Received: 28 April 2021 | Revised: 13 September 2021 | Accepted: 19 October 2021

DOI: 10.1002/pits.22624

RESEARCH ARTICLE

Individualizing the autism assessment process:

A framework for school psychologists

Marilyn J. Monteiro

Independent Psychology Practice, Dallas,

Texas, USA Abstract
School psychologists familiar with the autism evaluation
Correspondence
Marilyn J. Monteiro, Independent Psychology process have an awareness of the complexity of this
Practice, 14674 Midway Rd., Suite 215,
school‐based process. This paper provides school clinicians
Addison, TX 75001, USA.
Email: communications@ with an introduction to a visual framework and descriptive
marilynmonteiro.com
language to think and talk about the complex students they
evaluate in positive, nuanced, and accessible terms. This
framework shifts the way in which school psychologists
describe students during the autism assessment process
away from the reductive language of deficits to the ex-
pansive language of describing individualized patterns of
strengths and differences. The shift away from labeling
behavioral deficits to describing patterns of behavioral
differences leads to a positive narrative and creative ways
to develop supports and interventions for students across
age and ability levels. The use of this strength‐based lan-
guage supports parents, teachers, and students in their
development of an individualized understanding of the di-
agnosis, promoting resiliency in the individual and in their
support systems. Readers are provided with a student
sample case to show how using this visual framework
provides a way to describe individual students using a be-
havioral profile of strengths and differences, linking those
profiles to positive behavior supports.

KEYWORDS
discussing the diagnosis with parents, positive behavior supports,
positive student narrative, school‐based autism assessment
process, strength‐based language

Psychology in the Schools. 2021;1–13. wileyonlinelibrary.com/journal/pits © 2021 Wiley Periodicals LLC | 1

2 | MONTEIRO

1 | INTRODUCTION

The current autism spectrum prevalence rate of one in 54 children reported by the Centers for Disease Control and
Prevention (2020) makes it certain that most school psychologists will face the challenge of correctly identifying
and planning for students with autism spectrum brain style differences over the course of a school year. School
psychologists receive training on the diagnostic criteria, but the language used to identify autism spectrum dif-
ferences is by design negative and deficit‐focused. The diagnostic criteria are defined by deficits or impairments in
the key areas of social communication and restricted, repetitive behaviors (American Psychiatric Association, 2013;
United States Department of Education, 2004; World Health Organization, 2018). This deficit‐based language
reduces the student to an abstraction or constellation of behavioral symptoms that tell a diminishment story rather
than describing that individual in a nuanced, singular, and strength‐based way.
The organization of the autism spectrum diagnosis around deficits makes it challenging for school psychologists
to construct a distinctive and positive behavioral profile of individual students as they complete the autism as-
sessment process. Behavior rating scales and diagnostic instruments are designed to identify autism cut‐off scores,
highlighting the absence of neurotypical behaviors and skills without systematically identifying and describing areas
of strength and abilities that coexist with autism spectrum developmental differences. This creates several di-
lemmas for the school psychologist to resolve. When evaluating children with significant levels of autism spectrum
differences, school psychologists may readily identify the disorder, but they lack the descriptive language or
organizational framework to create a positive narrative that is reflective of the student's pattern of relative or
emerging strengths. This gets in the way of being able to support parents when discussing the diagnosis and leads
to a written report that highlights deficits and negative behaviors. When evaluating children with verbal fluency and
strong cognitive abilities, school psychologists often find conflicting behavior rating scale information from parents
and teachers and are vulnerable to ruling out autism spectrum differences by explaining away those differences or
attributing them to other conditions, such as attention or emotional challenges. The school psychologist then writes
a report that explains away the behaviors that are characteristic of the milder presentations of the autism spectrum,
leaving parents confused about what this means and which interventions to pursue to alleviate behavior concerns.
School psychologists make their diagnostic determinations based on patterns of behavior that emerge from
the autism assessment process, taking multiple sources of information into account. (Dilly & Hall, 2018;
Saulnier & Ventola, 2012) These sources typically include both quantitative and qualitative autism measures
(Constantino & Gruber, 2012; Gilliam, 2013; Goldstein & Naglieri, 2009; Lord et al., 2012; Monteiro & Stegall, 2018;
Reynolds & Kamphaus, 2015; Rutter et al., 2003; Schopler et al., 2010) leaving the school psychologist with
disparate sources of information and without a systematic framework to organize their results into a compelling and
individualized student narrative.
This paper introduces school psychologists to a visual framework and descriptive language to identify and
describe the students they evaluate in positive, nuanced, and accessible terms (Monteiro & Stegall, 2018;
Monteiro, 2010, 2016). The framework shifts the assessment process away from the language of deficits to the
language of describing the individualized patterns of strength and differences each student brings to the diagnostic
assessment process. The shift away from labeling behaviors as deficits or weaknesses to describing behavior
patterns of strengths and differences leads to a positive narrative and to creative ways to develop supports and
interventions. For example, identifying a student's object‐focused routines, when expressed as a deficit, is labeled
as a restricted, repetitive interest. When the same behavior routine is identified as a difference, the school psy-
chologist is better positioned to describe the behavior as the way in which the student organizes and regulates
behavior. The framework of understanding the student's object‐focused routine as a way to organize and regulate
behavior leads the school psychologist to describe the form of the object‐focused routine, as the routine is now
framed as having a neutral instead of negative value (difference, not deficit).
The school psychologist can then become curious about noticing and describing the dimensions of object‐
focused play. What specific observable dimensions comprise the organization of the object‐focused routine? Does
MONTEIRO | 3

