1. Corey Ray-Subramanian, PhD Integrated Development Services
2/25/2016
Engaging families in the Early Identification of Autism Spectrum Disorders
Corey Ray-Subramanian, PhD
Integrated Development Services

2. Learning objectives Recognize some early signs of ASD in toddlers
Identify  tools and strategies for engaging families in developmental screening
Have information on referral resources for young children with developmental concerns

3. Overview Defining ASD Importance of Early Identification
Early Indicators
Screening
Referral for Further Evaluation
Questions, Comments, Discussion

4. Autism spectrum disorder (ASD)
2/25/2016
Autism spectrum disorder (ASD)
Considered a neurodevelopmental disorder, but does not have a biological marker and is defined and diagnosed by behavioral features
Can be reliably diagnosed by 2 years of age (even younger in some cases) by an experienced clinician
(Bishop et al., 2008; Lord & Luyster, 2005)

5. Diagnostic criteria (abbreviated)
2/25/2016
Diagnostic criteria (abbreviated)
Persistent deficits in social communication and social interaction across multiple contexts
Deficits in social-emotional reciprocity
Deficits in nonverbal communicative behaviors used for social interaction
Deficits in developing, maintaining, and understanding relationships
Restricted, repetitive patterns of behavior , interests, or activities
Stereotyped or repetitive motor movements, use of objects, or speech
Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
Highly restricted fixated interests that are abnormal in intensity or focus
Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
(APA, 2013)

6. Asd Facts An estimated 1 in 68 children has ASD.
Boys are nearly five times more likely than girls to have ASD (1 in 42).
ASD prevalence continues to increase.
Specific risk factors have been identified and there are likely many causes for multiple types of ASD.
There is no link between vaccines and autism.
(CDC, 2015)

7. Importance of early identification
Early, intensive behavioral intervention has been shown to improve cognitive, language, and adaptive skills in children with ASD.
Early, intensive intervention is associated with long-term financial cost savings.
Access to autism-specific intervention services often requires a formal diagnosis.
Video link
(Koegel et al., 2014; Warren et al., 2011)

8. Early Social communication milestones (ASHA; CDC 2015)
3 months
6 months
9 months
12 months
18 months
24 months
Smiles socially
Coos
Laughs or squeals
Babbles
Likes to look at self in mirror
Enjoys playing peek-a-boo
Understands “no”
May point with finger
Follows your point
Responds to name
More complex babbling
Recognizes words for common objects
Uses gestures to communicate
Imitates different speech sounds
1-2 words around first birthday
Begins to respond to requests
Says more words every month
Simple 1-step pretend play with doll or stuffed animal
Points to request and to express interest in something
Follows simple commands without gestures
Points to a few body parts and pictures in a book when named
Understands simple questions
Puts two words together
Interested in other children and plays beside them
Simple 2-step pretend play

9. Early indicators (12-24 months)
2/25/2016
Early indicators (12-24 months)
Limited shifting of eye contact between objects and people (joint attention)
Fewer warm, joyful expressions with eye contact
Limited showing of objects or sharing enjoyment or interests
Lack of response to name
Lack of coordination of nonverbal communication
Limited use of gestures
Fewer communication bids for requesting, seeking help
Unusual prosody (e.g., rhythm and intonation of babbling)
Repetitive movements with objects
Repetitive movements or posturing of body, arms, hands, or fingers
Limited combining of actions in play
Any loss of speech, babbling, or social skills
(Wetherby et al., 2004; Landa et al., 2007)

10. Video examples Early Signs of Autism Video Tutorial
Kennedy Krieger Institute
related-disorders/outreach-training/early-signs-of-autism-video-tutorial
ASD Video Glossary
Autism Speaks & First Signs

11. Screening for asd
The American Academy of Pediatrics recommends that all children be screened by their primary health care providers at 18 and 24 months for ASD.
In childcare settings or home visiting programs, this can be done in the context of broader developmental screening.
(Johnson & Myers, 2007; Robins et al., 2013)

