diss cover page

270 Pages·2012·12.68 MB·English

by  Sarah Dufek

UC San Diego
UC San Diego Electronic Theses and Dissertations
Title
Community practitioner utilization of evidence-based practice for assessment of autism
spectrum disorder
Permalink
https://escholarship.org/uc/item/7nb4m8ht
Author
Dufek, Sarah Anne
Publication Date
2013

Peer reviewed|Thesis/dissertation
eScholarship.org Powered by the California Digital Library
University of California
UNIVERSITY OF CALIFORNIA, SAN DIEGO

Community Practitioner Utilization of Evidence-based Practice for
Assessment of Autism Spectrum Disorder

A dissertation submitted in partial satisfaction of the requirements for the degree

Doctor of Philosophy

in
Psychology

by

Sarah Anne Dufek

Committee in Charge:
Laura Schreibman, Chair
Natacha Akshoomoff
Lauren Brookman-Frazee
Gail Heyman
James Kulik
Aubyn Stahmer

2013
Copyright

Sarah Anne Dufek, 2013

All rights reserved.
The Dissertation of Sarah Anne Dufek is approved, and it is acceptable in quality

and form for publication on microfilm and electronically:

Chair

University of California, San Diego

2013

iii
DEDICATION

For Bernard

iv
TABLE OF CONTENTS

Signature Page ……………………………………………………………… iii
Dedication …………………………………………………………………... iv
Table of Contents …………………...……………………………………..... v
List of Tables ………………………………………………………………. vii
List of Figures .………………………………………………………………. viii
Acknowledgements …………………………………………………………. x
Curriculum Vitae ……………………………...……………………………. xi
Abstract …….……………………………………………………………...... xvii
Introduction ………………………….……………………………………… 1
Autism Spectrum Disorder ………………………………………….. 2
Importance of Accurate ASD Assessment ....……………………….. 5
Evidence-based Practice for ASD Assessment ……………………… 7
Community Practice for ASD Assessment ………………………….. 13
ASD Assessment in the School Setting ……………………………… 16
Barriers to Practitioner Use of Evidence-based Practice …………….. 21
Current Investigation ………………………………………………… 27

Methods……….……………………………….……………………………… 29
Participants …………………………………………………………… 30
Design ……………………….………………………………………... 32
Setting and Materials…...……………………………………………… 32
Procedure ……………………………………………………………... 33
Measures ……………………………………………………………… 36

Results ……….……………………………….……………………………… 48
Aim 1: Characterization of usual care for ASD evaluation in the
school setting…………………….……………………………. 49
Aim 2: School psychologist attitudes and feasibility of use of the
ADOS and SCQ…………………….…………………………. 52
Aim 3. Influence of school psychologist utilization of the ADOS
and SCQ on school psychologists’ ASD evaluation process….. 58
v
Discussion ……………………………………….…………………………….. 64
School Psychologist Usual Care for ASD Evaluation…………………. 65
Feasibility of Adoption of EBP for ASD Evaluation in the
School Setting…………………….……………………………………. 68
Impact of EBP Use on ASD Evaluation in the School Setting………... 71
Limitations…………………….……………………………………….. 74
Future Directions…………………….…………………………………. 76

Tables ……….……………………………….………………………………… 80
Figures ……….……………………………….………………………………… 97
Appendices ……………………………………………………………………... 120
A. Diagnostic Criteria for Autistic Disorder…………………….………… 121
B. Diagnostic Criteria for Asperger’s Disorder……………….…………… 122
C. Student Recruitment Script……………….…………………………….. 123
D. ADOS Administration Cards- Module 1……………….………………. 124
E. ADOS Administration Cards- Module 2……………….………………. 128
F. ADOS Administration Cards- Module 3……………….……………..... 132
G. ADAPT Survey- Intake……………….………………………………… 135
H. ADAPT Survey- Exit……………….…………………………………... 148
I. EBPAS Questionnaire……………….…………………………………... 164
J. ADOS Module 1 Fidelity of Implementation Coding Definitions…….... 165
K. ADOS Module 1 Fidelity of Implementation Coding Checklist……….. 181
L. ADOS Module 2 Fidelity of Implementation Coding Definitions……… 185
M. ADOS Module 2 Fidelity of Implementation Coding Checklist………. 203
N. ADOS Module 3 Fidelity of Implementation Coding Definitions……… 209
O. ADOS Module 3 Fidelity of Implementation Coding Checklist………. 222
P. ADOS Fidelity of Implementation Checklist Rating Scale……………. 226
Q. ADOS Components Coding Module 1 Definitions……………………. 227
R. ADOS Components Coding Module 1 Checklist………………………. 228
S. ADOS Components Coding Module 2 Definitions…………………….. 229
T. ADOS Components Coding Module 2 Checklist………………………. 231
U. ADOS Components Coding Module 3 Definitions……………………. 232
V. ADOS Components Coding Module 3 Checklist…………………….... 234
W. ASD-Specific Behavior Checklist……………………………………… 235

