The multidisciplinary evaluation(MDE)

The multidisciplinary evaluation (MDE)

• It is an assessment to gather information to know if the child is developing within normal range or has a problem and if so, the types of services needed. This assessment is a comprehensive evaluation of the child’s strengths, needs, what intervention services the child needs. It is important to understand the normal development of the children regarding cognitive, speech and language, motor, behavior and social skills. What are the red flags and how to set an intervention plan according to the child’s strengths and needs to be implemented at home and at nursery or school.

Our believes during Ax

For whom a Multidisciplinary Assessment is helpful?

A Multidisiplinary Assessment can provide helpful information if you wonder:

• Why doesn’t my child talking yet?

• Why does my child have trouble sitting still?

• Why can’t my child follow directions?

• Does my child have autism?

• What school or therapeutic intervention is best for my child?

What's the purpose of a Multidisplinary assessment?

The assessment provides information that can be used to develop early intervention strategies and determine what therapeutic services and activities are needed in order to optimize a child’s learning and educational success.

What should I expect during a Multidisciplinary Assessment?

• Observation of the child’s play, attention, social-emotional skills

• Evaluation of the child’s cognitive, communication, pre-academic , motor, adaptive and sensory-motor skills

• Identification of children with global developmental delay, communication disorders, Autism Spectrum disorder, Attention deficit hyperactive disorder or motor disorders.

• Identification of hearing or vision impairments

What can I expect at the conclusion of a Multidisciplinary Assessment?

• A comprehensive report and feedback about the child’s current strengths and weaknesses

• Individualized treatment and recommendations about how to best intervene to promote children’s optimal development

Can assessment be done for all children?

• Early and Periodic Screening, Diagnostic and Treatment guidelines recommend that developmental screening should be done at ages 9 months, 18 months, and 30 months, and that autism screening should be done at ages 18 months and 24 months.

Multidisciplinary Assessments

Neuro-Developmental AX

Cooperation and compliance

Attention and Activity Level

Social and Emotional Interaction

Play Skills

Cognitive Skills (attention and memory, general concepts, size and number concepts, reasoning and visual perception)

The Carolina Curriculum for Infants and Toddlers and preschools with Special

Needs.

• Age range : Birth – 36 months

• Purpose: “The CCITSN is a systematic curriculum that directly links a skills assessment with activities to promote those skills that have not been mastered.”

Time to administer : 60-90 minutes. It can be split into two or more sessions .

The Carolina Curriculum for Preschoolers with Special Needs

• Age range : 2 – 5 years

• Purpose: “The CCPSN is a systematic curriculum that directly links a skills assessment with activities to promote those skills that have not been mastered.”

Time to administer : 60-120 minutes. It can be split into two or more sessions .

• Areas included 0-2.5 y:

o Cognition

Visual pursuit and object permanence

object permanence: motor and visual

Auditory localization and object permanence

Attention and memory

Functional use of object and symbolic

Visual perception

Concept Development

Understanding space

Problem solving

o Social adaptation

Self direction

Social skills

Self help skills: eating

Self help skills: dressing

Self help skills: grooming

o Areas included 2.5-5y

o Cognition

Attention and memory

Concepts:

General

size and number

Symbolic play

Reasoning

Visual perception:

block designs

puzzles and matching

o Social adaptation

Responsibility

Self concept

Interpersonal skills

Developmental Progress chart

Progress chart after scoring

Brigance Inventory of Early Development

• Age range : Birth to developmental age seven

• Purpose:

o Determine readiness for schools

o Track developmental progress

o Provide a range of scores needed for documenting eligibility for special education services

o Enable a comparison of children’s skills within and across developmental domains in order to view strengths and weaknesses

o General knowledge and comprehension 0-7 y

Response to and experience with books

Body parts : receptive and expressive

Colors

Shape concepts

Quantitative concepts

Directional/position concepts

Classifying

Knows what to do in different situation

Knows use of objects

Knows function of community helpers

Knows where to go for services

o Basic math

Number concepts

Rote counting

Reads numerals

Numeral comprehension

Ordinal position

Numerals in sequences

Writing following and preceding numerals

Writes numerals dictated

Addition combination

Subtraction combination

Recognition of money

Time

o Social and emotional development

General social and emotional development

Play skills and behaviors

Initiative and engagement skills and behavior

• Bayley Scales of Infant and Toddler Development®, Third Edition (Bayley-III)

