SPED 760 Artifact: DSM & IDEA Criteria and GARS3

Michael Friedmann

Dr. Griswold

SPED 760

Module 3 Assignment

February 12, 2023

DSM & IDEA CRITERIA APPLIED TO “LUCAS”

1. Purpose and Scope of IDEA 2004 and its Applications to “the student” (In Brief)

​

              “The Individuals with Disabilities Education Act of 1997 (IDEA 97) has been re-authorized and is now known as The Individuals with Disabilities Education Improvement Act of 2004” (Wright; 2004, p. 6). It is known as and referenced under the acronym IDEIA 2004 or IDEA 2004. Within the language of IDEA 2004, under 20 U.S.C. § 1400(d) Purposes: (1) (A) [asserts that IDEA 2004 exists in specificity] “to ensure that all children with disabilities have available to them a free appropriate public education that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment, and independent living” (Individuals With Disabilities Education Act, 20 U.S.C. § 1400 (2004). Additionally, under 20 U.S.C. § 1400(d) Purposes: (3) [IDEA 2004 asserts in specificity that it exists in order] to ensure that educators and parents have the necessary tools to improve educational results for children with disabilities by supporting systemic change system improvement activities; coordinated research and personnel preparation; coordinated technical assistance, dissemination, and support; and technology development and media services” (Individuals With Disabilities Education Act, 20 U.S.C. § 1400 (2004).

​

2. Definition of Autism Spectrum Disorder under the DSM-5 (In Brief)

​

              Autism Spectrum Disorder was first categorized “as a spectrum” in the DSM-IV, which was “released in 1994 and revised in 2000” (KU; 2020, n.p.). Upon revision of the DSM-IV, professionals began referencing ASD and utilized “five separate Pervasive Developmental Disorders” which at that time “echoed the research hypothesis…that ASD is rooted in genetics, and that each category would ultimately be linked to a set of specific problems and treatments” (KU; 2020, n.p.). Now in its 5th edition, the DSM-V “is the primary source for defined clinical disorders in the United States” yet “the prevalence rates of ASD differ depending on clinical or administrative diagnosis” (KU; 2020, n.p.). Following the completion of the “Human Genome Project” in 2003, whereby “researchers [had] hoped to identify genes that [directly] contributed to ASD” they discovered, as they “tried to zero in on a list of ASD genes” that there were “hundreds;” yet none was found to be directly or “exclusively” linked “to ASD” (KU; 2020, n.p.). This lack of “exclusively linked” genetic correlation to ASD resulted in the conclusion that “genetic underpinnings and corresponding treatments for the five conditions specified in the DSM-IV would not be possible” (KU; 2020, n.p.). Following this fundamental shift in thinking, “experts decided it would be best to characterize ASD as an all-inclusive diagnosis, ranging from mild to severe” (KU; 2020, n.p.). Concerns grew over “a lack of consistency in how clinicians in different states and clinics arrived at a diagnosis of ASD, Asperger syndrome or PDD-NOS” (KU; 2020, n.p.). Additionally, due to “a spike in ASD prevalence in the 2000’s” some believed “that clinicians were sometimes swayed by parents lobbying for a particular diagnosis or influenced by the services available within their state” (KU; 2020, n.p.).

​

             Thereby, “to address both concerns, the DSM-5 introduced the term ASD” which was a “diagnosis…characterized by two groups of features: ‘persistent impairment in reciprocal social communication and social interaction’ and ‘restricted, repetitive patterns of behavior,’ both present in early childhood” (KU; 2020, n.p.). Additionally, the DSM-V saw changes by which “each group” or characterization included “specific behaviors, a certain number of which clinicians [had] to identify” while also “eliminating Asperger syndrome, PDD-NOS and classic ASD” and “debuting a diagnosis of Social Communication Disorder to include children with only language and social impairments” (KU; 2020, n.p.).

3. Student: “Lucas” Kindergarten (age 6 to 7 years):

​

               The first encounter with Lucas was at Meadows Elementary, when the student was in kindergarten (age 6 years). Lucas presented with substantial difficulties walking from his mother’s vehicle in the morning to the kindergarten portable where his classroom was, and presented with “highly unusual and abnormal social approaches” when efforts to correct behavioral deficits occurred. Lucas also presented at that time with a difficulty in engaging in normative “back-and-forth conversations” and would resort to elopement or fleeing behavior in an effort to avoid a request, or a demand or an expectation. Lucas could rarely make the walk on his own to his classroom and more often than not required adult accompaniment, not because he was not capable of completing the expectation, but because Lucas would resort to abnormal behavior by eloping or fleeing without any reason or stimuli or trigger. When in the classroom, Lucas would engage in behaviors consistent with ASD, including a “reduced” or a lack of “sharing of interests or emotion” and a “failure to initiate or respond to social interactions” or expectations. Lucas would never join the class in circle time or engage in play time with other students and always preferred to play alone or remain at his desk. Lucas would, at times, run around the room, and disrupt class and teaching windows in a repeated or repetitive and recurrent behavior. At the beginning of the year, he rarely left the classroom, but eventually, he began eloping from the classroom and running around the portable where other classrooms were located, causing disruption. After a few months, his eloping behavior progressed to leaving the portable and entering the main building where he would run around the hallways, almost always in a similar or repetitive pattern. It was recognized early on that part of Lucas’ behavior, in running or fleeing, relied heavily upon his being pursued or chased by adults. On another occasion, Lucas, while in the classroom, was up and moving around, when the prompt and expectation was to be in his seat. This behavior was repetitive and disruptive. It was further observed that Lucas had a difficult time using the bathroom or articulating the fact that he needed to use the bathroom, and he would engage in running and screaming repetitive behavior. [As a note, some of these behaviors are very similar to kindergartners who have not had experience in preschool and are merely learning the routines and dynamics and expectations of kindergarten, but in Lucas’ case, the behaviors were more severe and repetitive, requiring further evaluation.] It was further notated, that at this time, Lucas had limited verbal skills, and while he was verbal and could vocalize small, simple sentences, or desires and needs, he struggled with normative social interaction and communication, and resorted more often than not to frequent and repetitive behavioral outbursts and elopement. In regard to the bathroom issue, I inquired with his teacher if she had ever simply placed him in the bathroom to see if it would prompt him to use it, and voiced the hypothesis that perhaps his behavior in the classroom was a byproduct of his needing to use the bathroom (his version of the “pee pee dance”). I then opened the bathroom door (as the classroom was self-contained with its own bathroom) and ushered Lucas into the bathroom and closed the door, keeping my foot in it so that he knew it was not closed all of the way and he had the option to leave. He was prompted to “go potty.” He attempted to pull the door open a few times, and was re-prompted to “go potty.” Lucas then followed the prompt, went “potty” and then exited the bathroom and went directly to his seat, and sat down and began doing his work as expected. While this did not solve the repeated behaviors engaged in by Lucas, or why Lucas so often engaged in running, screaming, and jumping behaviors, it seemed to answer the question as to why Lucas may have been out of his seat and behaving in abnormal and unexpected ways. Additional note: it was observed on multiple occasions that Lucas preferred to walk and run on the tips of his toes. According to the Mayo Clinic (2022) “toe walking has been linked to autism spectrum disorders, which affect a child's ability to communicate and interact with others.” Furthermore, “a dysfunctional vestibular system, a common problem in autism, may be responsible for toe walking” as “the vestibular system provides the brain with feedback regarding body motion and position” (Edelson; 2022, n.p.).

