SPM and SPM-2 Quick Tips Case Study: What’s Behind Challenging Behaviors in the Classroom?

Every year, autism research yields an enormous amount of information about the causes and characteristics of the condition. As more autistic people design and contribute to research, we’re also learning what it’s like to undergo an autism evaluation from their perspective. Below, you’ll find a quick recap of some of 2024’s studies—especially those that could influence how we conduct autism assessments in the coming year.   

Should we use AI and other new technologies to identify autism? 

No single tool or test, on its own, can identify autism in a child or an adult. Emerging technologies like eye-movement sensors and machine learning algorithms are promising, and they may soon be part of a holistic autism evaluation. In fact, some technologies are already FDA-approved for inclusion in autism evaluations. But researchers agree that to support the whole child, data needs to be gathered by a multidisciplinary team using multiple sources of information and validated instruments (Jones et al., 2024). 

Should we focus on making the process more neurodiversity-affirming?  

It can be challenging to avoid deficit-focused language when conducting an evaluation to identify autism.  That’s chiefly owing to the nature of the diagnostic criteria themselves. In a 2024 study that explored the diagnostic experience of autistic adults, researchers said “the current dominance of the medical paradigm presents significant barriers for professionals to provide positive, neurodiversity-affirmative assessment experiences for autistic people” (Pritchard-Rowe et al., 2024).

What co-occurring conditions should we consider? 

Should we assess for sensory processing differences?  

People respond to sensory stimuli in their environments with different levels of sensitivity. Researchers think that differences in interoception (the ability to notice and accurately interpret sensory information within the body) may play a role in higher levels of anxiety in autistic people (Zoltowski et al., 2024).

What role should the family play in the evaluation process?    

In a 2024 article published in Pediatric Annals, pediatrician L. A. Alkureishi described the role of the family this way: “They are the experts for their child and for their family. They know what routines work well and which do not. They can advise (and assist you) on how to conduct an examination with minimal stress.”  She encouraged practitioners to have “respect for the tremendous experience that the family brings to the table” (Alkureishi & Hageman, 2024). 

Key Messages    

Autism evaluations require a holistic, family-centered approach. Recent research has shed more light on diagnostic options and co-occurring conditions, helping clinicians make more informed decisions about how best to support autistic individuals in reaching their own goals. As greater numbers of autistic individuals share their lived experience, research continues to expand what we know about autism, and the evaluation process can become more sensitive and effective.   

Poor social–emotional development and functioning can impact children throughout their lives, potentially leading to low self-esteem, poor school performance, and higher rates of suspension. A child’s self-concept is closely linked to social–emotional functioning, and universal Social–Emotional Learning (SEL) programs can enhance self-concept, thereby supporting social–emotional function. 

In the following article, WPS’s Tonalli Espinoza and Saad Iqbal answer these questions: 

1. How does social–emotional functioning affect a child’s academic progress?
2. How does social–emotional learning influence outcomes as children grow up?
3. How can you screen for social–emotional functioning?
4. What assessments are available for social–emotional learning?
5. How can you track social–emotional learning? 

The Importance of Social–Emotional Development and Self-Concept for World Preparedness 

Navigating today’s world successfully requires a level of social–emotional functioning that we do not currently teach our children sufficiently. Social–emotional skills are essential for connecting with others and maintaining healthy relationships (Ragozzino et al., 2003). Dr. Ragozzino and colleagues (2003) describe social–emotional competence as “the capacity to recognize and manage emotions, solve problems effectively, and establish and maintain positive relationships with others” (p. 169).  

We aim to prepare our children in many ways, but emotional intelligence and social–emotional functioning is sometimes passed over, with more emphasis placed on academics and sports. This, in turn, may lead to severe problems. For example, children who exhibit problems with social–emotional functioning early on have been shown to be more likely to: 

• experience rejection and low self-esteem; 
• perform poorly in school; and 
• have higher rates of suspension (Ho & Funk, 2018).  

If these individuals go into the world untreated, they may have difficulties obtaining/keeping a job, have problems leading a happy and satisfied life, or feel a sense of disapproval by society (Denham, 2018).  

Social–Emotional Development and Self Concept 

When we consider the importance of social–emotional functioning, we should also consider the development of children’s self-concept. The two have been shown to go hand in hand. In a study done by Coelho and colleagues, universal SEL programs were shown to enhance self-concept, thereby supporting the effectiveness of such programs (Coelho et al., 2014). In another study, adolescents were more likely to show better social–emotional practices if they had a more positive self-concept, implying the importance of promoting positive self-concept development in SEL (Ybrandt, 2008).  

Furthermore, self-concept contributes to students’ school success and world preparedness. Understanding oneself, especially at a young age, will allow a person to develop emotionally and socially on a more typical level. Notably, there is no single factor that makes up one’s self-concept. People’s self-concept is developed through the stimuli that they experience and with which they interact within their vicinity. Therefore, school professionals must be cognizant of the unique lifestyle, environment, personalities, and identities of students to help them perform the best that they can. 

A healthy self-concept matters for everyone. There’s some evidence to indicate that certain individuals may be more likely to develop lower self-concepts. For example, a systematic review by Maïano and colleagues (2018) found significant differences in self-concepts among youth with intellectual disabilities and typically developing youth. Specifically, global, behavioral, and cognitive–academic self-concepts were found to be lower among youths with intellectual disabilities than among typically developing youth. Thus, it is important to be cognizant of individuals with intellectual disabilities when developing assessments and resources.  

Social–Emotional Development and Long-Term Outcomes 

Many studies have demonstrated SEL’s relation to academic, social, and wellness outcomes. Together, these studies make it clear that social-emotional development and function affect many aspects of life as children mature.  

Academics 

There is a positive relationship between academic self-concept and academic achievement, and this relationship was higher for female students than for male students (Jaiswal & Choudari, 2017). In three data sets consisting of different early childhood/adolescence populations, Susperreguy and colleagues (2018) showed that one’s self-concept of ability in math and reading predicted later success in math and reading achievement.  

Mental Health  

When it comes to mental health outcomes, there is a positive correlation between depression and school stress, and a negative correlation between depression and intellectual self-concept, resilience (optimism, trust, support, sense of control), and social skills (Jauregizar et al., 2018).  

Job and Career  

If our concern and focus is to best prepare our children for the world, social–emotional functioning and self-concept need to be considered as much as other cognitive skills. In fact, it has been shown that noncognitive skills, like interpersonal abilities, are better at predicting success in the workplace than cognitive abilities such as test scores and IQ (Jones et al., 2015). Timothy Judge and colleagues found that positive self-concept is linked to better job performance, which can attract future employers and promote more positive relationships in the workplace (Judge et al., 1998).  

Public Health  

In regards to social–emotional functioning, even public health professionals have noted it as an area of increasing importance. Jones and colleagues (2015) note that low levels of social and emotional functioning may play a greater role in many public health problems, “(e.g., substance abuse, obesity, violence)” (p. 2283). For example, one’s likelihood of committing crimes in the future is heavily influenced by social empathy and the ability to regulate emotions (Bennett et al., 2005). Furthermore, professionals speculate that those who commit school shootings lack a wide range of prosocial skills and abilities that are associated with social–emotional competence (Paolini, 2015). Nevertheless, the issues at hand can be improved upon by the inclusion of SEL and universal screening for social–emotional problems in schools.  

These studies demonstrate the need to commit resources to youth’s developing self-concepts as early childhood/adolescence is an extremely malleable time. In the same way as with social–emotional competence, strategies to better develop self-concept should be implemented in schools, and universal screening should be used to identify students struggling in these areas, so that they may be given further help and intervention.  

An Argument for Universal Screening of Social–Emotional Development & Functioning 

The question remains: How do we identify students struggling with social–emotional competence and self-concept, and provide them with learning and interventions to better prepare them for the world? Universal screening seems to be the best answer.  

Many schools operate with the assumption that teachers will catch these issues and then direct students to the support they need. However, social–emotional difficulties may not be outwardly disruptive to the classroom. It’s also ineffective to rely on a subjective observer who is also busy running a classroom of 20 to 40 children. It is far more objective and practical to administer a universal screener that can be done in one sitting and that evaluates each child in the same way.  

Furthermore, universal screeners have been shown to have high predictive validity and can better predict future problematic behaviors than a single observer (Burke, 2012). This proactive method of identifying risk should be preferred over attempts to catch the problem once it has already caused harm to the classroom and/or individual (Eklund & Dowdy, 2014). 

In fact, this method may be the most cost-effective solution to minimize future crime, bullying, and time spent out of school, which in the long run could cost more for the school and society if left unchecked. In a recent study by von der Embse and colleagues (2021), a novel system modeling technique showed that implementing a prevention-oriented mental health model for schools would result in significant cost savings of roughly $30,000 for a school with 1,000 students, a 50% reduction in disciplinary referrals, and a 22% reduction in suspensions.  

Universal Screening Tools for Social–Emotional Functioning 

Schools can use several tools as universal screeners for the purpose of minimizing risk and determining intervention compatibility.  

BIMAS-2 for Universal Screening 

A prime example is the BIMAS-2, which utilizes universal screening, progress monitoring, and outcome assessment. Specifically, the BIMAS-2 identifies children who are struggling with their behavior and social–emotional skills and then monitors them with change-sensitive items to minimize harm and promote healthy learning environments (edumetrisis.com, n.d.). 

The BIMAS-2 has been shown to successfully improve attitudes, positive social behavior, and academic performance and to reduce conduct problems and emotional distress (edumetrisis.com, 2020). In a study done with over 1,200 students from urban communities, the integration of the BIMAS-2 as a universal screener was associated with improved outcomes to those who demonstrated levels of risk and was associated with fewer adverse childhood experiences (Battal, 2020). 

Piers-Harris 3 for Self-Concept  

In regards to self-concept, the Piers-Harris™ 3 involves a short, self-reported assessment, to provide a complete picture of one’s self-concept. Its widespread use among clinicians and experts could also be translated to school systems. In other words, schools can practically implement the Piers-Harris 3 as a universal screener to identify risk and subsequently provide the best intervention. Through collaboration, the process should be integrated with assessments of SEL, so multiple levels of risk can be evaluated and accounted for when intervention is considered. 

Screeners and Assessments as Part of Comprehensive SEL Program 

Furthermore, since social–emotional functioning has become of growing importance, some schools have created entire programs to address the issue. In fact, many screeners are a part of school-wide programs that attempt to solve different overarching concerns like behavioral problems, SEL, and reading difficulties. In other words, schools often use universal screeners as a first step to identify children who show risk for the issue of concern, which leads to schools having a means to address the problem with interventions. An example of this type of program is Second Step.  

After a universal screener is done, Second Step teaches social skills at a classroom level and uses social learning theory (i.e., observation, self-reflection, performance, and reinforcement) to teach children social competence through Grade 9, with a distinct curriculum for each grade that parallels the children’s developmental capabilities. Several studies have demonstrated that children who participated in Second Step were shown to exhibit less physical aggression, less verbal hostility, and more prosocial behavior than children who did not participate (Frey et al., 2000). 

WPS has partnered with Dr. Schanding, Associate Professor at the University of British Columbia and SEL researcher to pilot the Social–Emotional Learning Skills Inventory Screener (SELSI). The SELSI is a universal Tier 1 assessment for children and adolescents to assess SEL skills, teach SEL skills, and measure pre-/post-screening. SELSI is based on a framework developed by the Collaborative for Academic, Social, and Emotional Learning, which measures five core areas of SEL: self-awareness, self-management, social awareness, relationship skills, and responsible decision-making.  

Another tool is the Social Skills Improvement System (SSIS), developed by Dr. Gresham, PhD, professor in the Department of Psychology at Louisiana State University, and Dr. Elliott, PhD, Mickelson Foundation Professor at Arizona State University. The Social Skills Improvement System, SEL Edition and Progress Monitoring Scales assess the five core areas of SEL as well as the three domains of academic enabling skills (i.e, motivation to learn, reading, and mathematics).  

Studies have found universal screeners to be an effective method to screen children who are at risk for academic failure and to positively predict academic success (Eklund et al., 2017; Elliott et al., 2018). Additionally, Sim and colleagues (2019) conducted a systematic review and found strong evidence that preschool screening tools for language and behavior difficulties have high predictive validity.  

Understanding and developing youth’s and adolescents’ SEL and self-concept is crucial for them to become functioning members of society. Through universal screeners, we can work toward a future where every school understands the issues their students are facing and can provide the most effective and cost-effective solution. Universal screeners provide the framework to guide and develop students to succeed socially, emotionally, personally, and academically in a society where academics is the most important metric and where SEL and self-concept are often ignored.  

 Related Links: 

• Social and Emotional Learning: Why We Must Act Now
• SEL Products and Resources for Schools and Private Practice

On the way into her elementary school, a student takes a deep breath and yanks her T-shirt over her nose. Her mother watches her distress from the parent drop-off line while her teachers placidly observe what looks like quirky behavior.

For some kids, school stinks. 

Perfumes. Disinfectants. Smelly gym bags. It’s an all-day olfactory assault. 

For other kids, it’s not so much the smells as the sounds that overwhelm. Lockers slam, buses roar, feet thunder up and down the bleachers. How is a child with sensory sensitivities supposed to endure a single school day?  For many, the answer is, “I can’t.” 

School distress and sensory issues  

Researchers have identified sensory processing difficulties as a “key barrier” to classroom learning (Connelly et al., 2023). When students regularly have negative sensory experiences, it can impede learning. It can also cause anxiety and limit kids’ participation as well as their sense of inclusion. Sensory issues keep some kids out of school altogether: They’re simply unable to tolerate the overload.

This is how some parents describe their experience:

• “We are able to get her into school most days by carrying her...but if she was bigger...she would be missing school” 
• “Will go but after huge amounts of upset and panic…” 
• “Extreme withdrawal and a corresponding lack of expression/engagement” 
• “…Meltdowns at the end of the day” (Connelly et al., 2023) 

For students with sensory issues, difficulties often involve more than one sensory system: tactile and auditory systems are the most frequently implicated. The more sensory systems involved, the more likely it is that a student will have higher absences from school.  

Overlap with neurodivergence 

In some cases, sensory processing differences aren’t the only factor influencing chronic absenteeism. Autism, ADHD, and other neurodevelopmental differences—which often overlap with sensory issues—are also linked to more missed school days.

Research shows that many autistic children process visual information differently than their neurotypical peers. For example, it may take longer for an autistic child to shift their eyes and attention from one object to another. An autistic person might also focus more on visual details than on objects as a whole (Zhou et al., 2023). Autistic students are also more likely to process sounds differently—which makes classroom noise an even bigger educational challenge for autistic students.

These sensory differences can change both behavioral and academic outcomes. For example, there’s some evidence to suggest that repetitive behaviors increase when autistic students face an overload of sound stimuli (Mallory & Keehn, 2021). Academic participation can also be affected: In one study, teachers told researchers that autistic students with sensory sensitivities seemed less attentive, less aware, and less “available” in learning contexts (Gentil-Gutiérrez et al., 2021). 

Similar difficulties exist for students with ADHD (Rani et al., 2023). Sensory stimuli present an extra demand on a student’s attention—on top of the challenges posed by ADHD itself. Sensory difficulties add to the other risk factors for chronic school absenteeism, making it more likely that students with neurodevelopmental differences like ADHD and autism will miss school (Russell, 2022). There’s just too great a mismatch between the student and the environment.  

Improving the sensory ecosystem for everyone 

Schools are inherently stimulating—and often unpredictable. So how can educators reduce the cognitive load and attentional demands of school settings?

Here are a few strategies researchers suggest: 

1. Begin with a clear understanding of a student’s sensory needs. Some students need greater sensory input and some need less. Some students are likely to respond to sensory overload directly—even aggressively; others may respond by withdrawing. Knowing a child’s sensory profile will help you make better decisions about modifications to the educational environment. 
2. Collaborate with parents to learn how the child functions best at home. Parents are experts in their child’s needs, routines, and behaviors. They may be able to shed light on a child’s sensory triggers. Plus, strategies that work at home may improve a child’s experience during the school day.  
3. Design educational spaces with function and predictability in mind. Researchers have found that clearly defined activity zones support autistic children who appreciate routine and order (Tola et al., 2021). Using “wayfinding” cues can help visually oriented students navigate the classroom with ease. 
4. Minimize visual clutter. Autistic students and those with ADHD are capable of intense focus, particularly when they are working on tasks that interest them. To capitalize on this strength, you may want to select classroom posters and displays that are task-relevant rather than distracting (Mallory & Keehn, 2021). 
5. Include sensory spaces that allow students to separate from others (Irish, 2022). The features of these classroom areas can be adapted to the specialized needs of your students, including lighting and color choices. Sensory-friendly areas often supply familiar sensory items to calm or engage students who need them (Nair et al., 2022).  
6. Consider how you might vary lighting in a classroom. Since students respond differently to the intensity and quality of light, it might be helpful to allow students to choose their seating so they’re closer to a preferred type of light. Dimmer switches may also be a good way to give students and teachers additional lighting control (Nair et al., 2022).  
7. Prevent auditory overload by reducing ambient noise, especially speech. Less extraneous noise can help autistic students direct their attention, engage more with their work, and use classroom-appropriate behaviors. 

Key Messages 

People perceive, process, and respond to sensory information in so many different ways. For some children, the ceaseless sensory barrage of an average school day is just too much. They may opt to be absent for their own self-preservation.

