identifying and assessing infants, toddlers, & preschoolers with … · 2019. 10. 3. · typical...
TRANSCRIPT
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Identifying and Assessing Infants,
Toddlers, & Preschoolers with
Autism Spectrum Disorder (ASD)
Elizabeth R. Crais, Ph.D., CCC-SLPDivision of Speech & Hearing Sciences
Medical SchoolThe University of North Carolina at Chapel Hill
Oregon Speech-Language & Hearing Association Annual Convention October 11, 2019
Disclosures
Financial:
I am receiving an honorarium from the Association
Nonfinancial:
I am a co-author of the First Year(s) Inventory (FYI),
a screening tool that will be discussed briefly
The FYI is not commercially available and I receive
no money from it at this time
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Program for Early Autism Research,
Leadership, & Service (PEARLS)
www.med.unc.edu/ahs/pearls
Elizabeth Crais, Ph.D. & Linda Watson, Ed.D.,
Speech & Hearing Sciences
Grace Baranek, Ph.D., Occupational Science
Steve Reznick, Ph.D.
Developmental Psychology
Lauren Turner Brown, Ph.D.
Psychology/TEACCH
Acknowledgements Funding for our research has been provided by Cure
Autism Now, Autism Speaks, The Ireland Family Foundation, the Institute of Education Sciences (R324A100305, R324B070056) and NICHD (R01HD04216)
The opinions expressed are those of the author and do not represent views of the funding agencies
We owe a great debt to the families who have participated in our research and have consented for us to use their videos for presentation purposes. Please respect them and do not take pictures or make recordings of these videos or otherwise use them outside of your participation in this workshop
Seminar Objectives
Participants will be able to:
Identify symptoms of ASD in infants, toddlers, and
preschoolers
Choose appropriate tools for screening for ASD and
for diagnosis of communication deficits in infants,
toddlers, and preschoolers with ASD
Describe strategies for collaborating with parents and
other professionals in screening and assessing this
population
Where Are We Going? Current diagnostic framework for ASD
Early symptoms
What are they?
When do they appear?
Surveillance and screening for ASD in infants and toddlers
Activity: Communicating with a parent about a failed ASD screening
Early ASD assessment and diagnosis, and tools for use with infants and toddlers
http://www.med.unc.edu/ahs/pearls
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Why This Topic, and Why Now?
Continued rise in prevalence of ASD diagnosis (1/59 in U.S., 1/38 boys, 1/152 girls; Baio, CDC, 2018)
Growing body of research on ASD in children age two years and younger
Potential for very early identification & intervention
Likelihood that early interventionists will see toddlers with ASD pre-diagnosis
Considerations in Early ID of
Infants/Toddlers at-Risk for ASD
There are symptoms of ASD as young as 12 months of age
Symptoms recognized in majority of kids by 18 months
We can diagnose children as young as 2 years of age with good reliability & stability
Minority families or those with low incomes = less likely to receive an early diagnosis (Non-Hispanic white = 1/58, non-Hispanic black = 1/63, Hispanic =1/71)
(Baio, 2018; Baranek 1999; Bryson et al. 2007; Landa et al. 2007; Ozonoff et al. 2010; Pierce et al. 2011; Wetherby et al. 2008; Zwaigenbaum et al. 2005)
What is Autism Spectrum Disorder and
How Does it Differ From Autism?
Autism once viewed as subtypes (Autistic Disorder, Pervasive Developmental Disorder, Asperger’s, High Functioning Autism)
Researchers and clinicians have found it hard to distinguish between these groups
Diagnostic and Statistical Manual 5 (2013) now identifies one disorder = Autism Spectrum Disorder
Children viewed on spectrum with differences in communication, sensory, repetitive behaviors, the supports that are needed, & comorbidities
Some advocates prefer term “Autism” or “Autistic” to avoid “disorder”
Key Features of Autism
DSM-5 (2013)
Impairments in:
(1) Social Communication/Interaction
Difficulties
(2) Restricted/Repetitive Behaviors and
Interests (including sensory features)
2 Questions when Considering ASD
What is there that
shouldn’t be there?
What is not there
that should be?
