School Psychologist Survey
Important Information:
NOTES: This survey pertains to both children and adolescents with autism.
_______________________________________________________________________________________ Listed
below are several statements often heard regarding autism. Please indicate the extent to which you agree or
disagree with each of the following statements by using the scale below:
1.
STRONGLY
AGREE
MILDLY
AGREE
UNDECIDED
UNSURE
MILDLY
DISAGREE
Most children with autism are mentally
retarded.
Children with autism will outgrow the
disorder by adulthood.
Measles, mumps, and rubella shots
cause autism.
Autism can be cured by special diets or
nutritional supplements.
Children with autism are untestable.
High functioning autism and Asperger's
syndrome are the same disorder.
Children with autism do not give or
receive affection.
Autism is an emotional disorder.
Progress in skills means that a child no
longer has autism.
Please indicate how difficult it is to differentiate autism from the following disorders.
2. Mild Mental Retardation (IQ level 55-70)
Easy
Difficult
3. Severe Mental Retardation (IQ level 40-55)
Easy
Difficult
4. Profound Mental Retardation (IQ level 25-40)
Easy
Difficult
5. Communication Disorders
Easy
Difficult
6. Attention Deficit/Hyperactivity Disorder
Easy
Difficult
7. Oppositional Defiant Disorder
Easy
Difficult
8. Learning Disorders
Easy
Difficult
9. Anxiety Disorder/Avoidant Personality Disorder
Easy
Difficult
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STRONGLY
DISAGREE
10. Thought Disorder/Schizophrenia
Easy
Difficult
11. Obsessive Compulsive Disorder
Easy
Difficult
12. Stereotyped Movement Disorder
Easy
Difficult
13. Giftedness
Easy
Difficult
14. Selective Mutism
Easy
Difficult
15. Please rank order the most difficult disorders from which to differentiate autism. (Rank of 1 is most difficult)
Disorder
Rank
Mental Retardation (IQ level below 70) __
Communication Disorders __
Attention Deficit/Hyperactivity Disorder __
Schizophrenia __
Stereotyped Movement Disorder __
Please indicate whether the following features are either required or helpful when making a diagnosis of autism.
16.
REQUIRED HELPFUL
Self Stimulation Behaviors (e.g. Hand flapping, spinning, jumping)
Delayed Language/Communication Problems
Immediate/Delayed Echolalia
Poor Social Skills (lack of social responsiveness)
Lack of Showing/Pointing
Little to No Eye Contact
Abnormal Mood/Affect
Narrow or Unusual Range of Interests or Play
Onset before 36 months of age
Pedantic Speech
Impaired Cognitive Functioning
17. Individuals with autism are often diagnosed with additional disorders. Please estimate the percentage of individuals diagnosed
with autism who also have each of the following: (Please enter a number between 0 and 100. If you don't know, please leave
blank).
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Disorder
Percent
Severe/Profound Mental Retardation ___
Depression ___
Anxiety Disorder ___
Obsessive Compulsive Disorder ___
Seizure Disorder ___
Fragile X ___
Tuberous Sclerosis ___
Oppositional Defiant Disorder ___
18. In your school system, what kinds of services are provided for children with autism? (Select all that apply).
A. Screening.
B. Assessment.
C. Diagnosis.
D. Intervention.
E. Follow-up.
F. Case Management.
G. No autism services are provided.
Next, we would like to obtain information regarding your role in the assessment of children and adolescents
with autism.
19. As a School Psychologist, which one statement most accurately reflects your primary role in the determination of autism? (Select
one please).
A. I am qualified to diagnose autism
B. I participate as part of a multidisciplinary team to determine the special education eligibility of students with autism
C. A separate autism team conducts autism evaluations, but I sit on the multidisciplinary team to make eligibility decisions
D. I am not involved in assessing students with autism at all
If you answered question 19 with a, b, or c, please skip to question 21.
20. If you answered "I am not involved in assessing students with autism at all," please tell us why.
A. I have no training in autism
B. There is no demand for these services
C. Others within my school district handle these evaluations
D. I choose not to be involved in autism evaluations
E. Other
If you answered question 20 because you are not involved in assessing students with autism, please skip to
question 27.
If you responded to question 19 indicating you are involved in autism assessments, please continue with
question 21.
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21. Please rank the following statements regarding your goals for the assessment of autism. (Rank of 1 is most accurate).
Goal
Rank
The purpose of autism assessments is to determine whether or not
_
the disorder exists for a specific individual.
The purpose of autism assessment is to provide information
_
regarding the appropriateness of special education placement.
The purpose of autism assessment is to develop appropriate
_
interventions.
22. How many cases of suspected autism have you seen within the last year? (Please select only one).
A. None
B. 1-10
C. 11-20
D. 21-30
E. 31-40
F. 41-50
G. 50 or more
23. When conducting an assessment for autism, do you utilize a team approach?
Yes
No
If you answered "No" to question 23, please skip to question 25.
If you answered "Yes" to question 23, please continue with question 24.
24. If you use a team approach for diagnosing autism, please select all of the following who are typically on the team or who provide
evaluative information considered during the eligibility or intervention process. (Select all that apply).
