Autism Spectrum Disorders
Jessie Bradshaw & Anna KrasnoCALM
March 21, 2012
• Definition of Autism• Red Flags• Assessments & Screeners• Cultural Considerations• Trauma & Autism• Referrals & Community Resources• Treatment
• 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
Associated Features
• Cognitive Delays• Digestive Disorders• Sleep disturbances• Seizures• Anxiety• Depression
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
http://www.autismspeaks.org/what-autism/video-glossary
Later Red FlagsPreschool 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
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– 6-18 • Withdrawn• Social Problems• Thought Problems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)
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
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
Symptoms of Trauma and Autism
• Can look similar– Coping mechanisms– Repetitive behaviors– Low levels of eye-contact– Social isolation– Disruptive behaviors– Inflexibility, maintaining control
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
Resources
• STAR– starautism.com
• Alpha Resource Center• Early Start Program• First Five Program• Autism Speaks– Learn the signs
How to Talk to Families
1. Bring up your observations with the parent2. Wait for agreement3. Evaluations are free and can give families great
feedback4. Early intervention is key5. Early intervention is key6. Early intervention is key7. Follow up and offer help with interpretation and
support
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)
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
Pivotal Response Treatment
• Key components– Child Choice– Direct, natural, contingent reinforcers– Reinforces attempts
• Promotes inclusion of individuals with autism in all realms of life
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
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
Take Home Message
• Early identification
• Knowledge of evidence based treatment
Thank you!• Jessie Bradshaw: [email protected]• Anna Krasno: [email protected]