Early Indicators of Autism in Young Children

1. Early Indicators of Autism in Young Children Early Childhood Educators of BC Provincial Conference, May 13, 2004 Pat Mirenda, Ph.D. University of British Columbia

2. Why Early? • Research evidence is clear • Early identification of children who are “at risk” for autism spectrum disorder (ASD) facilitates early intervention • Early intervention is essential for better outcomes

3. Early Identification • Firm diagnosis possible by 36 months, with indicators for concern appearing earlier • Numerous studies have examined early indicators of ASD from 1st birthday party videotapes, parent surveys, formal test measures • Osterling & Dawson (1994) reviewed videotapes of the 1st birthday parties of 11 children later diagnosed with ASD and 11 typically developing children • At one year of age, children with autism did less pointing, showing objects to others (joint attention), looking at others, and orienting in response to name

4. First Signs • A U.S. project directed toward educating pediatricians to recognize early indicators of ASD • Produced a videotape and support package for distribution to physicians • Equally relevant for early childhood educators • Videotape: “First Signs” • http://www.firstsigns.org/index.html

5. Red Flags! • Relating with warmth and pleasure • Looking at faces and smiling back at others by 4 mo • No big smiles and joyful expressions by 6 mo • Back and forth vocalizations and gestures • No sharing of sounds, smiles, facial expressions by 9 mo • No responding to name when called by 12 mo • No babbling by 12 mo • No reciprocal gestures (pointing, showing, reaching, waving) by 12 mo

6. Red Flags! (Con’t) • Problem solving • No attempts to recreate or continue interesting displays or events, either motorically or communicatively (e.g., asking for “more” or “help”) • Two way communication with words • No words by 16 mo • No two-word meaningful phrases (without imitating or repeating) by 24 mo • ANY loss of speech or babbling at ANY age

7. ASD vs. Developmental Delay • Question: is it possible to distinguish between young children at risk for ASD and those at risk for other types of developmental delays? • Answer: YES!

8. Wetherby, Prizant, & Hutchinson (1998) • Compared 22 children with autism (CA 17-60 mo, mean 36 mo) and 22 children with language delays • Used the Communication and Symbolic Behavior Scales (CSBS) • Similar use of vocal/verbal communication • BUT children with autism had substantially lower scores in • Number of communicative functions • Use of communicative gestures, reciprocity (i.e., turn taking) • Social/affective signaling, and • Symbolic behavior

9. Osterling, Dawson, & Munson (2002) • Examined first birthday party videotapes of 20 infants later diagnosed with ASD, 14 later diagnosed with mental retardation (MR), and 20 typically developing infants • Infants with both ASD and MR • Used gestures less often • Looked at objects held by others less often and • Engaged in repetitive motor behaviors more often than those who were typical • Infants with ASD • Looked at others less often and • Oriented to their name less often than those with MR or those who were typical

10. “Baby Sibling” Project • A team of Canadian researchers are following >100 infant siblings of children with ASD to look for early indicators of risk • http://www.geocities.com/autismandpdd/OurStudies.him#Infant%20Sibling%20Study • Results to date indicate that approximately 25% of the “baby sibs” show some indication of difficulty in early development • Those with 7 or more markers are most likely be later diagnosed with ASD (not other disabilities)

11. “Baby Siblings” (Con’t) • The major markers are: • Failure to look at other people (i.e., decreased eye contact) • Failure to orient to name • Reduced reciprocal social smiling • Atypical sensory behavior • Difficulty initiating visual tracking and disengaging visual attention • Difficulty with imitation and • A general lack of social interest • Screening tool in development

12. Screening Tools • CHAT: Checklist for Autism in Toddlers • Screening instrument for 18-month olds, developed in the UK; 16,235 children screened (M=18.7 mo) • Baird, Charman, Baron-Cohen, Cox, Swettenham, Wheelwright, & Drew (2000): 6-year follow-up to the original CHAT study: • Good specificity (proportion of children without ASD identified as normal): 97.7% • Low sensitivity (proportion of children with ASD identified by the CHAT): 35.1% • Low positive predictive value (proportion of children with a positive screen who had a disorder): 8.1% for ASD; 16.7% for all developmental disorders

13. Screening Tools • Also M-CHAT (Modified-CHAT): American version of the CHAT, also translated into Spanish • Good specificity (95%) • Good sensitivity (97%) • Moderate positive predictive value (36%)

14. Screening Tools • Communication and Symbolic Behavior Scales Infant-Toddler Checklist (Wetherby & Prizant, 2002) • http://firstwords.fsu.edu/ • http://www.brookespublishing.com/store/books/wetherby-csbsdp/checklist.him • Advisable to use all of these as first stage screening tools: “Is there any type of developmental delay, not necessarily autism?”

15. What if Screening is Positive? • Refer family to their pediatrician • Pediatrician should refer the child for a multidisciplinary assessment • BC Autism Assessment Network (BCAAN): http://www.phsa.ca/Patients/autism.him • Fraser Health Authority AAN (Surrey) • Interior Health AAN (Kelowna) • Northern Health Authority AAN (Prince George) • Vancouver Island Autism Assessment Services (Victoria) • Vancouver Coastal Health Authority AAN (Vancouver)

16. Standards and Guidelines • Standards and Guidelines for Assessment and Diagnosis of Young Children with Autism Spectrum Disorder in British Columbia • http://www.healthservices.gov.bc.ca/cpa/publications/asd_standards_0318.pdf

17. The Punchline • ASD looks different in young children than in older children • More subtle • Fewer “behavior problems” and self-stimulatory behavior • More than 1-2 signs, typically • Social relatedness and social interaction skills are the most affected • Early childhood educators have an important role to play!!!

18. References Baird, G., Charman, T., Baron-Cohen, S., Cox, A., Swettenham, J., Wheelwright, S., & Drew, A. (2000). A screening instrument for autism at 18 months of age: a 6-year follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 694-702. Osterling, J., & Dawson, G. (1994). Early recognition of children with autism: A study of first birthday home videotapes. Journal of Autism and Developmental Disorders, 24, 247-257. Robins, D.L., Fein, D., Barton, M.L., & Green, J.A. (2001). The Modified Checklist for Autism in Toddlers: An initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders, 31, 131-144. Wetherby, A., Prizant, B., & Hutchinson, T. (1998). Communicative, social/affective, and symbolic profiles of toying children with autism and pervasive developmental disorders. American Journal of Speech-Language Pathology, 7, 79-91.