Early Indicators of Autistic Disorders - PowerPoint PPT Presentation

1 / 54
About This Presentation
Title:

Early Indicators of Autistic Disorders

Description:

'used to help identify the early signs of autism at 18 months by assessing the ... The aim is to establish performance skills that the child has not mastered. ... – PowerPoint PPT presentation

Number of Views:284
Avg rating:3.0/5.0
Slides: 55
Provided by: marcosa
Category:

less

Transcript and Presenter's Notes

Title: Early Indicators of Autistic Disorders


1
Early Indicators of Autistic Disorders
  • Christina Alvarez
  • Gipsy Fernandez
  • EDF 6211 Educational Psychology
  • Dr. Martha Pelaez
  • Florida International University

2
What is Autism?
  • According to the DSM-IV, autistic disorder is
    one of several pervasive developmental disorders
    (PDDs) that are caused by a dysfunction of the
    central nervous system leading to disordered
    development. All children with PDD are
    characterized by qualitative impairments in
    social interaction, imaginative activity, and
    both verbal and nonverbal communication skills
  • (Kabot et. al., 2003, p. 26)

3
Autism Spectrum Disorders
  • Autism
  • Asperger Syndrome
  • Pervasive Developmental Disorder Not Otherwise
    Specified (PDD-NOS)
  • Childhood Disintegrative Disorder (CDD)
  • Rett Syndrome

4
Autism
  • Most commonly diagnosed PDD
  • Impairs ability to communicate, form
    relationships, and interact with others
  • Results in a range of unusual and repetitive
    behaviors
  • Typically diagnosed by age 3 or 4 years
  • Frequently accompanied by mental retardation
  • Sometimes, uneven levels of intelligence
  • (Masland, 2005)

5
Asperger Syndrome
  • Not high-functioning autism
  • Similar symptoms as autism, without delays in
    language or possibility of mental retardation
  • Often, impressive vocabularies and sharp
    cognitive skills
  • Serious difficulties with social interaction
  • (Masland, 2005)

6
Asperger Syndrome
  • Obsessive interest in a particular topic
  • Preoccupied with repetitive routines or
    behaviors
  • Many have a history of developmental delays in
    motor skills and display poor physical
    coordination
  • (Masland, 2005)

7
PDD-NOS
  • Known as atypical autism
  • Diagnosis given to children with some symptoms of
    autism but who do not meet specific diagnostic
    criteria
  • In many cases, these children are later confirmed
    to have an identifiable disorder
  • (Masland, 2005)

8
Childhood Disintegrative Disorder
  • aka Hellers syndrome or regressive autism
  • More frequently in boys
  • Child appears to develop normally until 2-4 years
    of age when regression occurs
  • Previously learned skills are lost child may
    stop speaking or become disinterested in play
  • (Masland, 2005)

9
Rett Syndrome
  • Most commonly seen in girls
  • Steep developmental regression after 6 18
    months of age
  • Rapid behavioral changes loss of language,
    balance problems, sleep abnormalities, lack of
    interest in social relationships, extended
    tantrums
  • (Masland, 2005)

10
Rett Syndrome
  • Heads fail to grow at a normal rate
  • Most have mental retardation
  • Gradually lose purposeful use of their hands
    leads to repetitive hand washing movements
  • (Masland, 2005)

11
Why Early Diagnosis is Necessary
  • deficits identified are in skills that typically
    develop during the first 12-18 months of life
    (Wetherby et al., 2004, p. 474)
  • children with autism/PDD who develop language
    and symbolic play before the age of 5 have better
    prognoses (Robins et al., 2001, p. 132)
  • research shows that intervention provided before
    age 3 ½ has a greater impact than that after age
    5 (Wetherby et al., 2004, p. 473)
  • intervention beginning before age 3 may have an
    even greater impact (Wetherby et al., 2004, p.
    473)