Ages / Grades: 1 to 42 months

Administration: 30 to 90 minutes (depending upon age of child)

Areas covered :

Bayley scale cognitive

• The Cognitive Scale is comprised of 91 items that assess:

• Sensorimotor development

• Exploration and manipulation

• Object relatedness

• Concept formation

• Memory

Bayley scale social and emotional

• self-regulation and interest in the world

• communicating needs

• engaging others and establishing relationships

• using emotions in an interactive purposeful manner

• using emotional signals or gestures to solve problems

Bayley scale adpative behaviour

• social

• motor

• pre-academics

• home living

• self-care

• self-direction

• community use

• leisure

• communication

• health & safety

• DIAL-4(Developmental Indicators for the Assessment of Learning)

A complete tool for screening preschool and kindergarten children

Administration: 20-30 minutes; Speed DIAL: 15-20 minutes

Ages : 3y through 6y-11m

Areas covered :

Motor: fine and gross

Concepts

Language

Self help development

Social development

DIAL-4 (concepts)

1.Body Parts

2. Colors

3. Rapid Object Naming Object Identification, Rapid Naming

4. Rote Counting Counting Forward, Counting Backward,Number Identification

5. Meaningful Counting Counting Blocks, Number Relationships

6. Concepts

7. Shapes Identifying

Language Assessment

• Language is a Behavior to…………..!

• In Early Stages/Years we call it

Verbal Behavior

• Associated with all activities and skills

Play

Visual

Motor

Daily Routine

Assessing Language and Behavior Through Play

• Play is the work of childhood

• Toys are the child’s Vocabulary

Assessing Language & behavior through Play

•Reaction to play materials

Child’s interests and reinforcers

Duration spent on exploring toys/materials

How do he/she play with toys (play level)

Play ideas (e.g. repetitive)

Assessing Language and Behavior Through Play

Interaction with adults during play :

Verbally and non verbally

Assessing Language and Behavior Through Play

Compliance and cooperation

- Response to adults directions

- Efficiency of Reinforcers

Assessing Language and Behavior Through Play

• Level of language used Vs age

• Receptive

• Expressive

o Speech and language skills

Pre speech receptive language

Auditory attention

Sound localisation

Pre speech gestures

Pre speech vocalization

General speech and language development

Mean Length of Utterance

Personal data response

Verbal direction

Picture vocabulary

Repeats numbers

Sentence memory

Language and Behavior

VB-MAPP

• Is designed to: Identify the existing language and related skills for a child with autism and

other developmental disabilities (referring to the normal developmental milestones)

Covers language, academics, play, social, motor, and imitation

Age bracket: 0-4 years

The focus of VB-MAPP is on Verbal Behavior

• By Identifying the milestones: The focus on the intervention program can be sharper

The EIP goals can match the milestones

It will help to avoid placing too much emphasis on minor skills and steps that are not developmentally appropriate!

VB-MAPP

Milestones in three developmental levels

Level 1: 0-18 months

Level 2: 18-30 months

Level 3: 30-48 months

Contains 16 separate measurements of language and language related skills

Most of the scales correspond with Skinner’s Classification of verbal operants: echoic, mand, tact, intraverbal, ..etc

There are measures of the vocal output, play, and socialization skills

The 16 skill areas are presented in developmental sequence that is presented in three levels

VB-MAPP

Many skills can be assessed simply by observing the child in a play setting (assessing many play and social skills):

Does the child interact with others?

Mand to others?

Imitate his peers?

Some skills need to be assessed within specific time frame, e.g. duration of sitting in group activity

VB-MAPP

• Administration Time:

The ax can be completed in:

10 minutes, 2 hours, 8 hours…!

Actually it should take around 10 hours for higher levels and testing more sophisticated language skills!