the routine provide the means for the student to seek out visual, tactile, cause‐effect, goal‐directed, and/or
visuospatial reasoning input and opportunities, while simultaneously providing a routine that minimizes the un-
predictable elements of incoming language, social, and sensory demands? The change in framework and language
used by the school psychologist during the autism assessment process leads directly to a shift in perspective
regarding the form and function of behavior routines. This reframe from labeling deficits to describing differences
changes the assessment conversation and the outcome of the diagnostic process. The description of patterns of
strengths and differences and their functions becomes part of the individual student's positive narrative. Parents,
students, and teachers experience the autism assessment process as an enlightening and empowering one, gaining
an understanding of the student's unique worldview and perspective.
The use of descriptive language to identify the form and function of behavior patterns and routines of the
student being assessed for autism spectrum differences leads the school psychologist directly to the identification
of educational supports in the areas of organization, regulation, and social skills development.
The visual framework outlined in this paper provides the school psychologist with a compelling way to discuss
the diagnosis with parents in positive and accessible terms. This descriptive approach to systematically identifying
patterns of strength and differences leads the school psychologist to help parents and teachers better understand,
appreciate, and take the perspective of the individual with autism spectrum brain style differences. This strength‐
based individualization of the autism assessment process allows school psychologists to better recognize and plan
for autism spectrum differences in students across age and ability levels.

2 | THE VISUAL F RAMEWORK AND DESCRIPTIVE L ANGUAGE

When conceptualizing autism spectrum disorders, it is essential for the school psychologist to identify and
describe the individual presentation of the disorder in positive, descriptive terms. The visual framework and
descriptive triangle depicted below (Monteiro, 2010) shapes the clinician's thinking and language to identify
and describe patterns of differences in development and contrast these with identified areas of strength,
rather than using the negative diagnostic language of impairments.
Figure 1 depicts the descriptive triangle for autism spectrum brain style differences. The autism brain style can
be compellingly described as a pattern of strengths and differences in development in three key areas: language and
communication, social relationships and emotional responses, and sensory use and interests. A diagnosis of autism
spectrum differences includes describing patterns of developmental or brain style differences in each of the three
key areas. The use of this visual framework and the accompanying descriptive language lays the groundwork for not
only individualizing the autism assessment process but also for promoting narrative change in the way the student's
worldview is understood and appreciated. The terminology of “brain style differences” or “differences in development”