Typical Social & Communication Milestones
Can Help with Early Identification of Autism
3-6 months: emergence of turn taking (vocal, play)
6-9 months: response to name
9-12 months: follow attention of others; social
referencing with novel stimuli; good & varied
communication
12-15 months: initiate joint attention; beginning verbal
communication; functional play
15-18 months: early pretend play; developing vocabulary
of words used in different situations
Behaviors often not seen in children with ASD by 3 years
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Gestures and Early Communicative
Functions Social Interaction: Communicating to engage with a
person
Behavior Regulation: Communicating to gain access
to something, someone, or some action; or to protest
Joint Attention: Communicating to share interest in an
object or an event
Joint Attention
Behavior
Regulation Social
Interaction
Intentional
Communication
Social Symptoms
Atypical gaze
More averting gaze from others’ eyes
Less gaze to faces/eyes
Less looking at others
Harder to get infant/toddler to play social games
Harder to elicit social smile
Less looking at objects held by others
Lack of sharing joy (except in tickle,
roughhouse games)
(Jones & Klin, 2013; Osterling et al., 2002; Ozonoff et al., 2010;
Veness et al, 2012; Watson et al., 2007; Zwaigenbaum et al.,
2005)
Attention to Eyes Across First two Years
Jones & Klin (2013)
Social Communication/Interaction
Difficulties:
Failure to respond to name
Delayed speech/language
Loss of acquired words
Unusual prosody (rhythm of speech awkward)
Doesn’t attract attention to own activities
May not want parents to read/look at books together
No showing, giving, or pointing to objects to share interest
(Baird et al, 2000; Cassell et al., 2007; Landa et al.,
2007; Robins et al., 2001; Wetherby et al. 2004)
Social Interaction Gestures in Infants &
Toddlers with ASD, Other DD, or TD
(Watson et al., 2013)
(Other studies: Baird et al, 2000; Cassel et al., 2007; Colgan et al., 2006; Landa et al., 2007; Robins et al., 2001; Wetherby et al. 2004)
0
10
20
30
40
50
60
70
80
9-12 mos 15-18 mos
ASD
DD
TD
% of
children
using SI
gestures
NS diff ASD < DD, TD
Utility of Social-Communication Symptoms in
Screening 9-16 Month Olds
Work by our group on the First Year(s) Inventory:
Less likely to look quickly when parent calls child’s name
Less looking at things that parent points toward
Less likely to look at familiar person or object in response to to “Where is___?” (without parent pointing or showing)
Difficult to get child to look at picture book with parent
Few attempts to get parent’s attention to show something interesting
Facial expressions difficult to understand
Few attempts to get parent to play social games in which child and parent take turns
Less imitation of others
Less use of gestures to communicate
Less interested in other children
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Behavior Regulation Gestures in Infants &
Toddlers with ASD, Other DD, or TD
(Watson et al, 2013)
More use of contact gestures for behavior regulation (Other studies: Baird et al, 2000; Cassel et al., 2007; Landa et al., 2007; Robins et al., 2001; Wetherby et al. 2004)
0
10
20
30
40
50
60
70
80
9-12 mos 15-18 mos
ASD
DD
TD
% of
children
using BR
gestures
ASD < TD ASD < TD
Joint Attention Difficulties:
Joint attention diminished, often absent
Failure to share interest with others (e.g., monitor gaze of others; show or give objects, look at books together)
Little or no pointing to show objects/events
Pointing to get things may be present (regulate)
(Baird et al, 2000; Cassell et al., 2007; Landa et al.,
2007; Robins et al., 2001; Wetherby et al. 2004)
Joint Attention Gestures in Infants &
Toddlers with ASD, other DD, or TD
(Other studies: Baird et al, 2000; Cassel et al., 2007; Colgan et al., 2006; Landa et al., 2007; Robins et al., 2001; Watson et al., 2013; Wetherby et al. 2004)
0
10
20
30
40
50
60
70
80
90
100
9-12 mos 15-18 mos
ASD
DD
TD
AU < DD, TD AU < DD, TD
(Watson et al, 2013)
% of children
using JA
gestures
Early Object Play Development
Exploratory: exploration and simple manipulation of single objects
Relational: takes objects apart & puts them together
Functional: simple pretend play with realistic objects
Symbolic: more complex pretend play (e.g., object substitution, imaginary qualities, role play)
Exploratory Play
Relational Play
Functional Play
Symbolic Play
General Characteristics of Object Play
in Toddlers with ASD
Compared to their peers with typical development:
More repetitive & stereotyped play
Less varied, inventive play
More time in sensorimotor/exploratory play and
less time in more advanced levels of play
Functional play (early pretend play) is less
frequent & diverse
Fewer attempts to bring others into their play
Brian et al., 2008; Charman et al., 1997; Chawarska et al, 2007; Landa
et al., 2007; Wetherby et al, 2007
Play in Infants/Toddlers with
ASD VS TD
In our data (Wilson et al., 2017), infants with
ASD show less sophisticated play at 9–12 and
15–18 months than those with typical
development
To differentiate ASD and DD, pay particular
attention to unusual play features
Simple pretend play barely emerging even by
15-18 months
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Play Levels at 9-12 Months
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
TD
DD
AU
Wilson et al., 2017AU < TD & DD for F + S
Play Levels at 15-18 Months
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
TD
DD
AU
Wilson et al., 2017 AU & DD < TD for F + S
Utility of Object Play-Related Items in
Screening 12-month-oldsWork by our group on the First Year Inventory--
Some features of repetitive & stereotyped play were reported by parents more frequently for infants later diagnosed with Autism
Repeating a simple activity over and over
Getting stuck on playing with part of a toy instead of the whole toy
Rubbing or scratching objects for long periods of time
Playing with a favorite toy the same way all the time instead of exploring new ways
Sensory Features
DSM-5: “Hyper- or hypo-reactivity to sensory
input or unusual interest in sensory aspects of
environment” as a possible manifestation of
“Restricted, repetitive patterns of behavior,
interests, or activities.”
Thus, sensory features are being recognized
as among the possible core features
Categories of sensory features: hypo-
responsiveness, hyper-responsiveness,
sensory seeking; also “enhanced perception”
Sensory Features in Infants &
Toddlers with ASD
By around 12 months, infants with ASD show:
Hyporesponsiveness to social and nonsocial
stimuli; e.g., not orienting to novel sound or
object in environment, not responding to name
call.
A transition from being overly passive to overly
reactive to stimuli, showing distress
More sensory-based play behaviors & unusual
visual explorations of objects
Baranek, 1999; Ozonoff et al., 2008; Zwaigenbaum et al., 2005
Sensory Features in Children
with ASD More extreme features of hyper- and hypo-
responsiveness and sensory seeking than
children with other DD
Hypo-responsiveness seems most specific to
ASD
More likely to show “mixed pattern” of both
extreme hypo-responsiveness and extreme
hyper-responsiveness
Baranek et al., 2006; Lord et al., 1994; Watson et al. 2011; Wiggins
et al., 2009
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Study 1: Sensory Experiences Questionnaire
(Baranek et al, 2006, J .Child Psychology & Psychiatry)
Group with ASD
Study 1: Sensory Experiences Questionnaire
(Baranek et al, 2006, J .Child Psychology &
Psychiatry)
Group with DD
Repetitive & Restricted Behaviors
Types of RRBs include:
Motor stereotypies
Repetitive use of objects
Nonfunctional rituals & routines, insistence on sameness
Circumscribed interests, preoccupations
Stereotyped language
Consider: frequency of RRBs, type of RRBs, and whether social-communication red flags are seen in conjunction with RRBs
RRBs in Infants/Toddlers with ASD Between 12 & 24 months, RRBs among
toddlers with ASD are higher than in peers with other DD
Sensory interests
Hand & finger mannerisms
Repetitive behaviors with objects (spinning, rotating)
Repetitive movements of body (arm waving, hands to ears)
Unusual intonation of vocalizations/verbalizations
(Kim & Lord, 2010; Loh et al., 2007;
Ozonoff et al, 2008; Wetherby et al., 2004)
Repetitive Movements during CSBS-DP
Rocks, flips, turns over, or flicks object
Spins or wobbles object
Clutches objects
Pats, taps, or presses body part
Flaps arms or hands
Rubs or squeezes object
Lines up or stacks objects
Collects objects
(Morgan, Wetherby & Barber, 2008; Watt et al, 2008)
Not until
later age
How Early Can We Recognize ASD?
At 9-12 months?
