Early Indicators of Autistic Disorders

1
Early Indicators of Autistic Disorders

• Christina Alvarez
• Gipsy Fernandez
• EDF 6211 Educational Psychology
• Dr. Martha Pelaez
• Florida International University

2
What is Autism?

• According to the DSM-IV, autistic disorder is
  one of several pervasive developmental disorders
  (PDDs) that are caused by a dysfunction of the
  central nervous system leading to disordered
  development. All children with PDD are
  characterized by qualitative impairments in
  social interaction, imaginative activity, and
  both verbal and nonverbal communication skills
• (Kabot et. al., 2003, p. 26)

3
Autism Spectrum Disorders

• Autism
• Asperger Syndrome
• Pervasive Developmental Disorder Not Otherwise
  Specified (PDD-NOS)
  
• Childhood Disintegrative Disorder (CDD)
• Rett Syndrome

4
Autism

• Most commonly diagnosed PDD
• Impairs ability to communicate, form
  relationships, and interact with others
  
• Results in a range of unusual and repetitive
  behaviors
  
• Typically diagnosed by age 3 or 4 years
• Frequently accompanied by mental retardation
• Sometimes, uneven levels of intelligence
• (Masland, 2005)

5
Asperger Syndrome

• Not high-functioning autism
• Similar symptoms as autism, without delays in
  language or possibility of mental retardation
  
• Often, impressive vocabularies and sharp
  cognitive skills
  
• Serious difficulties with social interaction
• (Masland, 2005)

6
Asperger Syndrome

• Obsessive interest in a particular topic
• Preoccupied with repetitive routines or
  behaviors
  
• Many have a history of developmental delays in
  motor skills and display poor physical
  coordination
  
• (Masland, 2005)

7
PDD-NOS

• Known as atypical autism
• Diagnosis given to children with some symptoms of
  autism but who do not meet specific diagnostic
  criteria
  
• In many cases, these children are later confirmed
  to have an identifiable disorder
  
• (Masland, 2005)

8
Childhood Disintegrative Disorder

• aka Hellers syndrome or regressive autism
• More frequently in boys
• Child appears to develop normally until 2-4 years
  of age when regression occurs
  
• Previously learned skills are lost child may
  stop speaking or become disinterested in play
  
• (Masland, 2005)

9
Rett Syndrome

• Most commonly seen in girls
• Steep developmental regression after 6 18
  months of age
  
• Rapid behavioral changes loss of language,
  balance problems, sleep abnormalities, lack of
  interest in social relationships, extended
  tantrums
• (Masland, 2005)

10
Rett Syndrome

• Heads fail to grow at a normal rate
• Most have mental retardation
• Gradually lose purposeful use of their hands
  leads to repetitive hand washing movements
  
• (Masland, 2005)

11
Why Early Diagnosis is Necessary

• deficits identified are in skills that typically
  develop during the first 12-18 months of life
  (Wetherby et al., 2004, p. 474)
  
• children with autism/PDD who develop language
  and symbolic play before the age of 5 have better
  prognoses (Robins et al., 2001, p. 132)
  
• research shows that intervention provided before
  age 3 ½ has a greater impact than that after age
  5 (Wetherby et al., 2004, p. 473)
  
• intervention beginning before age 3 may have an
  even greater impact (Wetherby et al., 2004, p.
  473)

12
Why Later Diagnosis Occurs

• large gap between the age of the child at
  parents first concern, the age of the first
  evaluation, and the age of definitive diagnosis
  (Robins et al., 2001, p. 131)
• most potent predictorsare generally negative
  symptoms failure of normal behavioral systems
  to mature rather than positive signswhich may
  appear later (Robins et al., 2001, p. 141)
• reluctant to diagnose autism prior to the age
  that a child would typically develop (Baranek,
  1999, p. 213)
  
• limited by the lack of early screening
  instruments (Bryson et al., 2003, p. 506)

13
Screening Instruments Used in Research and
Diagnosis

• CHAT (Baron-Cohen, Allen Gillberg, 1992 )
  Checklist for Autism in Toddlers
  
• M-CHAT (Robins, Fein, Barton, Green, 2001)
  Modified Checklist for Autism in Toddlers
  
• ADI-R (Lord, Rutter, LeCouteur, 1994) Autism
  Diagnostic Interview Revised
  
• ADOS-G (Lord, Rutter, LeCouteur, 1994) Autism
  Diagnostic Observation Schedule-Generic
  
• CSBS (Wetherby Prizant, 1993) - Communication
  and Symbolic Behavior Scales
  

14
Screening Instruments Used in Research and
Diagnosis

• CSBS DP (Wetherby Prizant, 1998)
  Communication and Symbolic Behavior Scales
  Development Profile
  