​

4. First Grade (age 7 to 8 years):

​

               By first grade, Lucas had developed better verbal skills and presented with heightened intelligence and recall ability, although the information was typically a result of something Lucas was hyper-focused upon, from which he would not deviate when communicating verbally. The topic or subject was “stuck” for him and attempts to engage with other topics or other communication would either prompt him to redirect back to his topic of choice, or trigger elopement and clear frustration which resulted in jumping, screaming and/or running. [Additional note: crying was not always something Lucas engaged in when frustrated when in kindergarten, but at the first-grade level, Lucas resorted to crying much more frequently, when denied a desired activity, or at times some minor reward.] Upon arriving at school in the morning, he would have a stuffed animal (it was always the same stuffed animal), and struggle some days to come into the building, while on other days he would simply walk in on his own. On days that he struggled to enter the building, one could observe his hovering behavior in the crosswalk (a hesitation, as he observed his surroundings before choosing elopement) or just after crossing the crosswalk, and his tells indicating that he was about to run or elope. Many mornings began with Lucas running around the school property and being followed or chased by his 1:1 paraeducator or school administration. Other days, after school began, Lucas would elope from his classroom and attempt to run out into the parking lot, requiring administrative or behavioral support. Differing from the previous year, when Lucas had not made attempts to leave the school property, his first-grade year, Lucas would almost always make attempts to leave the school property. Typical and repetitive elopement behavior for Lucas was leaving the main building and running towards the back field where an open fence lead out to another off-property field, two reservoirs, and a neighborhood. (Additional note: upon observing Lucas’ elopement behavior, I took it upon myself to consider options that might eliminate his leaving the school property through the open gate, and decided to wrap the gate with yellow police tape. When Lucas ran out to the gate and saw the yellow tape with the words “do not cross” Lucas would turn and run elsewhere, but never tear down the yellow tape or push through it.) Lucas always wore rain boots and took them off while in the SpEd/Learning Center (which was his most common location), and it was discovered that Lucas also hated getting his feet wet. We also determined that Lucas did not like the rain, and would never leave the building when running away, if it was raining. Lucas could only manage to stay in his classroom for short spans of time, and always required redirection tools or distractions, such as stickers or books in order to remain at his desk. He rarely engaged with the teaching materials presented in class, and would constantly make attempts to leave the classroom. As there was also a door leading outside from inside the classroom, he had two methods of escape, one door leading into the interior of the building, the other leading out to the playground. If one stood outside the classroom and observed Lucas, one would recognize his body positioning as a clear tell of his intended behavior, as he would slowly shift his body to clear his legs from under his desk, before eloping. In first-grade, Lucas was also assigned a 1:1 paraeducator to support him and remain with him and follow him when he eloped. Lucas was also placed on an IEP to address and accommodate some of his needs with interventions and supports. Any changes to the normative routine of his day would throw Lucas off and prompt elopement, whether it was a substitute teacher, a substitute paraeducator, someone being late; the triggers varied, but resulted in significant behavioral shifts.

​

Conclusion:

​

               Lucas was diagnosed with ASD. That same year his sister was in kindergarten, and exhibited some of the same behaviors he had the previous year. Both siblings were high functioning and developed verbal skills and retained material that they were able to recite upon prompting, with some limitations. Both siblings also presented with restricted interests and repetitive behaviors consistent with an ASD diagnosis. Further observations included abnormal social approaches, such as his elopement behavior, and while at times Lucas could briefly maintain a conversation it was solely based upon his topic of interest, whereas any deviation from that would prompt elopement. Lucas rarely initiated or responded to social queues. When forced to engage in expectations contrary to desired activity, Lucas would either have a complete breakdown, which would include screaming, crying, and running away. It was observed during his time in first-grade that his preferred activity was elopement, so that he could be chased (it became a game, and we began not following him in an effort to see if it would minimize the elopement behavior). [Additional note: the behavior mimicked K9 behavior in how he would run away, stop, and look back to see if he was being followed.] Lucas also presented with sensory issues, including sensitivities to sound and touch. Lucas had no friends, and engaged in no play with other students and preferred to, at all times, be alone. Lucas viewed everything through a literal lens, there was no room for deviation from the literal. He did not understand sarcasm nor find jokes funny. During social interactions Lucas was unable to make or maintain eye contact and he presented with unique body language and found it difficult to understand or use common gestures. Lucas also presented with sensory issues which included sensitivities to sound and touch. Lucas was further diagnosed with Attention-deficit hyperactivity disorder (ADHD). [F84.9 Pervasive developmental disorder, unspecified... F84.-) F20.-) A behavior disorder in which the essential features are signs of developmentally inappropriate inattention, impulsivity, and hyperactivity.]

​

Application of DSM-5 Diagnostic Criteria: Autism Spectrum Disorder:

Does the featured student meet the definition of autism under the DSM-5 (2013)? Lucas meets the definition of autism under the DSM-5 yet remains high functioning and communicative.

​

(1) Impairments in Social Communication and Social Interaction (currently or in past) [All three required]

​

(a) Deficits in social-emotional reciprocity: Lucas presents with highly unusual and abnormal social approaches and presents with an inability to conduct normal back-and-forth conversations as well as a reduced sharing of interests or emotion; and presents with a failure to initiate or respond to social interactions.

​

(b) Deficits in nonverbal communicative behaviors used for social interaction: Lucas presented with, at times/most times, abnormal to no eye contact whatsoever. Lucas presented with unique body language and did find it difficult to both understand and use common gestures. Lucas presented with sensory sensitivities including sound and touch. Lucas possesses verbal communication skills. Lucas possesses the ability to utilize facial expressions but struggles with common nonverbal communication.

​

(c) Deficits in developing, maintaining, and understanding relationships: Lucas presented with textbook difficulty varying behavior to suit different social situations, as his repeated behavior was elopement from every situation. Lucas also made no friends, played with no peers, and never engaged in or shared in imaginative play. Lucas existed in a literal realm with no deviation from it. Lucas presented with absolutely no interest in making friends or engaging with peers. His conversations were only with the familiar adults who were constantly engaged in curbing or addressing his constant elopement or disruptive and repetitive behaviors.

​

(2) Restrictive Patterns of Behavior, Interests or Activities (currently or in the past) [Two required]

​

(a) Stereotyped or repetitive motor movements, speech, or use of objects: The behavioral characteristics presented by Lucas do not meet certain criteria for category (a).

(b) Insistence on sameness, ritualized patterns of verbal or nonverbal behavior, or inflexible adherence to routines: Lucas presented with definitive difficulties with transitions which would prompt elopement, or in some cases, screaming, crying, and/or running. Small changes would cause Lucas to display extreme distress, and having a substitute or having an event fall behind schedule would cause a behavioral manifestation. While Lucas did not display a specific “greeting ritual” Lucas did present with similar morning behavior which was very routine and ritualistic. Lucas adhered to rigid thinking patterns that remained literal and allowed for no deviation. While Lucas did not always elope in the same direction or the same manner, his direction of escape was always the same, and he would always attempt to run out to the back gate and leave the school property. Lucas was extremely predictable once his behaviors were learned by support staff.

​

(c) Highly restricted, fixated interests that are abnormal in focus or intensity: Lucas presented with a “preoccupation with or strong attachment to” the same stuffed animal he brought to school every day. On days where he forgot it, there would be uncontrollable behaviors and elopements that would last the entire day. Lucas’ interests were hyper-focused with great intensity on his desired interests and there was no room for deviation.

​

(d) Hypo‐ or hyper‐ reactivity to sensory input or unusual interest in sensory aspects of the environment: Lucas presented with an “adverse response to specific sounds and textures.” While there was no definitive indifference to pain or temperature, he could elope in the winter months and go outside in near freezing temperatures without a coat, and not appear cold. Lucas presented with a hyper-reactive behavioral pattern that presented with him constantly needing to be in movement. His elopement behavior was chronic, constant, and almost routine. It was definitively a byproduct of his ASD and the behavior was his method of managing stress or crisis or fear or confusion or uncertainty. It also became the desired activity with the reward of being pursued. Environmental sensitivities to rain also factor into this category.

​

(3) Symptoms must be present in early childhood.

​

(a) Symptoms must be present during early development: As Lucas was first encountered in kindergarten at the age of 6-7 years, there is no information to support the fact that symptoms were present during early development. Despite this, conversations with Lucas’ mother were highly informative and she conveyed on more than one occasion during discussions relative to Lucas’ behavior and considerations for solutions and interventions, that she had been struggling with most of the same behaviors since his early development, establishing a basis for assertion that similar symptoms were present during early development based upon information conveyed by Lucas’ mother. Symptoms “may not fully manifest until older, when social demands exceed limited capabilities…or they may be masked later in life by learned coping strategies.”

​

(b) Symptoms must cause clinically significant impairment in occupational, social, or other important areas of current functioning: Arguably, the behavioral manifestations that Lucas presents with and struggles with, including his responses to extreme distress when routines change or fail to remain as expected cause a significant impairment to his social environment and impair his ability to learn and function in a normative manner. Current functioning impairments are clearly defined when attempts at social interactions or expectations fail forcing elopement behavior and defiance. Sensory issues also place restrictions upon Lucas’ ability to manage a classroom environment for extended periods of time.

​

(c) Symptoms are not better explained by intellectual disability (although intellectual disability may be a comorbid diagnosis.): Lucas does not present with an “intellectual disability” and remains persistently high functioning and able to engage with material he has an interest in, as well as absorb and retain and recite such material. The variable is whether or not he has an interest in that material.

​

(d)  Specify if there is:

i. Accompanying intellectual impairment – Lucas presents with textbook symptoms and indicators of Attention-deficit hyperactivity disorder (ADHD). F84.9 Pervasive developmental disorder, unspecified... F84.-) F20.-) A behavior disorder in which the essential features are signs of developmentally inappropriate inattention, impulsivity, and hyperactivity. Based further upon behaviors observed over the course of two years, I would further assert that Lucas also suffers from some form of an Anxiety Disorder to include but not limited to: 309. 21 (F93 0) Separation Anxiety Disorder, 300. 29 (F40.248) Situational (Phobia), 300. 23 (F40. 10) Social Anxiety Disorder – Performance Only.

​

ii. Accompanying language impairment – Lucas does not meet the criteria for this category of impairment.

​

iii. Association with a known genetic condition, medical condition, or environmental factor – Lucas does not meet the criteria for this category of impairment.

​

iv. Association with another neurodevelopmental, behavioral, or mental disorder – Lucas presents with textbook symptoms and indicators of Attention-deficit hyperactivity disorder (ADHD). F84.9 Pervasive developmental disorder, unspecified... F84.-) F20.-) A behavior disorder in which the essential features are signs of developmentally inappropriate inattention, impulsivity, and hyperactivity.

​

DSM-5 Autism Spectrum Disorder: Severity Levels

​

1. Social Communication: LEVEL 2 – MODERATE (Requiring Substantial Support): Lucas presented at the kindergarten-level (age 6-7 years) with “marked deficits in verbal and nonverbal social communication skills” and with “social impairments apparent even with supports in place” by the first-grade level (age 7-8 years). Lucas further presented throughout both grade levels with “limited initiation of social interactions and reduced or abnormal responses to social overtures from others” as a constant.

​

1. Restricted, Repetitive Behaviors: LEVEL 2 – MODERATE (Requiring Substantial Support): Lucas presents with considerable RRBs including restrictions to his learning environment and repetitive behaviors such as elopement, and jumping, and screaming and/or running. Lucas is also constantly “preoccupied or fixated on interests which appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts.” Lucas also presents with reactionary distress or frustration” which is apparent when RRBs are interrupted, and Lucas remains almost impossible to “redirect from fixated interests.” “Restricted and repetitive behaviors (RRBs) are a core feature of autism spectrum disorders [and] constitute a major barrier to learning and social adaptation” (Leekham, et al; 2011).

Application of IDEA (2004) Diagnostic Criteria for Autism

​

Does the featured student meet the definition of autism under the IDEA (2004)? Under IDEA (2004) the definition of Autism refers to “a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age three, that adversely affects a child’s educational performance.” By this definition, Lucas meets the definition of autism under the IDEA (2004) specifically due to his deficits in non-verbal communication, his deficits in social interactions, his sensory challenges, his resistance to environmental changes or changes in routines, his elopement behavior, his comorbidities, including Attention-deficit hyperactivity disorder (ADHD). F84.9 Pervasive developmental disorder, unspecified... F84.-) F20.-) A behavior disorder in which the essential features are signs of developmentally inappropriate inattention, impulsivity, and hyperactivity.

​

(a) Verbal communication: Lucas began kindergarten with limited verbal presets but was able to expand his verbal limitations by the time he began first-grade.

​

(b) Non-verbal communication: Lucas maintains deficits in nonverbal communications and understanding and responding to common gestures. “Deficits in nonverbal communication, of course, are requirements under DSM-5, as well as IDEA, as are deficits in social interaction [and] IDEA states that the disability is generally evident before age 3.” Lucas was observed presenting such deficits between ages 6-8 years, and his mother reported similar deficits prior to the age of 6.

​

(c) Social interaction: Lucas presents with significant social interaction deficits which are present and observable when in group settings, such as on the playground when he chooses to play alone, or when in the classroom where he chooses to avoid peer engagement or contact.

​

(d) Sensory challenges: Lucas presents with sensory challenges which include sounds and textures. He does not like the rain or his feet getting wet.

​

(e) Resistance to environment changes or changes in routines: Lucas presents as highly resistant to any changes to established routines, which result in elopement behavior or extreme distress behavior such as screaming or crying. Changes to environment when prompted by Lucas result in no perceptible resistance, but when an environmental change is forced without consent or an understanding of what change is occurring or why, Lucas will elope or scream or cry. Behavioral manifestations will occur when any routine is broken or deviated from.

REFLECTION:

​

               By impression, this assignment was of great usefulness as it provided a pathway by which a student of special education can research the definitions of ASD and how the DSM-5 and IDEA (2004) apply. These are imperative exercises in research and application that will play a huge role in how students of special education later apply their knowledge and understanding of ASD when working as educators in the field and in classrooms. This information and this process is of great use to me in my current and future practice as I work with students with ASD and will always work with students with ASD, and this knowledge helps to paint a complete and accurate picture of what deficits look like and what interventions and supports might provide the greatest help when preparing an IEP to support those students. I do not have any further suggestions on improvement of this assignment, although, I may have deviated from the expectation by using one of my own students from five years ago, and generating my own history for that student in order to complete the assignment. While this may appear as though it was more work, I found it insightful to examine and analyze a real individual who I interacted with, struggled with, worked with and learned from, as my subject for this assignment. It made this a much more personal journey, which makes the resolution and outcome of this assignment much more impactful and meaningful for me. I believe allowing students who currently work with students with ASD, or who have worked with such students in the past to utilize their own students as a subject for this assignment would be highly impactful for those students of special education preparing to enter the field.

REFERENCES:

Ciccarelli, S. K., & White, J. N. (2014). Psychology: Dsm 5. Pearson.

​

Edelson, S. M. (2022, February 24). Toe walking and ASD. Toe Walking and ASD. Retrieved February 14, 2023, from https://www.autism.org/toe-walking-and-asd/

​

Individuals With Disabilities Education Act, 20 U.S.C. § 1400 (2004). (n.d.).

​

Leekam, S. R., Prior, M. R., & Uljarevic, M. (2011). Restricted and repetitive behaviors in autism spectrum disorders: a review of research in the last decade. Psychological bulletin, 137(4), 562–593. https://doi.org/10.1037/a0023341

​

Mayo Clinic Staff. (2022, March 23). Toe walking in children. Mayo Clinic. Retrieved February 14, 2023, from https://www.mayoclinic.org/diseases-conditions/toe-walking/symptoms-causes/syc-20378410#:~:text=Autism.%20Toe%20walking%20has%20been%20linked%20to%20autism,It%20can%20also%20result%20in%20a%20social%20stigma.

​

University of Kansas (KU). (2020). ASD Diagnosis & History. Lecture presented in SPED 760: Module 3. Lawrence, KS: Special Education Department.

​

Wright, P. W. D. (2004). The individuals with disabilities education improvement ... - wrightslaw. Wrightslaw: Special Education Law. Retrieved February 12, 2023, from https://www.wrightslaw.com/idea/idea.2004.all.pdf

​

​

​

​

​

Michael Friedmann

Dr. Griswold

SPED 760

Module 4 Assignment

February 22, 2023

Student: “Lucas” Kindergarten to 1st Grade (age 6 to 8 years):

​

               The first encounter with Lucas was at Meadows Elementary, when the student was in kindergarten (age 6 years). Lucas presented with substantial difficulties walking from his mother’s vehicle in the morning to the kindergarten portable where his classroom was and presented with “highly unusual and abnormal social approaches” when efforts to correct behavioral deficits occurred. Lucas also presented at that time with a difficulty in engaging in normative “back-and-forth conversations” and would resort to elopement or fleeing behavior in an effort to avoid a request, or a demand or an expectation. Lucas could rarely make the walk on his own to his classroom and more often than not required adult accompaniment, not because he was not capable of completing the expectation, but because Lucas would resort to abnormal behavior by eloping or fleeing without any reason or stimuli or trigger other than the expectation to go to class.

