with emergency re-sponse personnel (e.g., fire, police, public health) as a part of their response to school crises. Researchhas indicated that a common crisis response challenge is generated when multiple agencies, unfamiliarwith each other’s work, are involved in a crisis response. Lack of familiarity can impede efficient andeffective response (Kartez & Kelley, 1988; Raphael & Meldrum, 1993). Given the reality that someschool crises necessitate the involvement of multiple agencies, it is important for schools to be pre-pared to communicate with and integrate other emergency response providers.

Incident Command System

The National Incident Management System (NIMS; U. S. Department of Homeland Security,2004) provides a common set of concepts, principles, terminology, and organizational processes toallow crises to be managed at all levels in an efficient, effective, and collaborative way. HomelandSecurity Presidential Directive (HSPD) 5- Management of Domestic Incidents, signed in 2003, com-municated the Bush administration’s executive decision to require all federal departments and agen-cies to adopt the NIMS, including the basic tenets of the Incident Command System (ICS) as a condi-tion for federal preparedness assistance through grants, contracts, and other activities (U. S. Depart-ment of Homeland Security, 2004). The ICS is to be used for a broad spectrum of emergencies, acrossall levels of government and nongovernmental agencies, and across disciplines. According to HSPD-5, the ICS should be used in prevention, preparedness, response, recovery, and mitigation programsand activities. As illustrated in Figure 1, the ICS is organized by five major functions: Command,Intelligence, Operations, Logistics, and Finance.

Command. This includes the incident commander, and if necessary, a crisis management teamcomprised of a public information officer (PIO), safety officer (SO), mental health officer, and liaisonofficer. The incident commander is the person who coordinates the response to crises. This person isprovided by the agency with the greatest interest in the event at that time, or by the agency chargedwith legal responsibility (Green, 2002). The incident commander sets the objectives for the group,assigns responsibilities, and coordinates the overall response. When a crisis crosses multiple politicalboundaries or jurisdictions, with several agencies having the authority and responsibility to deal withthe incident (e.g., a school shooting), the ICS makes use of a unified command, which involves usinga collective approach with a single set of objectives developed for the entire incident (U. S. Depart-ment of Homeland Security, 2004). The composition of the unified command is flexible, based on thelocation and type of the incident. The unified command ranges from command by a committee tohaving a single incident commander take everyone’s concerns into account (Green, 2002). For schooldistricts that encompass more than one jurisdiction (e.g., multiple police departments), it is important

School Crisis Teams within an ICS

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for the school crisis team to plan with all of those jurisdictions in advance to understand how thisstructure would be utilized in an emergency situation.

Within the command staff, the public information officer interfaces with the public, the media,and other agencies with incident-related information requirements. This person needs to gather accu-rate information about the incident’s cause, size, current situation, and resources committed (U.S.Department of Homeland Security, 2004). The safety officer, who is there for the safety of the responsepersonnel, conducts ongoing assessments of hazardous environments, coordinates safety efforts amongdifferent agencies, implements measures to promote emergency responder safety, and advises the inci-dent commander on all safety matters. Regardless of the use of a single incident commander or aunified command, there should only be one public information officer and one safety officer (U.S.Department of Homeland Security, 2004). The Los Angeles County Office of Education (n.d.) adds amental health officer position which may also be a part of the crisis management team and whichreports directly to the incident commander. The addition of a mental health officer may be particularlyvaluable due to the importance of assessing and coordinating mental health services for students, staff,and families. Unlike traditional emergency responders who constantly respond to crises, this is a lessfrequent role in schools, and being prepared to respond to the mental health issues that may arise is

Figure 1. This flowchart illustrates the elements of the ICS and their hierarchical relationships. It alsoprovides examples of the school crisis team roles and school personnel that might fill these ICS roles.

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critical. The liaison officer is the point of contact for representatives of other government agencies,nongovernmental organizations, and private entities. All agency representatives given the authority tospeak for their parent agencies or organizations coordinate through the liaison officer. In large inci-dents, each of the aforementioned members of the command staff may need one or more assistants tohelp with the duties. Additional command staff may be necessary depending on the incident (e.g., legaladvisor, medical advisor), which may be referred to as “section chiefs.”

Another important concept is the command post. It is critical that all incident command staffoperate from a single incident command post to ensure a coordinated response. This post should belocated in a safe area outside of the immediate impact area of an ongoing event. Incident commandstaff, regardless of the agency they represent, should all work from this single location (Green, 2002).Assuming the school office is safe and not impacted by the crisis event, this is the typical location fora school’s command post. When the command staff meets at the command post, section chiefs for eachfunction should be assigned. The command post should have the resources needed to organize a re-sponse (e.g., phones, fax, confidential meeting space).

Intelligence. This section is comprised of “the thinkers” (California Governor’s OES, 1998), whocollect, evaluate, and disseminate incident situation information and intelligence to the incident com-mander or unified command. Intelligence also prepares status reports, maintains status of resourcesassigned to an incident, and develops/documents the plan, including incident objectives and strategies.This section is constantly asking questions, evaluating new information, planning for future needs, andmaking use of recorders, logs, radios, campus maps, and buses. It also maintains a status board, whichmay be a flip chart keeping a summary of what is occurring (Los Angeles County Office of Education,n.d.).

Operations. Referred to as “the doers” by the California Governor’s Office of Emergency Ser-vices (OES, 1998), Operations is responsible for immediate response needs, including activities fo-cused on reducing immediate hazards, saving lives and property, establishing situational control, andrestoring normal operations (U.S. Department of Homeland Security, 2004). The person in charge ofOperations directs the strategic response to the incident by organizing the work force, matching sup-plies with needs, and managing resources. Operations oversees search and rescue, reunion, medicaland psychological first aid, security, and fire suppression (Los Angeles Unified School District, n.d.).Activities typically viewed as “crisis intervention” or the immediate response to the psychologicalchallenges generated by a crisis event fall under the control of Operations. Translation and culturalservices also fall under this section. Figure 2 illustrates examples of school personnel that may fill theOperations Section roles.

Logistics. This section is responsible for obtaining all resources needed to manage the crisis, thusthey are referred to as “the getters” (California Governor’s OES, 1998). These resources include per-sonnel, equipment and supplies, and services, including transportation. When Operations needs some-thing, they get it from Logistics and Logistics works with Intelligence to develop resources for futureneeds.

Finance. This section, consisting of “the payers” (California Governor’s OES, 1998), keeps arecord of all expenses. Although not all crises require this section, it is established when the agencyrequires finance and other administrative support services (e.g., payroll, claims and reimbursements).If only one specific aspect is needed (e.g., cost analysis), a technical specialist in Planning can providethis (U.S. Department of Homeland Security, 2004). In the schools, it is often the incident commanderor administrator who is directly involved in monetary decisions and approval of these decisions. Therecords of expense become important if federal or state funds are later allocated to the response.


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Integration of School Crisis Team within ICS

Both the ICS and models for comprehensive school crisis teams recognize the importance ofusing a coordinated system to respond to crises. Although the terminology differs, there is much over-lap (e.g., the public information officer and the media liaison are functional equivalents, as are thesafety official and the security/law enforcement liaison). The Incident Command System and tradi-tional school crisis team structures are hierarchical, with a central figure or coordinator (i.e., the inci-dent commander or the crisis team coordinator) who is responsible for the overall management of thesituation. In addition, each system includes clearly defined roles and responsibilities of persons in-volved in crisis response. The ICS and school crisis teams also acknowledge the multiple levels ofresponse that may be needed. That is, both have recognized that most incidents are handled on a dailybasis by a single jurisdiction at the local level (such as the school crisis team), but there are otherinstances that require coordination and involvement of multiple agencies. In both models, the schoolprincipal may take primary responsibility for all of the major functions. However, in more severecrises, the ICS utilizes the unified command, whereas the school literature organizes this by the build-ing, district, and regional or community team. ICS and school crisis teams can be integrated and offeruseful perspectives to inform the other. The following case scenarios illustrate how the integration ofmodels may work in school crisis events.

Case scenario 1. As students arrive at high school one morning, a teenager who has dropped out ofschool enters the building unnoticed. He walks down the hall and enters a classroom where 18 studentsand one teacher are present. As the teacher approaches the teenager to ask for his identification and thepurpose of his visit, the teenager approaches a male student, pulls out a handgun, and fires severalshots toward the student, saying “That’s what you get for cheating me.” In addition to killing theintended victim, the shooter wounds two other students who rushed to help the victim.

ICS response to scenario 1. In this situation, the incident commander (most likely the principal)takes immediate control of the situation and implements previously developed emergency response

Figure 2. This flowchart illustrates the elements of the ICS’s Operations section and their hierarchicalrelationships. It also provides examples of the school personnel that might fill these Operations Sec-tion roles.

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procedures to ensure the safety of the students and staff. Specifically, 911 would be called to requestemergency law enforcement and medical assistance and the school’s lockdown procedure (which typi-cally involves signaling all students and staff to report to their assigned location, close, lock, and coverall windows and doors, stay low, and remain silent; Brock et al., 2001) is initiated. As indicated by theschool’s disaster response protocol, other members of the school’s ICS team either assist with theimmediate crisis response or report to the command post, which is typically located in the school’soffice or an identified back-up location.

The Operations section, which includes the school security and safety coordinator (e.g., schoolresource officer) and medical emergency coordinator (e.g., school nurse), activate lockdown proce-dures and ensure that emergency medical assistance is provided. Once police and medical emergencyresponse personnel arrive on the scene, a unified ICS command is established; however, it is alsocommon for the incident command function to be transferred to law enforcement. Regardless of theincident command structure, the next steps are to ensure student safety by apprehending the shooterand removing the gun. Because the classroom is a crime scene, the search, rescue, and accountingspecialist works with the incident commander to evacuate students without disrupting evidence andaccounts for all students by collecting this information from teachers. The student assembly and re-lease specialist activates parent/student reunification procedures specified by the school’s disaster re-sponse plan. A special issue for this specialist is accounting for the students who left school on theirown following the crisis event. The public information officer keeps detailed documentation of eventsand the school’s response to ensure that he or she has the factual information necessary for parent andmedia communications. Working with the incident commander, the public information officer devel-ops and disseminates parental notifications, as well as press releases. Another likely activity that fallsunder the Operations Section is managing the large number of people, many of who will be distressedparents, who arrive on the scene after hearing about the event.

The intelligence chief collects, evaluates, and disseminates information to the incident commanderand supports the response team by evaluating information and making modifications to the plan asnecessary. The logistics chief ensures that all necessary resources, such as water, food, and crowdcontrol equipment, are available to respond to the aftermath of this crisis. The Finance section docu-ments all crisis related expenditures.

In the days and weeks following the incident, the school crisis/ICS team assesses the extent towhich students have been affected by the incident, the risk for psychological trauma, and the need forpsychological first aid. The mental health officer or the crisis intervention specialist typically directsthese efforts. In addition, it is important to determine when school can resume. This may be dictated bythe extent of damage to the classroom and the time needed to process and clean up the crime scene, aswell as the psychological needs of students to resume routines. The incident commander, with supportfrom the school crisis team, makes this determination. Further, factual and empathic communicationwith faculty, students, and parents is also essential. A group of ICS team members play important roles.Specifically, the Intelligence Section ensures that accurate information is gathered; the public informa-tion and mental health offices help to determine what information should be shared, identify neededsupport services, and implement a plan to help parents, students, and staff access these support ser-vices.

Case scenario 2. A fire begins in a science class of a middle school after an experiment goeshorribly wrong and spreads rapidly while school is in session. The clothing of the two students con-ducting the experiment catches on fire. While most of the class evacuates, the teacher and five studentsremain to try to help the students who have caught on fire.


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ICS response to scenario 2. During this incident, the principal serves as the initial incident com-mander. Presumably, the fire alarm is activated, which signals staff and students to follow appropriateevacuation procedures and notify the local fire department. The incident commander, working with thesafety officer and student care coordinator, ensures that evacuation procedures have been followed.Further, he or she verifies that a 911 call has been placed to report the incident and its exact location. Atthis time, the school district central office is also notified. When firefighters arrive, all fire suppressionacivities are immediately handed over. Throughout the response, the Intelligence Section is collecting,evaluating, and disseminating information to the appropriate response personnel.

Under the Operations Section, the school emergency medical coordinator provides first aid to theburn victims until emergency medical response personnel arrive on the scene. This person also needsto oversee triage of students to determine who need immediate aid due to smoke inhalation. Becausethe school building is unsafe due to the likelihood of the fire spreading, this situation highlights theneed for the school disaster plan to include the location of an alternate incident command post. At thislocation, ICS team members gather and direct additional actions. Among these additional actions, thestudent assembly and release specialist directs the transportation of students from the premises to anoff-site evacuation area, which is specified by the school’s disaster response plan. The crowd managerand traffic safety monitor ensure that there is a clear path for fire and other emergency personnel tosuppress the fire and treat victims. Because it is likely that many students will be very upset and thatthere may be a lot of time spent outside the school, the student care coordinator may direct teachers toorganize activities in which the students can engage (e.g., board games). As these events are occurring,the crisis intervention specialist begins the process of psychological triage based on issues such asproximity to the incident, relationship to victims, and prior psychological functioning. The LogisticsSection verifies that emergency supplies (e.g., bottled water and blankets) are on hand.

When the fire department arrives, that agency’s on-scene commander is likely to assume the roleof incident commander and the school principal becomes directly involved as a member of the crisismanagement team. A representative from the police department is also on the crisis management team.Of paramount importance is evacuating the injured teacher and students and providing appropriatemedical care, which likely falls to the fire department and emergency medical staff, though schoolstaff may be assisting. Student assembly and release coordinate efforts to release students in a mannerthat minimizes chaos and ensures that all students are accounted for. A member of Logistics keepsdetailed documentation of the event, which will be needed by Finance for the later filing of any insur-ance claims.

Many issues are addressed in the days, weeks, and months following the incident. Depending onthe extent of the damage, the Intelligence Chief and other members of the team work quickly to iden-tify where to resume school if the school building is not safe to occupy. Solutions may include alterna-tive sites or portable classrooms. Although the logistics of this task are critical, the mental health needsof students and their families are also very important for the student care coordinator and the crisisintervention specialist. For instance, students who were close to the victims and witnessed the studentswho caught on fire are particularly at-risk for trauma. The staff and volunteer assignment coordinatorare responsible for coordinating efforts to deliver services to those in need. The public informationofficer provides factual information to the media and the communication section of Logistics keepsparents and community members informed. Finally, the Intelligence Section gathers information aboutthe cause (e.g., the results of fire department investigations) and consequences (e.g., when the schoolfacility will re-open) of the fire; and the public information officer and mental health officer or crisisintervention specialist help to determine what information will be shared.

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Concluding Comments

This article has provided a description of the integration of school crisis teams within the IncidentCommand System and proposed a mechanism by which school crisis teams can work within the ICS intwo different emergencies affecting schools. The roles and functions required for school crisis teamsparallel the roles and functions required by the ICS. Titles used within the ICS may initially be confus-ing to school personnel, since the ICS focuses on jobs assigned according to duties, whereas schoolcrisis teams often assign roles according to job title. However, the overall structure of the IncidentCommand System involves the primary leadership role of an incident commander, which is filled mostoften by an administrator or law enforcement agent, and supporting professionals with pre-assignedroles and responsibilities. When school crisis teams work within this structure, it provides for compre-hensive crisis planning and response, and also allows for clear communication with support agenciesthat are required by the federal government to use this structure. An added benefit of using the ICS tostructure a school or district crisis team is the potential it allows for school districts to obtain support,financially and otherwise, when an event occurs. The two examples demonstrate how a comprehen-sive response can be utilized within the NIMS Incident Command System to ensure that responses arecomprehensive, coordinated, and take multiple factors into consideration.

REFERENCES

Allen, M., Jerome, A., White, A., Marston, S., Lamb, S., Pope, D., & Rawlins, C. (2002). The preparation ofschool psychologists for crisis intervention. Psychology in the Schools, 39, 427-439.

Brock, S. E. (2002). Crisis theory: A foundation for the comprehensive crisis prevention and intervention team. InS. E. Brock, P. J. Lazarus, & S. R. Jimerson (Eds.), Best practices in school crisis prevention and intervention(pp. 5-17). Bethesda, MD: National Association of School Psychologists.

Brock, S. E., Jimerson, S. R., & Hart, S. R. (2006). Preventing, preparing for, and responding to school violencewith the National Incident Management System. In S. R. Jimerson & M. J. Furlong (Eds.), Handbook ofschool violence and school safety: From research to practice (pp. 443-458). Mahwah, NJ: Erlbaum.

Brock, S. E., Sandoval, J., & Lewis, S. (2001). Preparing for crises in the schools: A manual for building schoolcrisis response teams (2nd ed.). New York: Wiley.

California Governor’s Office of Emergency Services. (1998, June). School emergency response: Using SEMS atdistricts and sites. Guidelines for planning and training in compliance with the standardized emergencymanagement system. Sacramento, CA: Author.

Graham, J., Shirm, S., Liggin, R., Aitken, M. E., & Dick, R. (2006). Mass-casualty events at schools: A nationalpreparedness survey. Pediatrics, 117, 8-15.

Green, W. G. III (2002, August). The incident command system for public health disaster responders. Paperpresented at the meeting of the Public Health Task Group, Richmond Metropolitan Medical Response System,Richmond, VA.

James, R. K., & Gilliland, B. E. (2001). Crisis intervention strategies (4th ed.). Belmont, CA: Wadsworth/Thomson Learning.Kartez, J. D., & Kelley, W. J. (1988). Research-based disaster planning: Conditions for implementation. In L. K.

Comfort (Ed.), Managing disasters: Strategies and policy perspectives (pp. 126-146). Durham, NC: DukeUniversity Press.

Landesman, L. Y. (2005). Public health management of disasters: The practice guide (2nd ed). Washington, DC: American Public Health Association.Los Angeles County Office of Education, Safe Schools Center, Division of Student Support Services (n.d.).

Managing a school crisis using the standardized emergency management system: An administrator’s guide tocomplying with California government code 8607 (SEMS). Retrieved August 30, 2005, from http://156.3.254.236/lacoeweb/DocsForms/20010917013712_MSCpg19.pdf

Los Angeles Unified School District, Office of Environmental Health and Safety (n.d.). SEMS for schools. RetrievedAugust 20, 2005, from http://www.lausdoehs.org/docs/EmergencyServices/ESPresentationHandouts/SEMSforSchools.pdf

Nickerson, A. B., & Zhe, E. J. (2004). Crisis prevention and intervention: A survey of school psychologists.Psychology in the Schools, 41, 777-788.


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Peterson, S., & Straub, R. (1992). School crisis survival guide: Management techniques and materials for counselorsand administrators. West Nyack, NY: The Center for Applied Research in Education.

Pitcher, G. D., & Poland, S. (1992). Crisis intervention in the schools. New York: Guilford Press.Poland, S., Pitcher, G., & Lazarus, P. M. (2002). Best practices in crisis prevention and management. In A. Thomas

& J. Grimes (Eds.), Best practices in school psychology IV (pp. 1057-1079). Bethesda, MD: National Associationof School Psychologists.

Raphael, B., & Meldrum, L. (1993). The evolution of mental health responses and research in Australian disasters.Journal of Traumatic Stress, 6, 65-89.

U.S. Department of Education, Office of Safe and Drug-Free Schools. (2003). Practical information on crisisplanning: A guide for schools and communities. Washington, DC: Author.

U.S. Department of Homeland Security. (2004, March). National incident management system. Retrieved onSeptember 1, 2005, from www.fema.gov/pdf/nims/nims_doc_full.pdf

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Projective Assessment and School Psychology:Contemporary Validity Issues and

Implications for Practice

David N. Miller and Amanda B. NickersonUniversity at Albany, State University of New York

Projective techniques continue to be widely used by school psychologists despite frequent criti-cisms of their use. This article reviews contemporary validity issues in the use of projectivetechniques with children and adolescents, including incremental validity, treatment validity, andproblems associated with professional judgment and experience. A discussion of these issues andtheir implications for school-based projective assessment is provided, along with recommenda-tions for the appropriate use of projective techniques with children and youth within a problem-solving framework.

A central component of contemporary school psychology training and practice is data-based deci-sion making and accountability (Ysseldyke et al., 2006). Consistently recommended practices for con-ducting reliable, valid, and comprehensive assessments of child and adolescent emotional and behav-ioral problems involve gathering various sources of assessment data from multiple informants (e.g.,parents, teachers, students) across different settings (McConaughy & Ritter, 2002). In addition, assess-ments should not only estimate current student functioning by defining problems, needs, and assets,but should also be linked directly to the development and evaluation of interventions (Ysseldyke etal.).