FIGURE 1 Descriptive triangle for autism spectrum brain style differences

4 | MONTEIRO

represents an important shift in the way the school psychologist thinks and talks about individual students. The
language of differences is inclusive rather than exclusionary, as everyone has a brain style that includes areas of
strength as well as differences. As the school psychologist identifies the student's profile of brain style strengths
and differences, parents and teachers gain insight into the ways in which the student organizes and regulates in
relation to their sensory needs and incoming demands. This in turn leads to a heightened awareness of the types of
supports to be put into place at school and at home that are a fit for that student's brain style.
The first of the three areas that are the focus of the visual framework, is the area of language and commu-
nication, depicted at the top of the descriptive triangle represented in Figure 1. Students who have autism spectrum
brain style differences typically display a pattern of strengths and differences that includes the strength of orga-
nizing and using language best when the student is self‐initiating and when the student has a visual context for the
use of language. For example, verbal fluency is most accessible to students with autism spectrum language and
communication differences when that student is initiating a conversation around a well‐known preferred topic.
Similarly, students with limited to no verbal fluency are best able to spontaneously use language to label and
describe properties related to objects of interest, as a visual context supports their ability to access language.
Key differences in the area of language and communication include challenges in the student's ability to share
in conversational exchanges, extend their use of language when the topic is outside of their self‐initiated area of
preferred interest, and flexibly shift from engaging in conversational topics they select to those selected by their
conversational partner.
Highlighting these four elements of language and communication (initiation, shared exchange, extension, and
flexibility) can be done through the autism assessment process when the school psychologist sets up a diagnostic
conversation that includes inviting the student to share conversations about their areas of preferred interest, and
when objects with interesting and varied sensory properties are provided for exploration during the diagnostic
conversation. Setting up a diagnostic conversation with the student in this sensory‐driven way provides the school
psychologist with a behavior sample that amplifies the student's pattern of language and communication strengths
and differences. This allows the school psychologist to individualize and contextualize the diagnostic process for
parents and teachers.
The second of the three key areas that comprise the autism spectrum brain style pattern of strengths and
differences is the area of social relationships and emotional responses. Strengths in this area often seen in students
include strong connections and attachments with family members, a genuine desire to establish connections and
friendships with peers, and a basic ability to identify and express a range of emotions.
Key differences in this area include the gap between the desire to connect with others and the brain's ability to
interpret and use social and social communication cues, challenges in creating and expressing a social narrative about self
and others, and challenges in regulating the emotional reactivity inherent in the built‐in autism brain inflexibly in shifting
from the individual's sensory‐focused agenda to respond to incoming demands. As with the area of language and
communication, the four elements of initiation, shared exchange, extension and flexibility come into play. Students with the
autism spectrum brain style pattern of strengths and differences often do best in social situations and in regulating
emotional reactivity when they have a predictable context for social and emotional demands. The entry point for social
sharing for the autism spectrum brain style is the area of preferred interests and activities. As a result, students with autism
spectrum differences initiate social overtures through the lens of their interests and routines. This can be viewed as an area
of strength that can then be paired with the area of difference of challenges in sharing exchanges in a fluid way beyond
their initial overture, extending shared exchanges when their partner introduces novel elements, and flexibly including their
social partner in an extended series of shared exchanges.
These elements can be readily experienced and observed by the school psychologist when the diagnostic
conversation includes opportunities for the student to explore their areas of preferred interest, followed by the
school psychologist's introduction of social overtures as a social partner in the exchange. When the school psy-
chologist structures the diagnostic conversation with the student to start with encouraging the student to take the
lead in discussing and sharing about areas of passionate interest rather than setting a traditional social agenda, the
MONTEIRO | 5

message that the student's worldview is of interest and has value is powerfully conveyed to them. The distinctive
pattern of autism spectrum social strengths and differences become readily apparent when the student is able to
encounter the genuinely positive experience of being invited to take the lead in exploring areas of preferred interest
and play with a supportive partner.
The third and final of the three key areas that make up the autism spectrum brain style pattern of strengths and
differences is the area of sensory use and interests. The diagnostic criteria refers to this area of the descriptive
triangle as restricted interests and repetitive behaviors. Changing the language to sensory use and interests translates
the deficit‐driven and diminishing label to the descriptive and expansive framework of understanding and appre-
ciating how the student organizes, regulates, and manages sensory preferences and sensitivities, and how those
patterns of sensory use are reflected in the student's interests.
During the assessment process, the school psychologist can then focus on observing and describing the form and
function of the student's areas of preferred interest as areas of strength. This leads to the school psychologist describing
the type of thinker the student represents (visuospatial, three‐dimensional, tactile, cause‐effect, binary, goal‐directed,
categorical, systematic, scientific, contextual, and so on). The function of the student's areas of preferred interest includes
the three main components of organization, regulation, and the blocking out of incoming stressors. In other words, the
form and content of the preferred activities serve the function of organizing the student's behavior and regulating their
emotional system while blocking out incoming sources of stress (language, social, sensory, work, transition, and other
demands).
When the school psychologist structures the diagnostic conversation to start with the invitation for the student
to share information about their preferred interests while providing access to interesting objects that contain a
range of sensory properties (visual, tactile, auditory, movement, and cause‐effect) the student shows the amplified
contrast between the routines and activities that lead to the brain becoming alert and engaged and the social and
communication incoming demands that are hard work and sources of stress for the autism spectrum brain.