A. Audiologist
B. General Education Teacher
C. Medical Doctor
D. Occupational Therapist
E. Optometrist/Opthamologist
F. Parent/Guardian
G. Physical Therapist
H. Psychiatrist
I. Psychologist
J. School Nurse
K. School Principal
L. Social Worker
M. Special Education Teacher
N. Speech Pathologist
O. Other
Next, we would like to obtain information about specific instruments and procedures used when conducting
autism assessments.
Please indicate how often you conduct or use the following when given referrals for possible autism. If you
work as a part of a team, please rate only those methods YOU employ or for which you are responsible.
25.
Always Often Sometimes Never
Review of school records
Review of academic work
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Observe teacher/classroom to determine environmental factors
Review of family systems/home environment
Parent interview
Child interview
Behavioral observations at school
Behavioral observations in the child's home
An intelligence test
An academic achievement measure
An adaptive behavior measure
A physical/medical exam
An autism measure
A sensory assessment
A developmental history
Please rate the following scales based on your own use of the instruments. If you work on a team, please rate
the items as they pertain to YOUR own individual use.
26.
Always Often Sometimes Never
Childhood Autism Rating Scale (CARS).
Gilliam Autism Rating Scale (GARS).
Asperger Syndrome Diagnostic Scale.
Gilliam Aspergers Diagnostic Scale (GADS).
Autism Diagnostic Interview-Revised (ADI-R).
Checklist for Autism in Toddlers (CHAT).
Autism Behavior Checklist (ABC).
Autism Diagnostic Observation Schedule (ADOS).
Next, we would like to find out about recommendations and/or interventions you use with children or
adolescents with autism.
27. Do you recommend and provide treatment for individuals with autism?
Yes
No
If you do not recommend and provide treatment for individuals with autism, please skip to question 30.
If you do recommend and provide treatment for individuals with autism, please continue with question 28.
Indicate how often you RECOMMEND the following interventions for individuals with autism.
28.
Always Often Sometimes Never
Recommend special education placement
Refer to a physician
Refer to a diagnostic team for a second opinion
Refer for augmentative communication evaluation
Parent training
Parent support groups
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Individual therapy/counseling
Social skills training
Speech/language therapy
Medication
Picture schedules
Family or group counseling
Please indicate how often you PROVIDE the following interventions for individuals with autism.
29.
Always Often Sometimes Never
Monitor effects of medication
Provide social skills training
Provide parent training
Provide parent support groups
Develop behavior modification for use at home
Develop behavior modification for use at school
Consult with teacher to make changes in instructional strategies
Work with teacher to monitor effectiveness of behavior modification plans
Help teacher/student/parent to set up visual schedules
Work with parent to monitor effectiveness of home interventions
Provide individual/family/group counseling
Provide discrete trial training
Provide presentations on autism
Use floor time techniques to teach communication and social skills
Next, we are interested in the training you have received specific to autism, and what you think about the
training.
30. Please select the types of training you have received specific to children with autism. (Select all that apply).
A. Formal course work in training program
B. Internship or residency experience
C. Workshop presentations or inservice trainings
D. I have not had any training on autism
Considering all of your professional training, how prepared are you to deliver the following services for students
with autism?
31.
Not prepared at all Minimally prepared Somewhat prepared Very prepared
Consultation
Assessment
Intervention
32. Overall, indicate your confidence level in adequately addressing the needs of children with autism. This includes assessment and
recommendations/interventions. (Please select only one).
A. Not at all confident
B. Minimally confident
C. Somewhat confident
D. Very confident
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Finally, we'd like to ask you a little about yourself.
33. What degrees have you earned? (Select all that apply).
A. B.A./B.S.
B. Masters
C. Specialist
D. Psy.D.
E. Ed.D./Ph.D.
F. Other
34. In what field(s) and in what year(s) have you earned your degrees? If none, please leave blank.
Degree
Field
Year (yyyy)
B.A./B.S.
______________________________
____
Masters
______________________________
____
Specialist
______________________________
____
Psy.D.
______________________________
____
Ed.D./Ph.D.
______________________________
____
Other (List degree and field)
______________________________
____
35. Please enter your current job title.
____________________________________________________________
36. How many years have you been licensed as a School Psychologist? (Please enter number of years. If you have been
licensed for less than one year, please enter "1").
__
37. How many years have you been licensed as a Nationally Certified School Psychologist? (Please enter number of years)
__
38. How would you describe the location of your current job?
A. Urban
B. Suburban
C. Rural
39. In what setting do you work? (Please enter the number of hours you spend working in each setting per week. If none, enter
"0").
Setting
School
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Hours per week
___
Clinic
___
Hospital/Institution
___
College/University
___
Private practice
___
Other
___
40. What is your gender?
A. Male
B. Female
41. What is your racial/ethnic group?
A. Caucasian, non-Hispanic
B. African American or Black, non-Hispanic
C. Hispanic
D. Asian/Pacific Islander
E. American Indian/Alaska Native
F. Others
42. Thank you so much for completing this survey. We really appreciate your help.
REMEMBER, YOU MUST CLICK "SUBMIT RESPONSES" TO RECORD YOUR RESPONSES.
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4/7/2009 2:24 PM
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