Listen, Screen & Recognize the Red Flags for Autism Spectrum Disorders
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Listen, Screen & Recognize the Red Flags for
Autism Spectrum Disorders
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Presented Byy Lori Kalash, Ed. D. Project Director for Great Plains
Autism Spectrum Disorder Treatment Program
(GPAST) and Great Plains Interdisciplinary ClinicProject (GPIC)
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What is autism?y Autism is defined using the Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV-
TR) as a condition displaying delays orabnormalities in:
Social InteractionSocial Interaction
3
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Pervasive Developmental Disordersy Autism
y Aspergers Syndrome
y PDD-NOSy Retts Syndrome
y Childhood Disintegrative Disorder
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ACT EARLY KNOW THE SIGNS
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http://www.cdc.gov/ncbddd/actearly/pdf/parents_pdfs/TrackChildsDevMilestonesEng.pdf
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SOCIAL DEVELOPMENT: 0-7 MONTHSTypical
y Develops Social Smile
y More expressive with face &
body y Imitates some movements
and expressions
y 4-7 monthsy Shows interest in watching
peoples facesy Smiles often while playing
with you
y Relate to parent with joy
y Interested in mirror images
y Red Flagsy Few facial expressions
y Doesnt cuddle
y Shows limited interest inwatching others
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SOCIAL DEVELOPMENT: 6-12 MONTHSy Typical
y Stranger Anxiety
y Exchange back-and-forth facial expressions
y Joint Attention
y Social games peek-a-
boo, patty cake, othery Object permanence
y Red Flags
y Doesnt distinguish
caregiver from othersy Doesnt look where you
point
y Not interested in socialgames
y Flat emotion/affect withpeople
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SOCIAL DEVELOPMENT: 12-24 MONTHSy Typical
y Use mother as securebase
y Separation distress
y Independence
y Knows people by pointing when named
y Simple pretendplay/imitation
y Red Flagsy No distress separating
from caregiver
y Strange attachment tohard objects (ratherthan stuffed animals)
y Doesnt seem to notice
you or others in theroom
y Seems to tune othersout and plays alone
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SOCIAL DEVELOPMENT: 24 36 MONTHSy Typical
y Parallel Play: plays by peers
y Associative Play: someexchange: sharing, turn-taking
y Cooperative Play: play
together cooperate withcommon goal
y Imaginative Play (creative, pretending)
y Red Flagsy Solitary Play
y
Little interest in peersy No Showing, Giving of
toys
y May be more interestedin household objects
than toysy May not imitate others
through play
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SOCIAL DEVELOPMENT: 3+ YEARSy Typical
y Creative Imaginative
Play y Recognizes emotions in
others
y Interest in others
y
Understand social rulesand routines
y Socially motivated
y Can take turns in games
y Red Flags
y Prefers to play alone
y Tunes others outy Difficulty reading body
language and emotions
y Lack of social
reciprocity (interest inothers,concern/recognition of others)
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COMMUNICATION: 0-7 MONTHSTypical
y 3 Monthsy
Cooingy 4 Months
y Laughs
y Turns to voice
y
Follows and reacts tobright colors
y 5 Monthsy Razzing
y Red Flagsy Unusually Quiet
y
No attention to voices
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COMMUNICATION: 6-12 MONTHSy Typicaly 6 Months
y Babblingy
Cries when unhappy y 8 Months
y Dada/mama nonspecifically
y 9 Monthsy Exchanges back-and-forth
soundsy Gesture games
y 10 Monthsy Understands noy Mama/dada specifically
y Red Flagsy No imitation of soundsy Only screechesy
No back and forth
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COMMUNICATION: 12-24 MONTHSy Typicaly 12 Months
y One step command with a gesturey Turns toward person when name
is calledy 13 Months
y Immature jargoningy 15 Months
y One step command without agesture
y Uses and understands at least
three wordsy 18 Months
y Knows people by pointing whennamed
y Points to body partsy Mature jargoning
y Red Flagsy Any regression of skillsy Appears deaf y No babbling
y No Words by 15 Months
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COMMUNICATION: 24 36 MONTHSy Typical
y 24 Months
