Screening for Autism Spectrum Disorder Handouts

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Screening for Autism Spectrum Disorder

Case Worksheet for Learners Case Goal

Early identification of autism spectrum disorder (ASD) and referral for subsequent specialized developmental services greatly improves long-term outcomes for children with ASD. The American Academy of Pediatrics (AAP) recommends ongoing developmental surveillance at every visit, developmental screenings at 9, 18, and 24 or 30 months, and autism-specific screening at 18 and 24 months.

Key Learning Points of This Case ­

1. Perform ASD-specific screening as recommended by the AAP. a. Review the AAP guidelines on screening for ASD. ___________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ b.

Discuss the importance of screening for ASD as part of developmental surveillance. ________________ ____________________________________________________________________________________ ____________________________________________________________________________________

c.

Choose an appropriate screening tool. _____________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

d.

2.

Administer and score a screening tool correctly ______________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Develop an appropriate management plan based on results of screening for ASD. a. Interpret screening results correctly. ________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ b.

Explain the results of screening to parents. __________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

c.

Formulate an appropriate plan of care based on screening results. _______________________________ ____________________________________________________________________________________ ____________________________________________________________________________________

Post Learning Exercise

1. Ask the caregivers of children at the 18-, 24-, and 30-month visits to complete the M-CHAT (the M-CHAT is available at http://www.firstsigns.org/screening/tools/rec.htm). 2. Practice explaining the process of screening to families and describe the limitations of screening tools. 3. Score the M-CHAT screening tools completed by caregivers. 4. Discuss the results with families of your patients. 5. Discuss with your preceptor where you would refer a child with a positive screen in your area (for example: audiology, Early Intervention, a developmental pediatrician). 6. Perform the M-CHAT follow up interview with a family. