What assessments and interventions are recommended for a student with developmental concerns, speech and language delays, behavioral difficulties, and a possible Autism Spectrum Disorder (ASD) diagnosis to inform their Individualized Education Program (IEP)?

Recommended Assessments and Interventions for IEP Development

For a student with developmental concerns, speech and language delays, behavioral difficulties, and possible ASD, the school must conduct a comprehensive multidisciplinary evaluation including cognitive assessment with verbal and nonverbal components, measures of sustained attention, working memory, and processing speed, receptive and expressive language testing, adaptive function assessment, autism symptom evaluation through both parent report and clinician observation, and fine/gross motor skills assessment. 1

Required Multidisciplinary Team Composition

The evaluation team must include:

• Psychologist to conduct cognitive and behavioral assessments 1
• Speech/language pathologist to evaluate communication deficits 1
• Developmental pediatrician, neurologist, or pediatric psychiatrist (if significant behavioral issues are present) 1

This interdisciplinary approach ensures diagnostic determination in 90% of cases and significantly increases engagement in follow-up care compared to single-discipline evaluations. 2

Core Assessment Battery Components

Cognitive and Processing Assessments

• Global ability indicator with both verbal and nonverbal components (such as BSID-II) 1
• Sustained attention measures to identify attention deficits common in ASD 1
• Working memory assessment - critical as working memory deficits are prominent across the ASD spectrum and partially mediate IQ reductions 1
• Processing speed evaluation - essential as processing speed deficits are consistently observed in ASD cases 1

Communication and Language Assessments

• Receptive language testing - decreased receptive language scores are a prominent characteristic of many ASD cases 1
• Expressive language testing - expressive language deficits are commonly observed 1
• Pragmatic language skills assessment (for older/cognitively able children) 1
• Communication Development Inventory-Words and Gestures (CDI-WG) to assess gestural and early language development 1

Autism-Specific Diagnostic Tools

• Autism Diagnostic Observation Schedule (ADOS) - gold standard clinician observation tool 1
• Autism Diagnostic Interview-Revised (ADI-R) - structured parent interview 1
• Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) for screening 3
• Childhood Autism Rating Scale (CARS) 3
• Autism Observation Scale for Infants (AOSI) for younger children 1

Behavioral and Adaptive Function Assessments

• Adaptive function evaluation across multiple domains 1
• Autism symptom assessment through both parent report and clinician observation 1
• Behavioral symptom screening for comorbid conditions 1
• Functional behavioral assessment if challenging behaviors are present (including pica, elopement, aggression, or self-injury) 1, 4

Motor Skills Evaluation

• Fine motor skills assessment - motor dysfunction is observed in nearly all ASD cases 1
• Gross motor skills assessment - motor challenges are present in the early developmental course of most ASD cases 1

Critical Assessment Considerations

Social Communication Markers to Evaluate

Between ages 12-24 months, assess for:

• Impairments in social attention - strong evidence supports this as an early ASD marker 1
• Social communication deficits including fewer nonverbal behaviors to initiate shared experiences 1
• Joint attention difficulties - significant differences distinguish ASD from typically developing children 1
• Reduced frequency of requesting behaviors 1
• Less frequent eye contact 1
• Atypical object use - evidence supports this as an early marker 1

Emotional and Behavioral Markers

At 24 months, children with ASD demonstrate:

• Lower positive affect 1
• Higher negative affect 1
• Difficulty controlling behavior 1
• Lower sensitivity to social reward cues 1

Required Educational Accommodations and Supports

Communication Interventions

• Speech/language therapy is essential for significant language and communication challenges 1
• Augmentative/alternative communication device evaluation for nonverbal or minimally verbal students with substantial functional communication needs 1, 4
• Early intensive behavioral interventions (20-30 hours per week) focusing on communication skills 5

Instructional Accommodations for Cognitive Profile

Given prominent working memory and processing speed deficits:

• Ensure attention is gained before instruction 1
• Speak slowly without infantilizing 1
• Use repetition and attention questions to ensure information encoding and retrieval 1
• Minimize multistep directives - keep directives to reasonable length 1
• Visual schedules, planners, and timers to circumvent organizational weaknesses 1
• Forward or backward chaining techniques with reinforcement for completion of multistep tasks 1

Behavioral Support Strategies

• Applied Behavior Analysis (ABA) techniques have demonstrated efficacy for specific behavioral problems 5, 6
• Parent training in behavior management as part of comprehensive intervention (5 hours per week recommended) 5
• Structured teaching methods with explicit instruction tailored to strengths and vulnerabilities 5

Timing and Follow-Up Recommendations

• Initial evaluation can begin at ages 3-4 to identify early intervention targets 1
• Fuller evaluation by ages 5-7 to guide education and treatment and inform the team of cognitive strengths and weaknesses 1
• Regular monitoring to adjust intervention intensity and strategies based on response 5

Common Pitfalls to Avoid

Do not assume one intervention addresses all conditions - speech delay, autism, and any comorbid conditions each require targeted approaches within the comprehensive treatment plan. 5

Do not delay comprehensive evaluation - early identification allows for timely interventions that significantly improve developmental outcomes and quality of life. 3

Do not overlook motor assessment - nearly all individuals with ASD have fine and/or gross motor challenges that require occupational or physical therapy. 1

Do not fail to assess for augmentative communication needs - a small but significant minority of children with ASD are nonverbal or minimally verbal and require alternative communication systems. 1, 4