y Puts two words togethery Uses and understands at
least 50 words
y Pronouns
inappropriately y Two step commands
y 34 Months
y States first name
y Red Flags
y Any regression
y
No compensation withgestures or sign
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COMMUNICATION: 3+ YEARSy Typical
y 36 Monthsy Uses thoughts and actions
together in both speechand play
y Uses pronounsappropriately
y Older childreny Gradually understand
pragmatics (figures of speech, myth, symbolism,jokes)
y Red Flagsy May say words okay but
has a difficult time using
language functionally y Ex. Can say the ABCs,
numbers, or words to TV jingles but can't ask forthings he wants
y Laughs for no clear reason
y Uses words or phrases thatare inappropriate for thesituation
y Takes things literally
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OTHER DEVELOPMENTy Fine/Gross Motor
y Cognitive skills
y Sensory y Does well with routine
y Red Flags
y Narrow or Restricted
interestsy Nonfunctional
adherence to routines orrituals
y Inflexible thinking
y Fascination with partsof objects(nonfunctional)
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OTHER DEVELOPMENTy Fine/Gross Motor
y Cognitive skills
y Sensory
y Red Flags
y May have delays in
learning if they havepoor imitation skills
y Sensory difficultiesy Doesn't seem to have any
fear
y Doesn't seem to feel painy Oversensitive to noise,
texture
y Eating/Gastrointestinal
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Screening & Early Interventiony Well-visits to childs pediatrician is the best time for
developmental screenings and for early identification
or concerns regarding autism. Without identificationthrough screening, a child may not receive the early &intensive interventions he or she needs.
y Early and appropriate intervention can be the key to
greater independence, increased participation in thewider community, and ultimately, a more productiveand fulfilling life as an adult.
y Identification is essential for intervention.http://www.firstsigns.org/screening/index.htmSee handout on Normal Developmental Milestones
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A.L.A.R.My A utism is prevalent
y Approximately 1 in 110 according to ADDM network
study released in December 2009. (Autism andDevelopmental Disabilities Monitoring/Center forDisease Control)
y Developmental disorders have subtle signs and may beeasily missed.
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A.L.A.R.My Listen to parents
y Early signs of autism are often present before 18 months
y
Parents usually DO have concerns that something iswrong
y Parents generally DO give accurate and quality information
y
When parents do not spontaneously raise concerns, askif they have any
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A.L.A.R.My A ct early
y Make screening and surveillance an important part of
medical practice. AAP recommends routine screeningfor ASD in all children at 18 and 24 months.
y Know the subtle differences between typical andatypical development
y Learn to recognize red flags
y Use validated screening tools
y Early and appropriate intervention
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M-CHAT/CASTy First level screeners (free for educational and clinical
purposes at firstsigns.org)
y
False positivesy Interview to clarify answers
y Screening recommended at 18 and 24 months for allchildren. (MCHAT)
y Screening advised at elementary level for all children(CAST)
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A.L.A.R.My R efer
y to Early Intervention or school programs (Do not wait
for diagnosis)y To an autism specialist, or team of specialists,
immediately for definitive diagnosis
y To audiology to rule out a hearing impairment
y
To local community resources for help and family support.
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A.L.A.R.My Monitor
y Other conditions know to be associated with autism
(seizures, GI, sleep, behavior)y Educate parents and provide them with up-to-date
information
y Advocate for families with other agencies
y
Watch for additional or late signs of autism and/or otherdevelopmental disorders
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Basic Screening Guidelines
http://www.firstsigns.org/screening/guidelines.htmPractice parameter: Screening and diagnosis of
autism. Neurology 2000, 55: 468-79.
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Q uestionsy [email protected]