Download Access policy practice advice: Autism Spectrum Disorder (doc 267.5

Access Policy Practice Advice: Autism
Spectrum Disorder
October 2011 (Version 2)
Department of Human Services
Contents
Purpose of the guide ........................................................................................................... 3
Part One ............................................................................................................................. 4
What is Autism Spectrum Disorder? ................................................................................ 4
How do we know someone has ASD?............................................................................. 5
Who can make a diagnostic assessment of ASD? .......................................................... 5
Complex presentations of ASD ....................................................................................... 6
Formal assessment tools in relation to ASD that may be used in diagnostic reports ....... 7
Part Two ............................................................................................................................. 8
Key issues to consider that can make determining whether a person with ASD is
within the target group for Disability Services difficult. ..................................................... 8
Part Three ......................................................................................................................... 10
Determining if a person with ASD is within the target group for disability services ......... 10
(i) Is ASD “permanent, or likely to be permanent”? .................................................... 10
(ii) Is there evidence of “a substantially reduced capacity in at least one of the
areas of self-care, self-management, mobility or communication? ...................... 10
(iii) Does the individual require “significant ongoing or long term episodic support”? . 19
(iv) Is the impairment “related to ageing”? ................................................................ 20
Appendix A Autism assessment tools ............................................................................. 21
Appendix B Adaptive Behaviour Measures ..................................................................... 25
Appendix C Behaviour Measure ...................................................................................... 30
Appendix D Eligibility for Medicare Rebate to access diagnosis and treatment ............... 31
Appendix E Useful contacts ............................................................................................ 32
Appendix F Recommended reading and resources ......................................................... 33
Access Policy Practice Advice: Autism Spectrum Disorder (Version 2)
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Purpose of the guide
The Victorian Government acknowledged Autism Spectrum Disorder (ASD) as a neurological impairment under
the Disability Act 2006 (the Act) in December 2008. This has allowed all people with ASD to be considered for
access to disability services.
In order for a person with ASD to be considered as within the target group for disability services under the Act,
the associated impact of the person’s ASD must be considered.
The purpose of this guide is to help Department of Human Services staff, and staff in community service
organisations, to determine whether a person is within target group to receive services as outlined in the Act.
This guide has been divided into three parts:
Part One
This section details what is meant by ASD and how it is diagnosed.
Part Two
This section highlights the key issues that can make determining whether a person with ASD is within the target
group for Disability Services difficult.
Part Three
This section has been designed to assist staff to gather the information required to determine if the person with
ASD is within the target group for disability services. In particular, guidance is provided regarding the associated
impact of the ASD and where information regarding these impacts can be found.
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Part One
What is Autism Spectrum Disorder?
Autism Spectrum Disorder (ASD) is the term used to describe a continuum or spectrum of neurological
conditions characterised by marked impairments in
-
social interaction
-
communication
-
restricted repetitive patterns of behaviours, interests, and activities.
Although individuals with ASD have core commonalities, they also can have a range of presentations within
these core areas. This is one of the reasons that the condition is referred to as a continuum or spectrum.
Autism Spectrum Disorder (ASD) encompasses:
1. Autistic Disorder
2. Asperger’s Disorder
3. Pervasive Developmental Disorder Not Otherwise Specified

Autistic Disorder
The diagnostic criteria for Autistic Disorder are:
(1) qualitative impairment in social interaction,
(2) qualitative impairment in communication, and
(3) restricted repetitive and stereotyped patterns of behaviour, interests, and activities,
with onset prior to 3 years of age.
“High Functioning Autism” is another term that is sometimes used. Generally this diagnosis is used to refer to
children diagnosed with Autistic Disorder who have delayed language but who later develop language and who
have overall intellectual ability above 65-70 on a standardised intelligence test.

Asperger’s Disorder
The diagnostic criteria for Asperger’s Disorder are:
(1) qualitative impairment in social interaction, and
(2) restricted repetitive and stereotyped patterns of behaviour, interests, and activities.
These criteria are also criteria for Autistic Disorder. However, the criteria for Asperger’s Disorder do not include
the criterion that there is qualitative impairment in communication. The criterion for Asperger’s Disorder is that
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there is no clinically significant general delay in language. However, individuals with Asperger’s Disorder do
have difficulty with social language. This is sometimes referred to as pragmatic language difficulties.
Further criteria for Asperger’s Disorder are that there is no clinically significant delay in cognitive development or
in the development of age-appropriate self-help skills, adaptive behaviour (other than in social interaction), and
curiosity about the environment in childhood. However, there is debate in relation to the criterion of there being
no significant delay in self-help skills and adaptive behaviour for the diagnosis of Asperger’s Disorder. This
guide recommends that difficulty with self-help skills and adaptive behaviour should be considered as a
presentation of Asperger’s Disorder.

