My Patient May Have Autism, Now What My Patient May Have Autism, Now What? Guidelines for Assessment, Intervention, and Next Steps. DoriAnn Adragna, Ph.D., Ed.S., Peak Pediatric Psychology Licensed Psychologist Licensed School Psychologist

My background Bachelor’s of Arts in Psychology from Colorado Mesa University Education Specialist Degree from the University of Denver Doctor of Philosophy from the University of Denver Completed a two year fellowship in pediatric traumatic brain injury Completed a one year psychology externship at JFK Partners and Children’s Hospital Colorado in Autism and other Neurodevelopmental Disorders Founding member of PEAK Pediatric Psychology

Objectives At the end of this presentation participants will: Be able to identify some of the early warning signs for an autism spectrum disorder Identify screening tools to determine when a more thorough assessment is warranted Learn how to help families navigate a new diagnosis

What is Autism? Previous Terms Used: Asperger’s Disorder Autistic Disorder Rett’s Disorder Pervasive Development Disorder Childhood Disintegrative Disorder Current DSM-V Terms: Autism Spectrum Disorder Category which includes a range of related disorders that vary in severity Severity can be Mild (level 1), Moderate (Level 2), or Severe (level 3)

Autism Spectrum Disorder The core of autism is a social communication disorder. The term Autism comes from the Greek word Autos which means “self.” As humans- we are social animals. We learn by observing the world around us. Children on the spectrum are typically described as being in their own world, having difficulty taking perspectives of others, have difficulty reading social cues and nonverbal communication, don’t observe others so they miss out on a lot of social learning

DSM V criteria that need to be met to have a diagnosis of ASD: A) Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text): Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers. Show videos is have time

DSM V-Major criteria that need to be met to have a diagnosis of ASD: B) Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text): Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases). Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day). Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests). Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement). **Show video if have time*** If do not meet these criteria, can look at differential diagnosis such as Social Pragmatic Communication Disorder which is basically all the symptoms in criteria A without the RI/RB

Early Warning Signs of ASD: Infant Does not orient to name Lack of eye contact Lack of ”social smile”

Early Warning Signs: Toddler/Preschool Speech development Delays Echolalia Impairments in nonverbal communication Play skills Functional vs pretend play Joint attention Interactions with peers Does the child approach other children at a park? How does the child respond to approaches from other children? Restricted interests/ Repetitive Behaviors Interest common to age but with more intense focus Fascination with certain items (long objects, water, toilet flushing, etc.) Complex hand mannerisms/Stereotypical movements Behavioral rituals/rigidity/difficulty with routines Video Examples (show here if they work)

Be On The Lookout for Regression Loss of skills previously acquired (such as if the child suddenly stops speaking) Research suggests screening at these age intervals for regression and to follow up with more assessment if warranted 18 months 24 months 36 months

ASD Screening Tools Ages and Stages Questionnaire (ASQ) Ages: 1 month to 5 ½ years old M-CHAT Ages: Toddlers ages 16-20 months Social communication questionnaire (SCQ) Ages: 4 years old and older with mental age of 2 years old

Formal Assessment Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) Developmental Interview Cognitive abilities Wechsler Intelligence Scales for Children, Fifth Edition Leiter International Performance Scale (Nonverbal assessment) Developmental Assessment Mullen Scales of Early Learning Adaptive Behaviors Adaptive Behavior Assessment System, Third Edition (ABAS-3) Vineland Adaptive Behavior Scales, Third Edition

Therapies Speech and Language Therapy Communication skills Pragmatic skills Occupational therapy Sensory concerns Fine/Gross motor skills Psychosocial interventions ABA therapy CBT Early intensive (25-40 hours a week over at least 2 years) therapy Floor Time (DIR) Model

How to Help a Family Navigate a New Diagnosis Reassure them that their child is still the same child that they know and love Connect them to local resources Provide referrals to occupational therapy, speech therapy, and behavioral therapy Check in with the family to follow up on referrals, therapies, applications

Priority Recommendations 100 day tool kit from the Autism Speaks Website https://www.autismspeaks.org/family- services/tool-kits/100-day-kit Social Stories/ Comic Strip Conversations Video Modeling The Autism Society of America, Colorado chapter can be contacted at 720-214- 0794 to gain information about local resources in Colorado. The Autism Speaks website also has a lot of helpful information for families of children with ASD. Please see www.autismspeaks.org The Arc of West Central Colorado provides advocacy and support for people with intellectual and developmental disabilities. Please see www.arcwcco.org for more information

Peak Pediatric Psychology Thank you! Questions? Let’s keep in touch drdori@peakpros.org Peak Pediatric Psychology