Diagnostic Tools/Tests - GARS-3 questions

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RocketMom
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22 Oct 2014, 12:13 pm

We have an evaluation set with a child psychologist and OT coming up in November. They sent ahead some diagnostic forms for me to fill out. One was the GARS-3. I can't find much information about personal experiences with this newer test (only with the older versions). It says it is for ages 3-22, and I think due to this large age gap some of the questions don't apply to my three year old. I am curious as to why they would choose this over a questionnaire more geared towards toddlers/preschoolers. Any experience with the scoring on this one?

They also sent along the BASC-2 (preschool age), and the Diagnostic Checklist Form E-2. That last checklist I have seen in much older books and doesn't seem current. Some questions are pertinent of course, but then some refer to "records" (music) and other antiquated things. I'm assuming they won't use it as a basis of diagnosis but would just use it for more information. Am I correct in thinking that? They also sent a sensory questionnaire but that is specific to this hospital system.

I plan to type up documents to go with each questionnaire instead of jamming things into the comments section or margins. Especially with the GARS I feel like there are things that need further explanation or clarification. I get flustered in interviews and don't want to forget what concerns or questions I want to bring up about each checklist.



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23 Oct 2014, 5:42 am

Our school district did a number of tests that included those plus ADOS plus a pre-school appropriate IQ test IQ test. I don't remember the GARS specifically, but I know there were questions that did not apply to my child's age. I did not think that was an issue b/c different children have different levels of aptitude and I assumed that an assessment for a large age range would be evaluated accordingly. (Meaning that the assessment expects the child not to be able to do skills years ahead of his/her age range, but has the ability to measure it, if the child can.)



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24 Oct 2014, 7:25 pm

of these forms are normed in age groups, so that questions that don't apply to your age are accounted for since most people with children the same age would answer the question the same way.


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RocketMom
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24 Oct 2014, 11:18 pm

That makes sense - so basically the threshold score for the younger groups is lower to account for those questions, if I am understanding correctly. I sure wish there was more information on the GARS-3, but it is so new, having been redone to match the DSM-5.



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25 Oct 2014, 7:56 am

I don't know specifically about the latest version, having done this whole thing, several years back and actually would be curious how the diagnostic process has changed. The multiple years aspect is not knew, itself, though.



jisaac16
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26 Oct 2014, 4:34 pm

School Psychologist here.

As for the norming, the GARS-3 is not normed based on age as stated above. Most standardized tests are normed that way and rightly so. The GAR-3 manual states that ratings are not intended to take age into consideration and not supposed to take peers into consideration. The idea is to compare the person being rated to the DSM-5 criteria for Autism. So, the rater is supposed to rate the person based on the criteria and that's it. The test claims to be valid and reliable based upon this method of rating and the research that the GARS-3 creators have done.

As a professional who uses this tool, I do not like it and do not agree with not having age based norms. Behavior at different ages looks very different and what is acceptable at one age may look "autistic" for another age group. I currently have a student rated on this as "very likely" to be autistic by parent and my rating on another instrument is in the "not likely" range and is nearly as low a rating as the child could receive. According to parent GARS rating, the student should need a severe level of help to make it behaviorally and academically. The student is currently functioning at a typical level for their age in general education both academically and behaviorally. I've had additional profeasionals observe the student as well and state that the child is nowhere close to autistic. Let me know if I can be of anymore help.



RocketMom
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26 Oct 2014, 9:01 pm

jisaac16 wrote:
School Psychologist here.

As for the norming, the GARS-3 is not normed based on age as stated above. Most standardized tests are normed that way and rightly so. The GAR-3 manual states that ratings are not intended to take age into consideration and not supposed to take peers into consideration. The idea is to compare the person being rated to the DSM-5 criteria for Autism. So, the rater is supposed to rate the person based on the criteria and that's it. The test claims to be valid and reliable based upon this method of rating and the research that the GARS-3 creators have done.

