MODULE: EARLY IDENTIFICATION OF AUTISM SPECTRUM DISORDERS

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1 SCREENING AND DIAGNOSIS INSTRUMENTS The fllwing ntes prvide a guide in reading the fllwing tables. * Age Range: Inclusive (e.g., 2 6 years = frm 2 years 0 mnths thrugh 6 years 11 mnths) Training Needs: Minimal: little t n training required, but presumes familiarity with instrument Mderate: presumes prir basic interviewing/cgnitive assessment training Intensive: additinal specialized training, such as wrkshp attendance, suggested Early Identificatin f Mdule 31

2 Table 1: Recmmended Screening Instruments ESAT ITC M CHAT PDDST II SCQ SRS STAT FORMAT AGE RANGE * mnths 6 24 mnths mnths mnths 4 years adult TIME TO COMPLETE TRAINING NEEDS 5 Minimal 5 10 Minimal 10 Minimal Minimal 10 Minimal 4 18 years 15 Minimal mnths 20 Intensive COMMENTS Quick Standardized n a narrw age range (may be useful fr lder infants, but unknwn) Sensitivity unknwn; lng term fllw up studies have nt been cnducted Quick Apprpriate fr yung infants Nt an autism specific screener; many children wh screen psitive will have nn autism language delays Quick Excellent specificity Sensitivity unknwn; lng term fllw up studies have nt been cnducted Quick Three versins can be used in different clinical settings and different types f screening Quick Maps n t DSM IV and ADI R (gld standard instrument) Nt standardized as a screening tl fr children yunger than 4 years, but new research suggests may be useful as yung as 2 yrs When used in cmbinatin with ADOS as a diagnstic instrument, excellent sensitivity and specificity Quick Standardized n very large sample with excellent psychmetric prperties Requires wrkshp and scring f training vides t use independently Secnd level screener meant t be administered after failing an initial screen Early Identificatin f Mdule 32

3 ESAT = Early Screening fr Autism Traits (Dietz et al., 2006) ITC = Infant-Tddler Checklist (Wetherby, & Prizant, 2002) M-CHAT = Mdified Checklist fr Autism in Tddlers (Rbins et al., 2001) PDDST = Pervasive Develpmental Disrders Screening Test (Siegel, 2004) PIA = Interview fr Autism (Stne et al., 2003) SCQ = Scial Cmmunicatin (Rutter et al., 2003b) SRS = Scial Respnsiveness Scale (Cnstantin, & Gruber, 2005) STAT = Screening Tl fr Autism in Tw-Year-Olds (Stne et al., 2000) Early Identificatin f Mdule 33

4 Table 2: Recmmended Instruments fr Diagnstic Evaluatin ADI R ADOS AOSI CARS FORMAT Interview r Observatin AGE RANGE * 18 mnths adult 12 mnths adult 6 18 mnths 2 years adult TIME TO COMPLETE 1½ 3 hurs TRAINING NEEDS Intensive Intensive 20 Intensive 30 Mderate COMMENTS Maps n t DSM IV Requires wrkshp and scring f training vides t use independently Primarily used fr research purpses; length makes it less feasible fr clinical practice Maps n t DSM IV Excellent psychmetric prperties; gld standard assessment tl New tddler mdule apprpriate fr 12 mnths and lder Requires wrkshp and scring f training vides t use independently Apprpriate fr very yung infants Requires wrkshp and scring f training vides t use independently Gd agreement with ther measures Based n lder (pre DSM IV) cnceptualizatins f autism Des nt measure sme central early signs f autism (shwing, jint attentin) ADI -R = Autism Diagnstic Interview Revised (Rutter et al., 2003a) ADOS = Autism Diagnstic Observatin Schedule (Lrd et al., 2002) AOSI = Autism Observatin Scale fr Infants (Brysn et al., 2008) CARS = Childhd Autism Rating Scale (Schpler et al., 1988) Early Identificatin f Mdule 34