• PDDST-II (Siegal, 1999) Pervasive Developmental
  Disorder Screening Test II
  
• STAT (Stone Ousley, 1997) Screening Tool for
  Autism in Two-Year-Olds
  
• ABC (Krug, Arick, Almond, 1979) Autism
  Behavior Checklist
  
• CARS (Schloper, Reichler, DeVellis, Daly, 1980)
  Childhood Autism Rating Scale
  
• Retrospective Video Analysis (Baranek, 1999
  Werner et. al., 2000)
  

15
CHAT

• Checklist for Autism in Toddlers
• most well known screening test for identifying
  ASD in young children (Kabot et. al., 2003, p.
  28)
  
• If CHAT suggests autism, an in-depth assessment
  is recommended if it does not, further
  evaluations are recommended. (Kabot et. al.,
  2003)
• used to help identify the early signs of autism
  at 18 months by assessing the childs attainment
  of developmental milestones (Robins et. al.,
  2001, p. 133)

16
M-CHAT

• Modified Checklist for Autism in Toddlers
• a 23-item parent-report checklist, examining
  childrens developmental milestones (Robins et.
  al., 2001, p. 140)
  
• a simple screen that can be given to all
  children during pediatric visits (p.133)
  
• does not rely on the physicians observation of
  the child, but on parents report of current
  skills and behaviors (p. 133)
  
• solely for the purpose of initial screening (p.
  141)
  

17
ADI-R

• Autism Diagnostic Interview Revised
• has demonstrated good sensitivity and
  specificity in validity testing (Kabot et. al.,
  2003, p. 29)
  
• requires extensive time and training to
  administer (p. 29)
  
• may be most useful as part of a more in-depth
  assessment in children for whom screening tests
  suggest a fairly high level of concern for
  autism (p. 29)

18
ADOS-G

• Autism Diagnostic Observation Schedule-Generic
• semistructured assessment of play, interaction,
  and social communication (Kabot et. al., 2003,
  p. 29)
  
• requires extensive training of clinicians before
  it can be administered (p. 29)
  
• four modules that match age and communication
  levels of individuals from childhood to
  adulthood (p. 29)

19
CSBS

• Communication and Symbolic Behavior Scales
• Consists of four parts
• evaluator offers a child eight communicative
  temptations toys for which the child must ask
  for help in order to play with them (Robins et.
  al., 2001, p. 135)
• evaluator engages the child in symbolic play
  using two different sets of toys (p. 135)
  
• evaluator assesses verbal comprehension (p.
  135)
  
• evaluator engages the child in combinatorial
  play (p. 135)

20
CSBS DP

• Communication and Symbolic Behavior Scales
  Development Profile (Wetherby et. al., 2004)
  
• Consists of three measures
• a one-page 24-item Infant-Toddler Checklist for
  screening, can be completed quickly by a parent
  (p. 476)
  
• a four-page follow-up Caregiver Questionnaire
  (p. 476)
  
• a Behavior Sample, a face-to-face evaluation of
  the child interacting with a parent and clinician
  that is videotaped for later analysis (p. 476)
  
• designed to measure seven pre-linguistic skills
  organized into three composites (p. 476)

21
PDDST-II

• Pervasive Developmental Disorder Screening Test
  II
  
• screening test designed for administration in
  different settings where there are concerns about
  possible ASDs (Kabot et. al., 2003, p. 29)
  
• designed for representative populations in
  primary care clinics, developmental care clinics,
  and autism clinics (p. 29)
  
• parental report measure (p. 29)

22
STAT

• Screening Tool for Autism in Two-Year-Olds
• designed for use by professionals involved in
  early identification and intervention (Kabot et.
  al., 2003, p. 29)
  
• relatively brief interactive measure that can be
  used to identify children in need of more
  extensive follow-up (p. 29)
  
• differs from the CHAT in that it was developed
  as a second-stage screening instrument to
  differentiate children with autism from children
  with other developmental disorders (p. 29)

23
ABC

• Autism Behavior Checklist
• one of the oldest of the autism checklists
  (Kabot et. al., 2003, p. 29)
  
• considered of limited usefulness (p. 29)

24
CARS

• Childhood Autism Rating Scale
• most widely used standardized instrument
  designed to aid diagnosis of autism in young
  children (Kabot et. al., 2003, p. 29)
  
• easy to administer (p. 29)
• can be usedin a variety of settings (p. 29)
• supported by research (p. 29)