Pervasive Developmental Disorder Not Otherwise Specified
Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) is a diagnostic category that can be
used when an individual demonstrates severe impairment in social interaction but not enough clear signs in
relation to communication impairment or repetitive behaviours for the diagnosis of Autistic Disorder or
Asperger’s Disorder.
How do we know someone has ASD?
The first step for the disability intake worker is to confirm that a client has a diagnosis of ASD and that this has
been adequately confirmed.
Given that ASD is a developmental condition, there will have been evidence of the condition in the individual’s
early development. Usually a diagnosis of ASD will have been made some time in the individual’s childhood but
this is not always the case.
Who can make a diagnostic assessment of ASD?
The assessment of an individual with ASD should involve a team of medical and allied health professionals
knowledgeable in the diagnosis of ASD. The multi-disciplinary team usually comprises of a paediatrician and/or
a child psychiatrist, a psychologist, and a speech pathologist. These are the ‘core disciplines’ that represent the
skills necessary to address the diagnostic criteria; however, in some teams an occupational therapist may also
be included.
Team assessment does not necessarily mean that a group of service providers must work in the same agency,
but it does reflect that ‘collaboration’ is necessary between the professionals. However, in some cases team
assessment may not be necessary. For example, if a verbally able adult seeks assessment from a psychiatrist
or psychologist very knowledgeable in the field it may not be necessary for a language assessment to be
sought. The guiding principal is that a team assessment should be sought if possible and that all professionals
involved should have had wide experience in autism assessment. Where a diagnostic assessment is provided
from only one practitioner it is recommended that additional information is sought as to why this is the case and
whether broader assessment is required.
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A diagnostic report may be prepared as a single collaborative report or prepared individually by team members;
however, the report should reflect team member’s opinion. Report/s need to include a detailed developmental
history, intellectual assessment, and specific ASD assessment. It is also very helpful if the report includes
assessment of the individual’s adaptive behaviour, but this may not always be included in a diagnostic report. If
a detailed collaborative diagnostic report is not available to the disability intake worker then this may need to be
sought.
Complex presentations of ASD
As mentioned, sometimes an individual will not have been diagnosed in childhood and a diagnosis is not made
until later in childhood, in adolescence, or even sometimes in adulthood. The most likely reason for late
diagnosis is that the individual had been diagnosed previously with a developmental condition frequently
associated with ASD (for example, Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, or
Tourette’s Disorder), and their ASD has been overlooked. Sometimes the individual has been misdiagnosed
earlier, or sometimes the individual may have both conditions (e.g. ASD and Attention Deficit Hyperactivity
Disorder). If a diagnosis of ASD is made later in a person’s life, developmental information from earlier in the
person’s life still needs to be gathered by the clinicians involved in diagnosis and be evident in the assessment
report.
It is also possible that a mental health diagnosis (such as Schizophrenia, or Obsessive Compulsive Disorder)
could have been given to a young adult or adult but ASD is later diagnosed. This can occur if a previous
clinician was focussed on the client’s present presentation and did not look adequately at the client’s early
developmental history. Again, it is possible that a previous misdiagnosis was made or that the client actually
has both conditions.
These are difficult issues in relation to a client and disability intake workers may need to seek further
assessment or opinion from a psychologist or psychiatrist who is knowledgeable in regard to ASD and complex
presentations.
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Formal assessment tools in relation to ASD that may be used in diagnostic reports
There are a number of well-standardised assessment tools with demonstrated reliability and validity that can be
used in a diagnostic assessment. Sometimes assessment may include the use of a tool that can screen for the
possibility of ASD (e.g. the Developmental Behaviour Checklist Early Screen (DBC-ES) and the Developmental
Behaviour Checklist Autism Screening Algorithm (DBC-ASA), Autism Spectrum Screening Questionnaire
(ASSQ), the Australian Scale for Asperger’s Syndrome (ASAS). However, if a screening assessment tool has
indicated the possibility of ASD follow-up diagnostic assessment is still needed.
The following diagnostic
assessment tools are frequently used:
Diagnostic Assessment Tool
Age Range Applicability
Autism Diagnostic Interview- Revised (ADI-R)
Early childhood to adult
Autism Diagnostic Observation Schedule (ADOS)
Early childhood to adult
Diagnostic Interview for Social and Communication
Disorders (DISCO)
Childhood Autism Rating Scale, Second Edition
Early childhood to adult
Early childhood to adult
(CARS-2)
Psycho-Educational Profile - Third Edition (PEP- 3)
Infants 6 months to 7 years of age
Autism Spectrum Rating Scale (ASRS)
2 to 18 years of age
Social Responsiveness Scale (SRS)
4 to 18 years of age
More detailed information about these measures is given in Appendix A.
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Part Two
Key issues to consider that can make determining whether a person with ASD is
within the target group for Disability Services difficult.
Individuals with ASD have a range of abilities across various areas, as well as additional conditions commonly
associated with ASD. This variation can make it difficult for disability workers to determine whether a person
with ASD meets the criteria set out in the Act. Given the possible variation in presentation, the following points
should be kept in mind:

Individuals with ASD have a range of intellectual ability.

Average or near-average intellectual ability does not mean that the individual has similarly average or
near-average adaptive behaviour.

Individuals with ASD have a range of language ability.

An individual with ASD can have receptive and/or expressive language deficits even if their intellectual
ability is not low overall. However, in this case, their intellectual profile on a formal assessment will
indicate poor verbal skills as part of a scale or index score.

When verbal skills appear intact, individuals with ASD will have ‘pragmatic’ language deficits. These
are deficits in the ability to engage in language for social purposes.

Average or near-average intellectual ability does not mean that the individual has similarly average or
near-average literacy or numeracy ability. The individual may have a Specific Learning Disability in
relation to literacy and/or numeracy ability and may demonstrate very low skills in these areas. It is also
important to realise that an individual can have marked deficits in relation to literacy skills even if they
appear to have quite good oral verbal language skills.

Individuals with ASD vary in their auditory memory ability. Only part of an individual’s intellectual ability
profile will indicate their verbal (auditory) memory ability. It is important to identify if an individual has
deficits in verbal memory as these deficits can have a profound affect on an individual’s everyday
functioning ability.

Individuals with ASD have executive functioning deficits; however, the severity of executive functioning
deficits can vary in different individuals. Executive functioning is a term used to describe a collection of
processes mediated by the frontal lobes of the brain.
These skills include the ability to initiate
behaviour, to plan and organise, and to shift problem solving strategies flexibly, when necessary. Such
skills are required in many daily living skills.
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
Most individuals with ASD have sensory processing difficulties; however, the range and severity will
vary. Sensory processing difficulties may have an impact on the individual’s ability to perform some
adaptive tasks.

