Jonah | age 8 | Riverview,Rive rvie w, MI Physician Guide for Autism Spectrum Disorders Created by 1 Derek | age 5 | Canton, MI AAoM Mission OUR MISSION The mission of Autism Alliance of Michigan is to lead collaborative efforts across the state that will improve the quality of life for individuals with autism through education, comprehensive services, community awareness, inclusion efforts, and coordinated advocacy. HOW WE INVEST IN THE MISSION The Autism Alliance of Michigan (AAoM) is leading efforts to make Michigan a better place to live for people with autism and their families. Our impact on families, communities, lawmakers, and service providers is not possible without the generous support of our corporate, foundation, and individual donors. 2 Physician Guide for Autism Spectrum Disorder Autism Screening • Research has found that Autism Spectrum Disorder (ASD) can be detected as early as 18 months or younger. By age 2, a diagnosis by an experienced clinician can be considered very reliable. However, many children do not receive a diagnosis until they are much older. This delay means children with ASD may not get the help that they need during their early years, which has been deemed so effective. The earlier ASD is diagnosed, the earlier treatment can begin. Screening tools are designed to help identify children who might have developmental delays. Screening tools do not provide conclusive evidence and do not result in a diagnosis. A positive developmental screening result for autism should be followed up with a referral to a developmental specialist, psychologist or autism evaluation center. Types of Screening Tools The American Academy of Pediatrics (AAP) recommends that all children receive autism-specific screening at 18 and 24 months of age, in addition to broad developmental screening at 9, 18, and 24 months. There are many different developmental screening tools that may be administered by professionals, community service providers, and in some cases, parents. Examples of screening tools include: • Ages and Stages Questionnaire (ASQ) • Communication and Symbolic Behavior Scales (CSBS) • Parents Evaluation of Developmental Status (PEDS) • Checklist for Autism in Toddlers (CHAT) • Modified Checklist for Autism in Toddlers- Revised (M-CHAT-R) • Pervasive Developmental Disorder Screening Test II (PDD ST II) • Screening Tool for Autism in Toddlers and Young Children (STAT) This list is not exhaustive, and other screening tests are available. 3 At 18 months does your child… • Look and point when he wants to show you something? • Look when you point to something? • Use imagination and pretend play? If the answer is NO the child may be at risk for autism. These items are based on the M-CHAT-R (Checklist for Autism in Toddlers) and should be asked of parents at well child visits. Recent research has identified 5 signs of autism in young children: The Five Early Signs of Autism in Infants 1. Unusual visual fixations. Unusually strong and persistent examination of objects. 2. Abnormal repetitive behaviors. Spending unusually long periods of time repeating an action, such as looking at their hands or rolling an object. 3. Lack of age-appropriate sound development. Delayed development of vowel sounds, such as “ma ma, da da, ta ta.” 4. Delayed intentional communication. Neutral facial tones and decreased efforts to gesture and gain parent attention. 5. Decreased interest in interaction. Greater interest in objects than people and difficult to sustain face-to-face interactions. Las Cinco Primeras Señales de Autismo en Infantes 1. Fijaciones visuales inusuales. Cuando un infante examina los objetos de una manera intensa y persistente. 2. Los comportamientos repetitivos y anormales. Cuando un infante repite la misma acción por mucho tiempo. Por ejemplo: Mirando a sus manos o haciendo rodar un objeto. 3. La falta de desarrollo de ciertos sonidos cuando habla. Cuando un infante tiene un retraso de los sonidos vocales, como “ma ma” o “da da.” 4. Un retraso en la comunicación intencional. Cuando un infante tiene una expresión facial que permanece neutral y no trata de hacer gestos o llamar atención de sus padres. 5. No quiere interrelacionarse con otros. Cuando un infante prefiere más jugar con objetos que con otras personas. Cuando un infante tiene dificultades para mantener interacciones cara a cara. 4 M-CHA T-R™ (Modified Checklist for Autism in Toddlers Revised) Pease answer these questions about your child. Keep in mind how your child usually behaves. If you have seen your child do the behavior a few times, but he or she does not usually do it, then please answer no. 1. If you point at something across the room, does your child look at it? Yes No (FOR EXAMPLE, if you point at a t oy or an animal, does your child look at the t oy or animal?) 2. Have you ever wondered if your child might be deaf? Yes No 3. Does your child play pretend or make-believe? (FOR EXAMPLE, pretend to drink Yes No from an empty cup, pretend to talk on a phone, or pretend to feed a doll or stuffed animal?) 4. Does your child like climbing on things? (FOR EXAMPLE , furniture , playground Yes No equipment, or stairs) 5. Does your child make unusual finger movements near his or her eyes? Yes No (FOR EXAMPLE, does your child wiggle his or her fingers close to his or her eyes?) 6. Does your child point with one finger to ask for something or to get help? Yes No (FOR EXAMPLE, pointing to a snack or toy that is out of reach) 7. Does your child point with one finger to show you something interesting? Yes No (FOR EXAMPLE, pointing to an airplane in the sky or a big truck in the road) 8. Is your child interested in other children? (FOR EXAMPLE, does your child watch Yes No other children, smile at them, or go to them?) 9. Does your child show you things by bringing them to you or holding them up for you to Yes No see – not to get help , but just to share? (FOR EXAMPLE , showing you a flower , a stuffed animal, or a toy truck) 10. Does your child respond when you call his or her name? (FOR EXAMPLE, does he or she look up, talk or babble, or stop what he or she is doing when you call his or her name?) Yes No 11. When you smile at your child, does he or she smile back at you? Yes No 12. Does your child get upset by everyday noises? (FOR EXAMPLE, does your Yes No child scream or cry to noise such as a vacuum cleaner or loud music?) 13. Does your child walk? Yes No 14. Does your child look you in the eye when you are talking to him or her, playing with him Yes No or her, or dressing him or her? 15 . Does your child t ry to copy wh at you do? (FOR EXAMPLE , wave bye-bye , cl ap, or Yes No make a funny noise when you do) 16. If you turn your head to look at something, does your child look around to see what you Yes No are looking at? 17. Does your child try to get you to watch him or her? (FOR EXAMPLE, does your child Yes No look at you for praise, or say “look” or “watch me”?) 18. Does your child understand when you tell him or her to do something? Yes No (FOR EXAMPLE, if you don’t point, can your child understand “put the book on the chair” or “bring me the blanket”?) 19. If something new h appens, does your child look at your face to see h ow you feel about it? Yes No (FOR EXAMPLE , if he or she hears a strange or funny noise , or sees a new toy , will he or she look at your face?) 20. Does your child like movement activities? Yes No (FOR EXAMPLE, being swung or bounced on your knee) © 2009 Diana Robins, Deborah Fein, & Marianne Barton The Modified Checklist for Autism in Toddlers (M-CHAT-R), one of the AAP recommended tools, is a validated developmental screening tool for toddlers between 16 and 30 months of age. It is designed to identify children who may benefit from a more thorough developmental and autism evaluation. The M-CHAT-R can be administered and scored as part of a well-child check-up, and also can be used by specialists or other professionals to screen for developmental delay and autism. Billing Code: 96110 5 M-CHA T-R Scoring Algorithm ‘No’ responses that should be counted as 1 point indicating ASD risk All questions except 2, 5, 12 ‘Yes’ responses that should be counted as 1 point indicating ASD risk Only questions 2, 5, 12 Risk Assessment High Risk for autism group Total Score of 8-20 Medium Risk for autism group Total Score of 3-7 Low Risk for autism group Total Score of 0-2 Management Recommendations High Risk Group Refer to developmental specialist, or autism diagnostic clinic Medium Risk Group Administer the follow up (available at www.mchatscreen.com - if the child’s score remains above 2 then the child falls in the High Risk Group and should be referred as above. If the child’s score drops below 2 then the child is Low Risk and should be re-screened at future well-child visits. Low Risk Group If the child is younger than 24 months, screen again after the child’s 2 nd birthday. No further intervention is required unless surveillance indicates risk for ASD. 6 Surveillance of Head Size In addition to behavioral signs of autism, early neurobiological signs identified within the first year of life can also be helpful in identifying children at risk for autism.