25
Retrospective Video Analysis

• families in increasing numbers have home videos
  which inadvertently provide documentation of
  their childrens development (Baranek, 1999, p.
  214)
• an excellent option for accessing very early
  periods in development months or years before a
  child with autism is diagnosed (p. 214)
  
• methodological problems(e.g. difficulty
  controlling variables such as the age of subjects
  and length, content, or structure of the video
  segments) can be controlled (p. 214)

26
Early Indicators 0-6 mos.

• Typically Developing Child
• Head turns when name is called
• Matches the direction of a moms head turn to the
  visible target
  
• Starts to develop joint attention
• Attends to affective displays of others
• Responds to emotions

• Autistic Child
• Does not respond to social cues without repeated
  prompting
  
• Displays minimal affective responses
• More passive, quieter
• May lag behind in motor skills
• (Zwaigenbaum, 2005 Dawson
• et. al., 2004 Werner et. al.,
• 2000)

27
Early Indicators 7-12 mos.

• Typically Developing Child
• Succeeds at joint attention
• Seeks emotional information from adult faces when
  presented with uncertainty (social referencing)
  

• Autistic Child
• Greater incidence of unusual posturing
• Needs more prompts to respond to name
• Mouthing of objects
• Social touch aversion
• (Zwaigenbaum et. al., 2005
• Dawson et. al., 2004 Werner et.
• al., 2000 Baranek, 1999)

28
Early Indicators 7-12 mos.

• Typically Developing Child
• Elementary vocal communication
• Early social imitation skills

• Autistic Child
• Pays little attention to distress of others
• Lacks of social smiling and appropriate facial
  expressions
  
• Unstable attention
• (Zwaigenbaum et. al., 2005
• Dawson et. al., 2004 Werner et.
• al., 2000 Baranek, 1999)

29
Early Indicators 13-24 mos.

• Typically Developing Child
• Exhibits joint attention
• Engages in social relations

• Autistic Child
• Minimal responses to others (lack of empathy)
• Does not exhibit pretend play
• (Dawson et. al., 2004 Kabot et.
• al., 2003 Robins et. al., 2001
• Charman et. al., 1997)

30
Early Indicators 13-24 mos.

• Typically Developing Child
• Communicates, both receptively and expressively
• Shows greater incidences of pretend play

• Autistic Child
• Impaired joint attention
• Less gazing at people
• Absence of pre-linguistic functions (i.e.
  declarative pointing, showing objects)
  
• (Dawson et. al., 2004 Kabot et.
• al., 2003 Robins et. al., 2001
• Charman et. al., 1997)

31
Early Indicators 13-24 mos.

• Red Flags Significant differences between the
  ASD and Delayed Development (DD) groups and the
  ASD and Typical Development (TD) groups
  
• Lack of appropriate gaze
• Lack of warm, joyful expressions with gaze
• Lack of sharing enjoyment or interest
• Lack of response to name
• Lack of coordination of gaze, facial expression,
  gesture, and sound
  
• (Wetherby et. al., 2004)

32
Early Indicators 13-24 mos.

• Red Flags Significant differences between the
  ASD and Delayed Development (DD) groups and the
  ASD and Typical Development (TD) groups
  
• Lack of showing
• Unusual prosody
• Repetitive movements or posturing of body, arms,
  hands, or fingers
  
• Repetitive movements with objects
• (Wetherby et. al., 2004)

33
Early Indicators 13-24 mos.

• Red Flags Significant differences between the
  ASD and TD groups, not the ASD and DD groups
  
• Lack of response to contextual cues
• Lack of pointing
• Lack of vocalizations with consonants
• Lack of playing with a variety of toys
  conventionally
  
• (Wetherby et. al., 2004)

34
Early Indicators 2-4 yrs.

• Typically Developing Child
• Pro-social behaviors are very developed
• Face recognition registers on EEG
• Socially appropriate contingent or synchronized
  gazing
  
• Plays with a variety of toys conventionally

• Autistic Child
• EEG does not differentiate between mothers and
  strangers face
  
• Social orientation, joint attention, attention to
  others distress still lacking
  
• (Dawson et. al., 2004 Kabot et.
• al., 2003 Dawson et. al., 2002)

35
General Indicators of Autism Communication

• Delay in, or total lack of, development of spoken
  language
  
• Difficulty initiating conversation
• Echolalia (repeating words or phrases instead of
  using normal language
  
• Doesnt respond to name
• Doesnt use or respond to gestures and other
  nonverbal cues
  
• (Siegal, 2003)

36
General Indicators of Autism Communication

• Infrequent crying, cooing, smiling
• Failures to vocalize, babble, engage in jargon
• Limited understanding of object labels or novel
  information
  