12. Resources for developing screening or monitoring programs
Tip Sheets for Implementing Developmental Screening
(Available in English and Spanish)
Wisconsin Early Childhood Collaborating Partners
Watch Me! Celebrating Milestones and Sharing Concerns
Centers for Disease Control and Prevention
Birth to 5: Watch Me Thrive!
U.S. Department of Health and Human Services & U.S. Department of Education

13. M-CHAT
The Modified Checklist for Autism in Toddlers (M-CHAT) is a widely used and well-validated screener for children ages 16 to 30 months.
The most recent version (M-CHAT-R/F) includes a parent-completed checklist and brief, structured follow- up interview.
Available for free at

14. Sharing concerns with families
Schedule a time to meet with parents in a quiet, private setting. Discussion can also occur during regularly scheduled parent—teacher conferences or home visits.
Share information on typical developmental milestones and activities for supporting young children’s development in a variety of domains (e.g., Milestones Moments booklet).
List the specific developmental concerns without jumping to any suspected diagnostic labels (e.g., autism, ADHD).
Consider parents’ individual and cultural beliefs about child development and offer them an opportunity to share their perspective.
Encourage parents to talk with their child’s health care provider about the areas of concern.
Provide information for Birth to 3 or Early Childhood evaluation services.

15. Referring for further evaluation
Under Age 3
Ages 3 - 5
Pediatrician/primary care provider
Bring completed M-CHAT to visit
Birth to 3
Contact county-specific agency
Will complete an evaluation and, if found eligible, develop an Individualized Family Support Plan (IFSP)
Pediatrician/primary care provider
Bring list of developmental concerns to visit
Early Childhood Services
Contact local school district
Will complete an evaluation and, if found eligible, develop an Individualized Education Program (IEP)

16. BiRTH to 3 AND Early childhood special education services
Birth to 3 Program Information:
Department of Public Instruction Early Childhood Special Education:
Introduction to Special Education (informational booklet for parents):

17. references
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edition). Washington, DC: Author. American Speech-Language-Hearing Association (n.d.). How Does Your Child Hear and Talk? Retrieved from Bishop, S. L., Luyster, R., Richler, J., & Lord, C. (2008). Diagnostic assessment. In K. Charwaska, A. Klin, & F. R. Volkmar (Eds.), Autism spectrum disorders in infants and toddlers: Diagnosis, assessment, and treatment (pp ). New York: Guildford. Centers for Disease Control and Prevention. (2015, April). Developmental Milestones. Retrieved from Centers for Disease Control and Prevention (2015, February). Facts About ASD. Retrieved from Johnson, C. P. & Meyers, S. M. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120,

18. References (continued)
Koegel, L. K., Koegel, R. L., Ashbaugh, K., & Bradshaw, J. (2014). The importance of early identification and intervention for children with or at risk for autism spectrum disorders. International Journal of Speech- Language Pathology, 16(1), Landa, R. J., Holman, K. C., & Garrett-Mayer, E. (2007). Social and communication development in toddlers with early and later diagnosis of autism spectrum disorders. Archives of General Psychiatry, 64(7), Lord, C. & Luyster, R. (2005, December). Early diagnosis and screening of autism spectrum disorders. Medscape Psychiatry & Mental Health, 10(2). Robins, D. L., Casagrande, K., Barton, M., Chen, C. A., Dumont-Mathieu, T., & Fein, D. (2013). Validation of the modified checklist for autism in toddlers, revised with follow-up (MCHAT-R/F). Pediatrics, 133, Warren, Z. McPheeters, M. L., Sathe, N., Foss-Feig, J. H., Glasser, A., & Veenstra-VanderWeele, J. (2011). A systematic review of early intensive intervention for autism spectrum disorders. Pediatrics, 127(5), e1303- e1311. 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,

19. additional resources
Learning Module on Early Identification of Autism Spectrum Disorder
National Professional Development Center on Autism Spectrum Disorders
Centers for Disease Control and Prevention Act Early Program Materials
Milestone Moments Booklet for Families
Available in English and Spanish

20. Questions, comments, discussion
Thank You!
Contact Info: