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– 6-18 • Withdrawn• Social Problems• Thought Problems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: jbradshaw@calm4kids.org• Anna Krasno: akrasno@calm4kids.org