• Limited understanding of instructions
• (Audet, 2004)

37
General Indicators of Autism Social Interaction

• Doesnt point to objects or show them to others
• Doesnt make eye contact at appropriate times
• Doesnt look at other peoples faces as much
• Doesnt respond to facial expressions or body
  language
  
• (Siegal, 2003)

38
General Indicators of Autism Social Interaction

• Doesnt smile back at others
• Lack of peer relationships appropriate to age
  level
  
• Less interest in other children
• Not motivated by praise or physical affection
• Doesnt clearly demonstrate sympathy or empathy
• (Siegal, 2003)

39
General Indicators of Autism Social Interaction

• Crying or laughing for no apparent reason
• Difficulty anticipating future events,
  understanding others actions
  
• Difficulty engaging in play with others
  (beginning play, remaining focused on play, joint
  attention to play)
  
• (Audet, 2004)

40
General Indicators of Autism Behaviors

• Engages in highly repetitive play
• Obsessively preoccupied with a specific interest
  or object
  
• Lack of make-believe or imitative play
• Dependent on routines, rituals, and familiarity
• Repetitive body movements (hand or finger
  flapping, eye rolling, twisting, spinning,
  rocking, etc.)
  
• (Siegal, 2003)

41
General Indicators of Autism Behaviors

• Preoccupation with parts of objects
• Easily over-stimulated by noises, crowds, or
  lights
  
• Extreme dislike of certain sounds, textures, or
  situations
  
• Doesnt have strong response to pain
• (Siegal, 2003)

42
General Indicators of Autism Sensory Processing

• Sensitive startle response
• Avoidance of eye gaze
• Under responsiveness to startle stimuli
• Unusual sleep patterns
• Unusual or exaggerated fears
• Dropping oneself on the floor
• Excessive seeking of movement
• (Audet, 2004)

43
General Indicators of Autism Motor Skills

• Low muscle tone
• Limited oral exploration or play
• Excessive drooling
• Prone to choke or gag
• Limited food tolerance
• Delayed development in gross and fine motor
  skills
  
• (Audet, 2004)

44
General Indicators of Autism Emotions

• Difficulties with emotional regulation
• Disproportionate frustration
• Difficulty expressing own emotional state
• Unconventional self injurious behaviors
• Action that is unexpected within the context
• (Audet, 2004)

45
Educational Strategies

• Incidental Teaching
• Uses naturalistic educational techniques
• Is child centered, child directed, and teacher
  guided
  
• Teaching opportunities for instruction are
  determined by observing the childs behavior.
  
• Uses arrangements of the environment to increase
  the childs participation
  
• (Murray-Slutsky, 2000 Watling, 2004)

46
Educational Strategies

• Direct Instruction
• Adults are directly involved in teaching and
  maintain control of the program.
  
• The aim is to establish performance skills that
  the child has not mastered.
  
• (Murray-Slutsky, 2000 Watling, 2004)

47
Parental and Educational Strategies

• Reinforcement
• Shaping the response
• Chaining
• Time Delay Procedures
• Token Systems
• Picture Exchange Communication System
• Representational Objects
• (Murray-Slutsky, 2000 Watling, 2004)

48
Parental and Educational Strategies

• Structured Teaching
• Visual Schedule (Schedules and Planned
  Activities)
  
• Concise Instructions
• Interesting Tasks
• Prompting (physical and verbal prompts)
• Anticipate challenging behavior
• (Murray-Slutsky, 2000 Watling, 2004)

49
References

• Audet, L. R. (2004). The pervasive developmental
  disorders A holistic view. In H.
  Miller-Kuhaneck (Ed.), Autism A comprehensive
  occupational therapy approach (p.41-66).
  Bethesda, MD AOTA Press.
• Baranek, G. T. (1999). Autism during infancy A
  retrospective video analysis of sensory-motor and
  social behaviors at 9-12 months of age. Journal
  of Autism and Developmental Disorders, 29(3),
  213-224.
• Baron-Cohen, S., Allen, J., Gillberg, C.
  (1992). Can autism be detected at 18 months?
  The needle, the haystack, and the CHAT. British
  Journal of Psychiatry, 161, 839-843.
• Bryson, S. E., Rogers, S. J., Fombonne, E.
  (2003). Autism spectrum disorders Early
  detection, intervention, education, and
  psychopharmacological management. Canadian
  Journal of Psychiatry, 48(8), 506-516.

50
References

• Charman, T., Swettenham, J., Baron-Cohen, S.,
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• Dawson, G., Carver, L., Meltzoff, A. N.,
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51
References

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