Early Indicators of Autism in Young Children

1
Early Indicators of Autism in Young Children

• Early Childhood Educators of BC Provincial
  Conference, May 13, 2004
• Pat Mirenda, Ph.D.
• University of British Columbia

2
Why Early?

• Research evidence is clear
• Early identification of children who are at
  risk for autism spectrum disorder (ASD)
  facilitates early intervention
• Early intervention is essential for better
  outcomes

3
Early Identification

• Firm diagnosis possible by 36 months, with
  indicators for concern appearing earlier
• Numerous studies have examined early indicators
  of ASD from 1st birthday party videotapes, parent
  surveys, formal test measures
• Osterling Dawson (1994) reviewed videotapes of
  the 1st birthday parties of 11 children later
  diagnosed with ASD and 11 typically developing
  children
• At one year of age, children with autism did less
  pointing, showing objects to others (joint
  attention), looking at others, and orienting in
  response to name

4
First Signs

• A U.S. project directed toward educating
  pediatricians to recognize early indicators of
  ASD
• Produced a videotape and support package for
  distribution to physicians
• Equally relevant for early childhood educators
• Videotape First Signs
• http//www.firstsigns.org/index.html

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Red Flags!

• Relating with warmth and pleasure
• Looking at faces and smiling back at others by 4
  mo
• No big smiles and joyful expressions by 6 mo
• Back and forth vocalizations and gestures
• No sharing of sounds, smiles, facial expressions
  by 9 mo
• No responding to name when called by 12 mo
• No babbling by 12 mo
• No reciprocal gestures (pointing, showing,
  reaching, waving) by 12 mo

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Red Flags! (Cont)

• Problem solving
• No attempts to recreate or continue interesting
  displays or events, either motorically or
  communicatively (e.g., asking for more or
  help)
• Two way communication with words
• No words by 16 mo
• No two-word meaningful phrases (without imitating
  or repeating) by 24 mo
• ANY loss of speech or babbling at ANY age

7
ASD vs. Developmental Delay

• Question is it possible to distinguish between
  young children at risk for ASD and those at risk
  for other types of developmental delays?
• Answer YES!

8
Wetherby, Prizant, Hutchinson (1998)

• Compared 22 children with autism (CA 17-60 mo,
  mean 36 mo) and 22 children with language delays
• Used the Communication and Symbolic Behavior
  Scales (CSBS)
• Similar use of vocal/verbal communication
• BUT children with autism had substantially lower
  scores in
• Number of communicative functions
• Use of communicative gestures, reciprocity (i.e.,
  turn taking)
• Social/affective signaling, and
• Symbolic behavior

9
Osterling, Dawson, Munson (2002)

• Examined first birthday party videotapes of 20
  infants later diagnosed with ASD, 14 later
  diagnosed with mental retardation (MR), and 20
  typically developing infants
• Infants with both ASD and MR
• Used gestures less often
• Looked at objects held by others less often and
• Engaged in repetitive motor behaviors more often
  than those who were typical
• Infants with ASD
• Looked at others less often and
• Oriented to their name less often than those with
  MR or those who were typical

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Baby Sibling Project

• A team of Canadian researchers are following gt100
  infant siblings of children with ASD to look for
  early indicators of risk
• http//www.geocities.com/autismandpdd/OurStudies.h
  imInfant20Sibling20Study
• Results to date indicate that approximately 25
  of the baby sibs show some indication of
  difficulty in early development
• Those with 7 or more markers are most likely be
  later diagnosed with ASD (not other disabilities)

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Baby Siblings (Cont)

• The major markers are
• Failure to look at other people (i.e., decreased
  eye contact)
• Failure to orient to name
• Reduced reciprocal social smiling
• Atypical sensory behavior
• Difficulty initiating visual tracking and
  disengaging visual attention
• Difficulty with imitation and
• A general lack of social interest
• Screening tool in development

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Screening Tools

• CHAT Checklist for Autism in Toddlers
• Screening instrument for 18-month olds, developed
  in the UK 16,235 children screened (M18.7 mo)
• Baird, Charman, Baron-Cohen, Cox, Swettenham,
  Wheelwright, Drew (2000) 6-year follow-up to
  the original CHAT study
• Good specificity (proportion of children without
  ASD identified as normal) 97.7
• Low sensitivity (proportion of children with ASD
  identified by the CHAT) 35.1
• Low positive predictive value (proportion of
  children with a positive screen who had a
  disorder) 8.1 for ASD 16.7 for all
  developmental disorders

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Screening Tools

• Also M-CHAT (Modified-CHAT) American version of
  the CHAT, also translated into Spanish
• Good specificity (95)
• Good sensitivity (97)
• Moderate positive predictive value (36)

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Screening Tools

• Communication and Symbolic Behavior Scales
  Infant-Toddler Checklist (Wetherby Prizant,
  2002)
• http//firstwords.fsu.edu/
• http//www.brookespublishing.com/store/books/wethe
  rby-csbsdp/checklist.him
• Advisable to use all of these as first stage
  screening tools Is there any type of
  developmental delay, not necessarily autism?

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What if Screening is Positive?

• Refer family to their pediatrician
• Pediatrician should refer the child for a
  multidisciplinary assessment
• BC Autism Assessment Network (BCAAN)
  http//www.phsa.ca/Patients/autism.him
• Fraser Health Authority AAN (Surrey)
• Interior Health AAN (Kelowna)
• Northern Health Authority AAN (Prince George)
• Vancouver Island Autism Assessment Services
  (Victoria)
• Vancouver Coastal Health Authority AAN (Vancouver)

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Standards and Guidelines

• Standards and Guidelines for Assessment and
  Diagnosis of Young Children with Autism Spectrum
  Disorder in British Columbia
• http//www.healthservices.gov.bc.ca/cpa/publicatio
  ns/asd_standards_0318.pdf

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The Punchline

• ASD looks different in young children than in
  older children
• More subtle
• Fewer behavior problems and self-stimulatory
  behavior
• More than 1-2 signs, typically
• Social relatedness and social interaction skills
  are the most affected
• Early childhood educators have an important role
  to play!!!

18
References

• Baird, G., Charman, T., Baron-Cohen, S., Cox, A.,
  Swettenham, J., Wheelwright, S., Drew, A.
  (2000). A screening instrument for autism at 18
  months of age a 6-year follow-up study. Journal
  of the American Academy of Child and Adolescent
  Psychiatry, 39, 694-702.
• Osterling, J., Dawson, G. (1994). Early
  recognition of children with autism A study of
  first birthday home videotapes. Journal of
  Autism and Developmental Disorders, 24, 247-257.
• Robins, D.L., Fein, D., Barton, M.L., Green,
  J.A. (2001). The Modified Checklist for Autism in
  Toddlers An initial study investigating the
  early detection of autism and pervasive
  developmental disorders. Journal of Autism and
  Developmental Disorders, 31, 131-144.
• Wetherby, A., Prizant, B., Hutchinson, T.
  (1998). Communicative, social/affective, and
  symbolic profiles of toying children with autism
  and pervasive developmental disorders. American
  Journal of Speech-Language Pathology, 7, 79-91.