Autism Spectrum Disorders in Early Childhood:Assessment and Intervention

1. Autism Spectrum Disorders in Early Childhood:Assessment and Intervention Dr. Gina Cosgrove-Campbell House Brief Overview of the Current DSM-V Criteria Important Developmental Markers and Symptoms Assessment and Intervention Considerations

2. Overview of the DSM-V Criteria • Patterns of pervasive impairment across developmental domains. • Viewed as a spectrum with varying levels of impairment across the areas of communication, cognition, socialization, motor and adaptive functioning. Diagnosis based on behavioral presentation. Autism Spectrum Disorders (ASD) • Even within the same diagnosis, profiles are heterogeneous.

3. DSM-V Overview • Social-Communication Impairments • Patterns of Restricted and Repetitive Behaviors/Sensory Needs • Level of Impairment is now identified (Level 1, Level 2, Level 3). Basically a severity scale. • Previous categories have been taken out: Asperger’s Syndrome, PDD-NOS. Lacked specificity.

4. Etiology/Prevalence • More prevalent among males (4:1) • Organically-based disorder (disruption in the early pruning process - “over-connected”). • Genetic Risk • Etiology Unknown, though theories are proposed including impact of toxins in the environment, vaccines, diet, metal exposure, fertility treatments - none have been supported by the research.

5. What are the early signs? • No babbling by 12 months. • No back and forth gesturing such as pointing, showing, reaching or waving by 12 months. • Decreased responsiveness to name. • No words by 16 months. • No two-word meaningful phrases by 24 months. • Lack of eye contact. • Failure to imitate verbal/non-verbal behaviors. • Any loss of speech, babbling or social skills. • Current Research on Eye Gaze in Infants and Toddlers (Building Joint Attention = Theory of Mind).

6. Issues in Early Identification • Child doesn’t have enough behaviors to see abnormalities • Parents are not yet aware of how social babies are • Adults automatically “fill in” for younger children • Factors that make assessment difficult (tired, hungry) • Don’t judge to0 quickly - but don’t miss opportunities

7. Communication Patterns of Children with ASD • Decreased initiation of meaningful language. • Conversational Difficulties - lack of reciprocity. • Repetitive/idiosyncratic language. • Odd prosody, limited integration of gestures and eye contact. • Deficits in understanding non-verbal communication (theory of mind).

8. Social Interaction Deficits • Lack of social referencing/ imitation. • Decreased joint attention/shared enjoyment. • Decreased range of affect. • Difficulties with taking the perspective of others - egocentric. • Difficulties with forming and maintaining friendships (may prefer adults to the exclusion of his/her peers). • Appear immature, naïve, lacking social insight (“pathetically childish”). • Yale Child Study Center - MRI imaging: Faces as Objects

9. Restricted Interests/ Repetitive Behaviors • Restricted play interests, over-reliance on sensory play. • Insistence on sameness. • Over-reliance on non-functional routines. • Obsessive areas of interest • Perseverative questioning/ restricted topics. • Inflexibility within daily situations - transitional challenges. • Stereotyped body movements

10. Related Challenges • Sensory Sensitivities (tactile, auditory, visual) • Self-regulatory challenges (emotional dysregulation, attentional needs, mood fluctuations, sleep disturbances, selective eating patterns). • Anxiety and compulsive patterns. Generalized Anxiety. • Hyperactivity, Inattentiveness, Impulsivity (ADHD) • Disorganization/ Motor planning weakness • Medication can be helpful in treating some of these symptoms.

11. Evidence-Based Practices • Recognition that intensity and the systematic nature of the intervention are the critical components to successful outcomes. • Importance of interpreting research (be a good consumer!) • Applied Behavioral Analysis and Discrete Trial Teaching (errorless learning). • Augmentative Communication Supports (PECS, Devices, IPads) • TEACCH Methodology - Examples of Visual Support Systems • Relationship-Based Approaches (RDI, FloorTime)

12. Communicative Intent of Behavioral Patterns-Teach Replacement Behaviors • It’s too loud in here • I need help • Let’s Play • I need a break • This is too hard • I don’t understand