Behavioral assessment methods (e.g., interviews, observations, informant-report measures) aregenerally viewed by school psychologists as more useful (Cheramie, Griffin, & Morgan, 2000) andacceptable (Eckert, Hintze, & Shapiro, 1997) than traditional assessment procedures such as projec-tive techniques for assessing students with suspected emotional and/or behavioral problems. However,projective techniques continue to be widely used with this population in schools (Hosp & Reschly,2002; Shapiro & Heick, 2004; Wilson & Reschly, 1996) and are viewed as important in the assessmentprocess (Kennedy, Faust, Willis, & Piotrowski, 1994). For example, results from a recent nationalsurvey indicated that school psychologists view projective techniques as helpful and that they fre-quently use them with children and adolescents across grade levels and for a variety of purposes,including special education eligibility determination and intervention development (Hojnoski, Morrison,Brown, & Matthews, 2006).

Projective techniques are assessment methods in which unstructured stimuli (e.g., inkblots; pic-tures) are presented to individuals who are then expected to respond verbally or motorically (e.g.,drawing) depending on the requirements of the task. Unlike other assessment tools, responses to pro-jective techniques are not “right” or “wrong” in a traditional sense. Rather, responses to projectivetechniques are typically assumed to reflect the unconscious drives, wishes, and/or feelings of a par-ticular individual (Chandler, 2003). Projective techniques originated from psychodynamic theory andtheir use is based on the “projective hypothesis,” which is the hypothesized tendency of individuals toview and interpret the world in terms of their own unique experience. An assumption underlying theuse of projective techniques is that “in trying to make sense out of vague, unstructured stimuli, indi-viduals ‘project’ their own problems, motives, and wishes” into the ambiguous situation that is pre-

Address correspondence to David N. Miller; University at Albany, State University of New York; ED 240;Albany, NY 12222. E-mail: [email protected].



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sented (Butcher, Mineka, & Hooley, 2007, p. 119). Examples of projective techniques include sen-tence completion tests, apperception tests, and projective drawings. These techniques are in contrastto more objective, behaviorally-based assessment methods.

Despite their wide use in schools, projective techniques have consistently been criticized through-out much of their history (Dawes, 1994; Lilienfield, Wood, & Garb, 2000), and their use with childrenand adolescents remains highly controversial (Merrell, 2003), with many promoting their use in schools(e.g., Bardos, 1993; Chandler, 2003; Naglieri, 1993; Yalof, Abraham, Domingos, & Socket, 2001) andothers condemning them (e.g., Batsche & Peterson, 1983; Gittelman-Klein, 1986; Merrell, Ervin, &Gimpel, 2006; Motta, Little, & Tobin, 1993). Much of the controversy surrounding the use of projec-tive techniques has focused on their psychometric properties. In particular, projective techniques havebeen criticized for their questionable degree of reliability (e.g., test-retest reliability) and validity (e.g.,construct validity), as well as their sometimes inadequate norms (Salvia & Ysseldyke, 2001). Theseissues, as well as the recent emphasis on evidence-based assessment practices (Mash & Hunsley, 2005)and the threat of legal sanction arising from decisions based on the results of questionable assessmenttools (Kerr & Nelson, 2002), have led to an increased call for restricting the use of projective tech-niques with children and youth, particularly in schools (Knoff, 2003; Merrell et al., 2006).

A central criticism of the use of projective techniques is ultimately related to the validity of theprojective hypothesis in general, and with children and youth in particular (Chandler, 2003). Issuesrelated to the psychometric properties of projective techniques and difficulties with validating theprojective hypothesis have been discussed in many sources (e.g., Chandler, 2003; Lillienfield et al.,2000; Merrell, 2003), and it is not the purpose of this article to review them here. Instead, the purposeof this article is to review research on some contemporary validity issues in the use of projectivetechniques with children and adolescents, focusing on issues of incremental validity, treatment valid-ity, problems associated with professional judgment and experience, and the implications of theseissues for school psychologists. A review of such issues is needed, given that no articles published inprominent school psychology journals (e.g., The California School Psychologist; Journal of AppliedSchool Psychology; Journal of School Psychology; Psychology in the Schools; School PsychologyInternational; School Psychology Review; School Psychology Quarterly) in the last decade have com-prehensively addressed these topics in the context of projective assessment in the schools. Prior toexamining these issues, however, we begin with a brief discussion of the use of projective techniqueswith children and adolescents, as well as some unique reliability and validity problems associated withtheir use.

RELIABILITY AND VALIDITY ISSUES IN THE USE OF PROJECTIVETECHNIQUES WITH CHILDREN AND ADOLESCENTS

As with adults, a variety of projective techniques have been used with children and adolescents,including the Rorschach (Allen & Hollifield, 2003; Ornberg & Zalewski, 1994), human figure andkinetic family drawings (Knoff, 2003; Knoff & Prout, 1985), the Bender-Gestalt Test (Koppitz, 1975;Tolor & Brannigan, 1980), the Hand Test (Sivec & Hilsenroth, 1994; Wagner, 1986), sentence-comple-tion techniques (Holt, 1980; Zlotogorski & Wiggs, 1986); and thematic storytelling techniques such asthe Thematic Apperception Test, the Children’s Apperception Test, and the Roberts Apperception Testfor Children (Dupree & Prevatt, 2003; Teglasi, 2001). Children and adolescents exhibit continuousdevelopmental changes, including variations in cognitive development, abstract thought, and languageacquisition (Chandler, 2003), which frequently make reliability and validity issues associated withprojective techniques much more challenging. Further, the use of projective techniques with children

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and adolescents has been criticized for several reasons, including difficulties in defining particularconstructs projective techniques are purported to assess (Merrell, 2003), possibilities of illusory corre-lations between assessment responses and child behavior (Gresham, 1993), the subjective nature ofevaluating responses (Hall, 2004), the potential for cultural bias (Paniagua, 1998), and the impossibil-ity of disconfirmation (e.g., one cannot prove the null hypothesis that small human figure drawings arenot indicative of a low self-concept; Gresham, 1993).

Some individuals have suggested that projective techniques are not tests and therefore should notbe subjected to the constraints normally applied to psychometric instruments (e.g., Schwartz & Lazar,1979), though as noted by Chandler (2003): “Certain basic questions may legitimately be asked of anyassessment method: Does it do what it purports to do, and does it do so with consistency?” (p. 55).Validity is not, however, a static or fixed construct; an assessment device can only be valid to a particu-lar degree and for a particular purpose. These purposes may include the description of personality, todiagnose or classify, to give a prognosis or make a prediction, to identify therapeutic needs, to providetreatment goals, and/or to select appropriate interventions and to monitor and revise them as needed(Meyer et al., 2001; Nelson-Gray, 2003).

A number of researchers examining the psychometric properties of projective techniques withboth children and adolescents have concluded that they have questionable or even poor levels of reli-ability and validity, particularly as diagnostic instruments or for predicting behavior (e.g., Gittelman-Klein, 1978, 1986; Knoff, 2002, 2003; Merrell, 2003; Merrell et al., 2006). In response to this criti-cism, some proponents of projective techniques argue that their real value lies not in assisting withdiagnostic decision-making or prediction, but rather in their utility for helping clinicians to betterunderstand and describe the individual being assessed (e.g., Lerner, 2000). This perspective, however,has been challenged by individuals such as Knoff (2003), who contend that “the primary goal of the(personality assessment) process is the treatment or resolution of referred behavioral or social-emo-tional problems so that a child’s normal development and positive mental health can continue. Thus, itis not enough to describe or understand a child’s social-emotional problems; we must move fromproblem analysis to intervention by using this understanding” (p. 105). The importance of the linkagebetween assessment and intervention is an increasingly significant one in school psychology (Brown-Chidsey, 2005), and is directly related to issues of incremental and treatment validity.

INCREMENTAL VALIDITY OF PROJECTIVE TECHNIQUESWITH CHILDREN AND ADOLESCENTS

Validity defines the inferences that one can make on the basis of a particular test score or assess-ment method. Evidence that a test is valid for particular inferences, however, does not necessarilymean that the test is valuable (Kaplan & Saccuzzo, 1997). A test or technique may be both reliable andvalid, but the decision to use it depends on additional considerations. For example, what informationdoes the test provide above that which is already known? Or, what information can the assessmentprocedure provide that cannot be gained in some other, easier way? This added bit of information isreferred to as incremental validity.

The notion of incremental validity is not a new one. Theoretical and applied work on test validityin the 1950s and 60s, particularly publications by Campbell, Cronbach, and their colleagues (e.g.,Campbell, 1960; Campbell & Fiske, 1959; Cronbach & Gleser, 1957), provided much of the ground-work. Building on this work, Sechrest (1963), who first proposed and articulated the concept of incre-mental validity, argued that assessment methods must lead to an improved prediction compared withthe results derived from other data that are easily and routinely obtained as part of the assessment

Projective Assessment and School Psychology

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process. This requirement is a rather stringent one, in that “it requires not only that the prediction of anoutcome with a test be better than that obtained by chance but also that the test demonstrate its value incomparison with other relevant sources of information” (Hunsley & Meyer, 2003, pp. 446-447).

In the context of projective techniques with children and adolescents, the concept of incrementalvalidity is particularly important, given that there are a number of other assessment procedures (e.g.,direct observations of behavior; broad-band and narrow-band behavior rating scales; structured diag-nostic interviews) that have demonstrated clear utility for diagnostic and predictive purposes, as wellas for suggesting treatment goals (Shapiro & Kratochwill, 2000). Despite the importance of this issue,a literature search conducted in PsycINFO with the words “incremental validity” and “projective tech-niques” or “projective tests” produced only five articles. Three of these articles (Garb, 2003; Garb,Lilienfield, Scott, & Wood, 2004; Lilienfield, Wood, & Garb, 2000) dealt primarily with incrementalvalidity and projective techniques in the context of adults, and uniformly concluded that the evidencefor incremental validity of projective techniques for identifying both causal variables and problembehaviors was weak. For example, Garb (2003) found that greater incremental validity was found forinterviews, objective personality inventories, and self-report measures than for widely used projectivetechniques.

Similarly, in a comprehensive review of the scientific status of projective techniques, Lilienfieldet al. (2000) concluded that, “with a few exceptions, projective indexes have not consistently demon-strated incremental validity above and beyond other psychometric data” (p. 27). Only two articles inthis search dealt with children and adolescents, both of which found no evidence of incremental valid-ity in projective techniques when used with children and youth for diagnostic purposes (Gittelman-Klein, 1987; Hartman, 1972).

Literature searches containing the words “incremental validity” and other commonly used projec-tive techniques (e.g., apperception tests, Thematic Apperception Test, Children’s Apperception Test,family drawings, school drawings, figure drawings, house-tree-person, sentence completion, etc.) pro-duced similarly sparse results. A study by Graybill and Blackwood (1996) was found that examinedthe utility of projective techniques (i.e., the Children’s Form of the Rosenzweig Picture-FrustrationStudy and the Make a Picture Story), self-report measures, and teacher behavior ratings for predictingadolescent aggressive behavior six years later. Although the authors concluded that the projectivetechniques were at least as valid as the other measures in predicting adolescent aggressive behavior,methodological problems with this study (e.g., limited items used in teacher ratings) make its resultssuspect.

Proponents of projective techniques have argued that the techniques possess incremental validityin the sense that they assess unconscious aspects of behavior that cannot be assessed via other, moreobjective personality assessment measures (Chandler, 2003). This contention, however, assumes thatunconscious processes have a significant and causal impact on behavior. Although this viewpoint hasbeen supported by some investigators (e.g., Westen, 1998), other researchers have not found this evi-dence compelling (e.g., Mash & Terdal, 1997; Shapiro & Kratochwill, 2000), and it is not a view thatappears to be widely accepted among contemporary school psychologists, given that many are in-creasingly adopting more behaviorally-oriented assessment techniques (Shapiro & Heick, 2004).

An important aspect of incremental validity is whether information can be gathered in other, easierways. Assessment procedures such as standardized rating scales and diagnostic interviews are ofteneasier and simpler to administer than many projective techniques, and frequently require less time andtraining on the part of the assessor. For example, even though research suggests that the Rorschachmay be a valid instrument for assessing adolescent thought disorders (Ornberg & Zalewski, 1994),

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other assessment methods (e.g., structured diagnostic interviews) provide equally valid assessments(Wood, Nezworski, & Garb, 2003) while having the additional advantage of frequently being quickerand easier to score and interpret. Moreover, given the relative rarity of schizophrenia or other thoughtdisorders in children and youth, the practical utility of using the Rorschach for this purpose is highlyquestionable.

Given the existing evidence indicating that projective techniques have problematic incrementalvalidity, it is incumbent upon proponents of these techniques to empirically and convincingly demon-strate that (a) the use of them adds needed and useful information in assessing children and adoles-cents; and (b) this information cannot be gained in any other way except through the use of projectivetechniques. To date, however, neither of these goals has been realized (Johnston & Murray, 2003).

A Special Case: The Rorschach

Almost all the research conducted to date on incremental validity and projective techniques hasinvolved the Rorschach, a technique in which individuals are asked to describe what they see in aseries of 10 cards containing ambiguous pictures of inkblots. The Rorschach is a “special case” withinpersonality assessment, however, because contemporary conceptualizations of the Rorschach considerit to primarily be a cognitive-perceptual task rather than a projective one (Exner, 2003), and responsesto it are believed to reflect the way in which individuals normally act in problem-solving situations(Prevatt, 1999). Administration, scoring, and interpretation of the most widely used approach to theRorschach, Exner’s (2003) Comprehensive System, is highly complex and requires advanced training.Although the Rorschach is not used by most school psychologists (Wilson & Reschly, 1996), it contin-ues to be described by some as useful in the assessment of students’ emotional functioning (e.g.,Flanagan & Esquivel, 2006; Prevatt, 1999; Yalof et al., 2001).

The Rorschach is the most widely recognized projective technique and the most controversial(Prevatt, 1999). The controversy surrounding its use is reflected in the studies which have examined itsincremental validity, with many researchers contending there is evidence to support it (e.g., Meyer,2000; Meyer & Archer, 2001; Viglione & Hilsenroth, 2001) and others arguing against it (e.g., Garb,2003; Garb et al., 2004; Lilienfield et al., 2000). Much of this research, however, has dealt with theincremental validity of the Rorschach with adults rather than children or adolescents. In one of the fewstudies that examined this issue with children or adolescents, Archer and his colleagues (Archer &Gordon, 1988; Archer & Krishnamurthy, 1997) studied adolescents and found that the Rorschach didnot provide incremental validity in terms of improved diagnostic prediction in comparison with theMinnesota Multiphasic Personality Inventory (MMPI), an objective measure of personality function-ing.

More recently, Janson and Stattin (2003) examined the incremental validity of the Rorschach inrelation to parental (i.e., mothers) reports of their children’s externalizing behavior and mother-childrelations in the prediction of adult delinquency. The authors found that an aggregate of Rorschach-based ratings of ego strength significantly improved the prediction of delinquency in adolescence overand above earlier identified best predictors (i.e., mothers’ ratings of mother-child relations and exter-nalizing behavior problems). An important limitation of this study, however, is that externalizing be-havior problems were measured by clinical parent interview (consisting of only 10 questions) ratherthan standardized rating scales, and “mother-child relations” were based on only one interview ques-tion (“How do you and your son get along together?”) rather than direct observations. The lack ofappropriate measures therefore makes the authors’ conclusions regarding the incremental validity ofthe Rorschach in this study questionable. More research examining the incremental validity of the


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Rorschach with children and adolescents is clearly needed. To date, however, there does not appear tobe compelling evidence to support the incremental validity of the Rorschach, or any other projectivetechnique, with children and youth.

TREATMENT VALIDITY OF PROJECTIVE TECHNIQUESWITH CHILDREN AND ADOLESCENTS

Treatment validity (also known as treatment utility) refers to “the degree to which assessment isshown to contribute to beneficial treatment outcome” (Hayes, Nelson, & Jarrett, 1987, p. 963). Al-though incremental and treatment validity are separate concepts, they are related. For example, whenevaluating the incremental value of a particular assessment instrument, Meehl (1959) recommendedthat one should also consider the extent to which assessment information is associated with the provi-sion of effective services.

Although case examples describing how projective techniques could potentially be used to sug-gest specific treatments have been reported in the professional literature, these cases are typicallyanecdotal, descriptive, and non-experimental (e.g. Dubey & Cassell, 2000). Empirical evidence dem-onstrating the treatment utility of projective techniques with children and adolescents is lacking. Forexample, a literature search conducted by the authors in PsycINFO containing the words “treatmentvalidity” and a variety of descriptors (e.g., “projective techniques,” “projective tests”, “apperceptiontests,” “Rorschach,” “figure drawings,” etc.) revealed no published articles in any peer-reviewed jour-nals for children, adolescents, or adults.

It should be noted that lack of treatment utility in child/adolescent personality assessment is notrestricted to projective techniques; many objective child and adolescent personality assessment meth-ods and procedures lack treatment validity as well (Braden & Kratochwill, 1997; Kratochwill &McGivern, 1996), and researchers such as Haynes (1993) have argued that “the integration of assess-ment data into treatment decisions remains one of the least researched aspects of applied psychology”(p. 252). However, given that projective techniques also frequently exhibit questionable or poor de-grees of other forms of reliability and validity – a situation which is typically not the case for manyobjective personality assessment methods – their lack of treatment validity provides additional supportfor individuals criticizing their use with child and adolescent populations. Moreover, there are otherassessment methods which have demonstrated treatment validity, such as functional behavioral as-sessment (Gresham, Watson, & Skinner, 2001). Although functional behavioral assessment is not withouttechnical adequacy problems of its own (Gresham, 2003), this assessment methodology has convinc-ingly demonstrated something that projective techniques to date have not – an effective link fromassessment to intervention.

PROJECTIVE TECHNIQUES, PROFESSIONAL JUDGMENT,AND CLINICAL EXPERIENCE

Piotrowski and Keller (1984) suggested that the validity problems associated with projective tech-niques are largely the result of inadequate instruction at the college and university level, and that as aconsequence “the validity of these tests has been underestimated since they are often used improperlyor superficially without the extensive and intensive training and experience needed for their appropri-ate application” (pp. 453-454). The suggestion that projective techniques can be used validly andeffectively if they are employed by individuals with extensive clinical experience and skill is a com-mon one among advocates of projective techniques (e.g., Lerner, 2000; Wagner, 1986). Given that theuse of projective techniques by school psychologists remains popular, and that many of them do nothave formal scoring systems (e.g., TAT; CAT) or are often scored by “personalized” rather than stan-

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dardized scoring systems (Kennedy et al., 1994), it appears that many school psychologists are relyingon their own clinical experience and professional judgment when interpreting them. Research, how-ever, has found significant problems and limitations associated with these variables.

Barnett (1988) described professional judgment as “personal processes that guide scientist andpractitioner behavior in controversial and ambiguous circumstances” (p. 658). Along with clinicalexperience, professional judgment has often been viewed as a key variable in determining clinicians’effectiveness (Dawes, 1994). Despite the intuitive appeal of the value of these variables, however,research examining their utility has not been positive. For example, in the context of projective draw-ings with children, results from several studies have indicated that practitioners are frequently unableto discriminate clinically unremarkable from clinically identified populations beyond a chance level(Cummings, 1986; Knoff, 2003). Research examining professional judgment in the context of otherprojective techniques has found similar results (Lilienfield et al., 2000).

In general, research suggests that school psychologists and other mental health professionals fre-quently make a variety of cognitive errors in conducting assessments, such as asking the wrong ques-tions, or engaging in fundamental attribution or information processing errors (Macmann & Barnett,1999). Assessments also are guided by the implicit or explicit theoretical orientation of the assessor,and conceptual and/or theoretical differences can lead to highly variable interpretations and practices(Barnett, 1988). For example, a particular child’s human figure drawing would likely be interpretedmuch differently by a school psychologist espousing a cognitive-developmental theoretical orienta-tion than by one with a psychodynamic orientation.

A school psychologist’s overconfidence in his or her own judgment and clinical experience canalso be problematic. Macmann and Barnett (1999) describe the “myth of the master detective,” whichrefers to “the erroneous belief that through sheer power of will or intellect, professionals can overcomethe limitations of their techniques” (p. 534). These researchers cite an extensive literature indicatingthat, without clear decision rules, exercising clinical judgment typically leads to great variability indecision outcomes. The research examining the value of clinical experience is similarly discouraging.Although training and experience may enable clinicians to develop an increased sense of confidence intheir diagnostic skills, research suggests this increased confidence does not improve the accuracy oftheir decisions. In fact, negative correlations between professional confidence and diagnostic accuracyhave been reported in several studies (Macmann & Barnett, 1999).

