1. Title of Slide Presentation Autism in the Early Years Casey Ferrara and Jennifer DeMello

2. Objectives for the Training Recognizing red flags for Autism/Social communication disorders Collecting observations in an organized way to share with other professionals Making appropriate referrals your child Transitioning out of Early Intervention

3. Definition of Autism A biologically based developmental disorder, affecting social interactions, play and language, and repetitive behaviors.

4. What can it look like? A deficit in social communication and social interaction across context not accounted for by general developmental delays and manifests in the following:

5. What can it look like? 1.Deficits in social emotional reciprocity ranging from : Abnormal social approach and failure of normal back and forth conversation Reduced sharing of interests, emotions, or affect Failure to initiate or respond to social interaction

6. What can it look like? 2. Deficits in non communicative behaviors used for social interaction such as: Poorly integrated verbal and non verbal communication Abnormalities in eye contact and body language Deficits in understanding and use of gestures Total lack of facial expressions and non verbal communication

7. What can it look like? 3. Deficits in developing, maintaining, and understanding relationships such as: Difficulties adjusting behavior to suit various social situations Difficulties in sharing imaginative play or in making friends Absence of interest in peers

8. What can it look like? Restricted repetitive patterns of behavior, interests or activities manifested by at least two of the following:

9. What can it look like? 1. Stereotyped or repetitive motor movements, use of objects or speech such as: Simple motor repetition Lining up toys or flipping objects Echolalia Idiosyncratic phrases- unusual

10. What can it look like? 2. Insistence on sameness Inflexible adherence to routines Ritualized patterns Verbal/ non-verbal behavior such as:  Extreme distress in small changes  Difficulties with transitions  Rigid thinking patterns  Greeting rituals  Need to take the same route or eat the same food everyday

11. What can it look like? 3. Highly restricted fixated interests that are abnormal in intensity or focus such as: Strong attachment to or preoccupation with unusual objects Excessively circumscribed (boundaries of limits) Perseverative interests

12. What can it look like? 4. Hyper or hypo reactivity to sensory input or unusual interests in sensory aspects of the environment such as: Apparent indifference to pain or temperature Adverse response to specific sounds or textures Excessive smelling or touching of objects Visual fascination with lights or movement

13. Observations What is going on in the home environment? Has something happened in this child’s life to affect their functioning? Is the child at risk for ASD? Does a family member have it?

14. Observations Gathering observations over several different times and different settings is helpful. www.cdc.gov/ncbddd/video/actearlycurricu lum/ www.cdc.gov/ncbddd/video/actearlycurricu lum Interview other adults that are familiar with your child. They may be able to provide a different perspective.

15. Screening Tools to Use for Observation M-CHAT(Modified Checklist for Autism in Toddlers) – you may get these results from pediatricians. Usually given at 16-30 months and used to assess risk for ASD. Parent can do it online @ m-chat.org STAT(Screening tool for Autism in Toddlers and Young Children)- staff need to be trained in order to use this. Used for children 24-36 months

16. Screening Tools to Use for Observations Many other tools are available- check with your area medical professionals to see if they prefer you to use something specific.

17. Preparing for Referral These are options for further assessment: Neurodevelopment centers Clinical psychologist Developmental pediatrician Behavioral pediatrician Children’s hospitals Child neurologist Child psychologist Please see attached resources

18. Preparing for Referral There may be a wait between the time you call and the time you go. There will be several appointments before you get any feedback. The appointments usually are intake, evaluation, feedback but can vary Prepare a list of questions for the doctor.

19. Evidence Based Practices

20. Prompting Prompting –Any verbal or physical help given to a toddler that assists them in engaging in a specific skill or behavior.

21. Most to Least Prompting Using the most amount of prompting necessary to get the child to perform a correct response. As the child provides proficiency in the behavior or task then less prompting. Usually this begins with physical prompting, then verbal prompting and then natural cues.

22. Least to Most Prompting Start with the least amount of prompting – natural cues, and then go to verbal prompting and physical prompting.

23. Time Delay The parent would give the prompt to the child and then wait to see if the child responds and then give the verbal prompt again with the physical prompt to go along with it after waiting a few seconds for the child to respond. It is to fade the use of prompts over time to help reach the target behavior without having to use the prompts.

24. Naturalistic Intervention Uses the child’s natural environments and interests as motivation and reinforcement. It is intentional in trying to achieve the child’s goals. It is child led and serves as an opportunity for teachable moments for the child.

25. Pivotal Response Treatments Providing intervention to infants and toddlers in pivotal areas will result in collateral effects in a related behavior. It will help reach out to areas beyond what is being taught.

26. Pivotal Response Treatments Multiple cues – so children don’t overgeneralize but can pick up on other characteristics that distinguish one thing from another Motivation – they will have higher responses to completing tasks if they are motivated Self-Management – shifting of the responsibility from the parent to the child. They will learn to monitor behavior so they can function in different environments

27. Reinforcement Reinforcement is almost always used with other evidence based practices. Positive reinforcement – when the child experiences something he likes right after using the skill or behavior with the likelihood that they will now repeat that behavior. Negative reinforcement – when we take away an object or aversive situation that the child does not like when the toddler does the skill or behavior

28. Modeling Modeling relies on adults or peers providing or demonstrating a target behavior. This is often combined with other strategies such as prompting and reinforcement.

29. Transitioning out of EarIy Intervention Transition process starts at 27 months If the family agrees a referral will be made to the families local school department We will work with the family to make a list of the strengths and needs in the different areas of development

30. Transitioning out of Early Intervention The school will determine if the child needs any further assessment before determining eligibility for services. Any previous assessment may be helpful for the school team determining eligibility for services – so bring any doctor reports or assessments that the child may have already completed. The transition summary completed by team is helpful to the school department.

31. Transitioning out of Early Intervention The school system may choose to do assessments on their own to better understand the child’s abilities and needs. The school will determine if a child is eligible for services at the age of three once the child is finished with EI services. If the child is not eligible for school services EI provider will give other resources for the family if further services are still needed.

32. Resources Please refer to handout