​

               When in the classroom, Lucas would engage in behaviors consistent with ASD, including a “reduced” or a lack of “sharing of interests or emotion” and a “failure to initiate or respond to social interactions” or expectations. Lucas would never join the class in circle time or engage in play time with other students and always preferred to play alone or remain at his desk. Lucas would, at times, run around the room, and disrupt class and teaching windows in a repeated or repetitive and recurrent behavior. At the beginning of the year, he rarely left the classroom, but eventually, he began eloping from the classroom and running around the portable where other classrooms were located, causing disruption. After a few months, his eloping behavior progressed to leaving the portable and entering the main building where he would run around the hallways, almost always in a similar or repetitive pattern. It was recognized early on that part of Lucas’ behavior, in running or fleeing, relied heavily upon his being pursued or chased by adults. On another occasion, Lucas, while in the classroom, was up and moving around, when the prompt and expectation was to be in his seat. This behavior was repetitive and disruptive.

​

               It was further observed that Lucas had a difficult time using the bathroom or articulating the fact that he needed to use the bathroom, and he would engage in running and screaming repetitive behavior. [As a note, some of these behaviors are very similar to kindergartners who have not had experience in preschool and are merely learning the routines and dynamics and expectations of kindergarten, but in Lucas’ case, the behaviors were more severe and repetitive, requiring further evaluation.] It was further notated, that at this time, Lucas had limited verbal skills, and while he was verbal and could vocalize small, simple sentences, or desires and needs, he struggled with normative social interaction and communication, and resorted more often than not to frequent and repetitive behavioral outbursts and elopement.

​

                It was observed on multiple occasions that Lucas preferred to walk and run on the tips of his toes. According to the Mayo Clinic (2022) “toe walking has been linked to autism spectrum disorders, which affect a child's ability to communicate and interact with others.” Furthermore, “a dysfunctional vestibular system, a common problem in autism, may be responsible for toe walking” as “the vestibular system provides the brain with feedback regarding body motion and position” (Edelson; 2022, n.p.).

By first grade, Lucas had developed better verbal skills and presented with heightened intelligence and recall ability, although the information was typically a result of something Lucas was hyper-focused upon, from which he would not deviate when communicating verbally. The topic or subject was “stuck” for him and attempts to engage with other topics or other communication would either prompt him to redirect back to his topic of choice, or trigger elopement and clear frustration which resulted in jumping, screaming and/or running. [Additional note: crying was not always something Lucas engaged in when frustrated when in kindergarten, but at the first-grade level, Lucas resorted to crying much more frequently, when denied a desired activity, or at times some minor reward.]

​

               Upon arriving at school in the morning, he would have a stuffed animal (it was always the same stuffed animal), and struggle some days to come into the building, while on other days he would simply walk in on his own. On days that he struggled to enter the building, one could observe his hovering behavior in the crosswalk (a hesitation, as he observed his surroundings before choosing elopement) or just after crossing the crosswalk, and his tells indicating that he was about to run or elope. Many mornings began with Lucas running around the school property and being followed or chased by his 1:1 paraeducator or school administration. Other days, after school began, Lucas would elope from his classroom and attempt to run out into the parking lot, requiring administrative or behavioral support. Differing from the previous year, when Lucas had not made attempts to leave the school property, his first-grade year, Lucas would almost always make attempts to leave the school property. Typical and repetitive elopement behavior for Lucas was leaving the main building and running towards the back field where an open fence led out to another off-property field, two reservoirs, and a neighborhood.

​

                Lucas always wore rain boots and took them off while in the SpEd/Learning Center (which was his most common location), and it was discovered that Lucas also hated getting his feet wet. We also determined that Lucas did not like the rain, and would never leave the building when running away, if it was raining. Lucas could only manage to stay in his classroom for short spans of time, and always required redirection tools or distractions, such as stickers or books in order to remain at his desk. He rarely engaged with the teaching materials presented in class and would constantly make attempts to leave the classroom. As there was also a door leading outside from inside the classroom, he had two methods of escape, one door leading into the interior of the building, the other leading out to the playground. If one stood outside the classroom and observed Lucas, one would recognize his body positioning as a clear tell of his intended behavior, as he would slowly shift his body to clear his legs from under his desk, before eloping. In first-grade, Lucas was also assigned a 1:1 paraeducator to support him and remain with him and follow him when he eloped. Lucas was also placed on an IEP to address and accommodate some of his needs with interventions and supports. Any changes to the normative routine of his day would throw Lucas off and prompt elopement, whether it was a substitute teacher, a substitute paraeducator, someone being late; the triggers varied, but resulted in significant behavioral shifts.