3 | C O NS TRU C T I NG T HE B R A I N S TY L E P R O F I L E US IN G T HE VI S UAL
FR AMEWORK

Constructing the individual student's brain style profile of strengths and differences provides the cornerstone for
individualizing the autism assessment process. When the school psychologist uses the descriptive language fra-
mework to develop the student's brain style profile, they are applying strength‐based descriptive language to
develop a recognizable and organized profile of behavior patterns that can then be linked to an individualized
educational support and intervention plan.
Tables 1–3 provide a sample Brain Style Profile for Mark, a 5‐year‐old student with verbal fluency for each of
the three key areas of the autism spectrum visual framework. The use of descriptive language to lay out his pattern
of strengths and differences in the three key areas provides an individualized way to identify Mark's autism
spectrum brain style differences. Pairing the descriptive language of strengths and differences with signifiers, or
examples of how Mark uses language, relates to others, and manages sensory preferences and sensitivities makes
his profile instantly recognizable to his parents and teachers.
Mark's descriptive brain style profile in the area of language and communication depicted in Table 1 organizes
how the school psychologist describes the key ways in which Mark understands, uses, and responds to language
and communicates with others. The school psychologist is then able to provide parents and teachers with a way to
recognize Mark's distinctive language and communication profile.
Table 2 provides the second area of Mark's brain style profile of strengths and differences, highlighting his
profile in the areas of social relationships and emotional responses.
The first two areas of the descriptive triangle for Mark's brain style profile tell part of the autism spectrum story
but not all of it. To complete the nuanced, layered, and comprehensive description of Mark's brain style profile, the
6 | MONTEIRO

TABLE 1 Mark's brain style profile—Language and communication

Strengths

Well‐developed vocabulary and language skills

Enjoys narrating his play scenarios with his action figures

Is a strong reader

Has a strong visual memory

Enjoys learning and shows intrinsic motivation to acquire knowledge and master facts in his areas of preferred interest
(Lego Super Mario mini‐figures, Super Mario Odyssey game details, drawing and building obstacle courses)

His language use is most organized and detailed when he is communicating about his interests, as he has a context for
the content of his conversation

Communicates his wants and needs effectively unless in a reactive state

Initiates conversations with others and is briefly responsive to social communication overtures from others when his
conversational partner follows Mark's lead

Differences

Mark's language use is primarily self‐initiated and focused on initiating conversations with others about his areas of
interest without the corresponding shared back‐and‐forth shared exchange elements (eye gaze, changes in facial
expression, and body orientation towards conversational partner)

It is hard work for Mark to notice and respond to verbal comments or directives from others and he is oftentimes
either unresponsive or reactive in response to incoming communication overtures

It can be challenging for Mark to follow conversational cues and prompts, including participating in shared
conversational exchanges with multiple exchanges and flexibly shifting from his preferred topics to topics
introduced by others

Mark's threshold for managing incoming language and communication input from others can be low at times, resulting
in either a withdrawal from the conversation or a reactive response

His reactive responses include losing his ability to communicate verbally and responding like a younger child by
vocalizing loudly (groaning, growling, or yelling; pacing, stomping, or becoming otherwise physically active;
intruding on the physical space of others)

school psychologist needs to include Mark's profile of strengths and differences in the area of sensory use and
interests. Mark's profile of strengths and differences in the third area is depicted in Table 3.
Building Mark's profile in all three areas tells the compelling and individualized story of Mark's pattern of
strengths and differences. It allows the school psychologist to describe Mark first, and then discuss the diagnostic
label associated with his singular narrative. The school psychologist will recognize that Mark's descriptors are
consistent with measurable and observable autism spectrum behavioral differences. Parents and teachers will
recognize their experiences with Mark, gain a better understanding of Mark's perspective, and have a context for
understanding the diagnostic label.

4 | L IN K I NG TH E S TR E N GT H‐ BASED N ARRATIV E WITH EDUCATIONAL

SUPPORTS

Just as the school psychologist benefits from having a strength‐based visual framework to describe each student's
brain style profile of strengths and differences in singular terms, they benefit from having an organized framework
to identify and describe recommended educational supports for the students they evaluate in an individualized way.
MONTEIRO | 7

TABLE 2 Mark's brain style profile—Social relationships and emotional responses

Strengths

Has an outgoing, friendly, gentle‐natured, and somewhat intense demeanor

Shows a genuine desire to share his world with others unless his threshold for managing social demands has been
surpassed and his emotional reactivity has been triggered

Enjoys it when others follow his lead and respond to his social overtures

Connects well with family members and teachers

Consistently seeks out interaction with one peer at a time, using his areas of interest as the social overture for play

