latrobe.edu.au CRICOS Provider 00115M Q: How best to facilitate educational transitions for children with autism? A: Earlier is better to smooth the journey Professor Cheryl Dissanayake Director, OTARC /otarc

2La Trobe University Current Practice Bent, C., Barbaro, J., & Dissanayake, C. (2015) Mapping the diagnosis of Autism Spectrum Disorders in children under 7 years in Australia: 2010 – Medical Journal of Australia Current mean age of diagnosis in under 7-year-olds in Australia is 49 months in Victoria is 50 months < 20% of children with ASD are diagnosed before 36 months < 3% with ASD diagnosed by 24 months

3La Trobe University Maternal and Child Health (MCH) Nurses trained to undertake developmental surveillance of early signs of autism at 12-, 18-, and 24-month routine consultations Level I Surveillance - identify infants who may be at risk for autism (within the MCH centre) “At risk” children referred to SACS team for developmental and behavioural assessments; followed-up every 6 months until 24 months Diagnostic decisions made at 24 months. Social Attention and Communication Study (SACS: )

4La Trobe University 20,770 monitored 216 referrals made 110 assessed106 not assessed 89 ASD (81% PPV) Approx 85 ASD (81% of 106) 174 ASD 1 in 119 PPV and Prevalence of ASDs in SACS cohort PPV = 81% has ASD 19% had DD/LD Prevalence =.84 86% stability of ASD diagnoses from 2- to 4-years

5La Trobe University SACS Papers Barbaro, J. & Dissanayake, C. (2010). Prospective identification of Autism Spectrum Disorders in infancy and toddlerhood using developmental surveillance: The Social Attention and Communication Study. Journal of Developmental and Behavioural Pediatrics, 31, Barbaro, J., Ridgway, L., & Dissanayake, C. (2011). Developmental surveillance of infants and toddlers by Maternal and Child Health nurses in an Australian community-based setting: Promoting the early identification of Autism Spectrum Disorders. Journal of Pediatric Nursing, 26, Barbaro, J. & Dissanayake, C. (2012). Developmental profiles of infants and toddlers with Autism Spectrum Disorders identified prospectively in a community-based setting. Journal of Autism and Developmental Disorders, 42, Barbaro, J. & Dissanayake, C. (2013). Early markers of Autism Spectrum Disorders in infants and toddlers prospectively identified in the Social Attention and Communication Study (SACS). Autism: International Journal of Research and Practice, 17,

6La Trobe University SACS-Revised Age at which behaviour monitored Behaviour12-months18-months24-months Pointing Eye contact Response to name Showing Imitation Gestures (Waving) Pretend play Social smiling Joint attention – following point Use/understanding of language Loss of skills Parallel play Interest in peers RED ticks indicate “KEY” items

7La Trobe University monitored between months 292 “at risk” 2% 233 assessed 80% 47 declined 189 ASD (81.1% PPV) 48 ASD estimated 237 ASD 1 in 60 PPV: 81.1% have ASD 19% have LD/DD Prevalence 1.67% 12 to be assessed SACS-R Preliminary Results: PPV and estimated prevalence

8La Trobe University Developmental surveillance using SACS-R is most effective and efficient approach to early identification of Autism to date Developmental surveillance Professional observations Repeated observations Screening  Parental questionnaires One time point SACS-R models a new approach for early identification of ASD Discussion

latrobe.edu.au CRICOS Provider 00115M ASDetect Launched February 2016

10La Trobe University ASDetect - MOBILE APPLICATION

11La Trobe University ASDetect – GIVING CONTEXT Free download Video-led questions Provides context and clear examples of key behaviours Eliminates doubt and ambiguity Familiar and identifiable environments and circumstances Comprehensive results report provided to users via Users are encouraged to seek formal assessment via a healthcare professional Autism is a sensitive topic and parents will reach out to ASDetect/OTARC to seek answers, validation and guidance Purpose built microsite

12La Trobe University SACS Follow-up Preschool 110  77 returned at preschool age (70%) 86% retained ASD diagnosis at preschool age 14% left the spectrum; all still had some language and/or social communication delays Cohort currently been seen at school age (between 7 – 9 years) by PhD candidate, Megan Clark 53 returned with 86% retaining their diagnosis from 4-years 80% retained ASD diagnosis from 2-years 77% in mainstream schools vis 57% of children diagnosed >3y < 5y

13La Trobe University Cognitive Profiles of SACS children

14La Trobe University An early start…. By identifying and diagnosing early you can enhance learning as children are able to get access to early intervention in a timely manner …. promoting their cognitive development and thus their ability to learn. Aim within the Autism CRC : 50% of children with Autism diagnosed by 24 months 70% diagnosed by 36 months

15La Trobe University Early Intervention As Autism impacts on the child’s ability to learn it can prevent children from reaching their potential. Children with Autism have difficulty learning through observing others and exploring their environments, and they have difficulty engaging with, playing with and communicating with others. Typically developing children learn from other people, by watching them, and imitating them. Autism impedes this process. Our aim is to minimize the impact of autism on learning by: 1. recruiting the youngest children with autism; and 2. teaching them to engage with other people so that they can begin to learn from them

16La Trobe University Naturalistic Developmental Behavioural Interventions (NDBIs) NDBIs integrate principals of developmental and behavioural science. NDBIs utilize ‘‘naturalistic’’ approaches delivered in everyday interactive social contexts (e.g., play and daily routines) which infants and toddlers find themselves in. The materials used in therapy are those preferred and selected by the child rather than the adult Intervention methods strongly informed by developmental theory Teaching incorporated within affectively rich social interactions and routine based Follow into the child’s attentional focus

17La Trobe University Early Start Denver Model Profs Sally Rogers & Geraldine Dawson Goal: to provide structured, hands-on strategies Suitable for children aged from 12 months. Specific curriculum and teaching practises Equips therapists / parents with the necessary skills to engage, communicate with, and teach their very young children with or at risk for ASD

18La Trobe University ESDM Goals To bring child back into the social loop by teaching the building blocks of social life  Imitation  Emotions  Communication  Sharing experiences  Social and Symbolic Play  Language Fill in gaps and accelerate developmental rate

19La Trobe University Early Start Denver Model Research Dawson G, Rogers S, et al. (2009). Randomized controlled trial of an intervention for toddlers with autism: The Early Start Denver Model. Pediatrics, 125 (1), e Dawson, G., Jones, E., et al. (2012) Early behavioral intervention is associated with normalized brain activity in young children with autism. J Am Acad Child Adol Psyciat. Estes, A., Munson, J et al. (2014). Long-Term Outcomes of early intervention in 6-year-old children with Autism Spectrum Disorder.. J Am Acad Child Adol Psyciat

20La Trobe University Victorian Autism Specific Early Learning and Care Centre: The Margot Prior Wing at La Trobe University

21La Trobe University 20 children each day with ASD Each child attends 3 days/week = 15 hrs /week/12months Pilot RCT on EI within inclusive versus segregate setting Group-based ESDM

22La Trobe University Group-based ESDM Publications Vivanti, G., Dissanayake, C., Zierhut, C., & Rogers, S. (2013). Brief Report: Predictors of outcomes in the Early Start Denver Model delivered in a group setting. Journal of Autism and Developmental Disorders, 43(7), Vivanti, G., Paynter, J., Duncan, E., Fothergill, H., Dissanayake, C., Rogers, S.J., & the Victorian ASELCC Team (2014). Effectiveness and feasibility of the Early Start Denver Model implemented in a group-based community childcare setting. Journal of Autism and Developmental Disorders, 44, Vivanti, G., Dissanayake, C., & the ASELCC Team (2016, in press). Outcome for children receiving the Early Start Denver Model before and after 48 months. Journal of Autism and Developmental Disabilities.

23La Trobe University Pilot RCT 16 children with Autism (between 2- to 3-years of age) were randomized to either receive the ESDM within a mainstream childcare setting with typically developing peers (Inclusion Group: 8 children) or amongst other children with Autism (Segregation Group: 8 children). Children in both settings made equivalent gains! Significant gains, particularly in language (assessed using standardized tests and spontaneous production in the classroom) and adaptive behavior, and significant decrease in Autism symptoms (SCQ) However…. small sample size (N = 16) …. …. thus needs replication

24La Trobe University ESDM Group

25La Trobe University Early Identification and Early Intervention Early identification and intervention not only has the potential to maximize developmental and educational gains for the child, but also improves family functioning and wellbeing  reaps long-term benefits for society. From a rationalist perspective, early detection and subsequent intervention serves to reduce whole-of- life costs incurred not only by the families, but also by governments.

26La Trobe University … climate of optimism … The importance of public education about the early characteristics of autism, and the value of early identification and intervention cannot be underestimated

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