Individuals with ASD can also have a number of additional difficulties. It has been found that ASD can
frequently co-occur with mental health issues.
One of the main areas of additional difficulty for
individuals with ASD is in relation to anxiety and depression.
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Part Three
Determining if a person with ASD is within the target group for disability services
The Disability Act 2006 defines disability as follows:
Disability in relation to a person meansa) a sensory, physical or neurological impairment or acquired brain injury or any combination thereof, which –
i)
is, or is likely to be permanent; and
ii)
causes a substantially reduced capacity in at least one of the areas of self-care, selfmanagement, mobility or communication; and
iii)
requires significant ongoing or long term episodic support; and
iv)
is not related to ageing; or
b) an intellectual disability; or
c) a developmental delay.
ASD is considered to be a neurological impairment within the definition above. Individuals with ASD must
therefore meet the four criteria (a) i – iv) to be considered as having a disability in accordance with the Disability
Act 2006. This section of the guide focuses on determining if a person with ASD meets these criteria.
(i) Is ASD “permanent, or likely to be permanent”?
Yes. ASD is identifiable as development unfolds during the first years of a person’s life or in the person’s early
childhood.
For this reason ASD is sometimes called a neuro-developmental disability.
An unusual
developmental pattern is manifest in cognitive and behavioural differences throughout the person’s life. The
neurological impairment may change in expression over the course of the person’s life but the underlying
neurological impairment is permanent. For this reason a diagnosis of ASD that is made early in a child’s life is
still a reliable indication of the disability being present throughout their life.
(ii) Is there evidence of “a substantially reduced capacity in at least one of the areas of self-care,
self-management, mobility or communication?
For each of these areas of adaptive behaviour questions which may help to determine whether an individual
with ASD has substantially reduced capacity are provided.
Key point:
It is important to note that it may not be possible to determine the adaptive behaviour skills of an individual with
ASD simply by asking the individual to answer questions. The individual with ASD may not fully understand the
question, or they may answer as they think they should.
In such cases, it is necessary to determine the
adaptive behaviour skills of the individual by using and adaptive behaviour assessment tool, and preferably
gathering this information from multiple sources (e.g. the individual, a teacher, and a parent/carer who knows
the individual well).
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In addition, if previous information from an adaptive behaviour assessment is relied upon to determine if an
individual with ASD has substantially reduced adaptive behaviour skills, it is suggested that the
assessment/report should not be more than two years old, given that adaptive behaviour skills can change over
time.
There are a number of well-standardised adaptive behaviour measures with demonstrated reliability and validity
that can be used by clinicians working with individuals with ASD. All clinicians using the assessment tool need
to have had appropriate training in its use. The following adaptive behaviour measures are commonly used:
Adaptive Behaviour Measure
Adaptive Behaviour Assessment System – Second
Age Range Applicability
Birth to 89 years
Edition (ABAS-II)
Scales of Independent Behaviour – Revised (SIB-R)
Early infancy to beyond 80 years
Vineland Adaptive Behaviour Scales, Second Edition
Birth to 90 years
(Vineland-II)
Each of these assessment tools provides standard scores and percentile ranks in particular areas of adaptive
behaviour for the individual being assessed. Sometimes adaptive levels are given in terms of an age score and
these can be helpful in giving an idea of the ability of the individual to tackle age level tasks, but they do not, in
themselves, indicate whether the individual’s ability is substantially reduced in terms of statistical norms based
on chronological age expectations.
Key point:
The adaptive behaviour of the individual is defined as being “substantially reduced” if the standard score or
percentile rank is at least two standard deviations below the mean. Standard scores in each of these tests have
a mean of 100 and a standard deviation of 15, so a standard score of 70 or below shows substantially reduced
adaptive behaviour.
However, it needs to be noted that in adaptive assessments, standard scores are given in terms of overall (or
global) adaptive behaviour AND in terms of specific adaptive areas. Therefore, someone’s overall adaptive
behaviour could be assessed as being at a standard score of above 70 and not substantially reduced overall,
but still be lower than 70 and ‘substantially reduced’ in one or more of the specific areas of self-care, selfmanagement, communication, and mobility.
Relevant sections of adaptive behaviour measures are referred to under adaptive behaviour category below.
More detailed information about these measures is given in Appendix B.
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Self-care
One of the main cognitive problems that individuals with ASD have is in relation to executive functioning skills.
These skills include the ability to initiate behaviour, the ability to plan and organise, and the ability to shift
problem solving strategies flexibly when necessary. Such skills are required in many daily living skills (e.g.
planning what to buy from the supermarket to prepare a meal or organising how to prepare and cook the
different parts of the meal).
In addition, an individual with ASD has neurological deficits in social understanding. This means that they may
not have the same social motivation to perform self-care tasks as other individuals. Accordingly, it has been
found that individuals with ASD have markedly lower levels of adaptive behaviour than predicted by their
intellectual ability.
In determining a person’s capacity in self-care (and other areas of functioning) one has to work out to what
extent the individual is able to complete an activity (i.e. minimally, partially, or fully) if they were to receive no
prompting or help. One may also need to determine what form of prompting has been tried (i.e. verbal or visual
prompts).
The following questions are examples of the sort of questions asked in adaptive behaviour measures of selfcare. The questions pertain to a range of developmentally sequenced abilities. However, in order to determine
whether an individual with ASD has a substantially reduced capacity in self-care compared with other individuals
of a similar age one needs to use a standardised measure.
-
Is the individual able to cut food with a knife to eat appropriately sized pieces?
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Is the individual able to prepare a simple uncooked snack?
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Is the individual able to plan and organize purchasing the food they need to prepare meals? Do they
prepare simple cooked foods for themselves?
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Do they manage left over food hygienically?
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Do they complete domestic duties frequently enough to maintain a hygienic environment?
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What is their level of independence in relation to all toileting tasks?
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Are they able to fully dress themselves independently?
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Do they wear clothing appropriate for the weather?
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Do they maintain a neat appearance? How often do they wash their clothes?
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Are they able to bathe or shower without assistance?
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How often do they bathe or shower themselves? Is basic hygiene maintained? Is body odour a problem?
-
Do they care for their basic health needs (e.g. selecting and buying personal care items such as soap,
shampoo, bandaids)?
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Do they make an appointment to see a health professional (e.g. doctor, dentist) if this is necessary?
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Key point:
It is possible that the individual will say that they can do something when they do not actually do it. While the
person may know that it is something that they should do, they may find it difficult to initiate or to plan and
organise doing it. They also may not have the social motivation to do it, and may be more drawn to undertaking
a preferred repetitive behaviour. In such cases it is necessary to consider the relevant sections of an
assessment based on an adaptive behaviour measure and to determine what they actually do.
Relevant sections of adaptive behaviour measures are as follows:
-
SIB-R
In the SIB-R, self-care skills are assessed in the Personal Living Skills cluster which consists of the subscales of
Eating and Meal Preparation, Toileting, Dressing, Personal Self-Care, and Domestic Skills. The standard score
and percentile rank is given for the whole Personal Living Scales cluster (mean of 100 and standard deviation of
15). In the SIB-R the cluster Personal Living Skills is made up of subscales that are all relevant indicators of
overall self-care skills. A standard score of 70 or below indicates substantially reduced self-care capacity. Refer
to Appendix B for further details about a number of additional scores given in the SIB-R.
-
Vineland-II
In the Vineland-II, self-care skills are assessed in the Personal and Domestic sub-domains within the Daily
Living Skills domain. The Daily Living Skills domain is reported as a standard score (mean of 100 and standard
deviation of 15) so a standard score of 70 or below in the Daily Living Skills domain is a good indicator of
substantially reduced self-care capacity.
The individual’s capacity in the sub-domains of ‘Personal’ and
‘Domestic’ are particularly relevant to an individual’s self-care capacity and can also be looked at. The subdomains are reported as a v-Scale Score (mean of 15 and standard deviation of 3) so a score of 9 or lower
indicates substantially reduced capacity. Further details are in Appendix B.
-
ABAS-II
In the ABAS-II, self-care skills are assessed within the Practical composite domain and particularly in the subdomains of Self-care, Home Living, and Health and Safety. In the ABAS-II the composite domain scores are
reported as having a mean standard score of 100 and a standard deviation of 15, so a standard score of 70 or
below in the Practical composite score is a good indicator of substantially reduced self-care capacity. The
individual’s capacity in the sub-domains of ‘Self-care’, ‘Home Living’, and ‘Health and Safety’ are particularly
relevant to an individual’s self-care capacity and can also be looked at. The sub-domains have a mean of 10
and a standard deviation of 3, so a score of 4 or lower indicates substantially reduced self-care capacity.
Further details are in Appendix B.
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Self-management
As individuals with ASD have a deficit in executive functioning skills, they can have reduced capacity in relation
to self-management (e.g. they may have difficulty planning an everyday task such as keeping an appointment).
They can also have a range of other difficulties that impinge on self management skills. For example, it is not
uncommon for individuals who have ASD to have sleep difficulties and to not have regular sleep patterns. This
in turn may affect their capacity to get to work on time.
Unexplained decreases in self-management and other everyday living skills over time may be indicators of
behavioural and emotional disturbance increasing. It has also been found that individuals with ASD who do not
have an intellectual disability have an even higher likelihood of behavioural and emotional disturbance. This may
be explained by assuming that these individuals have a greater understanding that they are having difficulty
managing in social situations.
The following questions are examples of the sort of questions asked in adaptive behaviour measures of selfmanagement. The questions pertain to a range of developmentally sequenced abilities. However, in order to
determine whether an individual with ASD has a substantially reduced capacity in self-management skills
compared with other people of a similar age one needs to use a standardised measure.
-
Is the individual able to read?
-
Does the individual have an understanding of numbers and are they able to make simple calculations?
-
Does the individual have an understanding of the concept of time?
-
Does the individual refer to a clock and use a calendar?
-
Is the individual able to manage getting to bed by a certain time so that they can get up at an appropriate
time the next day to fulfil responsibilities?
-
Does the individual have difficulty with any aspects of memory? Does the individual manage their daily
affairs through the use of a diary or other form of planner?
-
What level of independence is possible in terms of making appointments that are necessary (e.g. seeing a
doctor)?
-
Is the individual able to recognise money denominations?
-
Does the individual have an understanding of the function of money?
-
Does the individual understand the value of money and the need to budget?
-
What level of financial management of the household is possible? Is the individual able to manage the
household in terms of paying bills on time?
-
What level of independence is possible in terms of getting to work? Can the individual get to work and
other appointments on time?
-
How does the person manage with unexpected changes in their routines or plans?
-
To what extent is the individual able to regulate their emotions?
-
To what extent is the individual able to independently weigh the consequences of their actions before
making decisions?
-
Does the individual have realistic long-term plans?
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Key point:
It may not be possible to determine the individual’s self-management skills simply by observing the individual in
one setting. That particular setting may have relatively little social or sensory difficulty for them. In such cases it
is necessary to consider the relevant sections of an assessment based on an adaptive behaviour measure and
to gather information from multiple sources about their self-management ability in a variety of settings.
Relevant sections of adaptive behaviour measures are as follows:
-
SIB-R
In the SIB-R, self-management skills are assessed in the Community Living Skills cluster which consists of the
following sub-domains: Time and Punctuality, Money and Value, Work Skills, and Home/Community Orientation.
In the SIB-R the cluster Community Living Skills is made up of subscales that are all relevant indicators of
overall self-management skills. A standard score and percentile rank is given for the whole Community Living
Skills cluster (mean of 100 and standard deviation of 15). A standard score of 70 or below indicates
substantially reduced self-management capacity. Self-management skills are also assessed in the Problem
Behaviour Scale in the SIB-R. This scale assesses problem behaviours that are linked to poor personal and
social adjustment. In addition, information about maladaptive behaviour can also be obtained from the SIB-R
which may be helpful in relation to evaluating self-management capacity.
-
Vineland-II
In the Vineland-II, self-management skills are assessed in the Community sub-domain, which is part of the Daily
Living Skills domain. The Daily Living Skills domain is reported as a standard score (mean of 100 and standard
deviation of 15), but the sub-domain ‘Community’ is the most relevant to self-management capacity. A subdomains is reported as a v-Scale Score (mean of 15 and standard deviation of 3) so a score of 9 or lower
indicates substantially reduced capacity. Problem behaviours are assessed in the Maladaptive Behaviour Index
in the Vineland-II. An understanding of the level of problem behaviours would also be relevant in evaluating selfmanagement capacity.
-
ABAS-II
In the ABAS-II, self-management skills are assessed in the following subtests: within the Practical domain:
Community Use (if age appropriate), and Work Skills (if employed) as well as within the Conceptual domain in
the subtest Self-Direction. In the ABAS-II the composite domain score for ‘Practical’ and ‘Conceptual’ are
reported as having a mean standard score of 100 and a standard deviation of 15, however, the sub-domains
‘Community Use’, ‘Work Skills’ and ‘Self-Direction’ are the most relevant in evaluating self-management
capacity. The sub-domains have a mean of 10 and a standard deviation of 3, so a score of 4 or lower indicates
substantially reduced self-management capacity.
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Key point:
A disability worker may also need to ascertain if the individual with ASD has reduced self-management skills
substantially caused by their ASD or by an additional layer of behavioural and emotional disturbance that may
be seen as a mental health issue. This is difficult to determine but if the behavioural and emotional disturbance
seems substantial then working in cooperation with a mental health service may also be required.
A useful assessment tool to determine the associated, emotional, behavioural, and mental health issues that
individuals with ASD are at risk from suffering is the Developmental Behaviour Checklist (Einfeld & Tonge,
1992, 1995, 2002, in the form completed by parents/carers, DBC-P; the form completed by teachers, DBC-T;
and the form for adults, DBC-A). Further details are in Appendix C.
For information on local mental health service see Appendix E.
Mobility
Gross and fine motor difficulties, as well as difficulty with balance, can occur in individuals with ASD. Some
studies point to the prevalence of motor difficulties in higher functioning individuals who have ASD. Generally
these difficulties do not have major effects, but they can have minor effects in terms of general clumsiness,
sporting ability, and ability to ride a bicycle. Some individuals also have difficulty in terms of hand-writing ability.
If gross and fine motor difficulties are marked, then assessment by an Occupational Therapist is recommended
to precisely determine mobility function.
An individual’s capacity to move about outside the home may also be affected for other reasons than motor
skills. For example, some individuals with ASD have difficulty driving due to a number of factors such as the
high level of concentration needed and the multi-tasking required. In addition, individuals with ASD frequently
have difficulty in unfamiliar settings.
The following questions are examples of the sort of questions asked in adaptive behaviour measures of mobility.
The questions pertain to a range of developmentally sequenced abilities. However, in order to determine
whether an individual with ASD has a substantially reduced capacity in mobility skills compared with other
people of a similar age one needs to use a standardised measure.
-
Is the individual able to walk, manage stairs, hop, run, and climb ably?
-
Is the individual able to hand-write legibly?
-
Is the individual able to carry objects (e.g. grocery items) safely?
-
Is the individual able to ride a two-wheeler bicycle?
-
Is the individual able to drive?
-
Is the individual able to manage public transport?
-
Is the individual able to safely move about in the community?
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-
Are there marked additional complicating factors that hinder the individual’s mobility in the community
(e.g. are they able to manage in unfamiliar settings?)
-
Is the individual able to hammer and/or manage basic household repairs?
-
Does the individual receive support from an Occupational Therapist?
Relevant sections of adaptive behaviour measures are as follows:
-
SIB-R
In the SIB-R, gross and fine motor skills are assessed for all ages.
-
Vineland-II
In the Vineland-II, motor skills are only assessed for children who are under 6 years and 11 months, but there is
a procedure to estimate motor skill in individuals who are over this age.
-
ABAS-II
In the ABAS-II, motor skills are not assessed.
Communication
Some individuals with ASD who do not have an intellectual disability have receptive and/or expressive language
difficulties. However, generally individuals with ASD who do not have an intellectual disability have more subtle
pragmatic (social) language difficulties. For example, they may have difficulty in being able to ask for help and in
using language appropriately to support social interaction. They may also tend to understand language literally.
The pragmatic language difficulties may also include lacking interest in communicating, and failing to
understand the significance of communicating. They may also have difficulty understanding the non-verbal
aspects of communication. In any of these ways, their language interactions may fail to be effective and
mutually engaging.
Social communication also involves having an understanding of what others are thinking (theory of mind ability)
so that one can truly communicate. However, individuals with ASD have difficulty with theory of mind skills.
Therefore, in evaluating the communication of higher functioning individuals who have ASD, one has to not
simply evaluate spoken language. Rather one needs to evaluate the capacity of the individual who has ASD for
social communication.
The following questions are examples of the sort of questions asked in adaptive behaviour measures of
communication skills. The questions pertain to a range of developmentally sequenced abilities. However, in
order to determine whether an individual with ASD has a substantially reduced capacity in communication skills
compared with other people of a similar age one needs to use a standardised measure.
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-
Can the individual indicate verbally if they want something or don’t want something?
-
Does the individual say ‘please’, ‘thank-you’, ‘hello’ and ‘good-bye’ when appropriate?
-
Can the individual relate simple experiences and/or initiate conversations?
-
Can the individual seek clarification if they have not understood an instruction or request?
-
Does the individual read and understand written material appropriate for their age?
-
Can the individual answer a telephone and write down a message if necessary?
-
Can the individual follow an instruction with multiple parts?
-
Can the individual ask for help?
-
Can the individual look up needed information or seek out an appropriate person to ask for help from (e.g.
can they ask for something to be repaired)?
-
Does the individual participate appropriately in social situations?
-
Does the individual have friends and other meaningful relationships?
-
Can the individual maintain relatively amiable relationships in a work environment?
Relevant sections of adaptive behaviour measures are as follows:
-
SIB-R
In the SIB-R, communication skills are assessed in the cluster Social Interaction and Communication Skills with
the subtests of Social Interaction, Language Comprehension, and Language Expressive. The standard score
and percentile rank is given for the whole Social Interaction and Communication Skills cluster (mean of 100 and
standard deviation of 15). In the SIB-R this cluster is made up of subscales that are all relevant indicators of
overall communication ability. A standard score of 70 or below indicates substantially reduced communication
capacity.
-
Vineland-II
In the Vineland-II, communication skills are assessed in two domains. These are the Communication domain
which includes the sub-domains of Receptive, Expressive, and Written skills. They are also assessed in the
Socialization domain in the sub-domains Interpersonal Relationships, Play and Leisure time, and Coping Skills.
The domain scores are reported as a standard score (mean of 100 and standard deviation of 15), so a standard
score of 70 or below in the Communication domain is a good indicator of substantially reduced communication
capacity. A standard score of 70 or below in the Socialization domain may also indicate that poor skills in this
area are related to poor communication skill capacity. The individual’s capacity in each of the relevant subdomains can also be looked at. The sub-domains are reported as a v-Scale Score (mean of 15 and standard
deviation of 3) so a score of 9 or lower indicates substantially reduced capacity in that particular area.
-
ABAS-II
In the ABAS-II, communication skills are assessed within the Conceptual domain in the sub-domains of
Communication, and Functional Academic skills, as well as within the Social domain in the sub-domains Leisure
Skills and Social Skills. In the ABAS-II the composite domain score for ‘Conceptual’ and ‘Social’ are reported as
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having a mean standard score of 100 and a standard deviation of 15, so a standard score of 70 or below in
these domains is an good indicator of substantially reduced communication capacity. In particular, the subdomains ‘Communication’, and ‘Functional Academic skills’, ‘Leisure Skills’, and ‘Social Skills’ are the most
relevant in evaluating communication capacity. The sub-domains have a mean of 10 and a standard deviation of
3, so a score of 4 or lower indicates substantially reduced communication capacity in those particular areas.
(iii) Does the individual require “significant ongoing or long term episodic support”?
This assessment is similar for all people with a disability and requires an estimation of direct support needed in
relation to adaptive behaviour and maladaptive behaviour levels, taking into consideration the network of family
and community support already provided for the individual.
The following questions may be asked, where age appropriate, to assist in determining whether an individual
with ASD requires “significant ongoing or long term episodic support”:
-
Is the individual who has ASD currently receiving support?
-
Who is providing this support (i.e. family, friends, and/or services)? How long has this support been
provided for?
-
What sort of support is being provided? Has the individual previously requested support from any other
provider?
-
Have the individual’s support needs changed? If there has been a change, is there a known reason for
this change?
-
Is the individual socially vulnerable? Are there any safety issues or is the person at risk in some way?
-
Are there teaching programs that could skill the individual and reduce the risks for the individual?
-
Is the type of support being provided adequate?
-
Is the frequency of the support adequate?
-
Is there a need for more intense support?
Relevant sections of adaptive behaviour measures are as follows:
-
SIB-R
The SIB-R Support Score is a helpful objective measure of the level of ongoing support needed for an
individual.
This measure is based on the assessed individual’s adaptive behaviour and their maladaptive
behaviours.
-
Vineland-II
The Vineland-II (2005) does not provide a similar measure but adaptive behaviours difficulties and maladaptive
behaviours are both able to be assessed and a judgement made by the clinician.
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ABAS-II
-
The ABAS-II also requires the assessor to make a judgement about overall support needs from the given
scores.
(iv) Is the impairment “related to ageing”?
When a request to access disability services is made by, or on behalf of, a person who is aged 65 or above and
who has been diagnosed as having ASD, it is necessary to determine if their support needs are a direct result of
their age or of their ASD.
To answer this question a disability intake worker needs to determine if the areas of adaptive behaviour concern
are new or if they presented earlier in the person’s history (in some form).
In general new areas of adaptive behaviour concern will relate to the person’s age rather than the ASD.
The following questions may be asked, where age appropriate, to assist in determining whether the impairment
is related to ageing rather than having ASD:
-
At what age did the individual first present with the adaptive behaviour concern?
-
Did the adaptive behaviour concern present earlier in the individual’s life in some other way?
-
Is the adaptive behaviour concern typical of individuals with ASD?
-
Is the adaptive behaviour concern typical of individuals of a similar age?
-
Has the individual (or their carer) previously approached an aged care provider for support?
-
Would an aged care service be better able to manage the individual’s concerns?
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Appendix A Autism assessment tools
1. Autism Diagnostic Interview- Revised (ADI-R; Rutter, LeCouteur, & Lord, 2003)
The ADI-R is an extended interview that consists of questions focussing on three domains: Language/
Communication; Reciprocal Social Interactions; and Restricted and Repetitive Behaviours.
This assessment tool can be used to assess individuals from early childhood to adulthood who have a mental
age of at least two years. The only proviso is that care needs to be taken with the assessment of very young
children as children with Asperger’s Disorder may not demonstrate behavioural symptoms until they are older.
The interviewer records and codes the interview responses. Diagnostic algorithms can then be used to
determine the presence or not of ASD. Only one score is generated to determine if the individual has ASD or
not. There are not specific algorithms for the different diagnostic categories. A current behaviour algorithm can
also be generated to help with treatment and /or educational planning.
This assessment tool and the generated algorithm cut-off scores are considered to be valid and reliable
(Goldstein, Naglieri, & Ozonoff, 2009).
However, it is important to note the difference between an ADI-R
algorithm result and a clinical diagnosis. A clinical diagnosis is based on multiple sources of information,
including all testing results, and direct observation.
2. Autism Diagnostic Observation Schedule (ADOS; Lord, Rutter, DiLavore & Risi, 2002)
This assessment tool is suitable for assessing individuals from early childhood to adult age. It is a semistructured assessment of communication, social interaction, and play abilities. Assessment occurs through
observation of structured situations, through conversation, and through interview questions. The assessment
varies according to the individual’s expressive language ability. Module 1 is used for individuals who are preverbal or at single word language level. Module 2 is used for individuals who are able to use phrase speech.
Model 3 is used for children or adolescents who are verbally fluent. Module 4 is used for verbally fluent
adolescents or adults.
Separate algorithms are used for the interpretation of each module. On the basis of the cut-off scores a
diagnostic distinction is made between the individual having Autism or Pervasive Developmental Disorder Not
Otherwise Specified (PDD-NOS). The algorithms do not have a specific Asperger’s Disorder cut-off. However,
individuals with Asperger’s Disorder are likely to satisfy either the algorithm for Autism or the algorithm for PDDNOS.
This measure is considered to be valid and reliable (Goldstein, Naglieri and Ozonoff, 2009).
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3. The Diagnostic Interview for Social and Communication Disorders (DISCO; Wing, 1994)
The Diagnostic Interview for Social and Communication Disorders (DISCO, Wing, 1994) is an extensive
interview with a child’s parents. This interview consists of nearly 500 questions and provides details about the
child’s development and about a wide range of behaviours which have ever or currently been observed from
infancy upwards. This assessment tool can be used to assess individuals from early childhood to adult age.
The diagnosis of a specific social and communication disorder is made on the basis of the parent’s responses
through use of diagnostic algorithms in the DISCO manual. Algorithms are available for diagnosing each of the
Pervasive Developmental Disorders listed in DSM-IV-TR and ICD-10 including Autistic Disorder/Childhood
Autism and Asperger’s Disorder/Asperger’s Syndrome. A particular algorithm also identifies the more general
diagnosis of Autism Spectrum Disorder. Other algorithms are available for diagnosing other disorders.
4. The Childhood Autism Rating Scale, Second Edition (CARS 2; Schopler et al., 2010)
The Childhood Autism Rating Scale (CARS; Schopler, Reichler, & Renner, 1988 and CARS 2; Schopler et al.,
2010) is a behaviour scale developed to help identify children with autism and varying degrees of the disorder.
The earlier version of the CARS was helpful in assessing individuals from early childhood to elementary and
primary school age. The new CARS 2 is good for the younger age range but is now more versatile for a wider
age range and is suitable for all age ranges. The CARS 2 includes the CARS 2-ST (the original CARS) and the
new CARS 2-HF.
The CARS 2-ST is for children who have below average intellectual ability or marked
communication difficulties. The CARS 2-HF was developed to help identify high functioning individuals with
autism or Asperger’s Disorder who have an intellectual ability of at least 80. It is very helpful in that it includes
questions that are more responsive to typical behaviours at this end of the spectrum.
CARS and CARS 2 ratings are based on the clinician’s observations and parent report. Items are scored on a
scale between 1 (within normal limits) and four (severely abnormal for age) and are then summed and
categorised.
In the CARS and the CARS 2-ST summary scores indicating the possibility of autism differ
according to the age of the individual.
CARS 2-ST
Summary Score
Summary Score
Symptoms of ASD
All Ages under 13 years
Ages 13+
Minimal
15 to 29.5
15 to 27.5
Mild to moderate
30 to 36.5
28 to 34.5
Severe symptoms
37 and higher
or 35 and higher
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The new CARS 2-HF has different summary scores. They are for children who are verbally fluent and over 6
years of age. They are:
CARS 2-HF
Summary Score
Symptoms of ASD
Ages 6+
Minimal
15 to 27.5
Mild to moderate
28 to 33.5
Severe symptoms
34 and higher
5. Psycho-Educational Profile - Third Edition (PEP-3; Schopler, Lansing, Reichler, & Marcus, 2005)
The PsychoEducational Profile - Third Edition (PEP-3; Schopler, Lansing, Reichler, & Marcus, 2005) was
developed from the PEP-R (Schopler, Reichler, Bashford, Lansing, & Marcus, 1990) and is a standardised
observational assessment that is based on a developmental understanding of children.
It is designed to
evaluate the cognitive skills and behaviours typical of children who have ASD and other developmental
disabilities.
The instrument is appropriate for infants 6 months of age to children 7 years of age. It is not dependent on the
children being verbal.
The PEP-3 has two major sections that are complementary. The performance part is administered through
direct observation of the child, and the second part is completed by the parent or caregiver.
In the performance part of the assessment, structured observations give information in 10 areas (6 of which
measure developmental abilities and 4 measure maladaptive behaviours).
From these subtests three
composite scores are derived – Communication, Motor skills, and Maladaptive Behaviour. These scores are
norm-referenced. The total raw score of all test items is converted into developmental ages. Percentile scores
can also be determined based on an autism comparison sample.
Scores above the 89 th percentile are
considered to be at an adequate developmental/adaptive level, scores from the 75th to the 89th percentile are
considered to be at a mildly abnormal level, scores from the 25 th to the 74th percentile are considered to be at a
moderately abnormal level, and scores below the 25th percentile are considered to be at a severely abnormal
level.
In the other part of the assessment the parent or caregiver is asked to estimate the age at which their child is
functioning in relation to communication, motor, social, thinking, and adaptive behaviour. The PEP-3 provides
information that describes the severity of the child’s autism symptoms and gives information about the child’s
developmental level.
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6. The Autism Spectrum Rating Scale (ASRS; Goldstein & Naglieri, 2009)
The Autism Spectrum Rating Scale (ASRS; Goldstein & Naglieri, 2009) measures behaviours associated with
ASD’s for children and youth (aged 2 to 18 years). It is completed by parents (or caregivers) and/or teachers
who rate behaviours characteristic of the child or youth. There are 70 items in the form for children aged 2 to 5
years and 71 items in the form for 6 to 18 year olds. The assessment derives two empirically derived scales for
children aged 2 to 5 years (Social/Communication, and Stereotypical Behaviours) and three empirically defined
scales for 6 to 18 year olds (Self-regulation, Social/Communication, and Stereotypical Behaviours). An ARS
Total Scale is also derived for all ages.
The ASRS items are also linked to DSM-IV-TR criteria and a DSM-IV-TR scale is derived. The information
provided can lead to the differential diagnosis of Autistic Disorder, Asperger’s Disorder, and PDD-NOS.
In addition, eight treatment scales are derived.
These are Peer and Adult Socialization, Social/Emotional
Reciprocity, Atypical Language, Stereotypy, Behavioural Rigidity, Sensory Sensitivity, and Attention/SelfRegulation. These scales can help indicate the areas in which most treatment support is needed.
7. The Social Responsiveness Scale (SRS; Constantino & Gruber, 2005)
The Social Responsiveness Scale (SRS; Constantino & Gruber, 2005) is a 65-item questionnaire that assesses
various dimensions of interpersonal behaviour, communication, and repetitive/stereotypical behaviour of a child
or adolescent from 4 to 18 years of age.
There are two forms that can be completed, one by the parent or caregiver and one by a teacher who knows the
individual well. It can be used as a screener or as an aid in the process of clinical diagnosis. The SRS was
developed with the understanding that autistic symptoms form part of a continuum of symptoms that range in
severity. For this reason it is particularly helpful in identifying not only Autistic Disorder but also Asperger’s
Disorder and PDD-NOS.
Five subscales scores are generated as well as a Social Responsiveness Total score. The subscales domains
are: Social Awareness, Social Cognition, Social Motivation, Social Communication, and Autistic Mannerisms.
The Total score and subscale scores are converted to a standardized T-score. T-scores of between 60 to 75
are considered to be clinically significant and suggestive of Autism Spectrum Disorder in the mild to moderate
range. T scores above 76 are considered to be in the Severe range and strongly associated with ASD.
The
subscale scores can also be used to help determine important areas of treatment and follow-up support.
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Appendix B Adaptive Behaviour Measures
1. Scales of Independent Behavior – Revised (SIB-R; Bruininks, Woodcock, Weatherman, & Hill, 1996)
The Scales of Independent Behaviour – Revised (SIB-R; Bruininks, Woodcock, Wetherman, & Hill, 1996)
can be used to assess adaptive and problem behaviours of individuals from infancy to over 80 years of age. It
is designed to measure functional independence and adaptive functioning in school, home, employment, and
community settings. The SIB-R is available in three separate forms. Each of the forms can be administered in
either a structured interview format or as a checklist completed directly by the respondent. The three forms are:
-
the Full Scale Form
-
a Short Form ( a screening measure)
-
an Early Development Form ( for use with children from early infancy to 6 years of age, or older
children if they are developmentally below 8 years of age)
Each of these forms also has a Problem Behaviour Scale.
The SIB-R Full Scale Form is a broad measure of adaptive behaviour for all ages. It consists of four adaptive
behaviour clusters and 14 subscales. The clusters and subscales are:
Motor skills (all ages)
- Gross Motor
- Fine Motor
Social Interaction and Communication Skills
- Social Interaction
- Language Comprehension
- Language Expressive
Personal Living Skills
- Eating and Meal preparation
- Toileting
- Dressing
- Personal Self-Care
- Domestic Skills
Community Living Skills
- Time and Punctuality
- Money and Value
- Work Skills
- Home/Community Orientation
A standard score is generated for each of the four adaptive behaviour clusters. As well, a Broad Independence
Full Scale adaptive behaviour score is generated. Each of these four cluster scores is standardized to have a