12
Why Later Diagnosis Occurs
  • large gap between the age of the child at
    parents first concern, the age of the first
    evaluation, and the age of definitive diagnosis
    (Robins et al., 2001, p. 131)
  • most potent predictorsare generally negative
    symptoms failure of normal behavioral systems
    to mature rather than positive signswhich may
    appear later (Robins et al., 2001, p. 141)
  • reluctant to diagnose autism prior to the age
    that a child would typically develop (Baranek,
    1999, p. 213)
  • limited by the lack of early screening
    instruments (Bryson et al., 2003, p. 506)

13
Screening Instruments Used in Research and
Diagnosis
  • CHAT (Baron-Cohen, Allen Gillberg, 1992 )
    Checklist for Autism in Toddlers
  • M-CHAT (Robins, Fein, Barton, Green, 2001)
    Modified Checklist for Autism in Toddlers
  • ADI-R (Lord, Rutter, LeCouteur, 1994) Autism
    Diagnostic Interview Revised
  • ADOS-G (Lord, Rutter, LeCouteur, 1994) Autism
    Diagnostic Observation Schedule-Generic
  • CSBS (Wetherby Prizant, 1993) - Communication
    and Symbolic Behavior Scales

14
Screening Instruments Used in Research and
Diagnosis
  • CSBS DP (Wetherby Prizant, 1998)
    Communication and Symbolic Behavior Scales
    Development Profile
  • PDDST-II (Siegal, 1999) Pervasive Developmental
    Disorder Screening Test II
  • STAT (Stone Ousley, 1997) Screening Tool for
    Autism in Two-Year-Olds
  • ABC (Krug, Arick, Almond, 1979) Autism
    Behavior Checklist
  • CARS (Schloper, Reichler, DeVellis, Daly, 1980)
    Childhood Autism Rating Scale
  • Retrospective Video Analysis (Baranek, 1999
    Werner et. al., 2000)

15
CHAT
  • Checklist for Autism in Toddlers
  • most well known screening test for identifying
    ASD in young children (Kabot et. al., 2003, p.
    28)
  • If CHAT suggests autism, an in-depth assessment
    is recommended if it does not, further
    evaluations are recommended. (Kabot et. al.,
    2003)
  • used to help identify the early signs of autism
    at 18 months by assessing the childs attainment
    of developmental milestones (Robins et. al.,
    2001, p. 133)

16
M-CHAT
  • Modified Checklist for Autism in Toddlers
  • a 23-item parent-report checklist, examining
    childrens developmental milestones (Robins et.
    al., 2001, p. 140)
  • a simple screen that can be given to all
    children during pediatric visits (p.133)
  • does not rely on the physicians observation of
    the child, but on parents report of current
    skills and behaviors (p. 133)
  • solely for the purpose of initial screening (p.
    141)

17
ADI-R
  • Autism Diagnostic Interview Revised
  • has demonstrated good sensitivity and
    specificity in validity testing (Kabot et. al.,
    2003, p. 29)
  • requires extensive time and training to
    administer (p. 29)
  • may be most useful as part of a more in-depth
    assessment in children for whom screening tests
    suggest a fairly high level of concern for
    autism (p. 29)

18
ADOS-G
  • Autism Diagnostic Observation Schedule-Generic
  • semistructured assessment of play, interaction,
    and social communication (Kabot et. al., 2003,
    p. 29)
  • requires extensive training of clinicians before
    it can be administered (p. 29)
  • four modules that match age and communication
    levels of individuals from childhood to
    adulthood (p. 29)

19
CSBS
  • Communication and Symbolic Behavior Scales
  • Consists of four parts
  • evaluator offers a child eight communicative
    temptations toys for which the child must ask
    for help in order to play with them (Robins et.
    al., 2001, p. 135)
  • evaluator engages the child in symbolic play
    using two different sets of toys (p. 135)
  • evaluator assesses verbal comprehension (p.
    135)
  • evaluator engages the child in combinatorial
    play (p. 135)

20
CSBS DP
  • Communication and Symbolic Behavior Scales
    Development Profile (Wetherby et. al., 2004)
  • Consists of three measures
  • a one-page 24-item Infant-Toddler Checklist for
    screening, can be completed quickly by a parent
    (p. 476)
  • a four-page follow-up Caregiver Questionnaire
    (p. 476)
  • a Behavior Sample, a face-to-face evaluation of
    the child interacting with a parent and clinician
    that is videotaped for later analysis (p. 476)
  • designed to measure seven pre-linguistic skills
    organized into three composites (p. 476)

21
PDDST-II
  • Pervasive Developmental Disorder Screening Test
    II
  • screening test designed for administration in
    different settings where there are concerns about
    possible ASDs (Kabot et. al., 2003, p. 29)
  • designed for representative populations in
    primary care clinics, developmental care clinics,
    and autism clinics (p. 29)
  • parental report measure (p. 29)

22
STAT
  • Screening Tool for Autism in Two-Year-Olds
  • designed for use by professionals involved in
    early identification and intervention (Kabot et.
    al., 2003, p. 29)
  • relatively brief interactive measure that can be
    used to identify children in need of more
    extensive follow-up (p. 29)
  • differs from the CHAT in that it was developed
    as a second-stage screening instrument to
    differentiate children with autism from children
    with other developmental disorders (p. 29)

23
ABC
  • Autism Behavior Checklist
  • one of the oldest of the autism checklists
    (Kabot et. al., 2003, p. 29)
  • considered of limited usefulness (p. 29)

24
CARS
  • Childhood Autism Rating Scale
  • most widely used standardized instrument
    designed to aid diagnosis of autism in young
    children (Kabot et. al., 2003, p. 29)
  • easy to administer (p. 29)
  • can be usedin a variety of settings (p. 29)
  • supported by research (p. 29)

25
Retrospective Video Analysis
  • families in increasing numbers have home videos
    which inadvertently provide documentation of
    their childrens development (Baranek, 1999, p.
    214)
  • an excellent option for accessing very early
    periods in development months or years before a
    child with autism is diagnosed (p. 214)
  • methodological problems(e.g. difficulty
    controlling variables such as the age of subjects
    and length, content, or structure of the video
    segments) can be controlled (p. 214)

26
Early Indicators 0-6 mos.
  • Typically Developing Child
  • Head turns when name is called
  • Matches the direction of a moms head turn to the
    visible target
  • Starts to develop joint attention
  • Attends to affective displays of others
  • Responds to emotions
  • Autistic Child
  • Does not respond to social cues without repeated
    prompting
  • Displays minimal affective responses
  • More passive, quieter
  • May lag behind in motor skills
  • (Zwaigenbaum, 2005 Dawson
  • et. al., 2004 Werner et. al.,
  • 2000)

27
Early Indicators 7-12 mos.
  • Typically Developing Child
  • Succeeds at joint attention
  • Seeks emotional information from adult faces when
    presented with uncertainty (social referencing)
  • Autistic Child
  • Greater incidence of unusual posturing
  • Needs more prompts to respond to name
  • Mouthing of objects
  • Social touch aversion
  • (Zwaigenbaum et. al., 2005
  • Dawson et. al., 2004 Werner et.
  • al., 2000 Baranek, 1999)

28
Early Indicators 7-12 mos.
  • Typically Developing Child
  • Elementary vocal communication
  • Early social imitation skills
  • Autistic Child
  • Pays little attention to distress of others
  • Lacks of social smiling and appropriate facial
    expressions
  • Unstable attention
  • (Zwaigenbaum et. al., 2005
  • Dawson et. al., 2004 Werner et.
  • al., 2000 Baranek, 1999)

29
Early Indicators 13-24 mos.
  • Typically Developing Child
  • Exhibits joint attention
  • Engages in social relations
  • Autistic Child
  • Minimal responses to others (lack of empathy)
  • Does not exhibit pretend play
  • (Dawson et. al., 2004 Kabot et.
  • al., 2003 Robins et. al., 2001
  • Charman et. al., 1997)