Initiates social exchanges with others, mostly around his areas of interest

Differences

Challenging for Mark to engage in social exchanges with peers when they initiate the exchange outside of his areas of
preferred interest

Even within his areas of interest, it is hard work for Mark to sustain social exchanges for more than one or two
exchanges

Can be inflexible at times when working and playing with others

Has a routine of dominating social exchanges by directing others and telling them what to do

Sustained shared enjoyment, flexibility, and extension in social interactions is still emerging for Mark

High‐load language and social demands are a source of agitation for Mark and he responds by becoming increasingly
dysregulated, as noted by his withdrawal from the exchange or the triggering of his reactive behavior routines

Once he becomes dysregulated, it can be challenging for Mark to regroup and reset his brain

The value in organizing educational recommendations and supports into a framework includes helping teachers and
parents link the educational supports to a rationale that fits their understanding of the specific child. Most school‐
based assessment reports provide a list of recommendations as part of the assessment process. However, these
recommendations are typically listed in a way that makes it challenging for parents and teachers to absorb the
connection between the description of the student and the rationale for why they should consider applying the
recommendations at school and at home. When the school psychologist provides an accessible, organized fra-
mework to describe their recommended supports, parents and teachers have a clear context to understand the
value of following those specific recommendations.
Figure 2 depicts the visual framework identifying three key areas of support for individuals who are learning
and developing with the autism spectrum brain style: Organizational, Social Skills and Self‐determination, and Reg-
ulation. The three areas correspond with the autism spectrum brain style key areas of Language and Communication,
Social Relationships and Emotional Responses, and Sensory Use and Interests. The simple introduction of a visual
framework provides a powerful context for key educational recommendations that may not be recognized by
parents and teachers as essential supports without the established context.
In the area of Organizational supports, an essential concept that can be conveyed is the need for visual supports
and visual contexts for verbal directives. The autism brain style typically finds it to be hard work to manage
incoming verbal demands, as processing incoming verbal information requires the student to flexibly shift from their
visual or object‐focused attention to grasp and respond to the verbal context provided by the speaker. This can lead
to reactive behavior routines, including avoidant and refusal behaviors. Within the context of organizational sup-
ports, the school psychologist can make a powerful case for how the use of visual supports in the form of visual
schedules, checklists, first‐then visual T‐charts, visually structured work stations and so on (Cohen &
Gerhardt, 2016; Hodgdon, 2011) exemplify how the adult giving the student directives will best match the student's
8 | MONTEIRO

TABLE 3 Mark's brain style profile—Sensory use and interests

Strengths

Well‐developed skills in the areas of visual, three‐dimensional thinking

Systematically applies his thinking skills in his routines of creating scenarios with his mini‐figures, drawing and creating
obstacle courses, building structures with Legos, reading

Enjoys reading and watching videos to gain knowledge and information

Has developed interests that are in sync with his age

Attends to visual details and is and organizes well with a visual context

Learns through tactile exploration of cause‐and‐effect relationships using manipulative materials

Seeks out movement, reading, drawing, and manipulating objects as routines to self‐regulate and manage
environmental demands

Responsive to visual input and information

Organizes best when he establishes an object‐focused routine

Differences

It is challenging for Mark's to flexibly shift from setting up and engaging in his sensory‐seeking routines to follow the
agenda of the classroom

Transitions from his agenda to the agenda of others is often a source of reactivity and stress, and this triggers Mark's
inflexible thinking and behavior routines

Mark's reactivity is often triggered in response to transition, language, social and sensory input and demands

Mark fatigues quickly in response to communication demands and language input

It can be challenging for Mark to self‐regulate, resulting in frequent but unpredictable reactive behavior routines

Mark increases his voice volume when he is in a reactive state and this serves the function of blocking out incoming
demands and sensory input

Unstructured social situations are a consistent source of stress and distress for Mark

Mark displays some unusual body movements and mannerisms, including close visual inspection of objects, facial
grimacing, sitting with his legs in a “w” position, body tensing, vocalizing loudly when distressed, and moving away
from the source of demand

FIGURE 2 Descriptive triangle for autism spectrum key areas of support

language and communication brain style by pairing visuals with verbal directives. In simple terms, the school
psychologist can help parents and teachers understand the value in shifting from exclusively communicating di-
rectives verbally to linking verbal directives with visual supports (“show while telling”). This crucial addition of visual
supports both allows and reminds the adult to support verbal input with visual supports (“talk less and show more”).
MONTEIRO | 9

