Introduction Introduction to Autism Spectrum Disorder ... · Spectrum Disorder Understanding the ASD criteria Autism Spectrum Disorder •Autism is a developmental brain-based disorder.

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Introduction to Autism Spectrum

Disorder &Services for

Nebraska Children

Johanna Taylor, PhD, BCBAUniversity of Nebraska-Lincoln

Presentation for:

February 27, 2018

Introduction• Assistant Professor of Practice in Online Early Childhood

Special Education Program at UNL in the Department of Special Education and Communication Disorders.

• Master’s and doctoral degrees in Early Intervention with a Specialization in Autism Spectrum Disorder.

• Board Certified Behavior Analyst (BCBA) since 2007.

• In the field of autism and disabilities for about 15 years. Most recently was in Hawai’i as a Program Manager for an Early Intervention agency (children 0 – 3 years with disabilities) and BCBA.

Disclaimer

• The information presented today on the resourcesand support in Nebraska was identified solely by the speaker. It is possible that there are other resources available to help support individuals with autism in Nebraska.

Objectives• Participants will learn about the diagnostic criteria

for autism spectrum disorder (ASD).

• Participants will learn steps for accessing a diagnosis and support for a child with autism.

• Participants will be provided with a brief overview ofevidence-based interventions for autism.

Autism Spectrum Disorder

Understanding the ASD criteria

Autism Spectrum Disorder• Autism is a developmental brain-based disorder.

• Autism can be diagnosed before two years of age through behavioral observation (Lord, et al., 2006).

• Estimated prevalence of autism in the U.S. is 1 in 68 children (CDC, 2016).

• Individuals with autism fall somewhere along a:

SPECTRUMLOW-FUNCTIONING

HIGH-FUNCTIONING

(APA, 2013)

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There has been an increase. Why?

• Greater awareness.• Changes to diagnostic criteria and special education.• Availability of services. • We are better at diagnosing.

(Fombonne, 2009)

DSM-V Criteria for ASD

Social-Communication/

Interaction

AUTISM SPECTRUM DISORDER

Restricted Repetitive Behaviors

(APA, 2013)

DSM-V Criteria for ASD• Symptoms must be present in the early

development but possible that may not be seen until social demands in school occur.

• Severity ratings are assigned when diagnosed:

Level 1Requires support

Level 2Requires

substantialsupport

Level 3Requires very

substantial support

(APA, 2013)

Social-Communication CriteriaTo qualify for ASD, must meet all three social-communication criteria. Deficits in:

Social-emotional reciprocity

Non-verbal communication

Developing, maintaining,

and understanding relationships

and/or adjusting to

social context(APA, 2013)

Early Developmental Differences

• Child is not using 1 word by 16 months of age.

• Child is not combining two words by 2 years of age.

• Child does not respond to his name.

• Child does not use index-finger to point to objects to show.

• Child pulls you to items he wants.

• Child rarely smiles and has limited or no eye contact.

• Child has motor delays and/or falls often.

Early Developmental Differences

• Child does not seem to know how to play with toys:

• Does the same thing over and over with toys

• Does not play with toys in a meaningful way

• Child does not have imitation skills.

• Child is attached to one particular toy or object

• Has to take object with him everywhere

• Carries object throughout the house

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Restricted Repetitive Patterns of Behavior Criteria

To qualify for ASD, must meet two out of four criteria:

Stereotyped or repetitive motor

movements, use of objects or speech

Insistence on sameness, inflexible

adherence to routines, or

ritualized patterns or verbal nonverbal

behavior

Hyper- or hyporeactivity to sensory input or unusual interest in

sensory aspects of the environment

Highly restricted, fixated interests that

are abnormal in intensity or focus

(APA, 2013)

Early Developmental Differences

• Child demonstrates odd speech, language, or behavior.• Child demonstrates a regression in overall behavior:

communication, play, and social skills.• Child experiences tantrums that are out of control and

last for long periods of time. • May occur with transitions.• When he cannot have something he wants.• May occur when changes are made to schedule without

preparation.