Since chronic absenteeism is high across the nation, it’s important to find out why a student is missing school. If sensory overload is part of the reason, there are steps you can take to address the mismatch between students and surroundings so that everyone has an opportunity to be physically, mentally, and emotionally present. 

Among the many challenges early childhood teachers face, perhaps the most impactful is laying the groundwork for literacy. Studies have shown that early childhood educators have a profound effect on the development of reading skills—yet some teachers say they need more training in specific strategies to support emergent literacy (Weadman et al., 2023).

Two key abilities, phonological awareness and print awareness, make up a large part of reading readiness. How can early childhood teachers support students who need to build these skills so students are ready to read by the end of the school year?

School psychologist, speech-language pathologist, and early literacy expert Kathleen Williams, PhD, NCSP is the author of the Phonological and Print Awareness Scale (PPA Scale™), and she’s been helping preschool teachers answer that question for much of her career. Here are a few of the strategies she recommends. 

Find out where each student is starting. 

The beginning of a preschool year is busy. Many students are experiencing a school environment for the first time, and early childhood educators are creating learning opportunities across multiple developmental domains starting on day one. To ensure that all students can take full advantage of those carefully crafted opportunities, it’s important to understand what each student already knows and can do. Assessing phonological and print awareness is a good place to start. 

“We really need to know where children are if we want to know how far we’re going to take them—and we want to take them to reading fluently,” Dr. Williams explains. “I think we should start looking at children coming into pre-K and early education programs, trying to find—early on—those children who have not had experiences with print, or who have never had letter names pointed out to them. Why wouldn’t we want to know which students don’t have the skills they need to learn to read?” 

Explore letter and word sounds as you move through the day. 

In rich, challenging early literacy environments, preschool students play with sounds as much as they do toys. Teachers can draw students’ attention to word and letter sounds during routine tasks, daily play, and structured learning. Activities that develop phonological awareness ask students to:

• name letters
• connect sounds to letter symbols
• identify words that rhyme
• notice when words begin with the same sound
• match words with similar ending sounds 

“When you ask children to match words that end the same, they have to do two things,” Dr. Williams points out. “They have to separate the first part of the word from that last sound. Then they have to focus on just that last sound. We have found that it’s almost as difficult as the phonemic awareness task—where we ask children to count how many sounds they hear in a word.”

Another method Dr. Williams has found helpful is using tactile sensory experiences to practice letter and sounds. It can be productive to ask students to draw letters in sand, shape letters with modeling clay, or notice how their mouths feel as they make certain letter sounds.  

Guide students as they explore the print materials you’ve provided. 

Class read-alouds are a staple in most preschool classrooms. In addition to instilling a love for the experience of shared reading, reading aloud is also an opportunity to build print awareness—the knowledge of how books work.

Print awareness includes skills like: 

• understanding that printed words have meanings;
• identifying the parts of a book (cover, pages, etc.);
• starting in the top left corner of a text;
• following words from left to right; and
• knowing that words are made up of letters and sounds. 

“I know a lot of people prefer to read on an iPad or on their phones, but we’re talking about young children here,” Dr. Williams says. “If we have a young child, and we have a book—a tactile book with the element of print—we can let them see what reading is all about.”

In addition to reading aloud, teachers can post letters and labels in the classroom space to reinforce explicit instruction in letter-sound connections. That doesn’t mean teachers need to fill every available inch of wall space (which can be overwhelming for young children who are sensitive to visual stimuli). Instead, teachers can be mindful and purposeful in presenting focused literacy opportunities in the classroom. 

Learn more: How School Leaders Can Champion Early Literacy  

Notice signs that a student may have dyslexia. 

Students with typical development generally learn to match sounds to letter symbols once they’ve received explicit, systematic instruction. That process may take more time and effort for students with dyslexia and other learning or language conditions. 

When students don’t progress as expected, or when instruction doesn’t seem to be building early literacy skills, it may be time to request a dyslexia evaluation. Identifying dyslexia and beginning specialized intervention early is better than waiting for students to fail, experts at the Yale Center for Dyslexia & Creativity say. Early intervention can lead to individualized supports, better reading outcomes, and less anxiety.

Preschool teachers may need to educate families about the nature of dyslexia or its characteristics. “Some think it’s a visual problem, but it isn’t,” Dr. Williams notes. Imaging studies in children with dyslexia show differences in activity in centers of the brain involved in phonological processing and executive functions (Pellegrino et al., 2023). 

Learn more: The WPS Dyslexia Assessment Tool Kit 

Check in regularly to make sure your reading readiness plan is working.  

Lots of students respond well to explicit, systematic reading instruction. Some kids, however, may need extra support. In certain cases, a comprehensive evaluation may be needed to understand whether a health or language condition is interfering with the development of phonological and print awareness.

As you move through the school year, it’s a good idea to pause instruction to assess student growth in these crucial areas. If you’re using a formal assessment, select one that allows for progress monitoring. Growth scores may give you a good indication of how much and how fast students are learning, and that information will help you plan your instruction going forward.

“If we have that visual of the growth score, we have an understanding or a measure of how far we’ve brought these children during the school year, and I think that’s essential,” Dr. Williams says. 

Key Messages  

Early literacy preparation has long-lasting effects on the learning trajectories of preschool students. To build a solid foundation for reading, begin by assessing phonological and print awareness. It’s also important to prioritize explicit, systematic instruction of letter-sound connections, using read-aloud experiences and sensory cues to reinforce what students are learning about how words and texts work. As the school year progresses, preschool teachers can measure growth, adjust instruction, and request comprehensive evaluations for students who need them. This short list of early literacy strategies isn’t exhaustive, but like preschool, it’s a good place to start.  

Learn more about planning interventions with the PPA Scale in this on-demand webinar.  

Recently, a first-time mother confessed to me that she had changed pediatricians because she felt pressured about the way they spoke about developmental milestones. “The doctor was extremely rigid with us. She seemed to be saying if my child wasn’t doing a certain thing by a certain month, then we needed to take him to a fleet of therapists,” the mother told me. The doctor had mentioned actions like the child zipping up their own coat, “But every time we leave the house, it’s like we’re on fire,” the mother laughed. “I zip up the coat myself because I’m late for work!”  

Assessments are only as good as the data collected. Just because a child doesn’t zip up their coat doesn’t mean they can’t zip up their coat.  

Early childhood interventions run the gamut from encouraging a child to name every part of the process of washing their hands to working on basic concepts like the difference between cold and hot water. Much of the scientific and health-focused literature represents child development as a linear process, but for many families, milestones are reached in a diversity of ways. 

School readiness as a concept was introduced in 1991 as a pre-cursor to the No Child Left Behind Act – legislation that divided educators and parents on educational outcomes in this country. In 2019, the American Academy of Pediatrics reported on the modern state of school-readiness in a report of the same name. In it, they reiterated the three main elements: 

1. Readiness in the child
2. Readiness in the school
3. Family and community support for readiness (Williams et al., 2019) 

Although all three concepts of readiness work together, it can be illuminating to look at each one more closely. 

Readiness in the child

School readiness, in part, refers to a child’s grasp of basic concepts along with social–emotional learning and physical well-being. Many researchers point to data that school-readiness is predictive of later academic achievement and success. For example, when a teacher instructs the class to “start at the top” of a worksheet and “work your way down,” they are using spatial terms that, if a child knows those concepts, makes school success more reachable. The act of completing a task engages a child’s self-control and resilience, so if a child can persist at a task in pre-K or kindergarten, it predicts success later on.  Assessing a child’s school readiness may give early childhood teachers a sense of the supports a child needs to thrive in the classroom. 

Readiness in the school

What does readiness look like in a child’s school, classroom, and teacher? First, inclusion of every student, at every ability and language level, is essential.  

Imagine a kindergarten teacher meeting their students at the beginning of the school year. They invite each student to stand up, say their name, then sit down. The teacher starts at the back of the room and points at each child until everyone has taken a turn. Some students wait patiently. Some shout or laugh. Some watch to see how others respond. Some students forget their name or ask a question instead. Some students don’t want to stand, or they have a physical difference the teacher is unfamiliar with.  

Park et al. found ‘child-directed assistance’ to be especially “humanizing” in a Head Start classroom with a diversity of abilities, home languages, and IEP statuses. “’Child-directed assistance’ included interactions where the young children of color with disabilities were supported to pursue their own interests, make decisions, express themselves, or take their own time” (Park et al, 2021) instead of 'adult-directed assistance’ from teachers who physically or verbally maneuvered the children to follow directions.  

Read more about Head Start’s framework for preschool. 

Strong structures of leadership and responsibility should show a commitment to the success of every teacher. This might look like professional development, paying teachers for planning time outside of the workday, hiring extra help, and reducing class sizes. These kinds of policy choices lead to a school’s readiness capacity to offer more opportunities for parent engagement, better understanding of early child development and play, and smooth transitions between home and school – including cultural sensitivity and continuity of interventions. 