30
Early Indicators 13-24 mos.
  • Typically Developing Child
  • Communicates, both receptively and expressively
  • Shows greater incidences of pretend play
  • Autistic Child
  • Impaired joint attention
  • Less gazing at people
  • Absence of pre-linguistic functions (i.e.
    declarative pointing, showing objects)
  • (Dawson et. al., 2004 Kabot et.
  • al., 2003 Robins et. al., 2001
  • Charman et. al., 1997)

31
Early Indicators 13-24 mos.
  • Red Flags Significant differences between the
    ASD and Delayed Development (DD) groups and the
    ASD and Typical Development (TD) groups
  • Lack of appropriate gaze
  • Lack of warm, joyful expressions with gaze
  • Lack of sharing enjoyment or interest
  • Lack of response to name
  • Lack of coordination of gaze, facial expression,
    gesture, and sound
  • (Wetherby et. al., 2004)

32
Early Indicators 13-24 mos.
  • Red Flags Significant differences between the
    ASD and Delayed Development (DD) groups and the
    ASD and Typical Development (TD) groups
  • Lack of showing
  • Unusual prosody
  • Repetitive movements or posturing of body, arms,
    hands, or fingers
  • Repetitive movements with objects
  • (Wetherby et. al., 2004)

33
Early Indicators 13-24 mos.
  • Red Flags Significant differences between the
    ASD and TD groups, not the ASD and DD groups
  • Lack of response to contextual cues
  • Lack of pointing
  • Lack of vocalizations with consonants
  • Lack of playing with a variety of toys
    conventionally
  • (Wetherby et. al., 2004)

34
Early Indicators 2-4 yrs.
  • Typically Developing Child
  • Pro-social behaviors are very developed
  • Face recognition registers on EEG
  • Socially appropriate contingent or synchronized
    gazing
  • Plays with a variety of toys conventionally
  • Autistic Child
  • EEG does not differentiate between mothers and
    strangers face
  • Social orientation, joint attention, attention to
    others distress still lacking
  • (Dawson et. al., 2004 Kabot et.
  • al., 2003 Dawson et. al., 2002)

35
General Indicators of Autism Communication
  • Delay in, or total lack of, development of spoken
    language
  • Difficulty initiating conversation
  • Echolalia (repeating words or phrases instead of
    using normal language
  • Doesnt respond to name
  • Doesnt use or respond to gestures and other
    nonverbal cues
  • (Siegal, 2003)

36
General Indicators of Autism Communication
  • Infrequent crying, cooing, smiling
  • Failures to vocalize, babble, engage in jargon
  • Limited understanding of object labels or novel
    information
  • Limited understanding of instructions
  • (Audet, 2004)

37
General Indicators of Autism Social Interaction
  • Doesnt point to objects or show them to others
  • Doesnt make eye contact at appropriate times
  • Doesnt look at other peoples faces as much
  • Doesnt respond to facial expressions or body
    language
  • (Siegal, 2003)

38
General Indicators of Autism Social Interaction
  • Doesnt smile back at others
  • Lack of peer relationships appropriate to age
    level
  • Less interest in other children
  • Not motivated by praise or physical affection
  • Doesnt clearly demonstrate sympathy or empathy
  • (Siegal, 2003)

39
General Indicators of Autism Social Interaction
  • Crying or laughing for no apparent reason
  • Difficulty anticipating future events,
    understanding others actions
  • Difficulty engaging in play with others
    (beginning play, remaining focused on play, joint
    attention to play)
  • (Audet, 2004)

40
General Indicators of Autism Behaviors
  • Engages in highly repetitive play
  • Obsessively preoccupied with a specific interest
    or object
  • Lack of make-believe or imitative play
  • Dependent on routines, rituals, and familiarity
  • Repetitive body movements (hand or finger
    flapping, eye rolling, twisting, spinning,
    rocking, etc.)
  • (Siegal, 2003)

