7/20/2012. Objectives. Screening for Autism Spectrum Disorder: Characteristics and First Signs

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1 Screening for Autism Spectrum Disorder: Characteristics and First Signs Authors: Presenter: Stephen Contompasis, Vermont Interdisciplinary Leadership Education for Health Professionals - LEND Program Sandra Fritton & Chad Dillard, Virginia LEND Program Dawn Hendricks, VCU Autism Center for Excellence Dawn Hendricks, Ph.D. Objectives Why is screening for autism spectrum disorder important? What is autism spectrum disorder? What is the prevalence of autism spectrum disorder? What is the etiology of autism spectrum disorder? What are the characteristics of autism spectrum disorder? What are the red flags for autism spectrum disorder? 1

2 American Academy of Pediatrics (AAP) Screening Recommendations Recommend routine screening for autism spectrum disorder for all children at 18 and 24 months early and continuous surveillance and screening for ASD to ensure that children are identified and receive access to services as early as possible [is needed] American Academy of Pediatrics (AAP) Screening Recommendations Current data on screenings: Most American pediatricians screen for general developmental delays (82%) More than half use inadequately validated procedures to screen for developmental delays Only a small percentage reported screening specifically for ASD (8%) Video - Center for Disease Control and Prevention Video - CDC 2

3 Why Screen for ASD? Screening leads to early identification Early identification leads to early intervention tailored to child with ASD Early intervention reduces the severity of ASD-associated deficits Early intervention leads to quantifiable gains in language, communication, social functioning, and overall development It is important to begin intervention services for children suspected of ASD as soon as possible because they benefit more fully from intervention at an earlier age and quality of life can be enhanced. Pervasive Developmental Disorders OR Autism Spectrum Disorders Autism Asperger s Syndrome Pervasive Developmental Disorder Not Otherwise Specified What is Autism Spectrum Disorder? Developmental disorder Neurologically based Differences in brain structure and functioning Many areas implicated Can co-exist with other diagnoses 3

4 Prevalence of Autism Spectrum Disorder 1 in 88 children diagnosed with an ASD (Centers for Disease Control and Prevention, 2012) Occurs in all racial, ethnic and socioeconomic groups Boys are affected more than girls at a rate of 4:1 ASD is the fastest growing developmental disorder in the U.S. Etiology of Autism Spectrum Disorder Cause remains largely unknown Several causes have been implicated Genetic Syndromes including Fragile X, Tuberous sclerosis, Rett syndrome Sibling and twin studies have found heritability Environment Prenatal Perinatal Postnatal Genetic with environmental influences What are the Characteristics of Autism Spectrum Disorders? Characterized by impairment in 3 major areas Delayed communication Impaired social skills Presence of restrictive, repetitive and stereotypical patterns of behaviors including differences in sensory processing Secondary characteristics may be present Delayed motor skills Difficulty with adaptive skills (dressing, toileting, using skills in real life situations) IQ is not a criteria or consideration 4

5 The Autism Spectrum Continuum Communication Non-verbal Highly Verbal Social Interaction Passive Active Behavior Mildly Disruptive Highly Disruptive Impairment in Communication Development Nonverbal / Minimal Verbal Abilities Will see delays in language milestones 40% non-verbal May see regression in communication between months May use only single words or short phrases May demonstrate echolalia Difficulty understanding instructions and vocabulary (receptive language) Video - Centers for Disease Control and Prevention Echolalia Lucas, age 4 NCBDDD4 5

6 Impairment in Communication Development Highly Verbal May exceed language milestones May have advanced vocabulary and speak beyond their years Abnormal prosody, volume, or rhythm of speech Improper use of pronouns Difficulty with conversations May have difficulty following directions (especially multi-step) Difficulty understanding figurative language (i.e. jokes, sarcasm) Video Demonstration of communication impairment in a verbal child with autism 6 year old boys, one with autism and one typically developing Impairment in Social Interaction Passive Appears to prefer solitary situations Limited use of non-verbal communication including eye contact, facial expressions and gestures Little or no use of joint attention Difficulty regulating emotions (may anger / upset easily) Play skills are limited May play with only one item May play with a part of a toy (e.g., spin wheels on the car) May lack imaginative play 6

7 Video - Center for Disease Control and Prevention Demonstration of differences in social attention Nathan and Ben approximately 19 months old Twin boys, one with autism and one without Impairments in Social Interaction Active Engages and initiates social interactions Often inappropriate Often focus on preferred topic or interest Inappropriate use of nonverbal communication including eye contact, facial expressions and gestures Difficulty regulating emotions (may anger / upset easily) Play skills may be limited Limitations in imaginative play Impairment in interactive play Inability to read and comprehend the feelings, experiences, and motives of others Video Observation: Play of a child with autism Joseph, 4 years and 6 months Lining up cars Demonstrating self-stimulatory behaviors 7

8 Restrictive, Repetitive and Stereotypical Patterns of Behavior Behaviors range from mildly to severely disruptive Behaviors include the following: Stereotyped movements (e.g., spinning, hand flapping, pacing, drumming, toe walking) Strict adherence to routines Attachment to objects Intense interest in a certain topic Self-injurious behavior (biting, head banging) Atypical response to sensory stimulation Video Brian, age 4 Stereotyped movements Strict adherence to routine Attachment to object The Sensory Systems Visual Auditory Taste Smell Touch Vestibular Proprioception 8

9 Other Considerations Delays in motor skills (gross and fine motor) Turning over Walking Tone is stiff or floppy Head lags back when body is pulled to sitting position Reaches with one hand only Difficulty getting objects to mouth Other Considerations Delays in adaptive behavior Self-help skills Typical daily skills Gaining independence expected of child his/her age Diagnostic Features of ASD General "Red Flags" Does not respond to name Avoids eye contact and wants to be alone Has delayed speech and language skills Gets upset by minor changes Has obsessive interests Flaps their hands, rocks their body, or spins in circles Has unusual reactions to the way things sound, smell, taste, look, or feel 9

10 Video Einstein On: Baby and Toddler Milestones, Dr. Lisa Shulman Milestones at 7, 12 and 18 months Conclusion To obtain more information on typical developmental milestones, go to the website for Centers for Disease Control and Prevention 10