1. FIRST WORDS Project NECTAS Child Find Teleconference
Model Demonstration Project
Amy M. Wetherby, Ph.D.
Project Director
NECTAS
Child Find Teleconference

2. Need to Improve Early Identification of Developmental Disabilities
Percentage of Population Receiving Special Education or Early Intervention Services in 1997/98:
School-Age Children
6 to 18 years 10.95%
Preschool Children
3 to 5 years 4.79%
Infants and Toddlers
Birth to 2 years 1.70%
(US DOE, 1998)

3. Communication and language problems are the most common symptom in young children
Disability Category % Served
Specific Learning Disabilities 51.1
Speech or Language 20.8
Mental Retardation 11.6
Serious Emotional Disturbance
Multiple Disabilities
Hearing Impairments
Orthopedic Impairments
Other Health Impairments
Visual Impairments
Autism
Deaf-blindness
Traumatic Brain Injury
(US DOE, 1998)

4. Improving Early Identification
A child’s rate of language acquisition may be solidified by 2 to 3 years based on the rapid maturation of the brain.
Instead of waiting to see if a child is late in talking, it is important to evaluate skills that are early indicators of language development.

5. Prelinguistic Predictors of Persisting Language Problems
SOCIAL COMMUNICATION
Emotion and Use of Eye Gaze
Use of Communication
Use of Gestures
EXPRESSIVE SPEECH AND LANGUAGE
Use of Sounds
Use of Words
SYMBOLIC CAPACITY
Understanding of Words
Use of Objects

6. Profile Distinguishing Autism Spectrum and Delayed Language in Young Children (Wetherby, Prizant & Hutchinson, 1998)
EMOTION AND USE OF EYE GAZE
Weakness in gaze shifts/shared positive affect; excess negative affect
USE OF COMMUNICATION
Weakness in joint attention; comparable in behavior regulation
 USE OF GESTURES
Weakness in conventional & distal gestures; poor coordination of gestures and sounds
USE OF SOUNDS
Comparable limited consonant inventory & syllable structure  
 SYMBOLIC CAPACITY
Weakness in language comprehension and pretend play; comparable constructive play

7. Evaluation versus Assessment
Evaluation for Identification
Screening
Diagnostic testing
Determining initial and continuing eligibility
Assessment for Educational Planning
Profiling strengths and needs
Monitoring changes with treatment

8. Recommended Practices for Evaluation and Assessment of Young Children
Utilize multiple sources of information (parent report, observation & sampling)
Gather information from multiple observations
Provide information about child’s growth rate and capacity for development
Allow families and professionals to gather and share information to build consensus about strengths and needs

9. FIRST WORDS Project Evaluation Model
 Step One: Brief Parent Report
Infant/Toddler Checklist for Communication and Language Development
 Step Two: More Detailed Parent Report
CSBS-DP Caregiver Questionnaire
Ages and Stages Questionnaires
 Step Three: Child & Family Evaluation
CSBS-DP Behavior Sample of child interacting with caregiver and clinician

10. CSBS Developmental Profile: Behavior Sample
Warm-up
Communicative Temptations (Wind-up toy, Balloon, Bubbles, Jar, and Toys in Bag)
Sharing Books
Symbolic Play (feeding set)
Language Comprehension (object names, person names, and body parts)
Constructive Play (stacking blocks)
Caregiver Perception Form (caregiver rates how typical child’s behavior is during sample)
(Wetherby & Prizant, 1998)

11. CSBS Developmental Profile
Measurement Parameters for Checklist, CQ & BS
Emotion and Use of Eye Gaze
Use of Communication
Use of Gestures
Use of Sounds
Use of Words
Understanding of Words
Use of Objects

12. CSBS Developmental Profile
Correlations for Three Measures
Checklist and CQ r=.92 p< n=129
CQ and BS r=.78 p< n=127
Checklist and BS r=.72 p< n=114
(Wetherby & Goldstein, 1999)

13. CSBS Developmental Profile
Correlations for Test-Retest of the Three Measures
Checklist 3 month retest interval r=.88 p< n=108
CQ 4 month retest interval r=.87 p< n=112
BS 4 month retest interval r=.80 p< n=26
(Wetherby & Goldstein, 1999)

14. Correlations for CSBS-DP and MacArthur CDI Vocabulary Production at 24 months
Mean Initial Age months months
Checklist Use of Words r= .65 r= .60 TOTAL r= .44 r= .50
CQ Use of Words r= .80 r= .73 TOTAL r= .65 r= .64
BS Use of Words r= .58 r= .67 TOTAL r= .65 r= .64
(Wetherby & Goldstein, 1999)

15. Possible Outcomes of Children Late in Talking
 Late Bloomer
 Impairment in one or more of the following:
Hearing
Speech
Language
Communication

16. Accuracy of Diagnosis at Age 2
Diagnosis of Specific Language Impairment
About half of children identified as late talkers at age 2 receive a diagnosis of specific language impairment at age 3
Children who are delayed in expressive language only are very likely to catch up on their own
Children who are also delayed in receptive language, use of gestures, and play are more likely to have persisting language problems
(Paul, 1991; Rescorla, 1991; Thal, Tobias, & Morrison, 1991)

17. Accuracy of Diagnosis at Age 2
Diagnosis of Autistic Disorder
72% of children diagnosed at age 2 retained that diagnosis at age 3
94% retained diagnosis of ASD at age 3
Diagnosis of Atypical Autism (PDD-NOS)
42% of children diagnosed at age 2 retained that diagnosis at age 3
74% retained diagnosis of ASD at age 3
(Lord, 1995; Lord & Risi, 2000)

18. Clinical Features of Autism Spectrum in Young Children
Social Impairments were prominent at 24 months
Communication Impairments were prominent at 24 months
Restricted Repertoire of Activities and Interests were not prominent until 36 months
(Lord, 1995; Stone, Lee, Ashford, Brissie, Hepburn, Coonrod, & Weiss, in press)

19. Markers Based on CHAT at 18 months
Proto-declarative pointing
Gaze-monitoring
Pretend play
12 of 16,000 failed these 3 key items and 10 received diagnosis of autism (.06%).
22 of 16,000 failed 2 of the 3 items and 15 were developmentally delayed without autism (.08%).
(Baron-Cohen, et al., 1992; 1996)

20. Features Distinguishing Autism Based on Home Videotapes at 12 months
Pointing
Showing
Looking at Others
Orienting to Name
Only the latter two distinguished children with autism from children with developmental delays.
(Osterling & Dawson, 1994; 1999)

21. Practice Parameters for Screening and Diagnosis of Autism Spectrum
Absolute Indications for Immediate Further Evaluation:
No babbling by 12 months
No gesturing (pointing, waving bye-bye) by 12 months
No single words by 16 months
No 2-word spontaneous (not just echolalic) phrases by 24 months
ANY loss of ANY language or social skills at ANY age
**********
Child Neurology Society and American Academy of Neurology
(Filipek, Accardo, Baranek, et al., 1999)

22. Linking to Intervention
We are now serving a small proportion of young children needing services
Improving early identification efforts will increase the need for early intervention, …..so be ready to expand services

23. FIRST WORDS Project Menu of Service Options
Preventative Family Education/Support Services
Intensive, Individualized Early Intervention

24. Preventative Family Education/Support Services
parent education group meetings in the community
infant/toddler peer play groups
caregiver education modules for families and service providers
parent support and networking groups
resource and referral database 

25. Intensive, Individualized Early Intervention
individualized intervention through a family-guided assessment of the child’s communication and the communicative environment
parents are essential partners in the identification of specific concerns, intervention planning, and evaluation of outcomes
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