Sensory-Motor/Sensory-Regulatory
More mouthing
More social touch aversions
Less visual orientation to novel stimuli
Difficulty shifting attention to new stimuli
Tendency to fixate attention instead of actively explore
Extreme passivity with extreme distress reactions
(Baranek, 1999; Cassell et al., 2007;
Watson et al., 2008; Zwaigenbaum et al. 2006)
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How Early Is Autism Diagnosed?
Median age around 52 months, (Baio, CDC, 2018)
Later mean ages of diagnosis for PDD-NOS (49 months)
and Asperger’s disorder (74 months)
First comp eval = non-Hispanic: 42% by 36 months
African-American: 43 months (5.1x as likely to get dx
after age 4)
Hispanic: 41 months (6.9x as likely to get dx after age 4)
Gradual improvements in early diagnosis
Substantial numbers of children continue to miss the
opportunity for early intervention
Why Screen for ASD in Toddlers?
Symptoms recognized in majority of kids by 18
months
Parents’ initial concerns more likely to be about
speech/language
25-30%: regression reported, usually between18 &
24 months
AAP (Johnson & Myer, 2007): screen ALL children
twice by 24 months (specifically at 18 & 24 months)
AAP does not endorse a specific screener
Parent & Physician Recognition of Symptoms
Parent initial concerns (Chawarska et al., 2007)
• 14.7 months for Autism• 20% at 18 m
• Types of concerns Language & speech 71%
Social difficulties 61%
Medical problems/motor delays 29%
Stereotyped behaviors 17%
80% of parents report initial concerns by the end of the
2nd year (DeGiacomo & Fombonne, 1998)
Pediatrician made observations of autistic-like behaviors in
children later diagnosed • 10% of children with ASD obs during 1st year• 59% of children with ASD obs during 2nd year (but only ½
referred) (Niehus & Lord, 2006)
Focus Group Study with PCPs
(Crais et al., 2014)
Eight groups with 66 health care providers & staff
Some primary care providers:
Hesitant about ASD screening & talking to families
Don’t use standardized tools
Are unaware of follow-up questions and/or newer version of M-CHAT-R
Over-rule positive results based on clinical judgment
Need more continuing education on red flags, screening tools, & talking to families
Other barriers (time, low billing rates, resources, staff turnover, knowledge, low confidence in screening tools, limited availability of EI services)
Survey of Needs of Young, NC Children
with ASD (Martinez et al., 2018, JADD)
Conducted statewide survey of caregivers of young
children with ASD
• Children under 9 years of age
• Focus on key milestones: first concerns, screening,
diagnosis, and entry into EI services; families’ pathways
to obtain services; & needs of parents for services and
supports
• Web & paper surveys
• N = 450, 80/100 counties represented
• Demographics: 77% White, 13% Black, 13%
Hispanic/Latino, 4% Asian, 2% American Indian (32%
below state income median)
Survey of Needs of Young, NC Children
with ASD (Martinez et al., 2018)
Less than ½ (47%) of children screened by PCP
(despite AAP Guidelines to screen ALL children twice
by 24 months, Johnson et al., 2007)
25% told “not autism” by a professional before ASD
diagnosis
54.3% diagnosed with other autism-related conditions
Almost ½ saw 3 or more separate professionals before
diagnosis
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Survey of Needs of Young, NC Children
with ASD (Martinez et al., 2018)
Mean age of first developmental concerns
Typically before 21 months of age
Parents most likely to notice concerns
If parents noticed > more likely to enter EI services earlier
50% started EI services before ASD diagnosis
Mean age of entry into EI services
30 months
Mean age of ASD diagnosis
38.8 months (18 months gap from first concerns to dx)
Survey of Needs of Young, NC Children
with ASD (Martinez et al., 2018)
Screening was associated with reduced delay in
diagnosis
Problems finding providers were associated with
greater delay
Screening, travel distance, and delay in diagnosis were
all associated with shifting diagnoses & being told child
did not have ASD
Level I Screening Tools
Distinguish infants and toddlers with autism from the general population
General Developmental Screening Ages and Stages Questionnaire (ASQ)
(Squires, Bricker, & Potter, 1997)
Parents Evaluation of Developmental Status (PEDS) (Glascoe, http://www.pedstest.com)
Communication and Symbolic Behavior Scales Infant-Toddler Checklist (CSBS-ITC) (Wetherby & Prizant, 2002)
CSBS-DP Infant-Toddler Checklist
Parent-report tool
25 questions across communication & play
domains
Empirically supported for 6-24 month olds
(Wetherby & Prizant, 2004) and shown to raise
red flags for autism although it is not an
autism specific screener
Recent findings suggest that the sensitivity of
the CSBS-DP-ITC for DD is 0.91 in children
under 24 months (Oosterling, Swinkels, van
der Gaag, Visser, Dietz & Buitelarr, 2009)
Communication and Symbolic Behavior Scales
Developmental Profile (CSBS DP™)
Infant-Toddler Checklist (Wetherby & Prizant, 2002,
Brookes Publishing)
Communication and Symbolic Behavior Scales
Developmental Profile (CSBS DP™)
Infant-Toddler Checklist (Wetherby & Prizant, 2002,
Brookes Publishing)
http://www.pedstest.com/
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Level I Autism Screening Tools
Modified Checklist for Autism in Toddlers Revised with Follow-Up (M-CHAT-R/F) (Robins, Fein, & Barton, 2009)
Valid for screening between 16 and 30 months of age
20 Yes/No questions
First stage, parent completes MCHAT-R
Second step, professional asks follow-up questions for items failed (“No” response)
Expect “Yes” for all items (“No” = ASD risk), except 2, 5, and 12: “Yes” on these indicates ASD risk
M-CHAT-R/F and
Follow-up Questions
Have you ever wondered if your child might be deaf?
Is your child interested in other children?
If you point at something across the room, does
(child’s name) look at it?
Follow-up questions
PASS Examples:
Looks at object
Points to object
Looks and comments on
object
Looks if parent points and
says “look!”
FAIL Examples:
Ignores parent
Looks around
room randomly
Looks at parent’s
finger
MCHAT-R/F Scoring Algorithm
LOW-RISK: Total Score is 0-2; if child is younger than 24 months, screen again after second birthday. No further action required unless surveillance indicates risk for ASD.
MEDIUM-RISK: Total Score is 3-7; Administer Follow-Up to get additional information about at-risk responses. If M-CHAT-R/F score remains at 2 or higher, the child has screened positive. Action required: refer child for diagnostic evaluation and eligibility evaluation for early intervention. If score on Follow-Up is 0-1, child has screened negative. No further action required unless surveillance indicates risk for ASD. Child should be rescreened at future well-child visits.
HIGH-RISK: Total Score is 8-20; It is acceptable to bypass the Follow-Up and refer immediately for diagnostic evaluation and eligibility evaluation for early intervention.
MCHAT-R/F Process
Sensitivity: 85% Specificity: 93%
Currently the best evidence available is for the M-CHAT as ASD-specific screener for 18 and 24 months, but only if used with the follow-up questions (Kleinman et al., 2008; Robins, 2008)
Download forms and scoring
http://mchatscreen.com/Official_M-CHAT_Website.html
MCHAT-R/F Outcomes
Significant false positives without follow-up questions
Even with follow-up questions, significant number of children who fail M-CHAT-R will not be diagnosed with ASD. However, they are at risk for other DDs
Recent study: 48% of screen positive children diagnosed with ASD, 95% with ASD or other DD (Robins, et al., 2014)
• Therefore, follow-up is warranted for any child who screens positive!!!
A New Screening Tool
Based on our retrospective video analysis, clear behavioral markers for ASD at 12 months of age are evident (Baranek, 1999, Reznick et al., 2006).
Most children seen by primary care physicians at 12 months for vaccinations.
UNC-CH research team developed parent report tool to identify risk for ASD in 12 month olds - First Year Inventory (Baranek, Watson, Crais, & Reznick, 2003).
http://mchatscreen.com/Official_M-CHAT_Website.html
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First Year Inventory(FYI, Baraneck, Watson, Crais, & Reznick, 2003)
12 month parent report
Social-communication
items
Sensory-regulatory items
63 items total
• 46 items: parents check
“never,” “seldom,”
“sometimes,” or “often”
• 14 multiple choice items
• 1 item on sound
production
• 2 open-ended questions
regarding concerns
FYI Sample Questions: Checklist &
Multiple-choice Formats •Does your baby turn to look at you when you call your baby’s name?
•Does your baby seem overly sensitive to your touch?