The area of social skills and self‐determination supports sets a context for the school psychologist to describe
recommended supports to build social and self‐determination skills through the lens of the autism spectrum brain
style. Parents and teachers are provided with a context to understand the need to develop and use visual supports
such as social thinking materials (Winner, 2006), conversation maps, photo stories, cartooning, and so on
(Baker, 2006; Bellini, 2016; Gray, 2015) to scaffold the anticipation and response to social demands, along with the
development of the student's self‐determination social narrative.
In the area of Regulation supports, the school psychologist provides a context for understanding the binary
autism brain style and resulting brain inflexibility that leads to reactive and dysregulated behavior routines. Sup-
ports in this area can then be contextualized for parents and teachers as necessary for the student to develop the
ability to self‐monitor and regulate their reactivity in response to input. Identifying regulation as a key area in need
of support reminds the school psychologist to help parents and teachers understand the value in identifying and
setting up opportunities to use sensory regulation routines as part of a brain reset routine throughout the school
and home day.

5 | C ONS TRU CT I NG T HE S TU DEN T PROF ILE OF EDUC ATION AL

S U P P O R T S U S I N G T H E VI S U A L F R A M E W O R K

Organizing the recommended educational supports into the visual framework helps parents and teachers better
understand how those recommendations are an extension of understanding the student's autism spectrum brain
style differences.
Tables 4–6 provide the recommended educational supports for Mark, our 5‐year‐old sample student with
verbal fluency for each of the three key areas of the autism educational supports framework. For each of the three
areas, the rationale for why the supports are recommended is addressed before specific organizational, regulation,
or social skills and self‐determination supports are listed. This provides the student's parents and teachers with a
contextualized way to think about the value of the specific supports recommended by the school psychologist for
that individual student.
When the school psychologist lays out the rationale for organizational supports, along with ways to in-
dividualize the use of visual supports, parents and teachers gain an appreciation for the gap between Mark's verbal
abilities and his ability to manage verbal input throughout the day. This provides the school psychologist with
practical ways to support the adults in adjusting their communication style to fit with Mark's autism spectrum visual
and contextual brain style.
Table 5 lays out the rationale for Mark's supports in the area of social skills development and self‐
determination, the second area in which Mark's brain style profile of strengths and differences requires in-
dividualized supports.
After the school psychologist addresses the rationale and specific support recommendations in the areas of
organizational and social skills development, the third area, regulation supports, can be addressed. Table 6 provides
a sample way to discuss the rationale for regulation supports as well as how to describe specific regulation support
recommendations.
As with the visual framework to describe Mark's individual presentation of autism spectrum brain style
strengths and differences, the visual framework that describes the three key areas of educational supports conveys
to parents and teachers that understanding and supporting autism spectrum brain style differences is a complex and
nuanced process. Although the school psychologist will recognize that the educational supports listed in the sample
case are essential for the autism spectrum brain style, parents and teachers will experience the recommended
supports as necessary for the individual student. This personalizing of the process places the school psychologist in
the role of being a key advocate for helping others understand the student's unique and singular story and how that
story links to practical supports.
10 | MONTEIRO

TABLE 4 Mark's organizational supports

Rationale for organizational supports

In the area of organization, currently, Mark is often prompt‐dependent on his teacher and parents to structure
transitions and to help him manage changes in his established routines. Because Mark has well‐developed language
skills, the adults mostly rely on verbal prompts and explanations to guide Mark through daily transitions. This leads
to Mark becoming quickly fatigued with processing incoming verbal information and his subsequent pattern of
shutting down or reacting to the demands with resistance or agitation. Introducing the use of visual supports while
reducing the amount of verbal input in the form of directions and explanations provided to Mark will provide him
with input that best matches his visual processing style. As Mark's brain also consistently seeks out patterns and
routines, the use of visual supports will significantly reduce his stress level, as he is placed in charge of checking his
schedule, using checklists, and visually anticipating a sequence of “first/then” throughout his day. Mark can then be
prompted to “tell” and “show” the adult the steps involved in the organized behavior during transitions, a
distinctively different experience from his current experience of following verbal directives.

