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2. Autism Spectrum Disorders 3. Parental Concerns (Wiggins, Baio, Rice, 2006) (CDC) ASD 3 5. 4. 4 EARLY DETECTION AND EARLY INTERVENTION 5. ! 3 . 6. ( ) -- 7. 7 Red Flags 8. 12 "" Red Flags -- 9. 18 Red Flags 18 ( ) 10. 24 2--4 Red Flags ( ) 11. 12. - 18 . -- . . . . . . 13. -- 18 3 . . . . 14. -- . " ". . . . . 15. -- peekaboo 16. -- . . . . . 17. -- 18. ASD : : /// : : // Tics: 9 19. Screening Instruments Checklist for Autism in Toddlers (CHAT) The Quantitative CHAT (Q-CHAT) The Modified CHAT (M-CHAT) The Screening Test for Autism (STAT) The Pervasive Developmental Disorders Screening Test II (PDDST-II) The Early Screening for Autism Questionnaire (ESA) All of these sound wonderful BUT What about the toddler in the family doctors office? 20. Screening Results Screening results are consistent with typical development. No signs of developmental delays or risk factors identified. Screening results are consistent with typical development; however, presence of risk factors. Screening results indicate a possible delay or disorder. Risk factors may be identified. Routine monitoring Referral for services and supports & heightened monitoring Assessment, referral for services and supports as needed, & heightened monitoring 21. SECTION A:- : ( ) ( ) () () ( ) ( ) 22. SECTION B:- : - - " (.) ( .) - . ( .) - "." ( .) - ( .) 23. M-CHAT: Does your child... Like to be swung? Take interest in other children? Like climbing? Enjoy peek-a-boo? Ever pretend to talk on the phone? Ever use index finger to point to ask? To indicate interest? Play properly with small toys? Bring objects to show? Look you in the eye? Seem oversensitive to noise? Smile in response to you? Imitate you? Respond to name? If you point, does he look? Walk? Look at things you are? Make unusual finger movements near face? Act as if deaf? Understand what people say? Stare at nothing? Look at your face to check reaction? Robins et al, 1999 http://www2.gsu.edu/~psydlr/Diana_L._Robins,_Ph.D._files/M- CHATInterview.pdf 24. Please fill out the following about how your child usually is. Please try to answer every question. If the behavior is rare (e.g., you've seen it once or twice), please answer as if the child does not do it. 1. Does your child enjoy being swung, bounced on your knee, etc.? Yes No 2. Does your child take an interest in other children? Yes No 3. Does your child like climbing on things, such as up stairs? Yes No 4. Does your child enjoy playing peek-a-boo/hide-and-seek? Yes No 5. Does your child ever pretend, for example, to talk on the phone or take care of dolls, or pretend other things? Yes No 6. Does your child ever use his/her index finger to point, to ask for something? Yes No 7. Does your child ever use his/her index finger to point, to indicate interest in something? Yes No 8. Can your child play properly with small toys (e.g. cars or bricks) without just mouthing, fiddling, or dropping them? Yes No 9. Does your child ever bring objects over to you (parent) to show you something? Yes No 10. Does your child look you in the eye for more than a second or two? Yes No 11. Does your child ever seem oversensitive to noise? (e.g., plugging ears) Yes No 12. Does your child smile in response to your face or your smile? Yes No 13. Does your child imitate you? (e.g., you make a face-will your child imitate it?) Yes No 14. Does your child respond to his/her name when you call? Yes No 15. If you point at a toy across the room, does your child look at it? Yes No 16. Does your child walk? Yes No 17. Does your child look at things you are looking at? Yes No 18. Does your child make unusual finger movements near his/her face? Yes No 19. Does your child try to attract your attention to his/her own activity? Yes No 20. Have you ever wondered if your child is deaf? Yes No 21. Does your child understand what people say? Yes No 21. Does your child sometimes stare at nothing or wander with no purpose? Yes No 23. Does your child look at your face to check your reaction when faced with Yes No something unfamiliar? Modified Checklist for Autism in Toddlers (M-CHAT) 25. Screening in Primary Care Surveillance for Social and Communication skills Screen at 18 and 24 months with specific screening test Reassess at well child visits and if concerns arise Later age at diagnosis for children with high functioning ASD 26. Autism is a MEDICAL disorder, not a MENTAL disorder. Most Autistic patients have environmentally-induced toxicity. Autism is therefore preventable, reversible, and treatable. 27. " ". 28. Management Plan Should address: Establishing goals for language/communication interventions Establishing goals for educational intervention Prioritizing target symptoms/comorbid conditions Monitoring multiple domains of functioning Behavioral adjustment Adaptive skills Academic skills Social/communication skills Social intervention with family members and peers Monitoring medications 29. Treatment Social Skills Training Behavioral Therapy Facilitaed communication (not proven) B6 and Magnesium (not proven) Pharmacotherapies Used as one would with nonautistics 30. Treatment Goals Minimize core features and associated deficits Maximize functional independence and QOL Alleviate family stress Educational intervention Developmental Therapies Communication Sensory, fine motor, gross motor Behaviorally Based treatments Core and associated symptoms Social skills Medical or biologic treatments Support family in home and community