Learning the Signs: Identifying Early Indicators of Autism Spectrum Disorder

Transcription

1 Learning the Signs: Identifying Early Indicators of Autism Spectrum Disorder PRESENTER: GLORIA SAGE WV AUTISM TRAINING CENTER MARSHALL.EDU 1

2 West Virginia Autism Training Center The Autism Training Center was established in 1983 by the West Virginia Legislature, through the efforts of parents of children with Autism. Anyone, regardless of age, who has a primary diagnosis of Autism Spectrum Disorder and who lives in West Virginia can be referred for services. The mission of the WV-ATC is to provide support to individuals with ASD as they pursue a life of quality. 2

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4 Overview of ATC Programs and Services Lending library for registered clients (Tier I) In-service training and workshops (Tier II) On-line short training videos Bi-Annual magazine College coursework Person-Centered Planning Programs (Tier III) Family Coaching sessions & Webinar Trainings (Tier II) College Program for Students with Autism Spectrum Disorders Autism Mentor training Autism Registry Statewide Collaborative with DOE for School Wide PBIS & Early Childhood PBIS WV DOE Partnerships for Summer Training Academies Website: 4

5 Learner Objectives At the end of this session, you will be able to: Identify several Red Flags for ASD in young children Identify possible causations of ASD Identify some reasons for importance of early intervention services Learn about some co-existing conditions that are common with ASD Learn about some ways you can support parents and siblings Learn about your broader role as an SLP working with ASD Access a number of resources to assist you in learning about and providing services to children with ASD 5

6 What is Autism Spectrum Disorder (ASD)? Autism spectrum disorder (ASD) is a complex developmental disability Signs typically appear during early childhood and affect a person s ability to communicate, and interact with others. ASD is defined by a certain set of behaviors and is a spectrum condition that affects individuals differently and to varying degrees. There is no known single cause of autism, but increased awareness and early diagnosis/intervention and access to appropriate services/supports lead to significantly improved outcomes. 6

7 Some of the behaviors associated with autism include delayed learning of language; difficulty making eye contact or holding a conversation; difficulty with executive functioning, which relates to reasoning and planning; narrow, intense interests; poor motor skills and sensory sensitivities. A person on the spectrum might follow many of these behaviors or just a few. The diagnosis of autism spectrum disorder is applied based on analysis of all behaviors and their severity The prevalence of autism is reported as 1 in 68 births and 1 in 54 boys, according to the CDC s autism prevalence report issued in March

8 What causes ASD? There is no known single cause for autism spectrum disorder, but it is generally accepted that it is caused by abnormalities in brain structure or function. Brain scans show differences in the shape and structure of the brain in children with autism compared to neurotypical children. Researchers do not know the exact cause of autism but are investigating a number of theories, including the links among heredity, genetics and medical problems. In many families, there appears to be a pattern of autism or related disabilities, further supporting the theory that the disorder has a genetic basis. It also appears that some children are born with a susceptibility to autism, but researchers have not yet identified a single trigger that causes autism to develop. 8

9 How Does ASD Impact Individuals? ASD Impacts: How the person communicates with others How the person interacts with others How the person takes in and responds to sensory information The number and type of activities that the person engages in ASD impacts the entire family with a variety of social, financial and other practical demands 9

10 DSM-5 Diagnostic Criteria A. Persistent deficits in social communication and social interaction across multiple contexts. B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following. Level 1 "Requiring support Level 2 "Requiring substantial support Level 3 "Requiring very substantial support 10

11 Importance of early intervention Decades of rigorous research show that children s earliest experiences play a critical role in brain development. The Center on the Developing Child at Harvard University has summarized this research: Neural circuits, which create the foundation for learning, behavior and health, are most flexible or plastic during the first three years of life. Over time, they become increasingly difficult to change. Persistent toxic stress, such as extreme poverty, abuse and neglect, or severe maternal depression can damage the developing brain, leading to lifelong problems in learning, behavior, and physical and mental health. 11

12 The brain is strengthened by positive early experiences, especially stable relationships with caring and responsive adults, safe and supportive environments, and appropriate nutrition. Early social/ emotional development and physical health provide the foundation upon which cognitive and language skills develop. High quality early intervention services can change a child s developmental trajectory and improve outcomes for children, families, and communities. Intervention is likely to be more effective and less costly when it is provided earlier in life rather than later. 12

13 Red Flags for Autism in Young Children No big smiles or other warm, joyful expressions by six months or thereafter No back-and-forth sharing of sounds, smiles or other facial expressions by nine months No babbling by 12 months No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months No words by 16 months No meaningful, two-word phrases (not including imitating or repeating) by 24 months Any loss of speech, babbling or social skills at any age 13

14 Possible Symptoms at 6 months Not making eye contact with parents or caregivers during interaction No big smiles or other warm, joyful expressions by 6 months or thereafter Not cooing or babbling Not participating in verbal turn-taking (baby makes a sound, adult makes a sound, and so forth) No back and forth sharing of sounds, smiles, or other facial expressions by nine months or thereafter 14

15 At 14 months No attempts to speak Not pointing, waving, or grasping No response when name is called Indifferent to others Repetitive body motions such as rocking or hand flapping Fixation on a single object Oversensitivity to textures, smells, sounds Strong resistance to change in routine Any loss of language 15

16 By 24 months Does not initiate two-word meaningful phrases (without imitating or repeating) Any loss of speech, social skills or any developmental skill at any age 16

17 Joint Attention Deficits in Joint Attention (JA) are one of the most distinguishing characteristics of young children with autism. JA is defined as a normal, spontaneously occurring behavior whereby the infant shows enjoyment in sharing an object/event with another person by looking back and forth between the two. (American Academy of Pediatrics, 2007) 17