41
General Indicators of Autism Behaviors
  • Preoccupation with parts of objects
  • Easily over-stimulated by noises, crowds, or
    lights
  • Extreme dislike of certain sounds, textures, or
    situations
  • Doesnt have strong response to pain
  • (Siegal, 2003)

42
General Indicators of Autism Sensory Processing
  • Sensitive startle response
  • Avoidance of eye gaze
  • Under responsiveness to startle stimuli
  • Unusual sleep patterns
  • Unusual or exaggerated fears
  • Dropping oneself on the floor
  • Excessive seeking of movement
  • (Audet, 2004)

43
General Indicators of Autism Motor Skills
  • Low muscle tone
  • Limited oral exploration or play
  • Excessive drooling
  • Prone to choke or gag
  • Limited food tolerance
  • Delayed development in gross and fine motor
    skills
  • (Audet, 2004)

44
General Indicators of Autism Emotions
  • Difficulties with emotional regulation
  • Disproportionate frustration
  • Difficulty expressing own emotional state
  • Unconventional self injurious behaviors
  • Action that is unexpected within the context
  • (Audet, 2004)

45
Educational Strategies
  • Incidental Teaching
  • Uses naturalistic educational techniques
  • Is child centered, child directed, and teacher
    guided
  • Teaching opportunities for instruction are
    determined by observing the childs behavior.
  • Uses arrangements of the environment to increase
    the childs participation
  • (Murray-Slutsky, 2000 Watling, 2004)

46
Educational Strategies
  • Direct Instruction
  • Adults are directly involved in teaching and
    maintain control of the program.
  • The aim is to establish performance skills that
    the child has not mastered.
  • (Murray-Slutsky, 2000 Watling, 2004)

47
Parental and Educational Strategies
  • Reinforcement
  • Shaping the response
  • Chaining
  • Time Delay Procedures
  • Token Systems
  • Picture Exchange Communication System
  • Representational Objects
  • (Murray-Slutsky, 2000 Watling, 2004)

48
Parental and Educational Strategies
  • Structured Teaching
  • Visual Schedule (Schedules and Planned
    Activities)
  • Concise Instructions
  • Interesting Tasks
  • Prompting (physical and verbal prompts)
  • Anticipate challenging behavior
  • (Murray-Slutsky, 2000 Watling, 2004)

49
References
  • Audet, L. R. (2004). The pervasive developmental
    disorders A holistic view. In H.
    Miller-Kuhaneck (Ed.), Autism A comprehensive
    occupational therapy approach (p.41-66).
    Bethesda, MD AOTA Press.
  • Baranek, G. T. (1999). Autism during infancy A
    retrospective video analysis of sensory-motor and
    social behaviors at 9-12 months of age. Journal
    of Autism and Developmental Disorders, 29(3),
    213-224.
  • Baron-Cohen, S., Allen, J., Gillberg, C.
    (1992). Can autism be detected at 18 months?
    The needle, the haystack, and the CHAT. British
    Journal of Psychiatry, 161, 839-843.
  • Bryson, S. E., Rogers, S. J., Fombonne, E.
    (2003). Autism spectrum disorders Early
    detection, intervention, education, and
    psychopharmacological management. Canadian
    Journal of Psychiatry, 48(8), 506-516.

50
References
  • Charman, T., Swettenham, J., Baron-Cohen, S.,
    Cox, A., Baird, G., Drew, A. (1997). Infants
    with autism An investigation of empathy, pretend
    play, joint attention, and imitation.
    Developmental Psychology, 33(5), 781-789.
  • Dawson, G., Carver, L., Meltzoff, A. N.,
    Panagiotides, H., McPartland, J., Webb, S. J.
    (2002). Neural correlates of face and object
    recognition in young children with autism
    spectrum disorder, developmental delay and
    typical development. Child Development, 73(3),
    700-717.
  • Dawson, G., Toth, K., Abbott, R., Osterling, J.,
    Munson, J., Estes, A., et al. (2004). Early
    social attention impairments in autism Social
    orienting, joint attention, and attention to
    distress. Developmental Psychology, 40(2),
    271-283.
  • Kabot, S., Masi, W., Segal, M. (2003). Advances
    in the Diagnosis and Treatment of Autism Spectrum
    Disorders. Professional Psychology Research and
    Practice, 34(1), 26-33.