Recommended organizational supports

Mark would benefit from the following:

Develop a visual schedule that includes a dynamic and interactive component (check boxes off as part of his transition
time routine; linked with a visual depiction of a preferred area of interest, such as photos of a Super Mario mini‐
figure character following a path through key aspects of each activity or setting)

Implement a routine where the adults talk less, and show while telling using visual supports (schedule, “first/then” card,
job cards, T‐chart for words and actions); reducing verbal directions and verbal input is critical, as Mark self‐reports
and demonstrates a low threshold for incoming language demands

Set up his desk or work area with stacked drawers labeling each sequential activity throughout his day; coach Mark to
place his materials for each activity into the appropriately labeled drawer; coach him to have a transition routine of
starting activities by opening the appropriate drawer and taking out the required materials and ending the activity
by placing the materials back into the drawer; consider having a “pending” drawer or stackable where Mark can
have a routine of placing unfinished work as part of the transition from an unfinished activity to the next scheduled
activity

Establish the transition routine of taking materials out of containers and placing them into containers at the start and
end of tasks; this helps Mark maintain a sense of predictability and control across work tasks

6 | D I S C US S I N G TH E DI A G N O S I S W I T H P A R E N TS AN D T E A C H E R S

When the school psychologist uses a visual framework and descriptive language to construct the student's brain
style profile, they have a systematic, individualized, and positive structure in place to discuss the student's diagnosis
with their parents and teachers. Just as the sensory‐based diagnostic interview process with the student allows the
school psychologist to observe, experience, and document the student's nuanced, multilayered and singular be-
havior profile of strengths and differences before making their diagnostic determination, the diagnostic con-
versation using the descriptive triangle provides an opportunity for the school psychologist to tell the student's
story to the parents in a recognizable form before linking that description with the diagnostic label.
An effective way to use the descriptive triangle when discussing the student's diagnosis with parents and
teachers is to draw out each step in the process during the diagnostic conversation. This provides an unfolding
visual context for the diagnostic conversation, emphasizing the telling of the story of the individual child first before
a diagnostic label is identified. Parents are better able to absorb the information provided by the school psychol-
ogist when the strength‐based descriptive language process is used within the context of the visual framework.
School psychologists are encouraged to start by drawing the triangle on a piece of paper, telling parents the
assessment process helped them look at patterns of strengths and differences in three key areas of the student's
development or brain style. The school psychologist can then write the words “differences in development” or
“differences in brain style” inside the triangle. The linking of the visual triangle with the verbal explanation of
MONTEIRO | 11

TABLE 5 Mark's social skills and self‐determination supports

Rationale for social skills and self‐determination supports

In the area of social skills and self‐determination narrative, Mark is a child who is outgoing, affectionate, and creative in
his play. He seeks out others to share his interests and struggles with closing the gap between his desire for social
connections and his brain's ability to notice and respond to social cues from his social and play partners. Mark
struggles with understanding the perspective of others when he assumes the role of telling others what to do
instead of sharing a conversation or play routine with them. Mark has not yet developed the ability to use his
well‐developed language skills to talk about himself or his feelings in a detailed, self‐aware way.

Recommended social skills and self‐determination supports

Mark would benefit from the following:

Systematically use visual social scripts, comic strip conversations, and step‐by‐step visual maps to help Mark better
anticipate and to teach Mark social and social communication routines with peers; use T‐chart discrimination
sheets to help Mark identify his current words and actions and contrast those visually with the adaptive
replacement alternatives

Provide Mark with direct teaching of social and social conversation skills through social skills or social language groups;
shape his use of prosocial skills by creating videos as he practices social skills in small groups

To increase his awareness of his voice volume, use a visual scale with a moveable brad for each level of volume

Systematically use visual supports to increase Mark's vocabulary to identify and express his emotions (e.g., social
thinking visual supports would be helpful in teaching these important emotional vocabulary and awareness skills;
the Julia Cook book series for children would also work well for Mark)

Develop a notebook about Mark that contains all his tools; include his personal narrative in the notebook, built with
him over time, with his Brain Style Profile, narrative about himself and his life, and his skills, talents, and goals

Include “5 things my teacher needs to know about me” that highlights his strengths, interests, and differences; include
coaching to identify social aspects of his friends and classmates and age‐appropriate ways to engage socially with
peers

identifying patterns of strengths and differences in three key areas provides parents with a clear context for the
conversation as the school psychologist progressively describes the student's behavior profile.
As the school psychologist prepares to describe the student's pattern of strengths and differences in the area of
Language and Communication, they are encouraged to write those words at the top of the triangle. When discussing
the student's pattern of strengths and differences in this area, parents will absorb the information best when the
school psychologist provides examples unique to the student that illustrates the behavioral descriptors they discuss.
Using the word “differences” instead of “weaknesses” reduces the stress level of the parents, as they are no longer
preparing to absorb a deficit model of their child.
Asking parents: “Does it sound like I'm describing your child?” provides parents with an opportunity to endorse
the descriptions and examples provided by the school psychologist, and to share their thoughts and observations.
As the school psychologist moves to the next two areas of strengths and differences for Social Relationships and
Emotional Responses and Sensory Use and Interests, they are encouraged to write each of the headings on the
triangle graphic and then discuss their observations of the student's behavior profile in each of the areas. Providing
an overture for the parents to share their thoughts after the school psychologist describes the student's profile in
each area creates a shared experience between the parents and the school psychologist.
In this way, the school psychologist individualizes the diagnostic process for the parents. The parents ex-
perience the school psychologist talking in a systematic, accessible, and straightforward way about their child. This
establishes a bond of trust with the school psychologist that is more challenging to achieve when the school
psychologist is dependent on describing quantitative test results and autism scores. Most essentially, the use of the
visual framework provides parents with a context for making sense out of the diagnostic label as it relates to their
12 | MONTEIRO