Strengthen Your Early Intervention Process with Evidence-Based Best Practices  

Something often overlooked but essential to success is that the school is a safe, secure, and inclusive environment.  

Research has found an explosion in pre-K and kindergarten expulsions, a rise in police officers in schools, and dominance of a single interpretation of how to act in a classroom. For children who are 3, 4, or 5 years old, or even older, being subjected to an inflexible idea of what is “good” behavior can be traumatizing in racist, ableist, and exclusionary ways (Love & Beneke, 2021). 

Family and community support for readiness 

Parents, caregivers, and family play important roles in readiness as well. Community and family support can look like creating initiatives for: 

• Dedicated time at home to spend with kids, teaching, learning, and growing
• Healthcare access for prenatal and primary care, as well as access to nutritious food
• Access to high-quality childcare 

Poverty is one of the most influential factors in predicting school success and achievement. When families experience poverty, their children need more support, not less. But when a school district or community has less tax revenue, less government support, and fewer safe, healthy spaces, children’s success can be negatively impacted.  

When that first-time mother told me about all of her anxieties with her child’s adaptive behavior, milestones, and literacy, I couldn’t help but think of my own childhood. I never attended preschool. My parents didn’t know how to navigate that system, fill out paperwork, or arrange for transportation. I entered kindergarten with my mother’s advice to be quiet and obedient, and to listen to the teacher. I cowered in a corner until my teacher told me that in order to be obedient to her, I had to play and laugh and sing and drink chocolate milk and hold hands with other students. She started my love affair with learning, and that’s the very least we owe to children now. 

Key Messages

School readiness is one of the most reliable predictors of educational achievement. Assessments can give professionals valuable information about a young child’s comprehension of letters, numbers, comparisons, and emotional development. Accurate results help pinpoint areas of support and intervention, which can improve the outcomes for children of all backgrounds. But assessment results should never be used to exclude or delay a child’s entry into school. Differences in school readiness can result from a plethora of causes, and when students aren’t as ready, they need and deserve extra help that challenges them without being overwhelming.  

Read more: Assessing Early Development  

When it comes to administering the Autism Diagnostic Observation Schedule, Second Edition (ADOS®-2) Toddler Module, So Hyun Kim, PhD is among the most skilled clinicians in the world.  As an autism researcher, she has published dozens of studies involving autism diagnostic instruments—some of which she has helped to develop or translate. She has worked with hundreds of toddlers and their families to identify autism and other developmental conditions. And she has trained thousands of practitioners to administer the ADOS-2.

Dr. Kim joins WPS in a series of practical WPS ProLearn® workshops on administering the ADOS-2 Toddler Module. Here's a quick look at her tips for creating a compassionate and comprehensive autism assessment with toddlers. 

1. First, get familiar with the manual.  

The printed manual for the ADOS-2 Toddler Module is included in every ADOS-2 kit. It is a detailed, step-by-step guide and your best source for the methods and strategies to use when assessing autism in toddlers.

“It is thick, so it may be daunting in the beginning when you receive it and you’re trying to absorb information—but it does have really helpful information you need to know about the technicalities, how you administer certain tasks, what behaviors you’re looking for when you’re coding, and what each of the items means. It also has information about the diagnostic algorithm and how you can use that information within the bigger context of assessment,” Dr. Kim explains.

Familiarizing yourself with the manual will answer many of your questions in advance and save you time as you develop your own expertise.  

2. Start the assessment process by building rapport.

Depending on the age, personality, and background of the child, interacting with strangers can be stressful in the toddler years. To minimize that stress, Dr. Kim’s team conducts the autism assessment after the child has become comfortable in the clinical setting.

“The ADOS-2 should not be the very first thing kids do when they walk into the clinic,” she explains. “Many times, these kids are wary of new settings and unfamiliar people, so they might be a bit more clingy with their parent or caregivers in the beginning.”

After an initial warm-up where clinicians simply interact and play with the children, they’ll conduct broader developmental testing.

“Before we start the ADOS-2, we gain information about general development levels with children. During that time, they definitely do warm up and I can establish rapport. Then we take a break,” Dr. Kim says. “That way, by the time I start the assessment, they are more comfortable with me and I am way more comfortable with the toddler and their caregiver.” 

3. Create a child-friendly setting.

“Environmental arrangement is very important, regardless of the age of the participant,” Dr. Kim notes, “but for little ones, we want to maximize the environment so that it’s child friendly and is not distracting for toddlers.”

Lighting, comfortable furnishings, background sounds, and room temperature can make the experience feel more like play and therefore calming to young children. In addition, the movements, gestures, facial expressions, and tone of voice used by those in the clinic may also help a young child engage.

Children with certain life experiences may be particularly sensitive to environmental conditions; knowing about a child’s sensory sensitivities, family history, adverse experiences, and cultural background may help you adjust the setting to suit the child.  

4. Expect some variability in how autism characteristics present.  

The features of autism can look different at different ages, language levels, and cognitive abilities, Dr. Kim explains. Specialized training and a background in working with autistic children can make it easier to recognize subtle indications that are more common with younger children.

“Also, there can be huge variability in typically developing children during this time when development is very dynamic,” Dr. Kim says. “Some children may not walk until 15, 16, or 17 months, whereas some children may start walking at 9 or 10 months. Some of the delays you might see in young children with autism may be part of a typical variation in development.” 

5. Make plenty of room for parents in the evaluation process.

“It’s very helpful for parents to see what you did during the assessment, so nothing is a secret,” Dr. Kim says. “In every step of the assessment, parents are actively involved as our partners. They are watching how we deliver the developmental testing, and they are involved with the ADOS-2. That way, we can say, ‘Mom, remember he did XYZ during the ADOS-2? That is something he is struggling with,’ or ‘Mom, he did XYZ during developmental testing, and that is his strength.’”

Dr. Kim emphasizes that working closely with parents can require some additional skill. For example, it may be necessary to help parents find the most beneficial way to participate in testing.

“Some parents may be eager to show you things and may not give the child a lot of chance to show skills on their own, spontaneously. In that case, you might have to help them kind of sit back and relax a little bit,” she notes. “Some children might need caregivers’ input to feel more comfortable. In that case, you might invite the caregivers to be more involved. There is that balance you have to strike—and with practice, you’ll be able to find that sweet spot.” 

6. Practice, practice, practice.

Administering the ADOS-2 Toddler Module involves carrying out many tasks simultaneously. You’ll be interacting with the child, interacting with the parent, observing behavior, and documenting what goes on—all at once. 

“It does require clinical expertise and previous experience with autism and other developmental disorders,” Dr. Kim acknowledges. “I would say practice is the key. As you practice more, you’ll get the hang of it.”

It’s important to be familiar with how to carry out the tasks the test requires, including the steps involved in each task.  

 7. Hone your expertise by training with experts. 

It’s important to remember that you’re not alone. As you make your way through the manual and practice administering the ADOS-2 Toddler Module, keep in mind that there are ways to make your learning curve a little shorter.  One way is to look for a mentor.

“Shadowing a seasoned clinician can be really helpful,” Dr. Kim says. “If there are seasoned clinicians who have done the ADOS-2 quite a bit, doing consensus coding with them can be helpful, too.”

Another possibility is pursuing extra hands-on training opportunities like those offered through WPS ProLearn. The ADOS-2 Clinical Workshop and the ADOS-2 Training Video Program are excellent foundational training resources and are presented several times a year. Either course fulfills the pre-requisite for participation in the Toddler Module workshop, which provides more specific guidance on autism assessment with very young children.

“The Toddler Module workshop…has a didactic component. We teach you how to administer each task,” Dr. Kim notes. And you get practice watching the video administration.”

Another important aspect of the Toddler Module workshop is consensus coding, where the workshop participants practice coding behaviors alongside the workshop leader.

“Consensus coding is really the meat of the training. We go through each code so you can really learn about what behaviors are targeted for each of the codes,” Dr. Kim explains. “Then we will talk about the algorithm—how you get internal classification from the diagnostic algorithm and how that can really inform your global clinical impressions.” The workshop also includes guidance on report writing.   

Key Message

Assessing autism in toddlers is challenging. Even with a validated assessment measure, there are more materials to manage, the tasks can be complex and highly structured, and toddlers themselves have varied profiles and developmental needs.

With plenty of preparation and practice, however, you can create an engaging social world during the assessment—and you can learn to balance all the different elements of a comprehensive evaluation skillfully.  

Watch the full interview here.

Register here for the WPS ProLearn® ADOS®-2 Toddler Module Workshop. Please note that to participate in this workshop, you must have completed either the ADOS-2 Clinical Workshop or the ADOS-2 Training Video Program.

Let’s imagine for a moment that you’ve just completed a school-wide dyslexia screening, and you have in your hands a list of students who are at risk for dyslexia.

What do you do now? 

