Identifying and Assessing Infants, Toddlers, & Preschoolers with … · 2019. 10. 3. · Typical Social & Communication Milestones Can Help with Early Identification of Autism 3-6

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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)


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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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)



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)



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



(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


Developmental Profile (CSBS DPTM)



Developmental Profile (CSBS DPTM)



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)


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/

Documents

Identifying and Assessing Infants, Toddlers, & Preschoolers with … · 2019. 10. 3. · Typical Social & Communication Milestones Can Help with Early Identification of Autism 3-6