1. Autism Spectrum Disorders Jessie Bradshaw & Anna Krasno CALM March 21, 2012

2. Definition of Autism Red Flags Assessments & Screeners Cultural Considerations Trauma & Autism Referrals & Community Resources Treatment

3. Developmental Disability – Autism – Asperger Syndrome – Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS) Three categories for a diagnosis – Social difficulties – Communication impairments – Restricted and repetitive behaviors 1 in 110 Children with Autism also commonly diagnosed with another DD – Mental Retardation: 19.2% – ADD/ADHD: 41.8% – Learning Disability: 60.7% – Other developmental delay: 79.5% Most heritable neurodevelopmental disorder – 20% of siblings (Boulet et al., 2009) Autism

4. Associated Features Cognitive Delays Digestive Disorders Sleep disturbances Seizures Anxiety Depression

5. Early Red Flags Infants and Toddlers Rare eye contact Lack of social smiling by 6 months No back and forth babbling or facial expressions by 9 months No babbling or gestures by 12 months No words by 16 months Under or over emotionally reactive Not orienting to name Would rather play with objects

6. http://www.autismspeaks.org/w hat-autism/video-glossary

7. Later Red Flags Preschool and School Age Little interest in other children No pretend play Odd or delayed speech Very few friends Behaviors – Strong preference for routine – Difficulty with transitions

8. Assessment Measures Child Behavior Checklist (CBCL) – 1 ½ to 5 Withdrawal Subscale Pervasive Developmental Problems DSM Scale – 6-18 Withdrawn Social Problems Thought Problems Ages and Stages Questionnaire (ASQ) – Social-Emotional – Language Ooi, Rescorla, Ang, Woo, Fung (2011)

9. Screeners M-CHAT – Modified Checklist for Autism in Toddlers – 16-30 months of age – 23 Questions – Pass/Fail CSBS-ITC – Communication and Symbolic Behavior Scales – Infant Toddler Checklist – 6-24 months – 24 Questions – Social, Speech, and Symbolic Subscales

10. Cultural Variables Autism found across cultures Children of minority status and low SES take longer to be diagnosed (Mandell et al., 2005; 2008) Take an ecological approach with families – Understand what disability means to the family – Gain knowledge of cultural routines/practices – Design goals to fit within cultural values – Collaboration

11. Symptoms of Trauma and Autism Can look similar – Coping mechanisms – Repetitive behaviors – Low levels of eye-contact – Social isolation – Disruptive behaviors – Inflexibility, maintaining control

12. Referrals Tri-Counties Regional Center – Any person believed to have a developmental disability, and any person believed to have a high risk of becoming the parent of a developmentally disabled infant, is eligible for initial intake and assessment services. – At the conclusion of the assessment process, eligibility for services is determined. If the person is eligible for services through the Regional Center, then the planning team needs to develop a plan for service delivery. Koegel Autism Center – Infant Program – Research studies – education.ucsb.edu/autism

13. Resources STAR – starautism.com Alpha Resource Center Early Start Program First Five Program Autism Speaks – Learn the signs

14. How to Talk to Families 1.Bring up your observations with the parent 2.Wait for agreement 3.Evaluations are free and can give families great feedback 4.Early intervention is key 5.Early intervention is key 6.Early intervention is key 7.Follow up and offer help with interpretation and support

17. Treatment Early intervention is essential – Younger siblings Use evidence based practice (Simpson, 2005) Skill-based behavioral interventions work – Discrete Trial Training – Pivotal Response Treatment (Koegel & Koegel, 2006)

18. Pivotal Response Treatment Uses behavior management principles Implemented in the natural environment Increases motivation for social interaction Includes parent education component Can be used for all ages

19. Pivotal Response Treatment Key components – Child Choice – Direct, natural, contingent reinforcers – Reinforces attempts Promotes inclusion of individuals with autism in all realms of life

20. Examines Function of Behaviors Functional Behavior Assessment (FBA) – Not all behaviors serve the same function – Across settings – Informs treatment planning Antecedent-Behavior-Consequence Positive Behavioral Support – Strength-based approach – Clinical significance

21. Other Treatments Limited support – Music Therapy – Art therapy – Gluten/Casein free diet (can be harmful) Not recommended – Hyperbaric chamber (can be harmful) – Chelation (can be harmful) – Facilitated communication – Auditory Integration Training

22. Take Home Message Early identification Knowledge of evidence based treatment

23. Thank you! Jessie Bradshaw: jbradshaw@calm4kids.orgjbradshaw@calm4kids.org Anna Krasno: akrasno@calm4kids.orgakrasno@calm4kids.org