mean of 100 and a standard deviation of 15. A developmental age for each of the subscales can also be
generated.
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Standard score classifications that are given as:
Adaptive level
Standard Score
Percentile
Very Superior
131 and above
98th – 99.9th
Superior
121-130
92nd - 97th
High Average
111-120
25th - 75th
Average
90-110
25th-75th
Low Average
80-89
9th-24th
Low
70-79
3rd-8th
Very Low
69 and below
Below 1st-2nd
In addition, standardised cluster scores can be looked at in terms of functional limitations with age-level tasks
and predicting how an individual will perform if presented with tasks to those measured in the SIB-R. The range
of abilities predicted is as follows:
Skill with age level tasks
Age level tasks will be
Advanced
Very Easy
Age-Appropriate to Advanced
Easy
Age- Appropriate
Manageable
Limited to Age- Appropriate
Difficult
Limited
Very Difficult
Limited to Very Limited
Extremely Difficult
Very Limited to Negligible
Extremely Difficult to Impossible
All three SIB-R forms also include questions to address maladaptive behaviour.
There are eight problem
behaviour categories. These are:
-
Hurtful to Self
-
Hurtful to Others
-
Destructive to Property
-
Disruptive Behaviour
-
Unusual or Repetitive Habits
-
Socially Offensive Behaviour
-
Withdrawal or Inattentive Behaviour
-
Uncooperative Behaviour.
These are aggregated into four indexes. These are:
-
Internalized Maladaptive Index
-
Asocial Maladaptive Index
-
Externalized Maladaptive Index
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As well, a General Maladaptive Index (which is an aggregate measure of all problem behaviours) is also
generated. The problem behaviour index scores have a mean of 0 and a standard deviation of 10. If the scores
are negative then they are lower than the mean.
A unique feature of the SIB-R is that there is a calculation of a Support Score. This combines the individual’s
adaptive level and the severity of maladaptive behaviours. The Support Score is intended to describe an
individual’s overall functional independence and level of need for support and supervision. Support Scores
range from 0 to 100. A higher score reflects greater independence. Definitions of support levels required are:
85-100 Infrequent or no support
70-84
Intermittent or periodic support
55-69
Limited but consistent support
40-54
Frequent or close support
25-39
Extensive or continuous support
1-24
Pervasive or highly intense levels of support.
2. Vineland Adaptive Behaviour Scales, Second Edition (Vineland-II; Sparrow, Cicchetti, & Balla, 2005)
The Vineland Adaptive Behaviour Scales, Second Edition (Vineland-II; Sparrow, Cicchetti, & Balla, 2005) can be
used from birth to 90 years of age and it there are a number of forms which may be used:
-
a 383-item Survey Interview Form (which the clinician conducts with the parent/caregiver)
-
a Parent/Caregiver Rating Form (which is a checklist completed by the parent/caregiver and gives
similar information to the Survey Interview Form)
-
an Expanded Interview Form (which the clinician uses if more detailed information is required)
-
a Teacher Rating Form (used in relation to students who are 3 to 21 years of age).
The possibility of using more than one form means that information may be obtained from a number of sources,
if desired.
Individuals 7 years and older, adolescents and adults are assessed in the following domains and sub-domains:
Communication
- Receptive
- Expressive
- Written
Daily Living Skills
- Personal
- Domestic
- Community
Socialization
- Interpersonal Relationships
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- Play and Leisure
- Coping Skills.
Children 6 years and 11 months of age or younger are assessed in all of the above domains but also the Motor
Skills domain (with Gross and Fine Motor sub-domains). For older children or adults a Motor Skills domain
score can be estimated.
An overall Adaptive Behaviour Composite score is also generated. The Adaptive Behaviour Composite and
each of the domains (Communication, Daily Living Skills, Socialization, and Motor Skills) have a mean of 100
and a standard deviation of 15. Scores can range from 20 (5 SD below the mean) to 160 (4 SD above the
mean).
In the Vineland-II, self-care skills are assessed within the Daily Living Skills domain in the Personal and
Domestic sub-domains. The Daily Living Skills domain is reported as a standard score (mean of 100 and
standard deviation of 15), and the sub-domains are reported as a v-Scale Score (mean of 15 and standard
deviation of 3).
The classifications for standard scores are as follows:
Adaptive level
v-Scale
Standard Score
Percentile
High
21 or above
130 or above
Moderately High
18-20
115-129
85-97
Adequate
13-17
86-114
16-84
Moderately Low
10-12
71-85
3-15
Low
1-9
20-70
2 or below
98 or above
With further classifications if the standard score is 70 or lower as follows:
Mild Deficit
50-55 to 70
Moderate Deficit
35-40 to 50-55
Severe Deficit
20-25 to 35-40
Profound Deficit
Below 20 - 25
It is also possible for children above 5 years of age, adolescents and adults to be assessed in relation to
maladaptive behaviour.
The Maladaptive Behaviour Index consists of three subscales - Internalizing,
Externalizing, and Other. The Maladaptive Level given is based on standardised ‘norms. The levels given are
labelled – ‘Non-significant’ if within a normal range, ‘Intermediate’ if within a borderline range, and ‘Significant’ if
more than two standard deviations different to the ‘normal’ population.
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3. Adaptive Behaviour Assessment System – Second Edition (ABAS; Harrison & Oakland, 2003)
The Adaptive Behaviour Assessment System – Second Edition (ABAS-II; Harrison & Oakland, 2003) can be
used from birth to 89 years of age. The following five forms can be used across the age ranges:
-
a Parent/Primary Caregiver Form
-
a Teacher/Day Care Form for children
-
an Adult Form that can be self-rated or completed by a parent or family member, or by a supervisor
or another person responsible for the individual
In the ABAS-II assesses 10 specific adaptive skills that are clustered into the following domains and subdomains:
Conceptual
- Communication
- Functional Academics
- Self-Direction
Social
- Social Skills
- Leisure Skills
Practical
- Home Living (or School Living, if age appropriate)
- Health and Safety
- Self-Care
- Community Use (if age appropriate)
- Work Skills (if employed)
A General Adaptive Composite score is also generated. Each composite score and the general overall score
has a mean of 100 and a standard deviation of 15. Each specific adaptive skill has a mean of 10 and a
standard deviation of 3.
The classifications for standard scores in the ABAS-II are as follows:
Adaptive level
Scaled Scale
Standard Score
Very High
16-19
130 or above
98th or above
High Average
14-15
120-129
91st-97th
Above Average
12-13
110-119
75th-90th
Average
8-11
90-109
25th-74th
Below Average
6-7
80-89
9th -24th
Low/Borderline
4-5
70-79
2nd-8th
Extremely Low
1-3
69 and lower
Below 2nd
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Appendix C Behaviour Measure
The Developmental Behaviour Checklist (DBC, Einfeld & Tonge, 1992, 1995, 2002)
The DBC includes a number of instruments for the assessment of behavioural and emotional problems of
children, adolescents and adults with developmental disabilities. The DBC-P is a version that can be completed
by parents or carers. The DBC-T is a version that can be completed by teachers. These versions can be used
for assessment of young people between the ages of 4 to 18 years. There is also a recent version produced for
assessment of adults (DBC-A).
The DBC indicates behaviours on five subscales, as well as a Total Behaviour Problem score.
The five
subscales are
-
Disruptive/ Antisocial
-
Self-Absorbed
-
Communication Disturbance
-
Anxiety
-
Social Relating.
A score of above 30 (which equates to above the 60th percentile) indicates a clinical (or concerning) level of
emotional disturbance. However, even higher scores of 46 or above above the 75th percentile) indicate levels
of disturbance to a very significant level.
Specific algorithms can also be generated in relation to the specific mental health issues of anxiety, depression,
and hyperactivity.
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Appendix D Eligibility for Medicare Rebate to
access diagnosis and treatment
Children – Birth to 13 years
Access to diagnosis
Eligibility requirement
Entitlement
Access to treatment
Referral from consultant
paediatrician or psychiatrist for
assessment and diagnosis of
suspected ASD
Diagnosis of ASD confirmed by
team and consultant
paediatrician/psychiatrist
Paediatrician/psychiatrist must
write referral by child’s 13th
birthday and assessment be
completed by child’s 15th birthday
Paediatrician/psychiatrist must
write treatment referral by child’s
13th birthday and treatment
sessions be completed by child’s
15th birthday
Access of up to twenty Medicare
rebatable sessions of psychological
intervention, speech therapy, or
occupational therapy
Access of up to four Medicare
rebatable sessions with child
psychiatrist, psychologist, speech
therapist or occupational therapist
All ages – Birth to adulthood
Chronic Disease Management
Initiative
Mental Health Care Plan
(formally Enhanced Primary Care Plan)
Eligibility requirement
Diagnosis of a chronic condition
(i.e. ASD)
Referral written by GP
Entitlement
Access of up to five Medicare
rebatable sessions with an allied
health practitioner.
People of Aboriginal or Torres
Strait Islander descent can access
up to five additional services (in
total) per calendar year.
Available each calendar year
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Diagnosis of mental health
condition (e.g. anxiety, depression).
This diagnosis can have arisen
from the GP’s assessment and
concern.
Referral written by GP,
paediatrician or psychiatrist
Access of up to ten Medicare
rebatable sessions from
psychologist, social worker or
occupational therapist (to support
mental health and emotional
wellbeing).
Access of up to ten Medicare
rebatable group sessions from
psychologist, social worker or
occupational therapist (to support
mental health and emotional
wellbeing).
Available each calendar year
31
Appendix E Useful contacts