When you introduce your baby to a new game (peek-a-boo, so-big, patty-
cake, etc.), how does your baby respond?
a. Almost always joins in immediately without any help.
b. Usually joins in, with a little help.
c. Joins in only with a lot of help.
d. Doesn’t seem very interested in new baby games.
What do you typically have to do to get your baby to look up from playing
with a favorite toy?
a. Just show him or her a different toy.
b. Move, shake or make a noise with the different toy.
c. Take the favorite toy away and give your baby the different toy.
Identification of ASD and
Other DDs Using cut-off for both Social-Communication &
Sensory-Regulatory domains yielded best performance
of FYI in screening for ASD:
Positive Predictive Value = .31 (31%
chance child identified by FYI will
have ASD at age 3)
Sensitivity = .44 (44% of children
with ASD by age 3 were identified by
FYI)
85% of children had DD or ASD
Clinical Use of FYI?
Not ready for clinical use yet!
Only normed for children at exactly 12 months of age (working on expansion 9-16 months and “Lite” version w/ fewer questions)
Too long (trying to shorten it)
Scoring is complicated
Keep up with our progress on our website:
http://www.med.unc.edu/ahs/pearls
Screening ScenarioOne day, you’re at a preschool seeing an older child for intervention and one of the teachers says, “We have this child we’re concerned about. He’s 18 months and just doesn’t seem to be very social. He carries objects around with him, but doesn’t play much with them. He’s not using words and he also doesn’t point out things or play social games with us. We’re worried from all we hear about autism, we’re wondering if it might be autism. When we raised some concerns with his Mom, she said it was fine to screen him if we thought it was important.”
You arrange to meet the mother and have her complete an M-CHAT –R/F questionnaire. The child fails 6 items on the M-CHAT-R/F questionnaire, and in the follow-up interview, the mother confirms her responses. What will you say to this mother? Pair up, and take turns being the interventionist and being the mother. Practice what you would say to the mother.
Cautions re: Interpreting
Screening Results in Toddlers
Failed screening (positive screen for ASD) indicates need for further evaluation
Negative screen does not mean child won’t have ASD at some future time
Even with the best current practice, about 50% of children who fail M-CHAT screening will not be diagnosed with an ASD (sensitivity .77-.92)
70-80% of children who fail ITC will have delays in communication, but only 6% will have ASD (so careful in comments & look at composite scores)
Professionals using Level 1 ASD screens should be VERY CAREFUL about making definitive statements to parents
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Level 2 Screening/Diagnostic
Tools for ASD
Autism Diagnostic Interview – Revised (ADI-Revised): 2-4 hour interview with parents of child’s history (Couteur, Lord, & Rutter, 2003)
(ADOS-T) – one-hour structured and unstructured interaction with child
12-30 months (Luyster et al, 2009)—available thru Western Psychological Services
Communication and Symbolic Behavior Scales
Developmental Profile (CSBS DP™)
(Wetherby & Prizant, 2002)
Emotion & Eye Gaze
Communication
Gestures
Sounds
Words
• Word Combinations
• Understanding
• Object Use (functional
& symbolic play, &
combinatorial play)
8 - 24 monthsSeries of “temptations” & book sharing, comprehension of names/objects, toy play
Communication and Symbolic Behavior Scales
Developmental Profile (CSBS DPTM)
(Wetherby & Prizant, 2002)
Communication and Symbolic Behavior Scales
Developmental Profile (CSBS DPTM)
(Wetherby & Prizant, 2002)
Communication and Symbolic Behavior Scales
Developmental Profile (CSBS DPTM) (Wetherby & Prizant, 2002)
Communication Development of
Toddlers with ASD: CSBS-DP
Toddlers with ASD lower than norms: Social composite
Speech composite
Symbolic composite
Toddlers with ASD lower than those with DD: Gaze shifts
Gaze/point following
Rate of communication
Joint attention acts
Inventory of different gestures
(Wetherby, Watt, Morgan & Shumway, 2007)
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MacArthur-Bates Communicative
Development Inventories (CDIs), Second
Edition (Fenson et al., 2006)
MacArthur-Bates Communicative
Development Inventories (CDIs) Words and
Gestures, Second Edition (Fenson et al., 2006)
MacArthur-Bates Communicative
Development Inventories (CDIs) Words and
Gestures, Second Edition (Fenson et al., 2006)
MacArthur-Bates Communicative
Development Inventories (CDIs) Words and
Gestures, Second Edition (Fenson et al., 2006)
MacArthur-Bates Communicative Development Inventories (CDIs, Words and Sentences),
Second Edition (Fenson et al., 2006)
MacArthur-Bates Communicative Development Inventories (CDIs, Words and
Sentences), Second Edition (Fenson et al., 2006)
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Goals of an “Interpretive Session”
Families come to you with different information
and expectations (helpful to know this ahead)
Need to convey information and make sure
families understand it
Assist parents with their emotional reaction to
the news / provide emotional support (and
tissues)
Content of An “Interpretive”
Session
Give parents the names
Explain to parents the nature of their child’s
problem using language the parents may use
and understand
Use the behaviors they’ve reported
Give parents information on the severity of the
condition (if you can)
Explain what is known/not known about the
cause
Acknowledge uncertainty
What Works When Approaching
Families About Your Concerns?