​

Conclusion:

​

               Lucas was diagnosed with ASD. Further observations included abnormal social approaches, such as his elopement behavior, and while at times Lucas could briefly maintain a conversation it was solely based upon his topic of interest, whereas any deviation from that would prompt elopement. Lucas rarely initiated or responded to social queues. When forced to engage in expectations contrary to desired activity, Lucas would either have a complete breakdown, which would include screaming, crying, and running away. It was observed during his time in first grade that his preferred activity was elopement, so that he could be chased (it became a game, and we began not following him in an effort to see if it would minimize the elopement behavior).

​

                Lucas also presented with sensory issues, including sensitivities to sound and touch. Lucas had no friends and engaged in no play with other students and preferred to, at all times, be alone. Lucas viewed everything through a literal lens, there was no room for deviation from the literal. He did not understand sarcasm nor find jokes funny. During social interactions Lucas was unable to make or maintain eye contact and he presented with unique body language and found it difficult to understand or use common gestures. Lucas also presented with sensory issues which included sensitivities to sound and touch. Lucas was further diagnosed with Attention-deficit hyperactivity disorder (ADHD). [F84.9 Pervasive developmental disorder, unspecified... F84.-) F20.-) A behavior disorder in which the essential features are signs of developmentally inappropriate inattention, impulsivity, and hyperactivity.]

SUMMARY OF FINDINGS FROM GARS-3

​

                When reviewing Subscale Performance values, Lucas presented with some substantial deficits (higher percentile rankings) in Social Interaction (SI) [91% percentile rank] and Social Communication (SC) [75% percentile rank] and Cognitive Style (CS) [95% percentile rank], while scoring below the median [50th percentile] in Restricted/Repetitive Behaviors (RB) [37% percentile rank], and Emotional Responses (ER) [37% percentile rank], and Maladaptive Speech (MS) [3% percentile rank]. When reviewing Composite Performance values, Lucas presented with a final Sum of Scaled Scores at 64 and a percentile rank of 65% and an Autism Index of 106 (high). These numbers establish a “Very Likely” Probability of ASD, with a Severity Level of 3 which Requires Very Substantial Support. Referencing the behavioral challenges which Lucas struggles with, primarily elopement and defiance, supports and interventions would establish a continuity of beneficial routines and expectations which should aid Lucas in reducing the triggering events which cause his behavioral manifestations.

                 The GARS-3 Autism Index rating fits quite well with outlining and categorizing the behavioral abnormalities, the issues with social interaction, with social communication, the emotional responses, and cognitive style as well as any restricted/repetitive behaviors which Lucas struggles with on a daily basis. It was interesting to see how the behaviors that Lucas struggles with could be quantified through numbers and percentile ranks and then cross-referenced with an interpretation guide. I find that utilizing and evaluative process which incorporates the GARS-3 could be immeasurable in gaining insight and establishing a better understanding of the needs a student struggling with ASD may require. Establishing functional and applicable supports and interventions will make daily interactions and expectations much more successful and attainable for the student.

                 This assignment was useful in how it provided guidance in the process of assessing and evaluating a student presenting with complex deficits in social interaction and social communication and emotional responses. The manner in which the GARS-3 itemizes each category pertinent to ASD and further establishes a measurement criteria that allows an evaluator to assess and further establish a numeric value to how severe a deficit may be is an immeasurable tool for someone working in a special education environment, especially when working with students at the preschool, kindergarten or 1st grade levels where such assessments and evaluations are imperative to a student’s success when ASD concerns are presented or observed.

REFERENCES:

Ciccarelli, S. K., & White, J. N. (2014). Psychology: Dsm 5. Pearson.

​

Edelson, S. M. (2022, February 24). Toe walking and ASD. Toe Walking and ASD. Retrieved February 14, 2023, from https://www.autism.org/toe-walking-and-asd/

​

Individuals With Disabilities Education Act, 20 U.S.C. § 1400 (2004). (n.d.).

​

Mayo Clinic Staff. (2022, March 23). Toe walking in children. Mayo Clinic. Retrieved February 14, 2023, from https://www.mayoclinic.org/diseases-conditions/toe-walking/symptoms-causes/syc-20378410#:~:text=Autism.%20Toe%20walking%20has%20been%20linked%20to%20autism,It%20can%20also%20result%20in%20a%20social%20stigma.