If you’re fortunate enough to work in a school district where certified academic language therapists (CALTs) are available, your next steps will likely be a lot clearer. That’s because a CALT is specially trained to identify dyslexia, to work with families to clarify priorities, to plan individualized education program (IEP) and 504 goals, and to provide individualized structured language therapy for as long as a student needs it.

In some regions, working with a CALT is a relatively new option. What should administrators, special educators, and school psychologists know about the benefits of having a CALT on the dyslexia team? 

What exactly is a CALT?  

CALTs are specialists with extensive training in English language systems, reading, and language-based disorders, including dyslexia and dysgraphia. They specialize in helping students build their reading skills from the ground up. 

To earn a CALT designation from the Academic Language Therapy Association (ALTA), educators must:

• hold a master’s degree or higher;
• complete at least 200 hours of graduate-level instruction in comprehensive multi-sensory structured language education;
• complete an extensive series of practicum experiences totaling at least 700 hours, supervised by a CALT Qualified Instructor (CALT-QI); and
• complete at least 10 graded demonstrations over a minimum 2-year period.

CALTs must also pass a national certification exam and adhere to an ethical code of conduct.

What are the benefits of including a CALT on your dyslexia team? 

Dyslexia is a complex neurodevelopmental condition. For that reason, experts generally recommend comprehensive dyslexia evaluations conducted by a multidisciplinary team (Mather & Schneider, 2023).

While no single profession has exclusive purview over dyslexia evaluation, it can be beneficial to include professionals with extensive, specialized dyslexia training.  

Here’s a brief look at the benefits of including a CALT on your dyslexia team: 

1. CALTs are highly trained dyslexia experts.

CALTs are dyslexia specialists. They have advanced training in decoding, encoding, phonology, phonics, orthography, morphology, semantics, syntax, and multi-sensory teaching methods.

Jackie Valadez, PhD, LDT, CALT-QI is an educational diagnostician and president of the Texas Dyslexia Center based in Boerne, TX. She explains, “The knowledge that CALTs bring to a campus, a district, or a reading and literacy team is so important. We understand reading development from its foundation. Through our extensive training, we know what dyslexia is, what it looks like, and where the struggles are.” 

Lynne Fitzhugh, PhD, LDT, CALT-QI has been training teachers at Colorado College since 2007. She founded and now directs the college’s Master of Arts in Teaching – Dyslexia Specialist Program. “We cannot address dyslexia without experts who are grounded in the structure of the English language,” she says. “I tell our students that my goal for them is that they are the most knowledgeable reading experts out there in their communities.” 

2. CALTs have considerable hands-on experience working with students who have dyslexia.

In addition to instructional requirements, CALTs spend 700+ hours in direct, clinical one-on-one or small group intervention with students in 3 practicum settings. 

“I would say the practicum experience is probably as important as the actual classroom knowledge,” Dr. Fitzhugh says. “It’s incredibly valuable.”

Clinical practicum experiences are supervised, and students receive feedback on their interactions with students, Dr. Valadez notes. “Trainees, initially, are learning as they are servicing students. Understanding the ‘why’ of what they’re doing can be an eye-opener,” she says. “Trainees attend seminars, receive further instruction in the curriculum, and discuss current research as they delve deeper into their two-year practicum.”  

3. CALTs are knowledgeable about both diagnosis and intervention.

Roles and responsibilities for CALTs vary according to the setting. But for most, their primary contribution relates to assessment and identification, whether they work in private practice, clinical sites, or schools.

“Where I worked, we tested for dyslexia and related disorders under section 504,” Dr. Valadez explains. “When a student was referred for dyslexia testing under special education, we collaborated with the school psychologist. The school psychologist did some of the testing, and we did some. We wrote the reports together, including the summary, findings, and recommendations. It was a collaborative approach.”

Many CALTs also manage intervention programs, which typically take two years to complete. Intervention programs take a structured literacy approach, systematically breaking language and reading skills into manageable pieces. Instructional sessions feature sight, sound, touch, and movement modalities. To be considered therapeutic, sessions must be held a minimum of 120 minutes per week. 

4. CALTs can be excellent parent and family advocates.

In some school districts, CALTs are part of the official school-based dyslexia team. In other places, they may be brought in chiefly to advocate for students and families in cases where the school may not yet be providing sufficient services for the student.

CALTs can be instrumental in explaining the evaluation and intervention process to students and families. They can help parents articulate their concerns, share their priorities, and contribute meaningful goals to IEP, 504, and other intervention plans. They can also communicate school initiatives to parents, helping to ensure families understand their rights and responsibilities.

Megan Pinchback, LDT, CALT, is the owner of Dyslexia On Demand, an organization that pairs CALTs with families, educators, and health care providers. She points out that she and her colleagues often support educational advocates during the IEP process. 

“When the school is lacking in the knowledge needed to serve children with dyslexia, a CALT can discuss the difference between dyslexia therapy and instructional support methods,” she explains. “We can also discuss meaningful servicing time and therapy-specific goals.” 

5. CALTs can bring continuity of care to the process. 

The two-year intervention program is a long-lasting educational partnership that can bridge school years. In fact, some CALTs continue to be a resource to students and families long after the initial program has concluded

Dr. Fitzhugh points out, “They may have completed a two-year remediation program, but there will still be times when that elementary child gets to junior high or high school and there are other needs—study skills or executive skills functioning—where our members provide advanced levels of support to see a student all the way through college and into adult life.”

Continuity of care also extends to other health concerns that can arise for students with dyslexia.  

“Dyslexia is neurobiological,” Dr. Valadez explains. “We know the characteristics of co-occurrences that may develop along with dyslexia or over time. Reading difficulties can affect students’ mental health and self-esteem, so we are always focused on the development and progress of the whole child.” 

6. CALTs can help to educate other members of the team about dyslexia.

Most teacher preparation programs offer limited training in dyslexia identification and intervention. While a growing number of higher education programs are training students in the Science of Reading (SOR), there’s still a long way to go to make sure teachers know what works for children with specific learning disabilities in reading. 

CALTs can be a resource for other members of the dyslexia evaluation team. “In some districts, CALTs write the goals and submit progress monitoring every nine weeks, and they alter the goals if they need to be altered,” Dr. Valadez says. “They really can be the literacy leaders on your campus. Some even serve in district administrative roles.”

“CALTs can also lead professional development and assist in Tier 1 curriculum selection, identifying the tools most truly aligned with the Science of Reading,” notes Megan Pinchback.  

7. Working with a CALT can be life-changing for students with dyslexia.

For students, families, and educators, learning alongside a CALT can be a transformative experience. 

“This is a life-changing field,” Dr. Fitzhugh confirms. “It changes the therapists we train, and they, in turn, are changing the lives of so many children who could experience academic failure if they are not identified to receive this intensive therapy. For me, it’s pure passion. This is what I was meant to do.”

Seeing how quickly students respond to therapy is moving, Dr. Valadez explains. During her clinical practicum as a CALT-trainee, she worked in a public school setting. “I had no idea how fast non-readers would start to read. To see them, hear them, be in front of them! By December, they were reading, these third-grade children. It was really emotional. It brought tears to my eyes. I remember saying, ‘Has anyone heard you read?’” 

Key Messages 

Certified academic language therapists are highly trained specialists in reading, dyslexia, and other language-related disorders. They can be instrumental in administering assessments, creating IEP and 504 plans, delivering interventions, and advocating for families and students with dyslexia. They can also build the knowledge of structured literacy and dyslexia within a school dyslexia team.

A strong, multidisciplinary dyslexia team features many different types of educational and health professionals. A CALT can be an important addition, not only because of their advanced reading-related knowledge, but because they can play a variety of roles to build out the functionality of the team and, ultimately, benefit the student.  

People are wonderfully diverse. Bodies, brains, abilities, experiences…they’re all strikingly different from one person to the next. The last thing a competent, compassionate practitioner would want to do is to pathologize that individuality—and yet the process of identifying neurodevelopmental conditions and designing supports can leave some neurodivergent people feeling isolated and stigmatized.

Bryden Carlson-Giving, OTD, OTR/L is one of a growing number of health and education professionals who are aiming to make the evaluation process more affirming for neurodivergent individuals. A neurodivergent practitioner himself, Dr. Carlson-Giving is the creator of  Neurodivergent Nexus, a knowledge translation tool to support affirming evaluation, assessment, and intervention practices. 

Building a neurodiversity-affirming evaluation, he says, begins with how we view differences and disabilities. When clinicians and educators start with a medical model of disability—the perspective that differences in functioning are the result of an underlying abnormality that needs to be corrected—it’s easy to see a neurodivergent child as a collection of impairments and deficits. 

When caregivers adopt a deficit-based view, the child’s self-image can ultimately be harmed. “It leads to really low mental health, low self-esteem, low self-identity. We’re setting up neurodivergent students and clients for failure, instead of having a healthy way of living that isn’t dominated by what other people think. We may be taking away the chance to have health defined on their own terms.” 