The potential for overconfidence in the accuracy of one’s clinical intuition (Myers, 2002), judg-ment (Meyer et al., 2001), and skill (Dawes, 1994; Garb, 1989) when making assessment decisions isa very real threat to assessment validity, and school psychologists who use projective techniques withchildren and youth would appear especially vulnerable, given the aforementioned potential problemswith these techniques. Although there have been occasional reports of statisticians being stunned bythe clinical acumen of particular highly skilled and experienced professionals (Kaplan & Saccuzzo,1997), such expert clinicians are often difficult to accurately identify, they frequently have difficultyteaching clinical skills to others (Butcher et al., 2007), and the processes by which they make clinicaldecisions have not been adequately investigated.

PROJECTIVE ASSESSMENT AND SCHOOL PSYCHOLOGY:IMPLICATIONS FOR PRACTICE

Given the aforementioned evidence indicating the lack of incremental and treatment validity ofprojective techniques with children and adolescents, we conclude, as have others such as Knoff (2002)and Merrell et al. (2006), that projective techniques are not needed in most cases for the personalityassessment of children and adolescents. Other assessment tools are available for purposes of diagno-


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sis, classification, and the identification of treatment goals (e.g., broad- and narrow-band behaviorrating scales; structured diagnostic interviews; direct observations) that are more reliable, valid, andeasier to interpret without reliance on clinical judgment. In addition, other methods provide a greaterlink between assessment and intervention (e.g., functional behavioral assessment).

There may, however, be some unique situations in which projective techniques might be usefulwhen assessing children and youth, such as for purposes of establishing rapport (Merrell et al., 2006)or generating hypotheses (Knoff, 2003). For example, when establishing rapport with a reticent childor adolescent who does not respond well to typical open-ended or close-ended interview questions, itmay be helpful to provide sentence stems or request a kinetic family drawing. Sentence stems, wherethe child completes the sentence with anything that comes to mind, may resemble more of a structuredschool task and be less threatening than face-to-face questions. When using sentence completion tasks,we recommend using the information provided to generate hypotheses and identify themes for furtherquestioning rather than interpreting responses from a traditional projective perspective (i.e., represent-ing an unconscious conflict). Similarly, the kinetic family drawing (KFD) can be an effective way toassess a child’s perceptions of his or her family (McConaughy, 2005). In fact, it is standard to admin-ister the KFD to 6- to 11-year-old children as part of the Semistructured Clinical Interview for Chil-dren and Adolescents (McConaughy & Achenbach, 1994), and to follow up with questions about whatthey perceive to be their family members’ thoughts, feelings, and actions in the picture.

If and when projective techniques are used with children and adolescents, however, they (like anyother assessment technique) should never be used in isolation. Rather, they should be used as only onecomponent of a comprehensive, multi-dimensional, multi-method assessment (Meyer et al., 2001).Further, projective techniques should never be used as the primary data source in the assessment ofchildren’s social-emotional-behavioral functioning (Prout & Ferber, 1988) or to make diagnostic orclassification decisions. Projective techniques also should be used to generate hypotheses – not toconfirm them (Knoff, 2003). Such hypotheses can then be supported, modified, or even discardedbased on the results from other assessment procedures that possess greater validity.

It is also recommended that a very low level of inference be employed by school psychologistsusing such procedures, and that interpretations of student responses be conducted from a cognitive-behavioral framework rather than a psychodynamic one. Although projective techniques have tradi-tionally been interpreted from a psychodynamic or psychoanalytic orientation, the techniques them-selves are essentially atheoretical (Prout & Ferber, 1988). Knoff (2003), for example, suggested thatthree other theoretical frameworks can potentially be useful in the interpretation of projective draw-ings, including cognitive-developmental, behavioral, and cognitive-behavioral orientations. In par-ticular, a cognitive-behavioral framework was identified as being potentially useful in the context ofprojective assessment under certain circumstances.

Knoff (2003), Prout and Ferber (1988), and Stark (1990) provide excellent examples of how acognitive-behavioral framework for the interpretation of a variety of projective techniques can beeffectively used with children and youth under certain conditions. For example, Stark (1990) describedhow certain projective techniques may be useful with children who may be depressed but are resistantto directly revealing what they are thinking, or for children who for whatever reasons are verballyuncommunicative. He recommends that the content of the projective stimulus should be chosen basedon the information that is of concern. For example, if the assessor is concerned about the child’sthoughts in social situations, the assessor might choose a card from an apperception test (e.g., RobertsApperception Test for Children), or a picture from a book, magazine, or cartoon, that would mostlikely elicit a useful response. The stimulus would then be used as a springboard for questions about

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what the figures in the picture might be thinking and/or feeling. Further probing can then be conductedto gain a better understanding of what the child believes is happening in the picture, what happenedbefore, what will happen next, as well as anything else that might help clarify the child’s thoughts insuch situations (Stark, 1990). Pictures are not the only techniques that can be used in these situations;others such as incomplete sentences, play, and figure drawings may be useful as well. In each case,however, “the child’s responses are directly interpreted as being a reflection of his or her own think-ing” and “there is no attempt…to interpret symbols as representative of underlying processes” (Stark,1990, p. 119).

CONCLUSION

In summary, despite the wide use of projective techniques by school psychologists with childrenand adolescents, the continued use of these techniques would appear inconsistent with best practices inschool psychology assessment. Although some unique circumstances in which projective techniquesmight be useful were identified (e.g., establishing rapport; generating hypotheses), at the present timeprojective techniques for children and adolescents have not demonstrated a substantial degree of eitherincremental validity or treatment validity, and there appears to be substantial problems associated withclinical experience and professional judgment in their interpretation. As such, these techniques willgenerally not be useful for identifying (a) significant variables that are causing, supporting, or main-taining the problem; or (b) interventions that will effectively and efficiently resolve the problem or thevariables causing or maintaining it (Knoff, 2003). School psychologists who continue to use projectivetechniques with children and adolescents are therefore encouraged to do so sparingly and cautiously,and to be cognizant of their strengths and limitations.

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Using Curriculum-Derived Progress Monitoring Data asPart of a Response-to-Intervention Strategy:

A Case Study

Natasha Henley and Michael FurlongUniversity of California Santa Barbara

The revised Individuals with Disabilities Improvement Education Act (2004) and subsequent Fed-eral Regulations promote the use of alternative process of identifying students with specific learningdisabilities based on how well a student responds to researched-based interventions. As thesestrategies are implemented, school psychologists have the opportunity to expand their roles andto assume leadership positions in implementing a response-to-intervention (RtI) model. A centralelement of all RtI approaches is the universal monitoring of students’ academic progress. As partof a general effort to implement a data-driven system, multiple sources of information may beused. This article contributes to these efforts by presenting a case study demonstrating how aschool psychologist took the first steps to implement a low-cost, continuous progress monitoringprocedure in one urban school. This was accomplished by using data readily available at theschool site (reading probes included with the district reading curriculum) to develop a systematicway to monitor progress by creating local school norms and using existing reading benchmarks.

Every year school psychologists in the U.S. conduct approximately 816,000 initial evaluations aspart of the process to determine eligibility for special education for students suspected of having aspecific learning disability (Federal Register, 2005). This would not be surprising to most school psy-chologists, because assessing students for special education is one of their primary job duties. Schoolpsychologists report that typically half of their day is spent on tasks related to individual assessment,such as administering intelligence tests (Reschly & Ysseldyke, 2002). For over 25 years, since thepassage of the Education for All Handicapped Children Act of 1975 (P.L. 94-142), school psycholo-gists have been key participants in the multidisciplinary teams that identify students with learningdisabilities, primarily using a model based on finding a discrepancy between IQ and achievement(Fuchs, Mock, Morgan, & Young, 2003; Lyon et al., 2001; Vaughn & Fuchs, 2003). However, due torecent changes in federal law, school psychologists may no longer use as much of their time adminis-tering intelligence tests. On December 3, 2004 the Individuals with Disabilities Education Improve-ment Act (IDEIA) was signed into law as Public Law 108-446. The new law allows alternative proce-dures for evaluating students suspected of having Specific Learning Disabilities. States are no longerrequired to use a discrepancy between intellectual abilities and achievement as part of the LD eligibil-ity process. States now “…must permit a process that examines whether the child responds to scien-tific, research-based interventions as part of the evaluation procedures” (Federal Register, p. 35802).

This change in federal law was expected. For the past few years several influential groups such asthe National Association of School Psychologists, the Office of Special Education Program in the U.S.Department of Education, and the National Center of Learning Disabilities have expressed concernsabout the continued use of an IQ-Achievement discrepancy model for diagnosing learning disabilities,and instead have proposed a model that is known as response-to-intervention (RtI; Fuchs et al., 2003;Jimerson, Burns, & VanDerHeyden, in press; Lyon et al., 2001). With the recent release of the newFederal Regulations, school psychologists and other educators now await guidance from their educa-tional agencies on the practical questions regarding how RtI will be implemented at state and local

Address correspondence to Natasha Henley, M.Ed.; University of California, Santa Barbara; Gevirtz GraduateSchool of Education; Phelps Hall 2206; Santa Barbara, CA 93106. E-mail: [email protected].



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levels. Of added interest is how the implementation of RtI approaches will affect the future expecta-tions and practices of school psychologists and the individual education assessment planning process.In looking at school districts that have been at the forefront of embracing RtI, some trends are emerg-ing. In both the Iowa Heartland Area Education Agency and the Minneapolis Public Schools, theamount of time school psychologists spend assessing students for special education eligibility de-clined significantly, while the amount of time school psychologists spent in consultation increaseddramatically (Shinn, 2002). At the same time, due to the expanded range of services provided byschool psychologists, the number of psychologist employed by Hartland Educational Agency in Iowaincreased dramatically in the past 15 years (from 32 to 60; Allison & Upah, 2006). The Office ofSpecial Education and Rehabilitative Services (OSERS) has anticipated that the role of school psy-chologists may change and that fewer school psychologists may be needed (Federal Register, 2005).OSERS, in explaining the proposed regulations for IDEA 2004, notes although the cost of document-ing continuously the academic progress of students as part of an RtI approach might be more costlythan previous assessment practices, “These costs are likely to be offset by reduced need for psycholo-gists to administer intellectual assessments. To the extent that small districts may not employ schoolpsychologists, the proposed criteria may alleviate testing burdens felt disproportionately by small dis-tricts under an IQ discrepancy evaluation model” (Federal Register, 2005, pp. 35823-35824). As RtIstrategies are implemented in the coming years, different assessments of whether this will increase ordecrease demand for school psychologists have been offered. However, it is certain that if schoolpsychologists do not seek ways to contribute to RtI initiatives, they may be left out of district plans. Asfederal regulations are operationalized and as state and local educational agencies begin to adopt spe-cific criteria, all educators, including school psychologists, will need to increase their knowledge ofRtI. Movement in this direction has already started with a recent survey indicating that 54% of schoolpsychologists were currently using some form curriculum-based assessments (CBA) to evaluate aca-demic progress on a daily basis (Shapiro, Angello, & Eckert, 2004). Efforts to infuse CBA universalassessment into all schools will require a range of viable options that consider the resources availableand costs to district large and small, and school psychologists can enhance these efforts.

