ETS is committed to serving test takers with disabilities or health-related needs by providing services and reasonable accommodations that are appropriate given the purpose of the test. This abbreviated version of our documentation guidelines for autism spectrum disorder (ASD) is provided as a quick reference. For full details, please review the "ETS Policy Statement for Documentation of Autism Spectrum Disorder in Adolescents and Adults" below.
Documentation must:
- Be completed by a qualified evaluator
Qualified evaluators are defined as those licensed individuals who are competent to evaluate and diagnose ASD or who may serve as members of the diagnostic team. Reference Section I of the policy statement. - Include test taker's identifying information
Include the test taker's identifying information including age at the time of their evaluation. In addition, the name, title, and professional credentials of the evaluator should be included on letterhead, typed in English, dated and signed. The qualified professional's training, expertise in the diagnosis of ASD, and appropriate licensure/certification are also essential. Reference Section I of the policy statement. - Be current
Documentation needs to be within the last five years. Reference Section III of the policy statement.
A documentation update for ASD is a brief report or a narrative by a qualified professional that includes a summary of the previous disability documentation findings as well as additional clinical and observational data to establish the candidate's current need for the requested testing accommodations. Reference Section III of the policy statement.
- Include a comprehensive history
Include a comprehensive history of presenting problems associated with the disability as well as information on the test taker's medical, developmental, educational, employment and family history. This should also include the date of diagnosis, duration, and severity of the disorder. Reference Section II, A of the policy statement. - Include relevant observations of behavior during testing
Behavioral observations, combined with the clinician's professional judgment and expertise, are often critical in helping to formulate a diagnostic impression. This may include the test taker's level of motivation, cooperation, anxiety level and attentiveness during diagnostic testing. Reference Section II, A (Diagnostic Interview) of the policy statement. - Include relevant testing domains
ETS acknowledges that a multi-disciplinary assessment approach is often critical for the diagnosis and treatment of the individual with ASD. Assessment domains may include any of the following: cognitive, expressive and receptive language, psychiatric and/or behavioral, and academic achievement. Reference Section IV (Relevant Testing Domains) of the policy statement. Reference Appendix III for a full list of tests for assessing adolescents and adults with autism spectrum disorder. - Include all test scores as standard scores and/or percentiles using adult measures
Reference Section IV of the policy statement. - Provide specific diagnosis/diagnoses
The report must include a diagnosis, or diagnoses, of ASD as stipulated in the DSM-5 or the ICD-10 and any co-morbid conditions, preferably with the accompanying numerical code(s). Reference Section II, B of the policy statement. - Discuss the current impact of the disorder on academic performance, employment, and other daily activities
Include additional sources of information such as school-based records (e.g., IEP, Section 504 Plan, Summary of Performance) or other related documents regarding the test taker's history, eligibility for services, and/or history of accommodations use in school and/or employment. Reference Section VI of the policy statement. - Include specific recommendations with a rationale based on objective evidence
Establish a link between the requested accommodations and the functional impact of the diagnosed disability that is pertinent to the anticipated testing situation. Reference Section V of the policy statement. - Include an interpretative summary
The interpretative summary at the end of the report is useful because many of the core features of ASD are not captured easily in test scores. The evaluator should rule out, to the extent possible, other diagnoses that may affect the expression of an autism spectrum disorder. Reference Section II, B (Specific diagnosis or diagnoses) and Section IV (Academic Achievement) of the policy statement. - When applicable, include additional sources of information
Other sources of documentation can be used to corroborate symptoms of the disorder and support the need for the requested accommodation(s). This can include a detailed letter from a college disability services provider, a vocational rehabilitation counselor, or a human resources professional describing current limitations and use of accommodations. In addition, a personal statement from the test taker in his/ her words explaining academic difficulties and coping strategies may also be helpful. Reference Section VI (Additional Sources of Information) of the policy statement.
Appendix IV. Social Cognition and the Autism Spectrum
The story of human survival is that of a highly interdependent species in which members of groups execute prescribed steps in the service of mutual cooperation. Most individuals within a group are born with the innate ability to grasp those steps necessary for cooperation within their group and to extrapolate to other groups through observation and learning.
Some have termed this "social cognition," a maturational process through which an infant moves through stages beginning with the awareness that it is a separate being through working with complex symbols to create communication and thought (Nowicki, 1992). Along the way children come to differentiate others' actions and feelings from their own, to evaluate whether or not someone is kindly disposed to them, to process linguistic and nonlinguistic cues, to take another's perspective, and to know the appropriate responses to a wide variety of interactions (Bushnell, et al., 1993). Understanding how others feel allows us to predict how they are going to behave, which may underlie social success as an adult.