AUTISM VICTORIA
Address: 24 Drummond Street, Carlton, VIC 3053, Australia
Postal Address: PO Box 374, Carlton South, VIC 3053, Australia
Phone: (03) 9657 1600
Fax: (03) 9639 4955
Web: www.autismvictoria.org.au
Autism Victoria also has a Professional ‘Adviceline’ that can be rung. Professionals can access this line
for any advice they might require.
Phone: 1300 598 272

AUSTRALIAN PSYCHOLOGICAL SOCIETY (APS)
Address: Level 11, 257 Collins Street, Melbourne, VIC
Postal Address: PO Box 38, Flinders Lane VIC 8009
Phone: (03) 8662 3300
Fax: (03) 9663 6177
Toll free: 1800 333 497
Email: [email protected]
Web: www.psychology.org.au
The APS website includes a list of practitioners who can undertake ASD assessments. Refer in the
website to:
Autism and Pervasive Developmental Disorders (PDD) Identified Practitioner’s List.

MENTAL HEALTH SERVICES
Find a mental health service by suburb or town at:
http://www.health.vic.gov.au/mentalhealth/services/index.htm
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Appendix F Recommended reading and resources
Attwood, T. (1998). Asperger's Syndrome. London: Jessica Kingsley.
Baron-Cohen, S., Tager-Flusberg, H., & Cohen, D. (2000). Understanding other minds: Perspectives from
developmental cognitive neuroscience. New York: Oxford University Press.
Gabriels, R. L. & Hill, D.E. (Eds.) (2007), Growing up with autism. New York: The Guilford Press.
Goldstein, S., Naglieri, J., & Ozonoff, S. (2009). Assessment of Autism Spectrum Disorders. New York: The
Guilford Press.
Hodgdon, L.A. (1999). Solving behavior problems in autism: Improving communication through use of visual
strategies. Troy, MI: QuirkRoberts
Howlin, P.(1997). Autism – Preparing for adulthood. UK: Routledge.
Lawson, W. (2001). Understanding and working with the spectrum of autism. London: Jessica Kingsley.
Wing, L. (1996). The Autistic Spectrum – A guide for parents and professionals. London: Constable.
Videos
Attwood, T. (1999). Asperger Syndrome: A video guide for parents and professionals. Arlington, TX: Future
Horizon.
Eisenmajer, R. (2006). Imagine having Asperger’s Syndrome. A first consultation. (Available directly from
author).
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