DSM-V Criteria for ASD

Social-Communication/

Interaction

AUTISM SPECTRUM DISORDER

Restricted Repetitive Behaviors

(APA, 2013)

Signs/Symptoms Resources

www.wellchildlens.com

www.cdc.gov/ncbddd/autism/index.html

https://www.autismspeaks.org/what-autism/learn-signs

Autism Screening & Evaluation

What is the process used to diagnose autism?

ASD Screening & Evaluation Process for a Clinical Diagnosis

Screening

Referral

Evaluation

Diagnosis

No diagnosis provided, continue monitoring/ other recommendations

made

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ASD Screening• Anyone can learn to screen for ASD. • Pediatricians are the most common people who

screen for ASD. • Others can learn including: parents, relatives,

child care providers, nurses, therapists, etc. • Details on screening process:

http://www.cdc.gov/ncbddd/autism/hcp-screening.html

Screening

ASD Screening Tools• M-CHAT (16 – 30 months)

• Social Communication Questionnaire ( older than 4 yrs)

Screening

ASD EvaluationWho Diagnoses Autism?

• Pediatricians • Psychologists • Pediatric Neurologist• Psychiatrists well-trained in ASD• Other well-trained professionals may participate

in a team w/ one of the above professionals.

Evaluation

Note: School psychologists can provide an ASD educational verification but not a clinical diagnosis.

ASD Evaluation: Best practice evaluations

1. Parent/caregiver interview – Autism Diagnostic Interview-Revised (gold-standard).

2. Review of relevant medical, psychological and/or school records.3. Cognitive/developmental assessment. 4. Direct play observation– Autism Diagnostic Observation Schedule (ADOS; gold-standard)

5. Measurement of adaptive functioning. 6. Comprehensive medical exam.

Evaluation

Referral Process for

Autism

What is the referral process if you suspect a child may have autism?

ASD Referral ProcessClinical Diagnosis of

Autism

Referral made to diagnosing professional

Access to ABA and other autism-specific treatments

Education/family support for children with autism

Referral made to NEDepartment of Education

Access to early intervention/

educational support in classroom

Do both, but if you’re going to

start somewhere

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ASD Referral ProcessReferral made to NebraskaDepartment of Education

Early Intervention Services (0 – 3 years)1-888-806-6287https://edn.ne.gov• Service coordinator• Speech language pathologist• Occupational therapist • Early intervention teacher• Physical therapist• Hearing specialist• Vision specialist

ASD Referral ProcessReferral made to NebraskaDepartment of Education

School-age Special Education Services (0 - 21 years)Contact educational service unit to have a child evaluated for special education services.

Parent Resources:

ASD Referral ProcessFunded through Department of Education• Early intervention (0 – 3 years)• School-based support in classroom Funded through private insurance/Medicaid• Outside therapy services (SLP, OT, PT, Psych)• Applied Behavior Analysis treatment Funded through Division of Developmental Disabilities (if meet eligibility criteria)• Respite• Community-based services

Autism Support

https://www.unl.edu/asdnetwork

• Build and enhance the capacity of NE schools and families in supporting children with autism.

• Provide training andtechnical assistance to NE educators supporting students with autism.

NE Autism Spectrum Disorders Network

Overview of Autism

Interventions

What interventions do we know are effective for autism?

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Optimal Outcomes• We know that there are factors that

contribute to individuals with autism having a better outcome in life. – Higher intelligence, joint attention/imitation, early

intervention, behavioral treatment (Schreibman, 2011)

– Strong language skills (Huckabee, 2003)

– Personal factors (Fien et al., 2013)

– Adaptive factors (Sutera et al., 2007)

Evidence-based Practices for Autism

Evidence-based practices

Interventions that scientific research has found to be effective for autism spectrum disorder.

What do we know for sure?• Most of the evidence-based practices identified

in these projects/resources use the principles of applied behavior analysis (ABA).