References .……………………………………………………………………........ 238

vi
LIST OF TABLES
Table 1: ASD Types Summary…………………………………………………….. 81
Table 2: ADOS Module 1 Administration Tasks and Coded Items……………….. 82
Table 3: ADOS Module 2 Administration Tasks and Coded Items……………….. 83
Table 4: ADOS Module 3 Administration Tasks and Coded Items……………….. 84
Table 5: Sample of Items from the SCQ …………………………………………... 85
Table 6: School Psychologist Demographics ……………………………………… 86
Table 7: Components of the ADOS Clinical Training protocol …………………… 87
Table 8: Category Designations for Reported and Observed ASD Assessment
Practices. ………………………………………………………………….. 88

Table 9: Average Interobserver Agreement Percentages for ADOS FI Coding for
Individual Tasks of each ADOS Module………………………………….. 89

Table 10: Average Interobserver Agreement Percentages for ADOS Components
Coding for Individual School Psychologists…………...……………….. 90

Table 11: School Psychologist Educational Eligibility Classification for all Child
Participants………………………………………………………………. 91

Table 12: Reported Frequency vs. Observed Frequency of School Psychologist
Practice for Individual School Psychologists ..………………………….. 92

Table 13: Overall Percent Agreement Between School Psychologist Reported
Frequency of ASD Assessment Practices and Observed Frequency of ASD
Assessment Practices During Baseline and After EBP Training………… 94

Table 14: Overall Classification Agreement Between the ADOS and Autism
Educational Eligibility Classification Determined by the School
Psychologists……………………………………………………………… 95

Table 15: ADOS Components Utilized by School Psychologists During Baseline by
Module …………………………………………………………………… 96

vii
LIST OF FIGURES
Figure 1: Project Timeline…………………………………………………….. 98
Figure 2: SCQ Training Implementation Time Points………………………… 99
Figure 3: Percent of School Psychologists Responding “always” or “most of the
time” to the Use of Specific ASD Assessment Practices at Intake and Exit
on the ADAPT survey………………………………………………… 100

Figure 4: ASD Assessment Practices of the School Psychologists Observed During
Baseline and After EBP Training ……………………………………. 101

Figure 5: ASD-Specific Assessment Practices Used by School Psychologists During
Baseline and After EBP Training ……………………………………. 102

Figure 6: Evidence-Based Practices Attitudes Scale Scores at Intake and Exit… 103
Figure 7: Overall ADOS Fidelity of Implementation by Module………………... 104
Figure 8: Percent of ADOS Administrations where ADOS Tasks were Omitted by
Module…………………………………………………………………. 105

Figure 9: ADOS Fidelity of Implementation by Task Module 1………………… 106

Figure 10: ADOS Fidelity of Implementation by Task Module 2……………….. 107

Figure 11: ADOS Fidelity of Implementation by Task Module 3……………….. 108

Figure 12: ADOS Fidelity of Implementation: Overall ADOS Administration…. 109

Figure 13: Overall ADOS Coding Reliability…………………………………….. 110

Figure 14: Percent of ADOS Components Implemented Over Time…………….. 111

Figure 15: Total Assessment Time at Baseline and After EBP Training in Hours. 113

Figure 16: Source of ASD-Specific Behaviors Identified in ASD Evaluation Reports
Over Time………………………………………………………...……. 114

Figure 17: ASD-Specific Behaviors Identified By School Psychologists Over Time
…………………………………………………………………………... 115

viii
Figure 18: Type of ASD-Specific Behaviors Identified by School Psychologists Over
Time………………………………………………………………….. 117

Figure 19: Overall Child Autism Educational Eligibility Determined by School
Psychologists Over Time……………………………….…………… 118

Figure 20: Overall Child ASD Classification Determined by MADDSP Over Time
……………………………………………………………………… 119

ix