As part of the broader RtI initiative, school psychologists can serve a primary role in RtI bybecoming more involved in collecting, analyzing, and using data to monitor student progress, what hasbeen called universal assessment and continuous progress monitoring (Deno, 2002; Fuchs, 2004). Theobjective of the present article is to present current research in assessing and monitoring reading skillsand then to present a case study of how one school psychologist (the first author) took the first steps increating a universal reading assessment process at an elementary school to identify and track studentswho were experiencing reading difficulties. This case study demonstrates how the school used readingprobes, developed by the Sacramento County Office of Education (2003) to assess the skills taught inthe Open Court‚ 2000 Reading series. These probes were already being as part of the existing readingcurriculum to implement a low-cost strategy to provide universal reading screening information tosupport pre-referral screening and intervention planning by the school’s student support team. Al-though the definition of a specific learning disability in IDEA includes other academic areas such asmathematics calculation and written expression, reading was chosen as the first academic area tomonitor. Hence, this case study is not offered as providing a complete approach to universal academicscreening and continuous progress monitoring, but offers one low-cost option, which if used, wouldallow a school to allocate other available resources to support the universal assessment of math andwritten expression, and to support the implementation of research-supported academic intervention, orboth.

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Although improving the reading competence of school children in America has long been a con-cern, two recently passed federal laws have emphasized now more than ever the need to effectivelytrack the progress of all students to ensure that every student can read at grade level. The No Child LeftBehind Act of 2002 (NCLB) mandates that all public school students will be proficient in reading by2014 or their schools will face financial sanctions. Unfortunately, from 25-40% of children do “…notread quickly well enough, quickly enough, or easily enough to ensure comprehension in their contentcourses in middle and secondary school” (Snow, Burns, & Griffin, 1998, p. 98). In a national assess-ment of reading in 2002 by the National Assessment of Educational Progress approximately 40% offourth graders were rated in the “nonfluent” range in oral reading. These struggling readers, as com-pared to the fluent readers, were more likely to read fewer words accurately, to read at a slower pace,and to have scored lower in reading comprehension (Dane, Campbell, Grigg, Goodmann, & Oranje,2005).

For schools to adopt alternative procedures for identifying students with learning disabilities, andin order to ensure that all students can read at a proficient level, schools need to proactively identifychildren who are the poorest readers, especially at the elementary school level because children whoare not reading at grade level in early elementary school are likely to fall further and further behindcompared to their higher-achieving classmates as they advance toward secondary school. Stanovich(1986) described this phenomenon as the “Mathew Effect” (from a Biblical verse in the Gospel ofMathew were the rich-get-richer). He noted that students who are poor readers read less frequently sothey do not practice reading as many words and are not exposed to as much vocabulary. One conse-quence of this is that they progress at a much slower rate; whereas, in contrast, “early achievementspawns faster rates of subsequent achievement” (Stanovich, 1986, p. 381). Good, Simmons, and Smith(1998) documented just how dire the situation is for the lowest achieving readers. Students who arepoor readers early in their school careers progress academically, however, they do so at a slower rate.The difference is not so apparent in first grade, but by second grade the lowest performing readers arereading at only half the rate of the average second grader. To progress to the level of an average reader,it is no longer enough for the poor reader to progress at the same rate as the average reader, they mustaccelerate the growth of their reading skill, but, of course, the fact that they practice reading less oftenmakes this extremely unlikely. A low achieving second grader must increase his or her reading rate twotimes as much as the average reader in to “catch up.” In a longitudinal study of students who weretracked from first through fourth grade, Juel (1988) found that first graders who were poor readers andwithout intervention had an 88% probability of staying poor readers at the end of fourth grade. By wayof comparison, poor readers at the end of fourth grade were only able to read as well as the goodreaders did at the beginning of second grade.

Even when students receive support services, their rate of improvement often continues to lagbehind. In a study of students with a learning disability and their general education counterparts on acurriculum-based measurement of reading, it was found that the first grade general education studentswere able to increase their reading speed by an average of two words per minute each week, whereasthe students with LD in special education had a highest rate of growth of only 0.83 words per minute.Although the growth rate of both groups of students slowed in the later grades, the progress of thestudents with LD never approached the level of the students in general education (Deno, Fuchs, Martson,& Shin, 2001).

Educators agree that the lowest performing students in reading need to be identified, and identi-fied early. However, few schools have systematic ways to screen all students experiencing readingdifficulties including those with unidentified learning disabilities. One of the most common ways is

Curriculum-Derived Progress Monitoring Data

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through teacher referrals, which might leave some at-risk students from being identified. Shinn, Tindal,and Spira (1997), for example, found that although teachers were generally accurate in referring stu-dents who were primarily low achieving readers, they referred a greater percentage of male students aswell as African-American students then their proportion in the population of struggling readers. Asdifferent teachers in each school and district each year have a different range of students with varyingacademic abilities and behaviors, which students will receive priority for an evaluation tends to changefrom year to year. “Teacher referrals may well reflect the reaction to a constellation of student behav-iors or characteristics, only some of which are obviously related to the reason for referral (Shinn et al.,1987, p. 38). Additionally, Gerber (2005) points out external factors that can affect teachers’ decisionson what educational progress is acceptable in a classroom. These factors can include litigious or per-suasive parents, pressure from school administrators, or school policies that oblige teachers to givepriority to certain categories of students such as those from low socioeconomic background or Englishlanguage learners.

To ensure that all struggling students are identified and helped, the National Association of SchoolPsychologists (NASP) and others recommend a systematic three-tiered approach to identify and helpstudents who are not performing at grade level when students are first experiencing difficulties (NASP,2003). Tier 1 involves “high quality instructional and behavioral supports for all students in generaleducation” (NASP, 2003, p. 2). Students in general education should be assessed and data collected toidentify the lowest performing students in order for those students to receive modified instructions andfurther interventions. When students are found not to be progressing at an adequate rate and are con-tinuing to fall behind, as measured by curriculum-based assessments, students then begin more inten-sive intervention. Tier 2, which is defined by NASP as: “Targeted intensive prevention or remediationservices for students whose performance and rate of progress lag behind the norm for their grade andeducational setting” (NASP, 2003, p. 3). The last stage, Tier 3, involves a comprehensive evaluation inorder to evaluate a student for possible special education and individualized educational planning.

To identify and track the lowest performing students both at the Tier 1 and Tier 2, NASP stronglyemphasizes data collection by using curriculum-based measurement (CBM), declaring, “Ongoing,curriculum-based assessment of basic literacy skills in an essential component of high quality instruc-tion” (NASP, 2003, p. 3). Although Curriculum-Based Assessment (CBA) is any informal method thatteachers use to assess students’ academic assessment in the local curriculum, CBM is a standardizedperformance measure (Shinn, 1988). Shinn and Bamonto (1998) define CBM as “a set of standardsimple, short-duration fluency measures of reading, spelling, written expression, and mathematicscomputation” (p. 1), which allow frequent measuring and monitoring of a student’s performance. Inestablishing the requisites of CBM, Deno (1985, p. 221) proposed four criteria that would have to bemet: (a) it would provide teachers a “reliable and valid way” of assessing student achievement, (b) itwould be “simple and efficient” to use, (c) the procedure and results would be “easily understood,” and(d) it would be “inexpensive.” CBM can be very useful in tracking an individual’s performance andgrowth in basic academic skills, but it is often used as a peer-referenced tool in order to compare astudent’s performance to their classmates and schoolmates. CBM is useful to school personnel be-cause it can “identify discrepancies in performance levels between individuals and peer groups, whichhelps inform decisions about the need for special services or the point at which decertification andreintegration of students with disabilities might occur” (Deno et al., 2001, p. 507).

One of the most common procedures in CBM for measuring reading achievement is by testingoral reading fluency (ORF). Most commonly, ORF is measured by having students read aloud a gradelevel passage for one minute, and then counting the total number of words read correctly (for precise

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procedures see Shinn, 1989, p. 239). Reading fluency can be defined as the ability to read accuratelywith good speed and expression. When a child reads at a slow, laborious, and inefficient pace, it will bevery hard for a child to construct meaning from text. The struggling reader spends most of his or hercognitive resources on decoding and, as a result, has fewer resources left to comprehend text. Thiscontrasts to a fluent reader who has “become automatic at word recognition task. Because the cogni-tive demands for word recognition are so small while the word recognition process is occurring, thereare sufficient cognitive resources available for grouping of words in to syntactic units and for under-standing or interpreting the text” (National Institute of Child Health and Human Development, 2000,p. 3-8).

Studies have repeatedly shown ORF to be a strong indicator not only of word recognition skill, butreading comprehension as well. For example, Fuchs, Fuchs, and Maxwell (1988) found the averagenumber of words read correctly per minute on an oral fluency test had the highest correlations (meanof 0.89) to the Stanford Achievement Reading Comprehension and Word Study Skills as compared tothe other measures of reading comprehension including written cloze, answering comprehension ques-tions, and oral recall. Marston (1989) summarized several studies on reading fluency and reported thatthe correlations between the rate of reading on brief ORF measures and performance on publishednorm-referenced achievement tests range from 0.63 to 0.90.