• ABA is a discipline focused on the application of behavioral science in real-word setting such as clinic, schools, and industry with the aim of improving socially important issues such as behavior problems and learning (Baer, Wolf, & Risley, 1968).

Applied Behavior Analysis Treatment

Applied Behavior Analysis (ABA) treatment is considered a “medically necessary” treatment for autism now covered by medical insurance. • ABA treatment uses the “science of learning”

to teach children new skills and eliminate challenging behaviors (e.g., tantrums).

• Tends to be more “intensive" than traditional therapies (e.g., speech therapy) and may be delivered in various environments (home, community, child care).

May work on teaching skills like:• Play skills (e.g., imitation, use of toys).

• Challenging behaviors

• Social-communication skills (e.g., eye contact, attention, requesting).

• Self-care skills (e.g., toileting, dressing, feeding).

RBT Role in ABA treatment of ASD

Law mandates diagnosis and treatment up to age 20 and allows for up to 25 hours per week of behavioral health treatment.

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Applied Behavior Analysis Treatment

• Board certified behavior analysts (BCBAs) are professionals that are considered to have extensive training in ABA but others may be qualified in Nebraska to provide treatment.–To find BCBAs in Nebraska go to

www.bacb.com (Behavior Analyst Certification Board).

Board Certified Behavior Analyst (BCBA)/Conducts assessments—determine needs, write treatment goals

Provides clinical oversight & supervision

Registered behavior Technician

Delivers treatment protocol, conducts day-to-day program implementation

Child diagnosed with autismReceives treatment to address

social, communication, behavioral, and self-help needs

Parent/caregiver trainingReceives training on specific

strategies to address treatment goals

Disclaimer: It is possible there are other professionals in Nebraska that can provide ABA to children with autism.

Applied Behavior Analysis Treatment

ReferencesAmerican Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

APA Dictionary of Clinical Psychology. American Psychological Association, 2013. Autism Speaks. Autism Spectrum Disorder. 2017; https://www.autismspeaks.org/what-autism Accessed December 4 2017.

Centers for Disease Control and Prevention. Autism Spectrum Disorder. 2017; https://www.cdc.gov/ncbddd/autism/index.html Accessed December 4 2017.

Fombonne, E. (2009). Epidemiology of pervasive developmental disorders. Pediatric research, 65(6), 591-598.

Lord, C., Risi, S., DiLavore, P.S., Shulman, C., Thurm, A., & Pickles, A. (2006). Autism from 2 to 9 years of age. Archives of General Psychiatry, 63(6), 694-701.

References (cont.)Fombonne, E. (2009). Epidemiology of pervasive developmental disorders. Pediatric research, 65(6), 591-598.

Huckabee, H. (2003). Correspondence of DSM-IV criteria for autistic spectrum disorders with standardized language measures of intelligence and language. Unpublished dissertation, University of Houston, Presented April, 2003.

Fein, D., Barton, M., Eigsti, I. M., Kelley, E., Naigles, L., Schultz, R. T., … Tyson, K. (2013). Optimal outcome in individuals with a history of autism. Journal of Child Psychology and Psychiatry, 54 (2), 195–205. doi: 10.1111/jcpp.12037.

Schreibman, L., Dufek, S., & Cunningham, A. B. (2011a). Identifying moderators of treatment outcome for children with autism. In J. L. Matson & P. Sturmey (Eds.), International handbook of autism and pervasive developmental disorders (pp. 295–305). New York, NY: Springer. Retrieved from http://dx.doi.org/10.1007/978-1-4419-8065-6_18

Sutera, S., Pandey, J., Esser, E. L., Rosenthal, M. A., Wilson, L. B., Barton, M., … Fein, D. (2007). Predictors of optimal outcome in toddlers diagnosed with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37 (1), 98–107. doi: 10.1007/s10803-006-0340-6.

Thank You! Questions?

Johanna Taylor, PhD, BCBAUNL Assistant Professor of PracticeEarly Childhood Special Education [email protected]