How to use the Modified Checklist for Autism in Toddlers and Talk with

Families

Developmental Milestones

& Early Signs of Autism

Cindy Carroll, M.A., CCC-SLPSpeech and Language PathologistASD Coach and ConsultantSupervisor of ASD Diagnostic Clinic Community M.J. Murdock Grant

TODAY YOU WILL LEARNTODAY YOU WILL LEARN

How to identify typical development through the use of CDC campaign materials

How to identify atypical behavior and how to refer when there are concerns

Learn how to administer the MCHAT screening tool

Discuss strategies about how to talk with parents when there are concerns

WHO ARE YOU?WHO ARE YOU?

What’s the problem?What’s the problem?

17% of kids have a delay in development or behavior

Less than half of children with delays are identified before starting school

Parents know their kids, but may not know how to tell if their child is on track

Parents who are concerned often do not know where to turn next

Common Parent ReactionsCommon Parent Reactions“He’ll grow out of it… let’s just give him more time.”

Most delays are not outgrown.

Waiting to find out loses valuable time

Why Should we Learn the Signs- Act Early?

“Most mommies and daddies tell me “I thought there was a problem at 14 or 15 months...and they told me let’s wait and see because sometimes some kids grow out of it.’ Well, that’s not a good answer. We’ve got to make the distinction between less important problems, where we can wait and see from core problems, which involve a lack of reciprocity and a lack of getting to know your world. For these core problems, we have to act on it yesterday. We can’t wait nine months, we can’t wait two months.” (Stanley I. Greenspan, M.D., Child Psychiatrist)

Developmental Awareness

Developmental surveillance/screening

Referral

Family Outcomes

Intervention

Why Is Developmental Screening Why Is Developmental Screening Important?Important?

We an improve identified developmental delays from 30% (surveillance) to 70-80% with developmental screening

Learn the Signs. Act Early.Learn the Signs. Act Early.A CDC campaign to increase:

• Awareness of milestones and warning signs• Knowledge about services and their benefit• Dialogue between parents and professionals

—doctors, child care providers, etc.• Early action – once a delay is suspected, don’t

just “wait and see!”

www.cdc.gov

Free MaterialsFree Materials• On the CDC website, you can download:

• Brochure• Booklet of checklists• Growth chart• Waiting room posters• Factsheets on a variety

of development topics

Nearly all are available in English and Spanish• http://www.cdc.gov/ncbddd/actearly/

downloads.html#lang

““Milestone Moments” BookletMilestone Moments” Booklet

Early Learning Providers Early Learning Providers must must incorporate what’s known about incorporate what’s known about typical children’s developmenttypical children’s development

“ Ask yourself, whether the goals you are teaching are the most important for that child at that point in the child’s development”. Stephen Camarata, PhD, CCC-SLP – Vanderbilt University

Theory of TouchpointsTheory of Touchpoints•Development is periods of disorganization and organization

•Bursts of regression and progression are expected

•There is overflow from one line of development to another

* T. Berry Brazelton, M.D., The Touchpoints Model of Development TM

Development follows Development follows the same path for the same path for every child – T/F?every child – T/F?

Development Development Follows a Follows a Predictable Path – Predictable Path – T/F?T/F?

Children with Autism have uneven developmental profiles

Developmental-sleuth Developmental-sleuth •Carefully Observe

•Seek to understand

•Respect celebrate each individual child’s behavior and skills

•Comparative Judgments are not helpful

•Look for strengths also

How do I refer?How do I refer?

1. Medical Home

2. Under 3 – refer to EI

3. Over 3 – Refer to Local SD

What is Autism?What is Autism?Core Deficits in:

1-Language and Communication

2-Socialization and Connectedness

3-Unusual Patterns of Behavior and Interests

Look for: Core Communication DeficitsLook for: Core Communication Deficits

• Delay in expressive language (25-30% of children with ASD stopped saying words between 15-21 mo).

• Delay in receptive (1 step commands – 12-14 months)

• Poor imitation (Echolalia)• Delayed onset of babbling past 9 months of age• Lack of coordination of gestural communication

(waving, pointing, showing)• Unusual prosody (variation in pitch,

intonation, irregular rhythm, unusual vocal quality

Communication is:

purposeful intentional transference of information within a social context with anticipation of results

Pre-intentional communication Vocalizations or behaviors directed “to the room”

Intentional communication Directing behavior towards others to achieve a goal - Social vs. non-social manner

Look For: Core Deficits in Social and Emotional Look For: Core Deficits in Social and Emotional ReciprocityReciprocity

• Eye gaze– facial expressions – coordinating with gaze

• Joint attention• Shared Enjoyment• Does not respond to name by 12 months of age• Prefers to play alone • Does not share interests with others –

sharing/showing • Only interacts to achieve a desired goal

Cindy’s Soap Box

JOINT ATTENTION – JOINT ATTENTION – responding and initiating responding and initiating

social “bids”social “bids”Look for pointing (12 month follow point)

Look for showing(12-14 months initiate)

Look for looking

Joint attention is critical for children to learn from their environment

We MUST support our kids with autism to learn HOW to learn from their environment

Children who “get this” have better outcomes – period.

Joint Attention Building BlocksJoint Attention Building Blocks

Joint Attention

Theory of Mind

Symbolic Play

Expressive Language

Restricted, Repetitive and Restricted, Repetitive and Stereotypical Patterns of BehaviorStereotypical Patterns of Behavior

• Obsessive interests• Rigid adherence to routines• Stereotyped motor movements• Preoccupations with parts of objects• Lines up toys or other objects• Repetitive Play lack of symbolic play• Transitions• Flaps hands, rocks body, or spins self in circles

www.firstsigns.org

American Academy of Pediatrics American Academy of Pediatrics –Screening at;–Screening at;

• 9 months• 18 months• 24 months• 30 months

• 18, 24 and 30 months autism specific screen

The Modified Checklist for Autism in The Modified Checklist for Autism in Toddlers (M-CHAT)Toddlers (M-CHAT)

FOCUSED Level 1 SCREENINGFOCUSED Level 1 SCREENING

Robins, Fein, & Barton, 1999

• User friendly to assess the risk for autism spectrum disorders and detect as many cases of ASD as possible

• High False Positive Rate – Tool not a rule

• Developed for but not limited to; physicians, teachers, therapists, paraprofessionals, psychologists, early interventionists, childcare providers, nurses, etc.

• Developed for toddlers 16-30 months

• Drills down to Joint Attention Skills (Improved from the CHAT)

THE SCREEINING IS CONSIDERED FAILED IF 2 OR MORE CRITICAL ITEMS OR/ ANY 3 ITEMS ARE FAILED.

MCHAT Follow-up MCHAT Follow-up interviewinterview

Use when;

-clinical judgment tells you that the family is not a good reporter

-the child fails the MCHAT and you need to probe deeper

-You are just starting to do MCHATS and you have the time – good teaching tool

CRITICAL ITEM

CRITICAL ITEM

CRITICAL ITEM

CRITICAL ITEM

(babies turn to name 8-10 months of age)

WHAT I LOOK FORWHAT I LOOK FORSet up the environment for gestures (clear container – give for help)

Scatter skills in the absence of Building Blocks (colors/numbers/matching)

Ask parents if they can point to it on command

Using chunked phrases but not single words

Can they hyperfocus for long periods of time

Do they treat me like a piece of furniture

Do they have an unusual level of independence?

Do they notice when parent steps out of the room?

What kind of toys do they gravitate to (interests in “hard” items? – mechanical things

Are they still in the sensori-motor stage?

Can they imitate (sing a song)

What do I do if I have a What do I do if I have a concern? concern?

What do you do if you suspect autism?What do you do if you suspect autism?

• Review developmental milestones - Take notes• Do the MCHAT together in a trusting relationship• YOU DON’T HAVE TO SAY AUTISM • Talk respectfully with the family• Review and share resources with the family• Coach the family to share concerns with their PCP• Consult with others who have knowledge of ASD• Follow up with the family – be honest – if you don’t

know – ask for help

http://www.autismspeaks.org/what-autism/learn-signs/talking-parents-about-autism-action-kit

Talking about ConcernsTalking about Concerns

I’m sorry but…….I’m sorry but…….

It’s not about YOU!

Start with positivesUse a respectful toneRead your audienceValidate and relaxRemember it is a process

Parents may Feel Parents may Feel Sad, nervous or worried about the future

Worried that they may not have the ability to care for a child with special needs

Frustrated or angry that family members have not be more supportive.

During the ConversationDuring the ConversationListen FIRSTShare positivesBe supportive, never judgmentalAvoid jargon, labels, and

terminologyGive time to process… pause..

breath

At the end of the At the end of the conversationconversation

Outline next stepsGive resourcesAsk what you can do to help?End on a supportive note

HOW DO WE REFER?HOW DO WE REFER?

Where can I refer parents?Where can I refer parents?WithinReach

Call center

The Birth-to-Three center in your area

ParentHelp123.org – now in Spanish!

http://withinreachwa.org/

Washington State Department of Early Learning Guidelines(ESIT) http://www.del.wa.gov/

•www.cdc.gov/actearly

•www.firstsigns.org – MCHAT English/Spanish

•www.autismspeaks.org – Video Glossary

•www.aap/org/publiced/autismtoolkit.cfm

•http://brightfutures.aap.org/

•www.parentingcounts.org

•www.zerotothree.org

•www.cdc.gov/autism

•www.autismsociety.org