The medical model of disability doesn’t necessarily address what the individual wants to address or prioritize. And it does not consider the social environment, which may not be providing enough support to allow neurodivergent people to participate in areas where they want to do so. 

Yet, in many systems and settings, eligibility for services may hinge on meeting deficit-oriented diagnostic criteria. In such circumstances, how can clinicians and educators make the evaluation process more affirming for neurodivergent students and their families?  

Dr. Carlson-Giving shares these recommendations from the forthcoming book, Neurodiversity Affirming Occupational Therapy Practice: An Anti-Ableist Approach, to be published by Jessica Kingsley Publishers: 

1. Start from a place of trust and understanding.  

“When you walk into the room, your first step is to believe the individual and their experience, especially if someone is open to talking about feeling misunderstood by society and feeling they can’t authentically be who they are,” Dr. Carlson-Giving says.

“Oftentimes in schools, I’ll have meetings with families and they’ll share… ‘When we met with our outpatient OT or with our pediatrician, we felt like we were not heard. We told them about masking, and the problematic features of an assessment tool and how it made us feel a lot worse about our child. We felt like they were not listening because they knew better.’” 

In neurodiversity-affirming practice, practitioners center the lived experience of the individual. “It’s the foundation of the entire evaluation,” Dr. Carlson-Giving says.  

2. Challenge accepted beliefs about what health and wellness look like.

What people believe about the nature of health and wellness affects the way they conduct assessments, write goals, and provide services. Your patient, client, or student may have a different definition of what health looks like for them and what contributes to their sense of well-being.

To look at health and wellness from your client’s perspective, you may need to dismantle some of what we have all learned about what “normal” looks like, Dr. Carlson-Giving points out. 

You may also want to explore your own privilege and your own identities—just as you might do when building your cultural sensitivity in other areas. This kind of reflection can be uncomfortable and challenging because it may involve the discovery that some of our beliefs are rooted in a type of ableism—the view that what is neurotypical is inherently healthier than neurodivergence. 

3. Select appropriate assessment tools.

One of the most affirming steps you can take is to ensure you are using assessments that consider the student’s lived experience and support their involvement in goal setting.

“My favorite assessment tools within pediatrics are the Perceived Efficacy of Goal Setting (PEGS) System, the Dynamic Assessment of Social Emotional Learning (DASEL), and the Visual Activity Card Sort,” says Dr. Carlson-Giving.

It's important to know that neurodivergent people sometimes mask or camouflage their characteristics during standardized assessments. That means test results may not accurately reflect an individual’s capabilities, daily experience, or needs. It’s also important to understand that many standardized tools are mapped to deficit-based diagnostic criteria. Information about a person’s strengths, and about environmental supports to improve their quality of life, may need to be gathered through other means.

One additional concern has been raised by some neurodiversity experts: “Standardized assessments often compare disabled and neurodivergent individuals to nondisabled individuals, making neurotypicality an implicit goal of therapy,” Dr. Carlson-Giving explains.

In many settings, resources and supports are linked to a formal diagnosis. For that reason, many autistic children and adults, as well as their families and advocates, say diagnosis matters (Rutherford & Johnston, 2022). While standardized tests are not always needed to access services, they are sometimes the key that opens the diagnostic door. Using function-based assessments such as the Goal-Oriented Assessment of Lifeskills (GOAL™) can open those doors while minimizing harm. A whole-child practice always strives to make room for individuality, even in a controlled assessment environment. 

4. Emphasize strengths in your report. 

“Language influences everything,” says Dr. Carlson-Giving. “People forget that how we talk about a diagnosis, especially when it’s new, will often translate into the parents’ or the family’s view of their child,” he explains.

An affirming report presents an accurate portrayal of a child’s strengths. It describes the child’s communication differences, interests, and competencies in neutral, non-judgmental terms. Instead of labeling a child’s behavior “restrictive and repetitive” in the narrative portion of a report, you might simply describe what the child enjoys doing: Artfully arranging toy ponies, for example. 

Dr. Carlson-Giving also recommends placing test scores at the end of a report so that more emphasis is given to the client’s goals, strengths, and interests.

More research needs to be done to clarify the benefits of strengths-based reporting, but there is evidence to suggest that when autistic individuals are supported in identifying and using their strengths, it can lead to “better quality of life, well-being, and mental health” as well as “feelings of self-worth…positive affect and self-esteem” (Taylor et al., 2023).  

5. Write affirming, empowering goals.

A core tenet of neurodiversity-affirming practice is writing goals that are meaningful to the individual at the center of the evaluation. 

“You’re asking probing questions,” Dr. Carlson-Giving says. “You’re asking what’s meaningful for them. You’re asking what they actually want to participate in, without any thought of what you think they should be participating in, or where they could be participating more or more efficiently.”

One thing to keep in mind: Neurotypicality itself shouldn’t be the goal. In neurodiversity-affirming practice, goals do not focus on correcting or reducing autistic traits or learning to be more neurotypical. Instead, goals reflect the priorities of the autistic individual and the family. They often aim to build self-advocacy skills, self-esteem, or mental health. Goals can also focus on aligning supports and environmental adaptations with a person’s expressed needs

When writing goals, Dr. Carlson-Giving notes, you’re asking about strengths and interests in terms that align with your professional discipline. “From an OT perspective, we’re asking, ‘What are the best parts of your day? What are the most challenging parts of your day? In your dream scenario, what would you like to get better at?’”

Collaborating on goal setting in this way builds self-advocacy and a sense of agency within the individual being evaluated. “It’s essential that the client has the opportunity to exercise their own self-determination and say how they want to experience the world and make decisions for themselves,” he explains.

In his research, Dr. Carlson-Giving illustrates how goals can be rewritten so they’re more accepting and supportive of neurodiversity:  

(Carlson-Giving, 2023) 

Key Messages 

These five steps are just a starting place.

Centering the lived experience of children and their families, redefining health from your client’s perspective, selecting appropriate assessment tools, adopting a strengths-based approach, and writing empowering goals are key features of neurodiversity-affirming practice. These strategies can be employed by occupational therapists, school psychologists, special educators, speech-language pathologists, and any other professional who serves neurodivergent children and adults.

Creating more affirming evaluations will take careful listening, learning, and reflecting. Parts of the process may require thinking anew about long-held practices. But early evidence suggests that there are likely to be significant benefits—both for you and for your marvelously diverse students.  

For many health and education professionals, developmental screening of infants and toddlers is a common responsibility. As you carefully observe a child’s behavior, language, movement, and social–emotional development, you may notice an area of concern—or perhaps a parent or caregiver presents a concern to you during a visit. That’s when it’s time for a closer look.

These guidelines can help you plan a thorough evaluation to clarify what’s going on with the baby or toddler in your care:

1. Check the recommendations, eligibility criteria, laws, and timelines for early intervention in the Individuals with Disabilities Education Act (IDEA) and in your state. Keeping up to date with these requirements is important because they can change from year to year. Meeting deadlines and eligibility criteria will have a direct impact on services for the children in your care.   

2. Consider the child’s risk and protective factors. Some delays run in families; later walking and talking is one example. Other delays may be linked to infections that occurred before birth, exposure to certain medications and environmental toxins, or malnutrition (Khan & Leventhal, 2023).     

3. Choose assessments in a language most likely to show you what a child knows and can do. IDEA requires professionals to screen and assess in a child’s “native language,” or the language spoken at home. Assessments involving pictures may still require a child to understand instructions or know the names of pictured objects. 

4. Select assessments that closely match a child’s characteristics. As you review your assessment options, consider a child’s age, developmental history, sensory needs, physical abilities, language skills, social–emotional development, and cultural background. A good match between assessment strategies and the child’s personal characteristics makes it more likely that assessment data will reflect what the child can actually do. 

5. Assess comprehensively. To deepen your understanding of the infant’s strengths and needs, you’ll want to assess different developmental domains in all settings where the child typically spends time. You’ll want to review medical records, if possible, and to find out as much as you can about family health and educational history. It’s a good idea to use different assessment methods, too—including observation, interviews, and standardized assessments where needed. 

6. Add authentic assessment to your tool kit. Observing children as they play and interact in natural settings can help you learn more about a child’s daily functioning in environments where they feel comfortable. While many states link eligibility for services to outcomes on standardized assessments, best practice is to consider the child in a natural context rather than solely in a clinical setting (Stein et al., 2023). 

7. Center the family’s concerns and address their priorities. A family-centered approach builds engagement and leads to better outcomes, researchers say. Family-centered early intervention:

• treats family members as equals;  
• respects cultural and social differences;  
• embeds goals in everyday life;  
• ensures families can access information;  
• considers family resources; 
• builds family competence; 
• incorporates family feedback at every stage of the process; 
• improves family decision-making capacity; and
• may lead to better developmental outcomes and greater family empowerment (Frugone-Jaramillo & Gracia, 2023). 

It’s especially important to make sure your reports are written in plain language the family can access, and that they address a family’s priorities and concerns in a useful way. 

8. Build a collaborative evaluation team. In some practice settings, a service coordinator acts as a liaison between the family and a multidisciplinary evaluation team. Pediatricians, developmental specialists, audiologists, occupational therapists, speech–language pathologists, physical therapists, psychologists, social workers, mental health professionals, teachers, daycare professionals, registered dieticians, caregivers, and other health professionals work together with the family to identify delays and plan interventions in all areas of development.  

9. Broaden your reach with telehealth service delivery. In a 2022 study, early intervention specialists described the behaviors that seemed to keep families engaged when they were receiving care via telehealth. Families stayed engaged when early interventionists:  

• showed empathy; 
• considered the child’s and parent’s expectations; 
• communicated with warmth and respect;   
• responded when children tried to interact; and   
• took action on parents’ feedback (Retamal-Walter et al., 2022). 

10. Use your own clinical judgment, as well as test results, in the assessment and planning process. An assessment may have strong psychometric properties, but your own clinical reasoning, along with that of your team members, is equally important. Clinical reasoning allows you to:

• synthesize the information you’ve received from all sources; 
• consider personal and contextual information about the child;  
• balance contradictory findings; 
• think deeply about different hypotheses; and 
• look for possible biases (Wilcox et al., 2023). 

11. Use tools that allow you to monitor progress effectively. Verifying eligibility is a big part of the early intervention process, but it certainly isn’t the last stop. Evaluating a child’s progress, updating your plan—and measuring the effectiveness of your program—are also important. The right assessment will be sensitive enough to help you find out whether interventions are working, whether a child is growing, and where your program might be improved moving forward.  

Learn more about enhancing your clinical reasoning through professional development with WPS ProLearn®. 

Key Message

Developmental screenings can take place in the course of regular care or to address the possibility of a delay. When a parent, educator, or health professional expresses concerns about development, using best practices ensures that the infant or toddler receives a thorough, timely, and sensitive evaluation.

To learn more about best practices in developmental screening and assessment, you may want to explore the recommendations provided by the Council for Exceptional Children, Division of Early Childhood.  

Childhood trauma can interrupt development in ways that have long-lasting effects on mood, sleep, executive function, learning abilities, and social interaction. Autism can also change how a child develops—and with some similar-looking effects. Differentiating between the two is important, not just because a diagnosis may impact service eligibility for a child, but because it may change the nature of the interventions you recommend.  

The Effects of Developmental Trauma

While most developmental delays are the result of unknown causes, some delays may occur because a child has been exposed to environmental and psychosocial factors such as maltreatment, poverty, or domestic violence. For some children, a delay may later be characterized as autism (Khan & Leventhal, 2023). That’s particularly true of delays in these areas:

• Motor skills 
• Emotional regulation 
• Behavior 
• Speech and language

How trauma presents depends in part on the developmental stage a child is in at the time of the adverse event. It may also depend on the child’s capacity for coping and the support resources available to the child. Trauma symptoms may appear right away, or they may be delayed for weeks or months.

When a child experiences trauma during a critical period of brain development, the results might include:

• disrupted attachments; 
• a change in self-regard or self-identity; 
• alexithymia, or trouble recognizing or naming emotions; 
• a change in emotional control, such as numbing or lower tolerance for frustration; and 
• loss of a sense of safety or security (Cruz et al., 2022).

Many experts classify these effects as developmental trauma disorder, though this condition isn’t specified in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition Text Revision (DSM-5-TR). The American Psychiatric Association (APA) does note that PTSD in children younger than six may have a distinct presentation. Among the symptoms the DSM-5-TR mentions are:

• problems with concentration; 
• sleep disturbance; 
• impairment in relationships 
• socially withdrawn behavior; 
• irritability or anger; and 
• avoidance of activities, places, conversations, or situations that bring back memories of a traumatic event (APA, 2022). 

Trauma can also affect a child’s flexibility and sensory sensitivities and can change the way children play. Researchers report that children’s play often becomes “ritualistic” and “repetitive.” Elements of the traumatic event may show up either explicitly or symbolically. (D’Elia et al., 2022).  

Similar Autistic Traits 

Autism is highly heterogenous, in that it can look different from person to person. Even so, autistic infants, toddlers, and young children may also have:

• differences in their attention or concentration abilities; 
• sleep disruption; 
• repetitive play patterns; 
• preference for sameness and routine; 
• differences in social interaction and communication; 
• sensory differences; and  
• mood difficulties such as intense frustration and anxiety (Alrehaili et al., 2023).  

Looking closely at a characteristic or behavior may help you determine whether it is linked to autism or to trauma. For example, children may repeatedly recreate a play scenario with a negative narrative “ending” if they are using play to process a traumatic experience. That’s different from an autistic tendency to repeatedly line up or arrange toys and other objects of interest. 

Questions You Can Ask 

To clarify whether a developmental delay may be connected to autism, to trauma exposure, or to both, you may want to ask questions like these: 

• Have elements of a child’s life or history set up an ongoing state of fear or terror that might interrupt mastery of age-appropriate competencies or cause social or behavioral difficulties? 
• Does a lack of interest in peers seem to stem from social withdrawal, from an attachment difficulty, or from a difference in social–emotional reciprocity? 
• If a child isn’t sharing emotions or expressing affection, is it part of an overall reduction in positive feelings, or does it appear to be connected to a more general pattern of social communication differences? 
• Does social communication or emotional reciprocity change as a child becomes more comfortable in an environment?
• Does a pattern of repetitive play seem to be related to avoiding or experiencing intrusive memories?
• If a child experiences an emotional “outburst,” was it sparked by irritability, by a sensory experience, or by a disruption in routines?
• If a child has sleep difficulties, are nightmares involved?
• Are behaviors and abilities consistent across settings and over time?
• When might an exposure to trauma have occurred?
• What developmental tasks might have been impacted, given the timing of the trauma exposure?
• What skills or competencies might a child have missed because of developmental disruption?
• What supports in the child’s own personality or in the environment surrounding the child might add risk or resilience potential?
• How do the child’s traits and behaviors change in response to intervention or treatment?

In addition, it’s vital to gather information about a child’s early developmental history, personal and family strengths, and the parent or caregiver’s concerns. You may want to consider using a trauma screening tool, a resilience assessment, or a measure of adaptive functioning such as the Adaptive Behavior Assessment System, Third Edition (ABAS®-3), in addition to validated autism assessments, to help you create as clear a picture of the child’s experience as possible.

Working with a multidisciplinary team, including a speech–language pathologist and an occupational therapist, will help you conduct a thorough and comprehensive evaluation. If you do find evidence of trauma exposure, you may want to explore resources offered by the National Child Traumatic Stress Network.  

Key Messages 

Autism and trauma can both affect a child’s developmental path. To differentiate between the two, you may need to work with parents, caregivers, health professionals, and early childhood educators to build a developmental timeline that identifies when behaviors and characteristics first emerged. If you know a child experienced trauma during a critical developmental window, you can also consider which tasks and competencies may have been affected. Validated assessments can help you structure much of this data-gathering, but you may also need to consider family and contextual factors to help you create a clear picture of a child’s history, needs, and resources. 

When a child has one or more developmental delays, one of the challenges practitioners face is determining whether a delay is related to autism or childhood trauma. Making that determination can be challenging because autism and trauma can affect development in similar-looking ways, and because the two can sometimes coexist in the life of a child.

Autistic children have a higher risk of acute stress disorder and post-traumatic stress disorder than their typically developing peers (Li et al, 2024). In addition, diagnostic overshadowing may make it easier to overlook trauma symptoms when autistic features are present, and trauma symptoms may make it harder to notice autistic traits (Stavropoulos et al., 2018).  

Trauma and Autism Both Affect Key Brain Structures

Large brain imaging studies have shown that exposure to trauma during vulnerable developmental periods can change brain structures, including the amygdala, the right putamen, and the frontal and cingulate regions (Jeong et al., 2021). Those brain structures are involved in the development of executive functions like these: 

• Holding information in mind while doing tasks (working memory) 
• Directing attention 
• Concentrating  
• Planning tasks 
• Controlling behaviors and impulses 
• Noticing, naming, and expressing emotions

Variations in brain structure development have also been linked to the expression of some autistic traits (Arunachalam Chandran et al., 2021). Brain imaging studies of autistic infants and toddlers show that many of these structural differences appear during the first two years of life, with some differences visible as early as six months (Girault & Piven, 2020).

In a meta-analysis that explored executive function in preschool children, Chirstoforou et al. (2023) found that autistic children tended to have difficulty with these tasks:

• Inhibition (being able to suppress or control impulses, behaviors, and attention) 
• Set-shifting (changing attention from one task to another) 
• Planning (organizing, prioritizing, and making decisions)

Researchers have also found that autistic preschool children sometimes experience emotional dysregulation that interferes with their ability to function socially and practically in some environments (Davico et al., 2022).  