• Testing sequence:

Testing should be in the sequence presented in the skill areas

Assessor could conduct a few tests on the echoic, then one the mand, then a couple on the tact…etc!

Order is essential in some higher tasks which are clearly based upon success at earlier levels, (number of tacts)

Verbal Behavior Milestones Assessment and Placement Program

VB-MAPP

Verbal Behavior Milestones Assessment and Placement Program

VB-MAPP

VB-MAPP

• Barriers assessment…!• Best and Most important component of the VB-MAPP

• Answers Most Important question about factors/barriers (24 barriers) existing that affect the “Learning” process and child’s progress! E.g.

Behavior problems

Instructional control

Impaired articulation (oro motor assessment..?)

Failure to make eye contact

Sensory defensiveness

Reinforcer Dependent

Prompt dependent

VB-MAPP

Language Barriers Scoring Form

1 2 3 4

4

3

2

1

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

4

3

2

1

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

4

3

2

1

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

4

3

2

1

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

Age at testing:

MS

Date of birth:

Child's name:

3yrs

Prompt

DependentScrolling

Behavior

Problems

Instructional

Control

Defective

Mand

Defective

Tact

4th test:

Tester

Defective

Scanning

Defective

Conditional

Discrimination

Failure to

Generalize

Weak

Motivators

Defective

Echoic

Defective

Imitation

Defective

VP-MTS

Defective

Listener

Defective

Intraverbal

Failure to Make

Eye Contact

Sensory

Defensiveness

Self-

Stimulation

Defective

Articulation

Obsessive-

Compulsive

Behavior

Hyperactive

Behavior

Response

Requirement

Weakens MO

Reinforcer

Dependent

Defective

Social Skills

Score

30

Date Color

4/27/09

Key:

Kyle

4/22/06

1st test:

2nd test:

3rd test:

VB-MAPP

• Barriers Assessment is helpful in developing

Initial Behavior Plan

VB-MAPP

• Transition Assessment

Help identify if the child I ready for school?

Ideal school setting for him/her?

Can he/she attend within Group?

How sociable they are with peers?

Does he/she exhibit any challenging problem behavior?

• The Carolina Curriculum for Infants and Toddlers and preschools with Special Needs.

o Communication 0-2.5y

Pre vocabulary/vocabulary

Imitation sounds and gestures

Response to communication from others

Conversation skills

o Communication 2.5y-5y

Expressive vocabulary

Receptive skills

Conversation skills

Sentence construction

Brigance Inventory of Early Development

Bayley scale

Bayley scale language

Receptive communication49 items that assess:

• pre-verbal behaviors

• vocabulary development

• vocabulary related to morphological development

• understanding of morphological markers

• items that measure children’s social referencing and verbal comprehension

Bayley scale language

expressive communication48 items that assess:

• pre-verbal communication:

• vocabulary development

• morpho-syntactic development

DIAL-4 (language)

1. Personal Information

2. Articulation

3. Objects and Actions (Expressive), Objects and Actions(Receptive)

4. Letters and Sounds (Alphabet Song, Letter Naming, Letter–SoundCorrespondence)

5. Rhyming and I Spy

6. Problem Solving

Sensory Motor Skills

Different Assessments of Sensory Motor Skills

I. Testing Muscles Tone

II. Functional Muscles Test

III. Manual Muscles Test

IV. PDMS-2 Peabody Developmental Motor Scale

V. Sensory Profile Care Giver Questioner

VI. Observation Based on the Sensory Integration Theory

VII. Clinical Observation

Testing Muscle Tone

• What is Muscle Tone

Muscle tone is the resistance offered by the muscle against stretch in resting condition

Functional Muscles Test

Manual Muscles

There are individual rates of growth and development.

“Developmental Milestones”

Are a set of functional skills that most of children can do at a specific time frame.

The actual age when

a normally developing

child reaches that

milestones can vary from

child to child

PDMS-2Peabody Developmental Motor

Scale6 subtests:

• Reflexes

• Stationary

• Locomotion

• Grasping

• Visual-Motor Integration

Observation Based on the Sensory Integration Theory