TABLE 6 Mark's regulation supports

Rationale for regulation supports

In the area of regulation, Mark frequently experiences agitation and distress regarding language, social, sensory, and
environmental demands. Providing visual tools to help Mark learn to self‐monitor and apply self‐regulation routines
will be very helpful for him. The use of proactive brain reset routines is strongly encouraged, as Mark needs to begin
to experience being able to begin to be overwhelmed and then doing an activity that regulates and restores his
energy level to replace his current routine of becoming overwhelmed and withdrawing and following his own agenda
instead of following verbal choices set by adults. The use of a visual “work/break” schematic will help Mark better
anticipate and connect the value of having expected times to engage in preferred activities, helping his sustain his
efforts and engagement with tasks that require managing incoming information.

Recommended regulation supports

Mark would benefit from the following:

Put together a self‐regulation, visual scale, developed with Mark, to help him identify the words, actions, and feeling
states he associates with each level of regulation, with levels 1‐3 being the target range and levels 4 and 5
identified as the “reacting” levels; paired with an area of visual interest or metaphor, such as weather or battery
levels (e.g., Level 1 = My brain and body are calm and working together, my brain is thinking about things I like, I
can find my words to talk to others, I can move my body, look at things I enjoy seeing, and do activities I like, such
as building and drawing; Level 3 = My brain and body are feeling stressed, and I need to take a brain reset break
doing something from my Brain Reset Menu list, I am talking loudly, I am having trouble focusing on what others
are saying or doing, and my body wants to move away from other people; Levels 4 and 5 = TOO MUCH!!!! My
brain and body are stressed, I need to take a break from all the listening and following directions, it is hard for me
to use my words so I need to take a break to reset my brain level)

Use a visual metaphor that links Mark's areas of preferred interest to his regulation visual graphic (e.g., Super Mario
characters overcoming various obstacles)

Pair his visual self‐regulation scale with prompts throughout the day to check in with the visual scale describing his
words, actions, and emotions and rating: “How am I doing?” to establish a proactive routine of self‐monitoring and
self‐regulation; include a high density of labeling his regulation levels with him when he is in a regulated state
(levels 1–3)

Include the development of a “brain reset menu” of activities and materials that can by proactively cycled through
during the day; link the use of these breaks with his self‐monitoring of his regulation scale

child. Once consensus has been established regarding the school psychologist's description of the student's brain
style profile of strengths and differences, the school psychologist is ready to guide the parents to the diagnostic
label of autism spectrum brain style differences. The school psychologist has then provided the parents with an
individualized and personalized context to understand the diagnosis and to understand why the school psychologist
is recommending specific educational supports.

7 | SUMMARY

School psychologists are increasingly faced with the challenge of identifying and supporting students with autism
spectrum brain style differences. This paper provided a framework for school psychologists to support the way in
which they conceptualize and describe patterns of autism spectrum strengths and differences in the students they
assess in the school setting. The importance of the use of positive, strength‐based language and how its use leads to
positive connections between the school psychologist and the students with whom they have diagnostic con-
versations, as well as between the school psychologist and the parents and teachers with whom they discuss the
student's autism assessment results cannot be overstated. As school psychologists gain the tools to support telling
MONTEIRO | 13

the nuanced story of the individual student, the autism assessment process is transformed into an empowering and
positive process for students and their families.

CO NFL I CT OF INTERES T S
Marilyn J. Monteiro is the author of several books and an autism assessment protocol discussed in this article. She
receives royalties from the publishers for those publications.

ORCID
Marilyn J. Monteiro http://orcid.org/0000-0002-0982-2073

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How to cite this article: Monteiro, M. J. (2021). Individualizing the autism assessment process: A framework
for school psychologists. Psychology in the Schools, 1–13. https://doi.org/10.1002/pits.22624