Trauma Can Lead to Developmental Delays 

Efforts to educate the public about developmental milestones and the need for autism screening have provided many families with good information about the ways autistic traits can show up in infants and toddlers. Information about the impacts of trauma on development aren’t as widely known.

While every child develops in a unique way, skills usually develop along a timeline. The skills a child learns in one phase of development form a foundation for the skills they learn later. Trauma can impact a person’s ability to concentrate, to remember, to think clearly, and to regulate emotions—all of which are abilities children need to learn a new skill.

Children who receive help following a traumatic experience may be able to make use of their resources to recover and to get their development back on track, so to speak. Without support and resilience, however, a child’s developmental path can be changed in important ways: 

• Development could be interrupted or slowed—especially if highly precise learning is involved, such as when a child is building complex motor skills. 
• A child might regress developmentally, losing some previously learned skills. 
• A child might make a developmental leap, learning skills for which they’re not yet mentally or emotionally prepared. This kind of leap is sometimes called precocious acceleration. 

Trauma Effects and Autistic Traits May Look Alike

Autistic traits and the effects of trauma can often present in similar ways (Stavropoulos et al., 2018). Researchers have found that autism and trauma exposure can both lead to:  

• avoidant behaviors; 
• repetitive play; 
• reduced exploration; 
• anxiety or depression symptoms; 
• changes in attention or concentration; 
• difficulty accurately interpreting others’ feelings; 
• emotional dysregulation; 
• developmental language differences; 
• difficulty with change or transitions; 
• sensory over- or under-sensitivities; and 
• sleep disturbances.

There is some evidence that the development of social cognition is also affected by trauma as well as autism. Social cognition is generally defined as the skills we use to perceive, interpret, and respond to social information, including abilities like these:

• Recognizing facial expressions
• Interpreting body language
• Inferring the emotional states of others
• Interpreting social cues
• Taking on or imitating social roles 
• Understanding complex interactions

These skills develop in a fairly predictable progression in most children. Trauma may interrupt the developmental sequence in some children, leading to differences in social cognitive abilities. For example, in a 2023 study involving roughly 4,400 British children, researchers analyzed patterns of childhood maltreatment from birth to age nine. They found that children who experienced abuse between 18 months and 6.75 years were particularly likely to have poorer social cognition later in childhood (Crawford et al., 2023). More exposure to maltreatment generally led to worse social cognition, especially for girls, researchers said.

These differences may emerge very early in development. One of the earliest skills babies learn is known as gaze-following—the ability to look where someone else is looking. In a recent Swedish study, researchers found that ten-month-old infants whose mothers had postpartum depression followed eye gaze less often than babies whose mothers did not have the condition (Astor et al., 2020). Autism also affects early social cognition skills like gaze-following. Researchers have found, for example, that autistic infants often communicate and cooperate less using eye gaze than typically developing infants of the same age (Ellis et al., 2020).

A similar skill, joint attention (two people intentionally paying attention to the same thing), is also affected by both autism and trauma. A delay in joint attention skills at eight months old was linked to autistic traits at 18 months old, one study found (Montagut-Asunción et al., 2022). A Chinese study showed that young children who had experienced parental deprivation, also had differences in the prefrontal cortex which led to joint attention deficits (Ding et al., 2021). 

To determine whether an apparent developmental delay is linked to autism, trauma, or both, it’s important to consider a child’s family history, cultural background, and developmental history—including a careful look at what developmental tasks could have been disrupted by an adverse event. 

Learn more: Autism is Cross-Cultural. Shouldn’t Your Assessments Be, Too?  

Key Messages 

Trauma and autism can both affect the way a child develops, sometimes leading to delays that pause, regress, or advance the development of important skills. It’s important to conduct a holistic evaluation that includes validated autism and trauma assessments, an analysis of cultural factors that could affect how either is expressed, and information gleaned from multiple sources and varied settings. It will take extra attention to determine the origin of a developmental delay when a child’s life has included trauma, but your time and care will enable you to plan supports that better meet a child’s needs. 

Learn more: The WPS Guide to Autism Assessment 

In recent years, practitioners have seen a surge in the number of girls and women requesting autism evaluations. That increase doesn’t necessarily reflect growth in the prevalence of autism; instead, it’s an indication that what we know about autism in girls and women is changing. Clinicians and educators are getting better at describing what the condition can look like in people who identify as female. And our culture is slowly becoming more accustomed to thinking about, talking about, and learning from autistic girls and women.

For Lindsey Sterling, PhD, clinical child psychologist and founder of the Sterling Institute for Autism, this shift in perspective is a welcome one. “We’re getting better at describing what autism is like in females both through research and in clinical experience, which means we have a better sense of what sets females apart so that we can incorporate that into our assessments,” Dr. Sterling says. “Even more exciting is the fact that neurodiverse women are starting to feel more comfortable speaking up and describing their firsthand experiences.” 

The growing number of autobiographies, podcasts, websites, and videos featuring autistic women is testament to the increasing acceptance. “We’re seeing women self-advocate, coming in for the assessments they need. There’s less shame around that. Women realize there is a community out there who understands them, and the neurodiversity movement, appreciating brain differences, is starting to gain momentum so there’s less stigma around an autism diagnosis,” Sterling says.

In the upcoming webinar, “Unmasking the Lives of Autistic Females,” Dr. Sterling will provide an overview of autism in girls and women across the life span, examining biological and neurological theories that might account for sex differences in autism expression. The course also explores diagnostic markers, unique strengths, and common lived experiences including camouflaging and masking. Dr. Sterling will describe the barriers to accurate and timely identification and explain which other neurodevelopmental and psychological conditions often co-occur with autism. And perhaps most important, she’ll outline an approach to accurate assessment of autistic females, including practical clinical recommendations. 

The course begins with some historical perspective. “Some of our earliest conceptions of autism, in the 1940s, involved picturing a little boy. That sort of stuck in people’s minds,” she notes. “In fact, when we did research, we would recruit participants, making sure that the ratio reflected what we thought was accurate—which was 4 males to 1 female. So the research findings and assessment measures were developed based on what we know about boys.”

Those findings shaped cultural attitudes about what autism was and wasn’t. “When we watch TV, we see portrayals of these quirky boys and men who are supposed to reflect autism, and that gets embedded in our understanding of what autism is: little professor-like males,” Dr. Sterling explains. “On top of that, there are additional cultural influences. For example, girls in general, not just autistic girls, are socialized to nod, smile, be affable and friendly. They are not given much room to be aloof or to check out. They’re supposed to be pleasers.” Those gender expectations, entrained at an early age, influenced how many autistic females presented publicly. 

“What we’ve learned over the years is that many girls are engaging in masking and camouflaging. They’re mimicking what they see around them. They’re learning what they’re supposed to be doing to blend in,” Dr. Sterling says. As a result, those who can mask or camouflage effectively may be overlooked or misdiagnosed by providers. Even family members and educators who interact daily with autistic female students can have a hard time recognizing autistic traits or characterizing behaviors as such.

As more research is conducted in alliance with autistic female subjects and researchers, practitioners are getting better at meeting the needs of this important population. “As psychologists, we’re trained to observe behavior and collect data from collaterals, which we should still do. But when it comes to females there’s this other piece that’s so important, and it’s listening and believing,” Dr. Sterling points out. “We have to rely on what people say is their experience of the world.”

Another step? Conducting a broad, thorough evaluation, including developmental histories and interviews with multiple sources.

“It’s really important to get a detailed developmental history. That’s important in any autism assessment, but especially with a female,” Sterling says, “because even though some of the challenges might not become apparent until later, when life gets more challenging and socialization gets more complex, it doesn’t mean that someone gets autism when they’re 20.” A developmental history can help you understand what life has been like for this person. 

If a parent isn’t available to provide that background or if few records exist, Dr. Sterling recommends a practical workaround. “We interview who we can to get other perspectives—a spouse, a partner, a sibling. We can ask, ‘What’s it like to live with this person? What have you noticed about what it’s like to social with them?’ With females, we have to be ready to be flexible, to dig a little bit deeper. Sometimes that means doing a longer assessment to really get to know the person, rather than basing our impressions on what we see on the surface,” she explains. “The more time we spend, the more likely it is that people will be able to unmask.” 

Dr. Sterling recommends that clinicians and educators take a close look at their own assumptions and experiences with autism, because they may lead to bias in assessment. She also advises a shift away from deficit-based evaluations and toward a more strengths-based approach, noting, “The assessment isn’t about finding out what’s wrong with someone. It’s about validating their experiences, recognizing what’s different, and empowering women so that they’re able to feel proud of their differences. We want to acknowledge and provide direction for the things that are hard.”

WPS is proud to shine a light on the outstanding work of Dr. Lindsey Sterling in “Unmasking the Lives of Autistic Females.” You can purchase the on-demand webinar here.