Although ORF has been shown to be a valid indicator of reading competence, it is frequently notused in schools. Fuchs, Fuchs, Hosp, and Jenkins (2001), examined reading measures published in thelast 80 years. Before 1960, 10% of tests measured oral fluency, whereas another 10% measured flu-ency in another form. From 1990 to 1999 only 6% of tests measured at least one type of readingfluency, whereas none specifically measured oral fluency. This has occurred despite a report findingthat 44% of American fourth graders were not fluent readers when asked to read grade-level passages(Pinnell et al., 1995). The report, Preventing Reading Difficulties in Young Children (Snow et al.,1998) by the National Research Council, which was a consensus document prepared by experts inreading research states that, “Because the ability to obtain meaning from print depends so strongly onthe development of word recognition accuracy and reading fluency, both of the latter should be regu-larly assessed in the classroom, permitting timely and effective instructional response where difficultyor delay is apparent” (p. 323). As the National Research Council’s report recommends, all schoolsneed to find cost-efficient ways to monitor student reading fluency. Further, since one strategy ormodel is unlikely to be appropriate for all schools and available strategies must take into considerationcost effectiveness, descriptions of various strategies are needed.

When local norms are developed for CBM, it can help a practitioner obtain and disseminate infor-mation about not only how a student’s academic level compares to his or her peers at various timesthroughout the school year, but also how much growth the student is making compared to his or herclass and school peers. Shinn (1989) points out that, “…the development of local norms is integral tothe establishment of CBM screening and eligibility procedures as they operationalize the expectationsof the mainstream environment” (p. 94). During a parent conference, a teacher telling a parent that herthird-grade daughter reads 30 words per minute and is not meeting grade level standards is not veryinformative. When local norms are developed, a teacher is able to tell a mother, for example, that,compared to other third graders at the school, 97 out of every 100 are more fluent readers and her childurgently needs intervention services in order to be able to catch up to her peers. Local norms are alsodesirable when the school population is comprised of many culturally and linguistically diverse stu-dents because local norms give schools the capacity to compare a student at the school with otherstudents from similar backgrounds (Kamphaus & Lozano, 1984). For example, in a school with scarce


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resources composed primarily of students who are reading below grade level, local norms allow aschool to identify, monitor, and provide extra services for the absolute lowest students. Additionally,the lowest students can receive priority for psychoeducational assessments to evaluate special educa-tion needs. For example, instead of assessing all students who are below grade level and referred for anassessment, a school psychologist and the student study team (SST) using local norms have otheroptions. They can, for example, explain to teachers, administrators, and parents at a pre-referral meet-ing that the student, while reading below grade level, is reading better than 40% of their peers at theschool and is continuing to advance in reading. In such a situation, it may be possible to accommodatethe student’s needs in the general education classroom, to better advocate for enhance resources for theschool, or both.

A procedure to create local CBM norms was suggested by Shinn (1988, 1989), who emphasizedits use as a cost- and time-effective method of assessing students for special education related deci-sions. The major tasks involve: “(a) creating a ‘measurement net’, a representative sample of eachgrade-level curricula materials for each grade level to be tested; (b) establishing a normative samplingplan; (c) training data collectors; (d) collecting the data; and (e) summarizing the data” (Shinn, 1998,p. 64). Although in the past, collecting and summarizing the data were tedious projects, with the wide-spread use of computers and statistical computer programs, developing local norms is far easier andcan be done relatively quickly. Nonetheless, CBM has been available for a number of years and its usehas not been rapidly and widely adopted. Even with the reauthorization of IDEA in 2004, the “rollingout” of RtI, with CBM as part of this broader initiative has faced a number of challenges. Despiteclaims by Shinn (1988) that CBM is easy and inexpensive to implement, he has developed a commer-cial computerized resource that schools can purchase to implement CBM assessment. Such strategiesprovide one option for school; however, other options are needed, particularly ones that draw on aschool’s current educational practices and do not depend heavily on capital resources. The next sectionpresents a case study of how a school psychologist at an inner city, urban school used its existingresources to systematically monitor student reading progress.

ELEMENTARY SCHOOL CASE STUDY

School Context

An important component of RtI approaches is to monitor students’ academic progress throughoutthe school year. This example demonstrates how a school psychologist at an urban elementary schoolimplemented a process to collect data and to monitor the reading performance of students at the schoolusing ORF probes. This is offered as a strategy to integrate academic progress data that are alreadybeing collected by teachers into a broader RtI strategy. Identifying the lowest performing students atthis school was especially challenging because the vast majority of students were not reading on gradelevel. The average (mean) total reading score for students at this school on the annual CaliforniaAchievement Test (CAT-6) given in the Spring of 2003 varied from the 27th percentile in second gradeto the 16th percentile in fourth grade. Although the majority of the students needed help, due to scarceresources, it was essential to identify those who were the lowest readers and who were continuing tomake limited progress so that they could then receive priority for Tier 2 intervention services.

School Description

The case study, in which the first author was the school psychologist, involved a pre-Kindergartenthrough fifth grade elementary school with approximately 1,000 students situated in an urban area of

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Los Angeles. The students attended school on a year-round basis with students were assigned to one ofthree alternating tracks—students attended school for four months and were on vacation for two months.Students attended 163 days per school year and each day was extended 30 minutes more each day tocompensate for attending school for 17 fewer days. The school population was 99% Hispanic, 73% ofstudents were classified as English Language Learners, and 95% of the student population was eligiblefor free or price-reduced lunch.

Only the scores of first graders in the last semester of first grade through fifth were used in thisstudy because the ORF probes were only administered in those grades. The numbers of students as-sessed in each grade varied throughout the year due to illnesses or students exiting or entering theschool throughout the year. Participants in the first fluency probe given in each grade numbered 164 infirst grade, 163 in second grade, 179 in third grade, 162 in fourth grade, and 153 in fifth grade. Specialeducation students in the Resource Specialist Program were administered the fluency probes, but stu-dents in special education who were placed in Special Day Classes were excluded from participating.

Steps Taken to Implement CBM Assessment

Step 1: Using what is readily available. An efficient way for school psychologists and their SSTsto begin implementing Tier 1 of RtI is to use data that are already being collected at the school site, ifavailable. For school psychologists already working at a school-site the monitoring progress is easierwhen fluency probes are already being instituted on a regular basis. For those who work at schoolswere school-wide oral reading fluency probes are not administered on a school-wide basis, manymeasures are available for a free or at a low cost. As part of the ongoing literacy program at the schoolstudents were administered curriculum-based oral reading fluency passages every six to eight weeks,depending on the grade level, as part of a mandatory Unit Test to assess the concepts and skills taughtin the Open Court‚ 2000 Reading Program, that this case study school used as its primary language artscurriculum in every grade level. The Unit Tests were developed, reviewed, and published by the Sac-ramento County Office of Education (2003). The students were not exposed to the reading probesbefore they were assessed. In addition to oral reading fluency, students were evaluated on the Unit Testthrough multiple-choice questions on reading comprehension, language skills, spelling, vocabulary,and through a writing assessment. The Sacramento County Office of Education developed benchmarkscores in reading fluency by taking the total number of words read per minute correctly at the 50th

percentile of their norming sample. The case study school district’s goal was to have every student inthe district read at or above this benchmark score. Students were assessed in each grade on two readingprobes of approximately 150 to 225 words per passage. The oral reading fluency probes were scoredby the number of total number of words read correctly per minute (WCPM) on each passage.

Step 2: Collecting available data. The school employed a Reading Coach whose duties includeddistributing the Unit Tests containing the Oral Reading Fluency passages to every grade level. TheReading Coach also ensured that the Unit Tests were administered and collected within a given timeframe. The classroom teacher or teaching assistants administered the reading passages. Teachers or theteaching assistants tested the students either in a back corner of the classroom or in a quiet hallwayoutside of the classroom. Teachers were given written directions on administering the oral readingfluency passages. The directions specified that the students should not look at or be exposed to thepassages before reading the stories. Each student received a laminated copy to read while the teacherhad copy that listed the cumulative total number of words for each line in the margin. The directionsindicated that teachers should tell students:


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When I say “Begin” start reading aloud at the top of this page. Read across the page(DEMONSTRATE WHILE POINTING). Try to read each word. If you come to a wordyou don’t know, I will say the word for you. Read as quickly and accurately as you can, butdo not read SO fast that you make mistakes.As the students were reading, the teacher put a slash through words read incorrectly. Words that

the students read that were mispronounced, substituted, or omitted were scored as errors; however,words that were read incorrectly but self-corrected by the student were counted as correct. If a studentcould not read a word correctly after three seconds the word was told to the student and marked asincorrect. The total number of words read minus the errors was totaled and then recorded on the page.Each student was administered two separate reading passages for each of the unit tests.

Using a classroom report, the teacher then recorded the scores of all of the students in a class. TheReading Coach, who gave copies to the school psychologist, collected copies of the classroom reports.The average number of words read per minute correctly from the two passages was used in the analy-sis. As some grade levels completed one to two more units than others, only four fluency probes foreach grade level were selected. The fluency probes were selected so that students’ progress at approxi-mately two-month intervals—during the first quarter, second quarter school, third quarter, and fourthquarter—could be tracked.

Step 3: Analyzing and presenting the data. The next step in the process was to enter the scores intoa data processing program. Computer programs such as Microsoft Excel can compute averages, findstandard deviations and percentile ranks, and display the results in different formats including graphs.Although some teachers, administrators, and parents have a strong background in statistics and enjoylooking at rows of numbers, many do not, so presenting the results in an easy to understand format iscrucial. For the case study school, Table 1 presents the 16th, 50th, and the 84th percentiles across eachgrade level by time of testing and Words Read Correctly per Minute (WCPM). When this table wasfirst shown to the principal, she commented that it was informative, but the format made it difficult forteachers and parents to understand. Additionally, Table 1 did not include the district benchmark read-ing fluency scores that the teachers needed to know.

Table 1.WCPM (Based upon the Mean of Two Passages) by Grade and Time of Testing for the 16th, 50th, and84th Percentile Ranks for Urban Elementary School

GradePercentile

Rank1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

16 7 2350 23 47184

N/A N/A58 94

16 19 37 33 6050 44 64 68 96284 75 98 95 12016 50 49 58 6850 81 82 89 107384 110 110 122 14016 40 44 56 7050 74 75 91 101484 111 105 117 13716 63 69 63 7350 95 91 94 103584 129 123 124 142

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In response to the principal’s observations, a second table was then created to present both thewords-per-minute read correctly and the corresponding percentile rank for each grade level and quar-ter. For example, in Table 2 the scores of every second graders during the second quarter of the yearwere listed. Scores below the 16th percentile were shaded to illustrate that students scoring at this levelare most at-risk and should have priority for intervention services. Table 2 was better received becauseit helped to identify the lowest performing students across each grade level. The SST, in explaining tosome parents of the lowest performing students that their child was struggling in reading and wouldneed extra help, often used this table.

