First Signs of Autism Spectrum Disorder

Transcription

1 First Signs of Autism Spectrum Disorder Sylvia J. Acosta, Ph.D. Assistant Professor Tina R. Goldsmith, Ph.D., BCBA-D Assistant Professor University of New Mexico Center for Development and Disability December 9, 2011 A University Center For Excellence in Developmental Disabilities Education, Research, & Service Objectives To learn red flags and early signs of ASD. To understand what s involved in the early diagnostic process. To identify when to refer for an evaluation if there is concern. To obtain further resources about early diagnosis of autism. Current Diagnostic Trends Despite advances in early identification, diagnosis of ASD is often delayed until early preschool age (i.e., after 3 yrs). Numbers vary, but average age of first diagnosis is 3.2 for Autism, 3.7 for PDD-NOS, and 7.2 for Asperger s Disorder. Most parents report concern in first or second year of life. According to parents, time between concerns and dx: 1.7 years for Autistic Disorder 2.1 years for PDD-NOS 4.6 years for Asperger s Disorder 1

2 Why is it important to diagnose earlier? Early intervention has been shown to have the best outcome for children with an ASD. Autism-specific intervention offers the best possible outcomes. What factors contribute to late diagnosis? Inadequate screening practices Limited parental awareness of symptoms of ASD Delayed action by pediatricians after initial concerns are voiced Limited specialized dx services for children under 3 What s making it better? Increasing awareness of early symptoms amongst professionals and parents Very successful educational campaigns by CDC, Autism Speaks, and others Development of early screening instruments 2

3 How are we learning about early signs? What we ve done previously: Retrospective studies Videos of first birthday parties Asking parents about what s happened in the past Looking at babies at one point in time What we re doing now: Prospective studies Tracking babies over time Using research methodologies with more rigor So, who s doing this new, improved research? Baby Sibs Research Consortium (BSRC); est. in 2003 Partnership between Autism Speaks and National Institutes of Health (NIH) Goal is to bring together major research groups to discover earliest behavioral and biomedical markers Currently consists of two dozen scientists, representing approximately 20 research institutions, across 4 countries So, what s this consortium finding? What the earliest signs are How early we can diagnosis How stable diagnoses are How to best evaluate ASD And much, much more 3

4 Can we diagnose ASD in the 1st yr. of life? Short answer is no, not yet Most infants who later get ASD dx have relatively intact eye contact and social smiling at 6 mos. of age. However, frequency and quality start to decline between 6 and 12 mos Overall, symptoms become more apparent, at least at the group level, around 12 mos If you re concerned, recommend tx and re-eval in 3-6 mos Can we diagnose in the 2 nd year of life? Identifying a child in the first or second year of life can be challenging because Development in first years progresses rapidly Development often progresses at uneven pace across developmental domains BUT, prospective longitudinal studies suggest that both short- and long-term stability of expert clinical diagnosis is very good What else complicates the dx process? Deficits in social engagement can also be associated with severe cognitive impairment. Many symptoms of ASD can be found in other disorders and syndromes: delayed development of expressive language behavioral difficulties repetitive behavior 4

5 How stable is an early ASD diagnosis? Majority who receive ASD dx in SECOND year of life continue to receive ASD dx at 3 or 4. Children who do not maintain their dx typically have milder symptoms (esp. in social domain), and higher cog. functioning. Differentiation within the spectrum is more challenging, and associated with decreased stability. Changes within the spectrum over time are expected as symptoms evolve and verbal and nonverbal cognitive skills improve. How do these findings relate to our diagnostic categories? DSM is being revised Autism, Asperger s, and PDD-NOS get combined Social and Communication criteria get combined Severity ratings are used to differentiate individuals What exactly do we need to look at? Developmental level Social-communication Restricted and repetitive behavior Adaptive behavior Family, dev., and medical history Vision and hearing Comorbidities and other differential diagnoses 5

6 Do we have the tools to do this? We have measures and more are on the way BUT The gold standard for diagnosis of ASD, especially in infants and toddlers, is expert clinical opinion. What makes someone an expert clinician? Must hold the professional credentials necessary for providing a dx Must be knowledgeable regarding The typical course of development Developmental deviations associated with a myriad of non-asd disorders of infancy and childhood The onset and course of ASD symptomatology So just ONE clinician? Well, no. A best-practice evaluation calls for a team. But the team needs at least one expert. Teams can be made of»licensed clinical or developmental psychologists»speech pathologists»occupational and/or physical therapists»social workers»developmental pediatricians»other qualified professionals What do we need to know to identify toddlers so they can get the evaluation that they need? Remember, you need to understand typical developmental progression before you can understand deviations from it. Key deviations are known as red flags. 6

7 Red Flags for ASD No babbling (or reduced babbling), particularly back-and-forth social babbling. No words by 16 months, odd first words, or unusually repetitive word use No two-word phrases by 24 months. No compensation for EL delays with gestures. Diminished frequency/quality of social smile. Less positive and more negative affect, and less directed affect overall. Red Flags for ASD continued Diminished social interest/shared enjoyment Absent or atypical eye contact. Lack of response when name is called (and differences in responding to speech vs. nonspeech sounds). Difficulties with shared/joint attention. Play: reduced imitation, excessive manipulation or visual exploration, repetitive actions. Red Flags for ASD continued Visual or other types of sensory differences (e.g., aversion to touch, aversion to certain sounds, atypical visual tracking/fixation/inspection). Repetitive/atypical motor behaviors. Regression- loss of speech, socialemotional connectedness, or other developmental skills. 7

8 What do you do if you see Red Flags? Say something or contact someone who s better positioned to say something. If you re going to talk to a family Be honest. Discuss the characteristics that you notice without using jargon. Remember, the parent is the expert on their child-- have a dialogue with the parent. Be considerate of parent s feelings and respond accordingly. Discuss the child s strengths! What do you do if you see Red Flags? (cont ) Discuss why it may be helpful and important to screen their child: Early diagnosis Early intervention Autism specific intervention Prognosis Answers Conduct screening and/or refer for an evaluation Where can families go for an early diagnostic evaluation? Early Childhood Evaluation Program (ECEP) Center for Development and Disability University of New Mexico Website: For more information please contact ECEP at: (505) or toll-free: or at ECEP@salud.unm.edu. 8

9 If you re concerned about a child over 3 years of age The Autism Programs Neurodevelopmental Clinic Center for Development and Disability (CDD) University of New Mexico Call or toll free Website: Contact Sylvia J. Acosta, Ph.D. Assistant Professor SyAcosta@salud.unm.edu Tina R. Goldsmith, Ph.D., BCBA-D Assistant Professor tgoldsmith@salud.unm.edu A University Center For Excellence in Developmental Disabilities Education, Research, & Service 9