As a professional who uses this tool, I do not like it and do not agree with not having age based norms. Behavior at different ages looks very different and what is acceptable at one age may look "autistic" for another age group. I currently have a student rated on this as "very likely" to be autistic by parent and my rating on another instrument is in the "not likely" range and is nearly as low a rating as the child could receive. According to parent GARS rating, the student should need a severe level of help to make it behaviorally and academically. The student is currently functioning at a typical level for their age in general education both academically and behaviorally. I've had additional professionals observe the student as well and state that the child is nowhere close to autistic. Let me know if I can be of anymore help.


Thank you so much for your professional insight. Not having it normed by age seems so odd to me. I think that some of the questions are just not things that would really noticeable in a three year old - at least not to the parent's eye, which is who they are asking. For instance, I believe one of the questions is about being hyperfocused on one thing/subject - well for a three year old, that is pretty common (in my experience). Most kids fall in love with one or two things - Mickey or Elmo, trucks or trains, etc.

The changes in the DSM criteria, in my opinion, seem to make it much harder to diagnose at a young age (age three or four) - do you think this is the case? It seems to leave no room for looking at behavior through the lens of different ages, specifically toddlerhood. With all the emphasis on early diagnosis and intervention, it seems counter intuitive to me to create tests and standards that do not look at younger clients specifically. Is the CARS/etc not considered up to date anymore due to the DSM changes?

I plan to bring this up with the psychologist. Can I ask for other rating scales to be used during the evaluation (like CARS or similar)?



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26 Oct 2014, 9:19 pm

FYI, also, the BASC is just a basic general screener for all kinds of stuff. It is not something that will find autism. You should also ask for speech-language tests, particularly in social language - even if you get the test for autism. Not sure what it is for preschoolers, but the standard instrument for elementary school students is the TOPL.



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26 Oct 2014, 9:37 pm

First of all, your concerns and questions are all very intelligent and good to be asking.

Second, questionnaires on a whole should be taken with a certain level of caution by all parties involved. They can be accurate and helpful but can also be misleading. Additionally, the adults involved tend to answer the questionnaires and we don't generally get the child's impressions through questionnaires. So, there is a lot of factors to consider.

Asking for additional questionnaires should be well within your rights (not sure what state you are in, which may effect this) but it never hurts to try and at worst they will say "no". I would make sure you know the rules of your state with regard to this fact as best you can. I'm in California and the parents can ask us to use a test or questionnaire but we have the right to accept or refuse. For me, I will try to oblige unless there are ethical or other concerns that would create an issue.

The CARS2 is meant to be used by the Psych or other trained professional, however, I believe (and don't quote me) that the have forms appropriate for others to fill out as well. You can search the CARS2 online and should be able to find what they offer.

As for the GARS-3 it is very strange that they don't have age norms. While I get the effort to compare the individual specifically to the Autism criteria and not to other people, it seems the theory of that is better that that actual practice. Younger kids, in general, should have some behaviors that could look "autistic" but still be age appropriate but when you see the same behavior in a 4th or 5th grader, it may look really odd.

With my current case, I am combing through every answer on the GARS-3 and picking out the ones marked extremely different from teachers ratings and looking for trends. Most of the high ratings are communication related and this particular student has marked speech issues and will qualify for speech/language impairment which explains away 2 sections of the GARS-3 (social communication & maladaptive speech). It also explains several other answers in the other sections. That to me shows the primary problem is speech, if we can provide effective speech intervention, I suspect we will see the autism rating come down. Sometimes it helps to consider what is most impacting the student and attack that first. If change doesn't occur from there then another IEP and change in disability may be warranted.

With respect to preoccupation with object/items, some amount of this is normal for everyone of all ages. What I have typically seen with this in children with marked autism is a single subject such as trains or cars that is pretty much talked about on a daily basis to an extreme extent and is there over a long time. This can also be misleading though and would be much more obvious in the older kids (late elementary and more so in high school).

Also be aware the DSM-5 changed the definition for Autism and where I am (California) just changed or state's definition to more closely reflect federal regulations.

Hopefully I am not saying way too much. Even if all the signs of autism are present, the IEP team still needs to decide if it is adversely affecting the child's education and if it warrants special education. In other words, you can have the disability but it must be really impacting your education and it must warrant special Ed. I have seen many kids with high functioning versions of autism (which semi disappeared with the DSM-5) who were totally capable of general Ed other than needing a little extra support and mainly some social skills help.

Let me know if I can help anymore.



RocketMom
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26 Oct 2014, 10:33 pm

jisaac16 wrote:

Hopefully I am not saying way too much. Even if all the signs of autism are present, the IEP team still needs to decide if it is adversely affecting the child's education and if it warrants special education. In other words, you can have the disability but it must be really impacting your education and it must warrant special Ed. I have seen many kids with high functioning versions of autism (which semi disappeared with the DSM-5) who were totally capable of general Ed other than needing a little extra support and mainly some social skills help.



Currently, being three years old and only in "school" for three hours, twice a week, he is not having issues academically. Behavior, social, repetitive behaviors - that is where the issues are showing up. He is super bright (the special education evaluation with the school showed he is most likely gifted, though we don't have back official scores yet - we get those on the 14th). I am not so much looking for educational help (unless he needed it in the future - like placement in "gifted" classes, as I did all through school), but more social, behavioral, and sensory interventions. That is why we are doing this private evaluation. The school district suggested it since he will most likely not be within the range of needed help from the district simply based on academics.



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27 Oct 2014, 8:16 am

RocketMom wrote:
The school district suggested it since he will most likely not be within the range of needed help from the district simply based on academics.


The school district is responsible for functional skills as well as academic skills: they can't refuse services to a child with a deficit in communication, social skills, and sensory integration on the basis of giftedness or even just meeting academic standards. (Think about it - they couldn't refuse services to a child with a physical disability that causes deficits in the same areas - e.g. a gifted child who stutters, a gifted child with partial paralysis of the hands, a blind or deaf child with difficulty hearing or seeing social information.)

Any time the school refuses a service, think about whether they would refuse the same service to a child whose deficit is caused by a physical disability. Getting a private evaluation will give you a stronger case towards getting the school to to their job.

Also, see http://www.wrightslaw.com/info/2e.index.htm and http://aspennj.org/about-aspen



brainfriedmom
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21 May 2015, 12:10 pm

Hello, first post, total newbie, kind of losing my mind at the moment...

Shortest form:
My 7 year old son is the best student in the first grade class, already knew everything they planned to teach him for the entire school year according to his 1st semester teacher. Sounds great but here's the problems:
- He's bored and easily distracted
- The school refuses to consider letting him skip to the next grade
- The school says he's not "gifted" according to his IQ score, and therefore will not bring him anything new to learn.

Catch 22- he wont get anything new to learn, but they know he's bored and distracted.

He's also been bullied relentlessly and the school denies it.
The school says he has a disability, 504/OHI, but wont say what the disability is.

He doesn't qualify for gifted (which I don't want for him anyway) because of tests that are evidently affected by this unnamed "mild" disability. I can't get him help for the disability because I dont know what it is, or if it would change his scores, and even if it did, they wont consider skipping- unless that was somehow the recommendation from the Independent testing. (They said they'd pay for Independent testing but delayed so long as to make it pointless, so I am paying myself and moving ahead.)

He could actually muddle along without services or skipping, but this would cause so much damage, being held back from learning (the teacher complains he wants to read when he is bored by what she's teaching), increasing his acting out in class, I have to support him and teach him to reject the school's authority- not good. So we filed a complaint (PA) and now have a great lawyer and advocate and evaluator working against this bigoted intransigent unreasonable school to try to get my son something new to learn.

I personally think that the large part of his unwanted behaviors will disappear as soon as he's in a class with his intellectual peers. This is based on common sense, loads of research (see A Nation Deceived, American Psychological Association, even the PA Dept of Ed) and my personal experience at home and each time the class learns something new, he is so happy and excited and FOCUSED. Since December when I stopped being the school's enforcer at home, unwanted behaviors have been shed and our life is happy again. I see distraction behaviors fading, to the point that I see him as totally "typical" in behavior. Full disclosure, I never thought he had any speech problem, I think it's all overkill. I have met the seriously affected families and I know that these conditions are real, but I not for my son. Denial, maybe.

