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Early Indicators of Autism in Young Children

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Early identification of children who are 'at risk' for autism spectrum disorder ... Robins, D.L., Fein, D., Barton, M.L., & Green, J.A. (2001) ... – PowerPoint PPT presentation

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Title: Early Indicators of Autism in Young Children


1
Early Indicators of Autism in Young Children
  • Early Childhood Educators of BC Provincial
    Conference, May 13, 2004
  • Pat Mirenda, Ph.D.
  • University of British Columbia

2
Why Early?
  • Research evidence is clear
  • Early identification of children who are at
    risk for autism spectrum disorder (ASD)
    facilitates early intervention
  • Early intervention is essential for better
    outcomes

3
Early Identification
  • Firm diagnosis possible by 36 months, with
    indicators for concern appearing earlier
  • Numerous studies have examined early indicators
    of ASD from 1st birthday party videotapes, parent
    surveys, formal test measures
  • Osterling Dawson (1994) reviewed videotapes of
    the 1st birthday parties of 11 children later
    diagnosed with ASD and 11 typically developing
    children
  • At one year of age, children with autism did less
    pointing, showing objects to others (joint
    attention), looking at others, and orienting in
    response to name

4
First Signs
  • A U.S. project directed toward educating
    pediatricians to recognize early indicators of
    ASD
  • Produced a videotape and support package for
    distribution to physicians
  • Equally relevant for early childhood educators
  • Videotape First Signs
  • http//www.firstsigns.org/index.html

5
Red Flags!
  • Relating with warmth and pleasure
  • Looking at faces and smiling back at others by 4
    mo
  • No big smiles and joyful expressions by 6 mo
  • Back and forth vocalizations and gestures
  • No sharing of sounds, smiles, facial expressions
    by 9 mo
  • No responding to name when called by 12 mo
  • No babbling by 12 mo
  • No reciprocal gestures (pointing, showing,
    reaching, waving) by 12 mo

6
Red Flags! (Cont)
  • Problem solving
  • No attempts to recreate or continue interesting
    displays or events, either motorically or
    communicatively (e.g., asking for more or
    help)
  • Two way communication with words
  • No words by 16 mo
  • No two-word meaningful phrases (without imitating
    or repeating) by 24 mo
  • ANY loss of speech or babbling at ANY age

7
ASD vs. Developmental Delay
  • Question is it possible to distinguish between
    young children at risk for ASD and those at risk
    for other types of developmental delays?
  • Answer YES!

8
Wetherby, Prizant, Hutchinson (1998)
  • Compared 22 children with autism (CA 17-60 mo,
    mean 36 mo) and 22 children with language delays
  • Used the Communication and Symbolic Behavior
    Scales (CSBS)
  • Similar use of vocal/verbal communication
  • BUT children with autism had substantially lower
    scores in
  • Number of communicative functions
  • Use of communicative gestures, reciprocity (i.e.,
    turn taking)
  • Social/affective signaling, and
  • Symbolic behavior

9
Osterling, Dawson, Munson (2002)
  • Examined first birthday party videotapes of 20
    infants later diagnosed with ASD, 14 later
    diagnosed with mental retardation (MR), and 20
    typically developing infants
  • Infants with both ASD and MR
  • Used gestures less often
  • Looked at objects held by others less often and
  • Engaged in repetitive motor behaviors more often
    than those who were typical
  • Infants with ASD
  • Looked at others less often and
  • Oriented to their name less often than those with
    MR or those who were typical

10
Baby Sibling Project
  • A team of Canadian researchers are following gt100
    infant siblings of children with ASD to look for
    early indicators of risk
  • http//www.geocities.com/autismandpdd/OurStudies.h
    imInfant20Sibling20Study
  • Results to date indicate that approximately 25
    of the baby sibs show some indication of
    difficulty in early development
  • Those with 7 or more markers are most likely be
    later diagnosed with ASD (not other disabilities)

11
Baby Siblings (Cont)
  • The major markers are
  • Failure to look at other people (i.e., decreased
    eye contact)
  • Failure to orient to name
  • Reduced reciprocal social smiling
  • Atypical sensory behavior
  • Difficulty initiating visual tracking and
    disengaging visual attention
  • Difficulty with imitation and
  • A general lack of social interest
  • Screening tool in development

12
Screening Tools
  • CHAT Checklist for Autism in Toddlers
  • Screening instrument for 18-month olds, developed
    in the UK 16,235 children screened (M18.7 mo)
  • Baird, Charman, Baron-Cohen, Cox, Swettenham,
    Wheelwright, Drew (2000) 6-year follow-up to
    the original CHAT study
  • Good specificity (proportion of children without
    ASD identified as normal) 97.7
  • Low sensitivity (proportion of children with ASD
    identified by the CHAT) 35.1
  • Low positive predictive value (proportion of
    children with a positive screen who had a
    disorder) 8.1 for ASD 16.7 for all
    developmental disorders

13
Screening Tools
  • Also M-CHAT (Modified-CHAT) American version of
    the CHAT, also translated into Spanish
  • Good specificity (95)
  • Good sensitivity (97)
  • Moderate positive predictive value (36)

14
Screening Tools
  • Communication and Symbolic Behavior Scales
    Infant-Toddler Checklist (Wetherby Prizant,
    2002)
  • http//firstwords.fsu.edu/
  • http//www.brookespublishing.com/store/books/wethe
    rby-csbsdp/checklist.him
  • Advisable to use all of these as first stage
    screening tools Is there any type of
    developmental delay, not necessarily autism?

15
What if Screening is Positive?
  • Refer family to their pediatrician
  • Pediatrician should refer the child for a
    multidisciplinary assessment
  • BC Autism Assessment Network (BCAAN)
    http//www.phsa.ca/Patients/autism.him
  • Fraser Health Authority AAN (Surrey)
  • Interior Health AAN (Kelowna)
  • Northern Health Authority AAN (Prince George)
  • Vancouver Island Autism Assessment Services
    (Victoria)
  • Vancouver Coastal Health Authority AAN (Vancouver)

16
Standards and Guidelines
  • Standards and Guidelines for Assessment and
    Diagnosis of Young Children with Autism Spectrum
    Disorder in British Columbia
  • http//www.healthservices.gov.bc.ca/cpa/publicatio
    ns/asd_standards_0318.pdf

17
The Punchline
  • ASD looks different in young children than in
    older children
  • More subtle
  • Fewer behavior problems and self-stimulatory
    behavior
  • More than 1-2 signs, typically
  • Social relatedness and social interaction skills
    are the most affected
  • Early childhood educators have an important role
    to play!!!

18
References
  • Baird, G., Charman, T., Baron-Cohen, S., Cox, A.,
    Swettenham, J., Wheelwright, S., Drew, A.
    (2000). A screening instrument for autism at 18
    months of age a 6-year follow-up study. Journal
    of the American Academy of Child and Adolescent
    Psychiatry, 39, 694-702.
  • Osterling, J., Dawson, G. (1994). Early
    recognition of children with autism A study of
    first birthday home videotapes. Journal of
    Autism and Developmental Disorders, 24, 247-257.
  • 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, 131-144.
  • Wetherby, A., Prizant, B., Hutchinson, T.
    (1998). Communicative, social/affective, and
    symbolic profiles of toying children with autism
    and pervasive developmental disorders. American
    Journal of Speech-Language Pathology, 7, 79-91.
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