5 Table 3: Other Measures f Autism Symptms (nt used fr diagnsis) CSBS DP FORMAT and AGE RANGE * TIME TO COMPLETE TRAINING NEEDS 6 24 mnths 30 Mderate COMMENTS Apprpriate fr yung infants Includes bth Caregiver and Behavir Sample Mre detailed fllw up t ITC Used t mnitr develpmental prgress PDDBI 18 mnths 12.5 years Minimal Measures wide range f skills, including adaptive behavir, sensry issues Used t assess respnse t treatment CSBS DP Interview 2 6 years Minimal Used t assess respnse t treatment CSBS-DP = Cmmunicatin and Symblic Behavir Scales Develpmental Prfile (Wetherby, & Prizant, 2002) PDDB-I = PDD Behavir Inventry (Chen, & Sudhalter, 2005) PIA = Interviews fr Autism (Stne et al., 2003) Early Identificatin f Mdule 35

6 ACTIVITY 1: Surveillance The purpse f this activity is t increase yur experience in bserving and describing red flags fr ASD in very yung children. This activity is based n viewing the Autism Speaks, ASD Vide Glssary at this site: Preparatin: If yu dn t already have a lgin accunt, set ne up fr viewing the vide segments. Yu will als need Adbe Flash 10 t view the segments. Directins: Select and watch at least tw segments. In a small grup r thrugh individual reflectin, discuss the fllwing questins. Yu may want t take ntes as yu are watching the segment t enrich the discussin. What is the develpmental r behaviral fcus f the segment? What is the age f the children being bserved? What did yu ntice abut the characteristics f the child wh is typically develping? What characteristics f ASD did yu bserve? Were there evident triggers that set ff r maintained a behavir yu bserved? Hw did the behavirs f the child with autism differ frm the typically develping child in terms f intensity, duratin, and frequency? What pprtunities fr interactin r interventin did yu bserve during the segment fr the typically develping child? Fr the child with ASD? Early Identificatin f Mdule 36

7 ACTIVITY 2: Screening The purpse f this activity is t review and practice administering a screening tl fr ASD. Preparatin: Obtain a cpy f ne f the screening tls listed in the mdule that is apprpriate fr an 18 r 24 mnth ld child. Thrugh yur wrk r persnal pprtunities, arrange t practice a screening tl fr a child wh is apprximately 18 r 24 mnths ld. The child may be typically develping r have develpmental delays r ther challenges. The M-CHAT is available fr free dwnlad at this site: Directins: Read the directins and practice using the instrument with a child wh is 18 r 24 mnths f age. In a small grup r thrugh individual reflectin, respnd t the fllwing questins. Hw was the frm cmpleted? Did yu cmplete the frm r did yu ask a parent r ther caregiver t cmplete the questinnaire? Did yu have any truble deciding hw t answer any questin? If s, which ne(s) and why? D yu have any questins abut scring r interpreting the results? What did the scre reveal? Did it surprise yu? If yu cnducted an interview, hw did it g? Hw cmfrtable were yu in asking the questins and listening t the parent respnses? What new infrmatin did yu learn frm the interview? What was yur interactin with the parent when yu shared the screening results? If the screening resulted in cncerning results, what fllw up actins did yu take? Early Identificatin f Mdule 37

8 ACTIVITY 3: Diagnstic Assessment The purpse f this activity is fr yu t reflect upn yur experiences with diagnstic assessments fr ASD. Preparatin: Previus experience with a diagnstic assessment fr ASD. Cnsider yur experience in any f these rles parent f the child being evaluated, member f an early interventin r schl team, referral surce, individual wh received an evaluatin as a child, prfessinal wh made a referral, member f the diagnstic team, recipient f a reprt. Directins: In a small grup discussin r thrugh individual reflectin, respnd t the fllwing questins abut yur experiences with a diagnstic assessment. If yu haven t experienced all aspects discussed belw, interview a parent r clleague t learn mre abut their experiences. Hw were yu invlved? What was the reasn fr the referral? Hw ld was the child? Where was the assessment cnducted? What cmbinatin f activities ccurred during the evaluatin? If instruments were used, which ne(s)? Wh administered the instrument? Hw was the decisin t make the diagnsis reached? Hw was the infrmatin delivered t the child s parents? What type f referrals and fllw up resulted frm the diagnstic sessin? Were written materials r ther resurces ffered t the parents? Early Identificatin f Mdule 38

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