1. My Patient May Have Autism, Now What
My Patient May Have Autism, Now What? Guidelines for Assessment, Intervention, and Next Steps.
DoriAnn Adragna, Ph.D., Ed.S.,
Peak Pediatric Psychology
Licensed Psychologist
Licensed School Psychologist

2. My background
Bachelor’s of Arts in Psychology from Colorado Mesa University
Education Specialist Degree from the University of Denver
Doctor of Philosophy from the University of Denver
Completed a two year fellowship in pediatric traumatic brain injury
Completed a one year psychology externship at JFK Partners and Children’s Hospital Colorado in Autism and other Neurodevelopmental Disorders
Founding member of PEAK Pediatric Psychology

3. Objectives At the end of this presentation participants will:
Be able to identify some of the early warning signs for an autism spectrum disorder
Identify screening tools to determine when a more thorough assessment is warranted
Learn how to help families navigate a new diagnosis

4. What is Autism? Previous Terms Used: Asperger’s Disorder
Autistic Disorder
Rett’s Disorder
Pervasive Development Disorder
Childhood Disintegrative Disorder
Current DSM-V Terms:
Autism Spectrum Disorder
Category which includes a range of related disorders that vary in severity
Severity can be Mild (level 1), Moderate (Level 2), or Severe (level 3)

5. Autism Spectrum Disorder
The core of autism is a social communication disorder.
The term Autism comes from the Greek word Autos which means “self.”
As humans- we are social animals. We learn by observing the world around us.
Children on the spectrum are typically described as being in their own world, having difficulty taking perspectives of others, have difficulty reading social cues and nonverbal communication, don’t observe others so they miss out on a lot of social learning

6. DSM V criteria that need to be met to have a diagnosis of ASD:
A) Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):
Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
Show videos is have time

7. DSM V-Major criteria that need to be met to have a diagnosis of ASD:
B) Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
**Show video if have time***
If do not meet these criteria, can look at differential diagnosis such as Social Pragmatic Communication Disorder which is basically all the symptoms in criteria A without the RI/RB

8. Early Warning Signs of ASD: Infant
Does not orient to name
Lack of eye contact
Lack of ”social smile”

9. Early Warning Signs: Toddler/Preschool
Speech development
Delays
Echolalia
Impairments in nonverbal communication
Play skills
Functional vs pretend play
Joint attention
Interactions with peers
Does the child approach other children at a park?
How does the child respond to approaches from other children?
Restricted interests/ Repetitive Behaviors
Interest common to age but with more intense focus
Fascination with certain items (long objects, water, toilet flushing, etc.)
Complex hand mannerisms/Stereotypical movements
Behavioral rituals/rigidity/difficulty with routines
Video Examples (show here if they work)

10. Be On The Lookout for Regression
Loss of skills previously acquired (such as if the child suddenly stops speaking)
Research suggests screening at these age intervals for regression and to follow up with more assessment if warranted
18 months
24 months
36 months

11. ASD Screening Tools Ages and Stages Questionnaire (ASQ)
Ages: 1 month to 5 ½ years old
M-CHAT
Ages: Toddlers ages months
Social communication questionnaire (SCQ)
Ages: 4 years old and older with mental age of 2 years old

12. Formal Assessment
Autism Diagnostic Observation Schedule, Second Edition (ADOS-2)
Developmental Interview
Cognitive abilities
Wechsler Intelligence Scales for Children, Fifth Edition
Leiter International Performance Scale (Nonverbal assessment)
Developmental Assessment
Mullen Scales of Early Learning
Adaptive Behaviors
Adaptive Behavior Assessment System, Third Edition (ABAS-3)
Vineland Adaptive Behavior Scales, Third Edition

13. Therapies Speech and Language Therapy Communication skills
Pragmatic skills
Occupational therapy
Sensory concerns
Fine/Gross motor skills
Psychosocial interventions
ABA therapy
CBT
Early intensive (25-40 hours a week over at least 2 years) therapy
Floor Time (DIR) Model

14. How to Help a Family Navigate a New Diagnosis
Reassure them that their child is still the same child that they know and love
Connect them to local resources
Provide referrals to occupational therapy, speech therapy, and behavioral therapy
Check in with the family to follow up on referrals, therapies, applications

15. Priority Recommendations
100 day tool kit from the Autism Speaks Website
services/tool-kits/100-day-kit
Social Stories/ Comic Strip Conversations
Video Modeling
The Autism Society of America, Colorado chapter can be contacted at to gain information about local resources in Colorado.
The Autism Speaks website also has a lot of helpful information for families of children with ASD. Please see
The Arc of West Central Colorado provides advocacy and support for people with intellectual and developmental disabilities. Please see for more information

16. Peak Pediatric Psychology
Thank you!
Questions?
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Peak Pediatric Psychology