If the school was paying for the evaluation, then they'd have to abide by those recommendations, even skipping him a grade. Since I am paying for it, that's a bit more questionable, especially since they wanted to use a different evaluator, who was already booked up.

Of course I don't know what the evaluator is going to say. This evaluator and also the Belin Blank institute based on the records I have provided (since he was 2 teachers have been raising red flags, each time I duly took him for testing, speech and OT, but he was never DX'd with anything, he was "at risk" for ADHD but met his goals in ST and OT, he was not on the spectrum... and I have 130 pages of reports submitted to these evaluators before they even started) are looking at ADHD or mild autism.

If my son has a special need, I will get him the help he needs. So here we go with testing.

And the [email protected]$(@%! GARS and GADS.

I am relieved to see I am far from alone in my difficulty filling out these forms. You raised in this thread most of my objections to these tests. I am not a trained psychologist or mental health professional but I have a pretty good brain (yeah, I am supposedly a very high genius) and I am an old fart, born in the 60s and every bit of my instinct and logic and research is telling me not to fill these idiotic forms out.

Additional to the complaints listed here, for even the questions that might apply how can I answer honestly and accurately how he behaved over a period of time when I have seen such a drastic cumulative change even in the last month? Average it? That can't be right. This page http://www.autism-pdd.net/testdump/test13160.htm recounts one parent's with an MSW in Social Work's experience,
"... GADS and GARS are not the best tests in the world, but they are used to provide documentation that meets your state criteria for autism spectrum disorders. Err on the side of too much or too frequent for the behaviors if you want to document the need..."
and then:
"...I've done those and when we had the IEP meeting to go over the results, the teacher's answers were way off from mine and yet it was written as follows, use extreme caution when comparing mom's to teachers .They had written that mine was exaggrated and scored on the mod/to extreme scores."
(not sure if the second quote is from the same parent, or part of the original question)

Sorry it took so long to explain, here's why I am posting:
These tests stinkaroo, for all the reasons everyone has said.
Erring on either side of behaviors will do us no favors, if the test is taken at face value. And if the school can say that I "exaggerated" and discount the scoring, why even bother? We all agree if he has something its mild.
I don't know what we'd want anyway, if he does have a problem of course I want him to get help, but the obvious thing is that he needs something new to learn. So if the tests say he is totally typical, or if they find he has special needs, I still have to sort out the major point, getting him something new to learn.
Which they already know, actually, they told me. I had no idea.
If the recommendation from the evaluator says he has SN and qualifies for an IEP and that he should be skipped, does that mean they will skip him?
If the recommendation from the evaluator says he does not qualify for an IEP for SN but he should be skipped, does that mean they won't skip him?
If the recommendation from the evaluator says he has an SN that affected his score for gifted and he qualifies for a gifted IEP, does that get him closer to skipping? This is bizarre, because IQ is not the indicator for skipping. Mastery of grade level material is what qualifies a child for skipping. They already know he mastered the grade level material and learns faster than anyone in his grade.
So then if the recommendation from the evaluator says he doesn't have an SN that affected his testing, which was not even the right testing, and the evaluator says he should be skipped, how strong is that recommendation to overcome their already unreasonable unexplained moratorium on skipping grades? (the school district doesn't let any student skip grades, or even take a class in a grade ahead, so it's not just my kid).

Which brings me back to this dratted GARS and GADS testing.

I told the evaluator, whom I respect, I cannot do these forms, along with some others, for all the reasons already stated and some that I added. He's pressuring me to answer these forms and I just can't bring myself to answer questions that do not apply to our family, that answering one way errs one way or another, that the school can say I erred intentionally, that lead to a diagnosis/label that may be wrong.

The school did their meager testing and they were the ones that pointed out these problems were not significant at home, only in school- and that was back in December when I was having all sorts of problems with my son at home, because I was forcing him to do what the school wanted.

What do I do? Fill out the stupid questionnaires with guesses and pray for the best? Even as I typed that, I know I cannot do that. My feeling is that if they can't evaluate him with empirical data, I am not going to allow them to complete the evaluation.

Many thanks for letting me vent, and for this discussion.