51
References
  • Krug, D. A., Arick, J. R., Almond, P. J.
    (1979). Autism screening instrument for
    educational planning. Portland, OR ASIEP
    Educational Co.
  • Lord, C., Rutter, M. L., LeCouteur, A. (1994).
    Autism Diagnostic Interview-Revised A revised
    version of a diagnostic interview for caregivers
    of individuals with possible pervasive
    developmental disorders. Journal of Autism and
    Developmental Disorders, 24, 659-685.
  • Masland, M. (2005, February 21). Children in the
    grip of autism More families faced with a
    difficult diagnosis . Retrieved June 1, 2005,
    from
  • http//www.msnbc.msn.com/id/6901860/.
  • Murray-Slutsky, C. Paris, B. (2000). Exploring
    the Spectrum of Autism and Pervasive
    Developmental Disorders Intervention
    Strategies. San Antonio, TX Therapy Skill
    Builders Press.

52
References
  • Robins, D. L., Fein, D., Barton, M. L., Green,
    J. A. (2001). The modified checklist for autism
    in toddlers An initial study investigating the
    early detection of autism and pervasive
    developmental disorders. Journal of Autism and
    Developmental Disorders, 31(2), 131-144.
  • Schloper, E., Reichler, R. J., DeVellis, R. F.,
    Daly, K. (1980). Toward objective classification
    of childhood autism Childhood Autism Rating
    Scale (CARS). Journal of Autism and
    Developmental Disorders, 10, 91-103.
  • Siegal, B. (2003). Helping Children with Autism
    Learn. New York Oxford University Press.
  • Siegal, B. (1999). Pervasive Developmental
    Disorder Screening Test II. San Francisco
    University of San Francisco, Langley Porter
    Psychiatric Institute, Pervasive Developmental
    Disorder Laboratory and Clinic.

53
References
  • Stone, W. L., Ousley, O.Y. (1997). STAT
    manual Screening Tool for Autism in
    Two-Year-Olds. Unpublished manuscript,
    Vanderbilt University.
  • Watling, R. (2004). Behavioral and educational
    intervention and approaches for the child with an
    ASD. In H. Miller-Kuhaneck (Ed.), Autism A
    comprehensive occupational therapy approach
    (p.245-271). Bethesda, MD AOTA Press.
  • Werner, E., Dawson, G., Osterling, J., Dinno,
    N. (2000). Brief report Recognition of autism
    spectrum disorder before one year of age A
    retrospective study based on home videotapes.
    Journal of Autism and Developmental Disorders,
    30(2), 157-162.
  • Wetherby, A., Prizant, B. (1993).
    Communication and symbolic behavior scales
    normed edition. Baltimore, MD Paul H. Brookes.

54
References
  • Wetherby, A., Prizant, B. (1998).
    Communication and symbolic behavior scales
    developmental profile research edition.
    Baltimore, MD Paul H. Brookes.
  • Wetherby, A. M., Woods, J., Allen, L., Cleary,
    J., Dickinson, H., Lord, C. (2004). Early
    indicators of autism spectrum disorders in the
    second year of life. Journal of Autism and
    Developmental Disorders, 34(5), 473-493.
  • Zwaigenbaum, L., Bryson, S., Rogers, T., Roberts,
    W., Brian, J., Szatmari, P. (2005). Behavioral
    manifestations of autism in the first year of
    life. International Journal of Developmental
    Neuroscience, 23, 143-152.
Write a Comment
User Comments (0)
About PowerShow.com