Many terms have been used to describe the innate ability to tell what other people are thinking or feeling and to use that knowledge to predict or understand their behavior. Social sensitivity and social perception refer to the ability to pick up overt and subtle interpersonal cues (including face, gesture, language and situational cues). This is largely an input stage of gathering information. The related output domain involves appraisal and action, often called social skills and (more recently) social cognition, in which an individual uses input cues to evaluate, predict and generate appropriate behavioral responses (Bushnell et al., 1993; Blakemore et al., 2001).
Social Cognition in ASD:
It has been suggested that ASD individuals vary in the degree to which they understand the social world (social perception) and possess the skills with which to interact and predict (social cognition) and that this dichotomy may underline symptom severity across the spectrum (Tager Flusberg, 2003; Joseph et al., 2002; Baron Cohen, 2009).
Individuals with ASD may appear naïve and clueless, suggesting that social awareness and perception are impaired. There may be problems recognizing, interpreting and responding to cues sent by conversation partners, especially in unstructured or unfamiliar situations. The child or adult with ASD desires contact but is typically socially awkward. Others may see him or her as uninterested, withdrawn, peculiar or just different. He or she often has limited use of social language and poor understanding of nonverbal cues or may not be able to adjust behavior to match different situations or contexts. For example, he or she may enter an interaction but fail to appreciate cues (such as age, gender or social status) that might indicate the need for a different approach. Following an inappropriate behavior, he or she may not recognize cues from the other individual that signal a blunder has been made and may lack the skill to correct the behavior (see Wolf et al., 2009 review). Such difficulties might underlie the problems individuals with ASD have in complex social situations, where the behavior of others is unpredictable (Rajendrand & Mitchell, 2007). The individual with AS may try to work out the interaction in a literal fashion, as he or she cannot look beyond the obvious in understanding what is going on (Baron Cohen, 1999; Klin et al., 2002).
Klin (2003) further proposes that the ASD brain is simply not wired to process and interpret social situations automatically (Klin et al., 2003; Rajendran & Mitchell, 2007) and that the child with an autistic disorder is not cued into the social world from the outset. This leads to difficulties in the development of important social skills that depend on accurate processing of social cues.
The social world moves quickly. Stimuli and situations must be processed automatically to predict behavior. We use context to further our understanding of a cue in order to arrive at a fast analysis. For example, certain gestures and cues might be appropriate within the context of a football game that would be hostile or inappropriate in a different context. In other words, we need to be able to separate what is contextually relevant from what is not to process quickly and accurately. Individuals with ASD, however, tend to see situations in fixed, absolute terms rather than relative to context (Frith, 2004). It has been suggested (Vermuelen, 2013) that a developmental brain anomaly related to sensitivity to social context is the underlying domain of deficit.
The Social Brain:
Much recent work has examined brain regions involved in social cognition, including those for facial recognition and analysis, perceiving feeling states in self and others, and predicting others' actions. The "social brain" is not a single brain region but a large network of brain regions. Limbic areas related to memory and emotion (amygdala, ventral medial frontal lobes) in both hemispheres are involved in processing feelings of self and others, while analyzing cues regarding motivation and intention is more related to the operations of the lateral and medial frontal lobes and posterior cortical areas (Hadjikani et al., 2006). Because of this wide distribution, deficits in social cognition are not unique to any single medical or mental condition but can be disrupted across many conditions (of which ASD may be the best example).
Developmental abnormalities in the right hemisphere have been demonstrated in ASD (McKelvy et al., 1995). Many studies have shown abnormalities in brain regions thought to be involved in empathy and social behavior (see Dawson et al., 2002). In addition, the right hemisphere is especially skilled at perceiving and interpreting faces (Klin et al., 2002). Abnormal development of these regions may underlie the early development of autism. Dawson and colleagues have speculated that autistic infants do not pay attention to faces because they lack the neural circuitry to make sense of that information, which compromises the child's subsequent development of the ability to understand and relate to other people (Dawson et al., 1998, 2002; Klin et al., 2002).
Conclusions:
ASD is a developmental disorder comprised (in large part) of deficits in social cognition. It appears that specialized brain regions support social perception, including gaze information, face discrimination, and motion/intention cues and that early disruption impacts the ability of infants to engage the social world. This developmental failure limits social and cognitive development of the young child and may contribute to emergence of ASD symptoms. Deficits thus include both the input of social cues and the output of socially appropriate behavior. It is important to note that these are clearly domains which vary independently along a scale from mild to severe (as with all ASD symptoms) and that much remains to be understood about individual and group differences, prognostic signs, and response to various treatment which might address core deficits in social cognition.
(L. Wolf, 2013)
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