Remain objective “this is what I observed”
Focus on social skill, not just language
Don’t pass judgments - do a lot of listening
“Here’s what I saw today. I understand you
may not see some of these types of behaviors
at home because it is a different setting.”
Focus on original concerns of family and any
remaining ones not addressed
Increasing Family Participation in
Sharing Assessment Information
Help family prepare for the discussion
Ask family to share their information first (e.g.,
thoughts on process, tools they completed)
First address issues of importance to family
First talk about strengths & what child can do
Use “rule out” approach
Check out family perceptions at end (or along
the way)
Next Steps (Especially if Doubt on
Caregivers’ Part)
Suggest caregivers consider observing in other
settings (e.g., childcare, with other kids)
If others (e.g., child’s physician, relatives) have
expressed concerns, return to those mentioned
Be aware of local resources and share
information about them (e.g., other parents,
helpful websites)
Maintain ongoing communication if family
needs more time
SUMMARY
Reliable diagnosis of ASD in toddlers is possible
in many cases
Diagnosis in toddlers requires knowledge of how
ASD symptoms manifest in very young children
SLPs should play an important role in early
screening and diagnosis of ASD
Families should play a key role in screening for
ASD
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Resources
American Academy of Pediatrics
http://www.aap.org/healthtopics/autism.cfm
CDC Learn the Signs/Act Early
(www.cdc.gov/ncbddd/actearly/concerned/html)
Autism Speaks ASD glossary
http://www.autismspeaks.org/
MCHAT Revised, with Follow-Up (M-CHAT-R/F)
(Diana Robins) www.mchatscreen.com
CDC Learn the Signs/Act Early
Autism Case Training
Individual Modules
Identifying
Diagnosing
Managing
Online Course Available
CE credit
CDC Milestones
NC Autism Alliance
CDC Milestone Checklist
NC Autism Alliance
http://www.cdc.gov/ncbddd/actearly/concerned/htmlhttp://www.autismspeaks.org/http://www.mchatscreen.com/
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Additional Resources
http://firstwords.fsu.edu (Infant/Toddler
Checklist & Scoring, ASD glossary)
Autism Navigator
http://autismnavigator.com/resources-and-
tools/#about
National Professional Development Center
on Autism Spectrum Disorders (24
evidence-based practices, training
modules, online course)
(http:www.fpg.unc.edu/~autismpdC/)
Additional Resources
Caring for Children with ASD: A Resource
Toolkit for Clinicians (AAP, 2008;
$79.95/$69.95), www.aap.org
9-12 months: Is Your One-Year Old
Communicating with You? (AAP, 2004)
ASHA Practice Portal http://www.asha.org
Questions and Discussion
https://outlook.unc.edu/owa/redir.aspx?SURL=VibW5AECSLLflMkFtTrzNIqQHUPaf_gyJqiVSZVzHB6koavR14bSCGgAdAB0AHAAOgAvAC8AYQB1AHQAaQBzAG0AbgBhAHYAaQBnAGEAdABvAHIALgBjAG8AbQAvAHIAZQBzAG8AdQByAGMAZQBzAC0AYQBuAGQALQB0AG8AbwBsAHMALwAjAGEAYgBvAHUAdAA.&URL=http://autismnavigator.com/resources-and-tools/#abouthttp://www.aap.org/http://www.asha.org/