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How to use the Modified Checklist for Autism in Toddlers and Talk with Families

How to use the Modified Checklist for Autism in Toddlers and Talk with Families . Developmental Milestones & Early Signs of Autism . Cindy Carroll, M.A., CCC-SLP Speech and Language Pathologist ASD Coach and Consultant Supervisor of ASD Diagnostic Clinic Community M.J. Murdock Grant .

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How to use the Modified Checklist for Autism in Toddlers and Talk with Families

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  1. How to use the Modified Checklist for Autism in Toddlers and Talk with Families Developmental Milestones & Early Signs of Autism

  2. Cindy Carroll, M.A., CCC-SLP • Speech and Language Pathologist • ASD Coach and Consultant • Supervisor of ASD Diagnostic Clinic • Community M.J. Murdock Grant

  3. TODAY YOU WILL LEARN • How to identify typical development through the use of CDC campaign materials • How to identify atypical behavior and how to refer when there are concerns • Learn how to administer the MCHAT screening tool • Discuss strategies about how to talk with parents when there are concerns

  4. WHO ARE YOU?

  5. What’s the problem? 17% of kids have a delay in development or behavior Less than half of children with delays are identified before starting school Parents know their kids, but may not know how to tell if their child is on track Parents who are concerned often do not know where to turn next

  6. Common Parent Reactions “He’ll grow out of it… let’s just give him more time.” Most delays are not outgrown. Waiting to find out loses valuable time

  7. Why Should we Learn the Signs- Act Early?

  8. “Most mommies and daddies tell me “I thought there was a problem at 14 or 15 months...and they told me let’s wait and see because sometimes some kids grow out of it.’ Well, that’s not a good answer. We’ve got to make the distinction between less important problems, where we can wait and see from core problems, which involve a lack of reciprocity and a lack of getting to know your world. For these core problems, we have to act on it yesterday. We can’t wait nine months, we can’t wait two months.” (Stanley I. Greenspan, M.D., Child Psychiatrist)

  9. Family Outcomes Intervention Referral Developmental surveillance/screening Developmental Awareness

  10. Why Is Developmental Screening Important? • We an improve identified developmental delays from 30% (surveillance) to 70-80% with developmental screening

  11. Learn the Signs. Act Early. A CDC campaign to increase: • Awareness of milestones and warning signs • Knowledge about services and their benefit • Dialogue between parents and professionals—doctors, child care providers, etc. • Early action – once a delay is suspected, don’t just “wait and see!” www.cdc.gov

  12. Free Materials • On the CDC website, you can download: • Brochure • Booklet of checklists • Growth chart • Waiting room posters • Factsheets on a variety of development topics Nearly all are available in English and Spanish • http://www.cdc.gov/ncbddd/actearly/downloads.html#lang

  13. “Milestone Moments” Booklet

  14. Early Learning Providers must incorporate what’s known about typical children’s development • “ Ask yourself, whether the goals you are teaching are the most important for that child at that point in the child’s development”. Stephen Camarata, PhD, CCC-SLP – Vanderbilt University

  15. Theory of Touchpoints • Development is periods of disorganization and organization • Bursts of regression and progression are expected • There is overflow from one line of development to another * T. Berry Brazelton, M.D., The Touchpoints Model of Development TM

  16. Development Follows a Predictable Path – T/F? Development follows the same path for every child – T/F?

  17. Children with Autism have uneven developmental profiles

  18. Developmental-sleuth • Carefully Observe • Seek to understand • Respect celebrate each individual child’s behavior and skills • Comparative Judgments are not helpful • Look for strengths also

  19. How do I refer? 1. Medical Home 2. Under 3 – refer to EI 3. Over 3 – Refer to Local SD

  20. What is Autism? Core Deficits in: 1-Language and Communication 2-Socializationand Connectedness 3-Unusual Patterns of Behavior and Interests

  21. Look for: Core Communication Deficits • Delay in expressive language (25-30% of children with ASD stopped saying words between 15-21 mo). • Delay in receptive (1 step commands – 12-14 months) • Poor imitation (Echolalia) • Delayed onset of babbling past 9 months of age • Lack of coordination of gestural communication (waving, pointing, showing) • Unusual prosody (variation in pitch, • intonation, irregular rhythm, unusual vocal quality

  22. Communication is: • purposeful • intentional • transference of information • within a social context • with anticipation of results

  23. Pre-intentional communication Vocalizations or behaviors directed “to the room” Intentional communication Directing behavior towards others to achieve a goal - Social vs. non-social manner

  24. Look For: Core Deficits in Social and Emotional Reciprocity • Eye gaze– facial expressions – coordinating with gaze • Joint attention • Shared Enjoyment • Does not respond to name by 12 months of age • Prefers to play alone • Does not share interests with others – sharing/showing • Only interacts to achieve a desired goal

  25. Cindy’s Soap Box

  26. JOINT ATTENTION – responding and initiating social “bids” • Look for pointing • (12 month follow point) • Look for showing • (12-14 months initiate) • Look for looking

  27. Joint attention is critical for children to learn from their environment We MUST support our kids with autism to learn HOW to learn from their environment Children who “get this” have better outcomes – period.

  28. Joint Attention Building Blocks Theory of Mind Symbolic Play Expressive Language Joint Attention

  29. Restricted, Repetitive and Stereotypical Patterns of Behavior • Obsessive interests • Rigid adherence to routines • Stereotyped motor movements • Preoccupations with parts of objects • Lines up toys or other objects • Repetitive Play lack of symbolic play • Transitions • Flaps hands, rocks body, or spins self in circles

  30. www.firstsigns.org

  31. American Academy of Pediatrics –Screening at; • 9 months • 18 months • 24 months • 30 months • 18, 24 and 30 months autism specific screen

  32. The Modified Checklist for Autism in Toddlers (M-CHAT)FOCUSED Level 1 SCREENING • User friendly to assess the risk for autism spectrum disorders and detect as many cases of ASD as possible • High False Positive Rate – Tool not a rule • Developed for but not limited to; physicians, teachers, therapists, paraprofessionals, psychologists, early interventionists, childcare providers, nurses, etc. • Developed for toddlers 16-30 months • Drills down to Joint Attention Skills (Improved from the CHAT) Robins, Fein, & Barton, 1999

  33. THE SCREEINING IS CONSIDERED FAILED IF 2 OR MORE CRITICAL ITEMS OR/ ANY 3 ITEMS ARE FAILED.

  34. MCHAT Follow-up interview • Use when; • -clinical judgment tells you that the family is not a good reporter • -the child fails the MCHAT and you need to probe deeper • You are just starting to do MCHATS and you have the time – good teaching tool

  35. CRITICAL ITEM

  36. CRITICAL ITEM

  37. CRITICAL ITEM

  38. CRITICAL ITEM (babies turn to name 8-10 months of age)

  39. Set up the environment for gestures (clear container – give for help) Scatter skills in the absence of Building Blocks (colors/numbers/matching) Ask parents if they can point to it on command Using chunked phrases but not single words Can they hyperfocus for long periods of time What I look for

  40. Do they treat me like a piece of furniture Do they have an unusual level of independence? Do they notice when parent steps out of the room? What kind of toys do they gravitate to (interests in “hard” items? – mechanical things Are they still in the sensori-motor stage? Can they imitate (sing a song)

  41. What do I do if I have a concern?

  42. What do you do if you suspect autism? • Review developmental milestones - Take notes • Do the MCHAT together in a trusting relationship • YOU DON’T HAVE TO SAY AUTISM • Talk respectfully with the family • Review and share resources with the family • Coach the family to share concerns with their PCP • Consult with others who have knowledge of ASD • Follow up with the family – be honest – if you don’t know – ask for help

  43. Talking about Concerns http://www.autismspeaks.org/what-autism/learn-signs/talking-parents-about-autism-action-kit

  44. I’m sorry but……. It’s not about YOU! Start with positives Use a respectful tone Read your audience Validate and relax Remember it is a process

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