1. Signs, Symptoms and Diagnosis of Autism in Children Karen S. Fairchild, LCSW Social Work Month Lecture Series at BYU March 7, 2013

2. 2 Social Communication Motor Sensory Profound Intellectual Disabilities Gifted Self-AbsorbedQuirky Non-VerbalHighly Verbal AwkwardAgile HyposensitiveHypersensitive Measured I.Q. Behavior Aggressive, Destructive Odd Spectrum of Autism Created by Dr. Tina Dyches

3. Myths about Autism Caused by “cold” refrigerator mothers Children with eye contact do not have Autism Children who are “social” do not have Autism All people with Autism have extraordinary skills

4. Myths about Autism (con.) People with Autism just need love to get better People with Autism just need more discipline to get better Autism can be outgrown There is a cure for Autism

5. Red Flags in Young Children No big smiles or other warm, joyful expressions by six months or thereafter No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months or thereafter No babbling by 12 months No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months

6. More Red Flags No words by 16 months No two-word meaningful phrases (without imitating or repeating) by 24 months Any loss of speech or babbling or social skills at any age *This information provided by First Signs, Inc. ©2001-2005.

7. Thoughts on Diagnosis Reasons to get a diagnosis Understanding Services and Intervention When? ADOS now at 18 Months Identification and Intervention most important Concerns about getting a “label”

8. Typical Behavior Characteristics of High- Functioning Individuals with Autism Adapted from C. Bees (1998). The GOLD Program: a program for gifted learning disabled adolescents. Roeper Review, 21, p. 160.

9. Early Intervention Kids on the Move (Alpine School District) Kids Who Count (Nebo School District) Provo Early Intervention Program (Easter Seals) Federally Mandated If there are concerns about development, do not hesitate to have a child assessed through early intervention.

10. Early Screening Modified Checklist for Autism in Toddlers (M- CHAT™)—available readily and free online Many false positives; follow up with interview Scientifically validated for children ages 16-30 months old American Academy of Pediatrics recommends that all children be screened for Autism at 18 and 24 months old. The M-CHAT is one of their recommended tools.

11. Diagnostic Tools Current Tools Observation—Autism Diagnostic Observation (ADOS) Developmental History (Parent Report)—Autism Diagnostic Interview-Revised (ADI-R) Childhood Autism Rating Scale (CARS) Future Brain Imaging—Pinpoint subgroups and treatment Genetic Testing

12. Causes of Autism?? Probably multiple causes Genetic Environmental The definition I hold onto: A genetic predisposition with something in the environment that triggers it.

13. What is Autism? The essential features of Autistic Disorder are the presence of markedly abnormal or impaired development in: social interaction and communication and a markedly restricted repertoire of activity and interests —DSM-IV

14. Current Prevalence Rates Prevalence 1 out of 88 nationally 1 out of 47 in Utah County

15. Changes in DSM-5 Name changed from Pervasive Developmental Disorder to Autism Spectrum Disorder Single Diagnosis rather than a category containing five individual diagnoses (PDD-NOS and Asperger’s eliminated) Three symptom domains become two Domains Severity Criteria added to better capture the idea of a spectrum (3 levels) New diagnostic category (not on the autism spectrum) of Social Communication Disorder --Sally Ozonoff, Editorial: DSM-5 and autism spectrum disorders—two decades of perspectives from the JCPP, Journal of Child Psychology and Psychiatry, 53:9 (2012), ppe4-e6

16. Social Communication & Interaction –proposed A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: 1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction.

17. Social Communication & Interaction –proposed (continued) 2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures 3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people.

18. Behaviors, Interests, Activities — proposed B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following: 1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases). 2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).

19. Behaviors, Interests, Activities — proposed (continued) 3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). 4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects). NEW

20. Additional Diagnostic Criteria— proposed C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities). NEW D. Symptoms together limit and impair everyday functioning.

21. DSM–V Workgroup Severity Level for ASDSocial Communication Restricted Interests and Repetitive Behaviors Level 1 Requiring support Without supports in place, deficits in social communication cause noticeable impairments. Has difficulty initiating social interactions and demonstrates clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions. Rituals and repetitive behaviors (RRB’s) cause significant interference with functioning in one or more contexts. Resists attempts by others to interrupt RRB’s or to be redirected from fixated interest. Severity Levels-proposed Jerri Maroney, Andrea Kliss, Edward Toyer, AmeriHealth Mercy Family of Companies

22. DSM–V Workgroup Severity Level for ASDSocial Communication Restricted Interests and Repetitive Behaviors Level 2 Requiring substantial support Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions and reduced or abnormal response to social overtures from others. Jerri Maroney, Andrea Kliss, Edward Toyer, AmeriHealth Mercy Family of Companies Severity Levels-proposed

23. Severity Level for ASDSocial Communication Restricted Interests and Repetitive Behaviors Level 3 Requiring very substantial support Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning; very limited initiation of social interactions and minimal response to social overtures from others. Preoccupations, fixated rituals and/or repetitive behaviors markedly interfere with functioning in all spheres. Marked distress when rituals or routines are interrupted; very difficult to redirect from fixated interest or returns to it quickly. Jerri Maroney, Andrea Kliss, Edward Toyer, AmeriHealth Mercy Family of Companies Severity Levels-proposed

24. Resources in Utah County Autism Resources of Utah County http://www.autismresourcesuc.org/http://www.autismresourcesuc.org/ (local conferences, autism awareness events, local resource lists) Bridges Autism Program at Kids on the Move http://www.kotm.org/programs/bridges/ 801-616-5800 (preschool, social groups, Kindermusik with autism focus, individualized service plans, Floortime, parent support group, toy lending library, home visits, ABA home-based programs, assessment, and diagnosis) http://www.kotm.org/programs/bridges/

25. Resources in Utah County (con.) Timpanogos Assessment and Psychological Services (TAPS) Dr. Mikle South, 801-810-8378 (diagnostic assessments, social skills groups, IQ testing, etc.) Kids on the Move Library—Many great books are available and requests for book purchases are considered – 801-221-9930 Wasatch Mental Health’s GIANT Steps Autism Program http://www.wasatch.org/autism.html 801-226-5437 (preschool, parent training)http://www.wasatch.org/autism.html

26. Resources in Utah County (con.) Clear Horizons Academy http://www.clearhorizonsacademy.org 801-437-0490 (preschool, elementary grade classes) http://www.clearhorizonsacademy.org BYU Comprehensive Clinic 801-422-7759 (speech therapy, autism treatment) Wasatch Mental Health 801-373-4765 (Medicaid Provider—diagnosis, therapy, groups)

27. Resources in Utah County (con.) Orem Pediatric Rehabilitation 801-714-3505 (speech therapy, occupational therapy [sensory processing disorders], physical therapy) Autism Council of Utah www.autismcouncilofutah.org (Website with compilation of community autism resources and information)www.autismcouncilofutah.org

28. Autismspeaks.org Video Glossary First Signs Tips for Families Treatment Recommendations Research Updates Legislative Updates Much more