Table 2.WCPM and Corresponding Percentile Rank for Second Grade, 2nd Quarter—Shaded Region Indi-cates Second Graders Most At-Risk

Figure 1 was developed after a discussion with the principal at the school about identifying stu-dents who were struggling with reading. At this school, as at many schools, when an interventionprogram was available each teacher in a grade would nominate for it two or three of his or her lowestperforming students. Figure 1 helped the SST to understand why relying only on teachers referrals forinterventions or for a possible assessment for special education is not always the best way to identifythe neediest students. Each dot represents a student’s average reading fluency score. It is easy to ob-serve that across classes the students are not distributed evenly in terms of their reading ability. At thisschool with a majority of English language learners, students were assigned to classrooms based ontheir level of proficiency in English on a combination of oral and academic language measures. Oneteacher with a classroom of strong readers might refer the two lowest students for extra help even thosestudents are not among the lowest students across all third-grade classrooms. In comparison, a teacherwith a classroom of struggling readers might need to refer one-third of his or her students for availableinterventions.


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Figure 1.Reading Fluency Scores Reported by TeacherNote: Each dot indicates a student’s average score.

The final graph (created using Microsoft Excel, contact authors for a step-by-step description ofhow to generate these graphs) that was developed to facilitate the SST review process was not only themost useful in monitoring student progress, it was easily understood and appreciated by teachers,administrators, and parents. Figure 2 included the benchmark or target scores that were set by thedistrict as well as the 16th, 50th, and 84th percentile rank for each grade level by quarter in words readcorrectly per minute. A student’s progress could then be marked (in colored ink on the original) on thegraph each quarter. Figure 2 allowed the school to monitor every student’s progress while being able tocompare each student to how well he or she was performing compared to other students at the school,as well as whether or not the student was meeting district grade level reading fluency standards. UsingFigure 2 for each of the lowest performing students who are not progressing was then used to identifythose for Tier 2 focused interventions. Before implementing this CBM data procedure, teachers at thecase study school who had low performing students (not reading at or above the benchmark scores)had a difficult time knowing how low the student was performing compared to others at the samegrade level at the school. These procedures to organize the school’s readily available, but not analyzedoral probes, provided the teachers an objective way to assess the relative need of each student to bestprioritize the use of available resources.

Teachers 1-9

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Figure 2.Reading Fluency Scores Reported by Benchmark Scores and the 16th, 50th, and 84th Percentile Ranksfor Each Grade Level and Quarter in Words Read Correctly Per Minute

DISCUSSION

This case study provides one pragmatic demonstration of how school psychologists can take thefirst steps to coordinate existing student performance data as part of a universal screening and continu-ous progress monitoring strategy (National Research Center on Learning Disabilities, 2005). BeforeRtI can be implemented in any school, a valid and workable system for assessing and monitoring allstudents must be in place—ideally as part of the regular education practice, as was done in this casestudy. With the passage of IDIEA in 2004, school psychologists, now more than ever before, need topossess the knowledge and skills necessary to help implement an RtI program in their schools orschool districts if the decision is made by their local or state educational agency to implement an RtImodel as part of the process to identify students with specific learning disabilities.

This case study had several benefits for the first author and her school. The first author benefitedby becoming more familiar with analyzing curriculum-based measurements and implementing a progressmonitoring system before RtI is recommended or even mandated at a particular school. Additionally,the first author was pleased to step out of the traditional role of being seen as a “tester” and enjoyedbeing seen as a problem solver with expanded responsibilities. The school benefited because the prin-

READING FLUENCY CHART Urban Elementary School

0

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90

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150

1.3 1.4 2.1 2.2 2.3 2.4 3.1 3.2 3.3 3.4 4.1 4.2 4.3 4.4 5.1 5.2 5.3 5.4

Grade & Quarter16th Percentile 50th Percentile 84th Percentile Target Score


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cipal and most of the teachers were very receptive to the information that was provided, in part becauseit assisted them to make better and more efficient use of student performance data that they werealready collecting.

Although the experience was a positive one, there were several limitations to this case study.Some teachers at the school did not accept that reading fluency was a good indicator of overall readingability and thus did not want to depend on the reading fluency scores for any critical decision making.Although research has shown that ORF is a valid and reliable indicator of reading ability, there is oftena lack of acceptance, especially among teachers (Hamilton & Shinn, 2003; Shinn, Good, Knutson,Tilly, & Collins, 1992).

Other teachers were concerned about comparing English-proficient students with students whowere classified as English Language Learners (ELLs). They brought up the point that a student whospeaks English fluently when entering kindergarten should be expected to make more progress inreading by the end of second grade than a student who entered kindergarten without knowing anyEnglish. Some teachers proposed that two progress monitoring charts be created—one for ELLs andone for English-only students (with the goal that every student reach the benchmark standards) toprioritize which students in each of the two language groups needed the most amount of help. Al-though the reliability and validity of CBM-ORF has been studied extensively, its use with limitedEnglish speakers has received surprisingly little attention. In this case study school, 73% of the stu-dents where classified as English Language Learners and the state in which the study took place bor-ders Mexico. Baker and Good (1992) found CBM in English was as reliable and valid for bilingualEnglish-Spanish Hispanic students when compared to English-only students. However, this study onlyincluded second graders, and Baker and Good caution that in later grades when vocabulary in thereading passages becomes increasingly more challenging some limited-English speakers may be ableto decode words with only limited comprehension of what is being read. In a study of almost 4,000first through third graders, bias was found in ORF probes in predicting reading proficiency on a groupadministered nationally normed achievement test based on ethnicity and home language; thus Kleinand Jimerson (2005) express caution in using ORF probes as the only determination in deciding whichstudents should receive additional services. The study suggests that if ORF probes alone are usedHispanic students who come from homes where Spanish is spoken would be under identified to re-ceive additional services whereas Caucasian students whose come from homes where English is spo-ken would be over identified to receive additional services (Healy, Vanderwood, & Edelston, 2005).

The major limitation for this case study was the lack of continuity that can occur as educationalreforms are developed. At the end of the year the principal of the school within which this case studywas conducted was reassigned due to a large shift of administrators within the district. Additionally,the first author was given a different school assignment the following school year. As a result, none ofthese data are currently being used at the school. This demonstrates that even when a school SSTorganizes to track and organize available CBM information to support database decision making, itfaces the additional challenge of being sustained at the school regardless of changes in key personnel.The experience of the case study school shows that regular education based, universal CBM proce-dures can be implemented at a school, but these efforts will require additional district, Special Educa-tion Local Plan Area (SELPA), and State support if they are to have continuity across time.

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TheCaliforniaSchoolPsychologist

2006 Volume 11

Includes a Special Topic Section:

Autism Spectrum Disorders:Promoting Understanding

and School Success

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The California School Psychologist

Copyright by CASP, 2006 Produced annually by the California Association of School Psychologists. Articles herein printed are theexpressions of the author(s) and are neither statements of policy nor endorsements of CASP. Submission of manuscripts for reviewand consideration for publication in the The California School Psychologist journal are to be mailed directly to the Editor. SeeGuidelines for Authors on the back cover of this volume for more information. Individuals (other than members) with an annualsubscription to CASP Today do not receive The California School Psychologist as part of their subscription. Individual copies ofThe California School Psychologist are available for $20.00.ISSN: 1087-3414

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Stephen E. Brock Michael J. Furlong Kristin M. PowersCalifornia State University, Sacramento University of California, Santa Barbara California State University, Long Beach

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Design, Layout, and Formatting of The California School Psychologist 2006, Volume 11completed by Shane R. Jimerson, Michael J. Furlong, Mary Skokut, Rene Staskal, and Sarah Sweeney at

The Center for School-Based Youth Development, at the University of California, Santa Barbara

CASP BOARD OF DIRECTORS 2005-2006

STUDENT EDITORIAL PANELGabrielle Dujanderson Jeremy Kaplan Sarah Pletcher

University of California, Santa Barbara California State University, Long Beach University of California, Santa Barbara

Danielle DeLong Amber Klein William RandallCalifornia State University, Sacramento University of California, Santa Barbara California State University, Sacramento

Sarita Garcia Meagan O’Malley Mary SkokutCalifornia State University, Long Beach California State University, Sacramento University of California, Santa Barbara

Angelique Akin-Little Jean Elbert Steven LittleUniversity of the Pacific California State University, Northridge University of the Pacific

John Brady Terry Gutkin Stacy O’FarrellChapman University San Franciso State University University of California, Santa Barbara

Susan Bryner Kristi Hagans-Murillo Alberto RestoriClovis Unified School District California State University, Long Beach California State University, Northridge

Randy Busse Carolyn Hartsough Jonathan SandovalChapman University University of California, Berkeley University of California, Davis

Amanda Clinton-Higuita Michael Hass Jill SharkeyCalifornia State University, Sacramento Chapman University University of California, Santa Barbara

Valerie Cook-Morales Bonnie Ho Meri Harding StorinoSan Diego State University California State University, Hayward Sonoma State University

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The California School Psychologist2006 Volume 11

Stephen E. Brock An Examination of the Changing Rates of Autism in Special Education

Michael P. BatesAlyce MastrianniCarole MintzerWilliam NicholasMichael J. FurlongJenne SimentalJennifer Greif Green

Bridging the Transition to Kindergarten: School Readiness Case Studiesfrom California’s First 5 Initiative

Natasha HenleyMichael Furlong

John S. CarlsonTara BrinkmanAmy Majewicz-Hefley

Medication Treatment Outcomes for School-Aged Children Diagnosedwith Autism

The Role of the Autism Diagnostic Observation Schedule in theAssessment of Autism Spectrum Disorders in School and CommunitySettings

Using Sociograms to Identify Social Status in the ClassroomBrian P. LeungJessica Silberling

Amanda B. NickersonStephen E. BrockMelissa A. Reeves

School Crisis Teams within an Incident Command System

David N. MillerAmanda B. Nickerson

Projective Assessment and School Psychology: Contemporary ValidityIssues and Implications for Practice

Natacha AkshoomoffChristina CorselloHeather Schmidt

Using Curriculum-Derived Progress Monitoring Data as Part of aResponse-to-Intervention Strategy: A Case Study

The California School Psychologist - CASPOnline4 The California School Psychologist, 2006, Vol. 11...

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