18 Joint Attention in the Typically Developing Child JA begins with joyous smiling in recognition of and response to a parent or caregiver s smile and vocalizations. At approximately 8 months of age, a typically developing infant will follow a parent s gaze and look in the same direction when the parent looks away. At 10 to 12 months of age, typically developing children begin to follow a point 18

19 Joint Attention in the Typically Developing Child (cont.) The typically developing child around the age of 14 to 16 months will begin to point to simply comment or share an interesting object/event. As the child points he/she will look between the object/event of interest and the parent. It is the shared social experience that the child seeks and not necessarily the object/event. 19

20 Joint Attention in Children with Autism (cont.) Children with autism fail to point to comment at age appropriate times and when they do, they are less likely to show the positive effects of social connectedness. 20

21 Co-Morbid conditions Sensory issues 30% Feeding/gastrointestinal issues-50% Immune disorders-25% Sleep issues-50% Seizures-10-30% Pica-30% Low muscle tone-30% Anxiety disorder 21

22 Early Identification of Autism In 2016, research demonstrated that a brief parent questionnaire, administered at a baby s one-year well-baby check-up, can help pediatricians identify babies who have autism or are at high risk of developing it. The study involved 137 pediatricians who handed out a simple 24-item checklist to all parents bringing in babies for routine one-year checkups. The questionnaire, called the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist, took the parents about 5 minutes to complete. 22

23 It included such questions as Does your child smile or laugh while looking at you? and How many blocks or rings does your child stack? The pediatricians then reviewed the checklist (a 2-minute process), flagging those babies who scored below a pre-set threshold. (A previous study showed this checklist to be valid.) In all nearly 10,500 children were screened, and 346 were flagged as at risk for autism and referred to an autism clinic for further evaluation. 23

24 Of these, about half were followed to 3 years, 32 of them receiving a diagnosis of autism spectrum disorder (ASD). Another 56 were diagnosed with language delay, 9 with developmental delay, and 36 with other diagnoses. The screen was able to accurately predict autism or other developmental delays about 75 percent of the time. This suggests that the questionnaire or a similar screen may be useful for earlier identification of ASD and other developmental delays that would benefit from early intervention. 24

25 Some children with autism are showing features by 6 months of age. We can begin to identify children at significant risk for autism by 14 months of age. (Study of videotapes of 1-year BD parties) Need early identification and enrollment in appropriate programs and therapies to hit critical periods of brain development and capitalize on neuroplasticity. 25

26 NIH Brain Scan Study 26

27 Research on Early Markers of Autism Yale School of Medicine found an early marker for autism by studying eye gaze of 2-year olds Researchers used eye tracking technology. They presented the children with 10 videos. Each video showed an actress looking directly into the camera, playing the role of caregiver, and engaging the viewer (playing pat-a-cake, peek-a-boo, etc.) 27

28 Results showed that two-year-olds with autism looked significantly more at the mouths of others, and less at their eyes, than typically developing toddlers. Found that the amount of time toddlers spent focused on the eyes predicted their level of social disability. The less they focused on the eyes, the more severely disabled they were. This suggests that the children are seeing faces in terms of their physical attributes rather than as a way of engaging and socializing. 28

29 Supporting Parents What do families need from their providers? Education Training/coaching Relationship/Support Resources Planning for the future (helping them to see the bigger picture ) 29

30 Needs of the Family Family members should be involved in all planning and program development related to their child/family member with ASD. But they also need teaching and coaching in how to apply strategies as part of daily routines. Embedding strategies within routines at home and in community settings empowers families to be involved and increases the chances of success for the child with ASD. 30

31 Relationship/Support Developing relationships with families is different than providing support Relationships have emotional connections and endure over time They create memories and expectations in the minds of the individuals These emotional connections can provide a deeper level of support for families and enable them to move forward 31

32 Supporting Siblings Siblings are often overlooked and recognizing their need for support and information is crucial. They are also an important resource that can be utilized in program planning for their brother or sister with ASD. Connect siblings with sibling groups or other sources of support Educate families on addressing the needs of siblings Include siblings in the planning process for the person with ASD ( in an age-appropriate way and to the extend they want to be included) 32

33 Resources Helping families connect to resources and activities that are supportive of families with a child with ASD can reduce stress and improve QOL for all family members Helping families navigate the massive amount of information that is available and steering them to websites and evidence-based therapies and practices helps families to make good decisions. 33

34 Your Broader Role as an SLP Advocate for children with ASD In-services for staff Training sessions for parents/coaching Local involvement through Autism groups/walks Attending/presenting at ASD conferences 34

35 Autism Internet Modules AIM is designed to provide comprehensive information to assist those working and living with individuals with ASD as they work to increase their knowledge and skill. These modules are available at no cost to any computer or digital telephone user. Thus, these modules are available on a global basis. These modules have the potential to positively impact the educational, family, vocational, and medical communities - on a local and worldwide basis - and may alter the ways in which ASD training occurs. There are currently 23 modules available. 43 additional modules are being planned. Go to 35

36 Autism Speaks 100 day Kit The Autism Speaks 100 Day Kit for Newly Diagnosed Families of Young Children was created specifically for families of children ages 4 and under to make the best possible use of the 100 days following their child's diagnosis of autism. Download a copy at: Request a 100 Day Kit: Families whose children have been diagnosed in the last 6 months may request a complimentary hard copy of the 100 Day Kit by calling 888- AUTISM2 ( ) and speaking with an Autism Response Team Coordinator. 36

37 Websites/Resources Autism Society of America: Autism Speaks: Day Kit: ASD Video glossary: 37

38 Identification and Evaluation of Children with Autism Spectrum Disorders, Pediatrics, vol. 120,number 5, pp Technical Assistance Center on Social Emotional Intervention for Young Children: WV Autism Training Center: 38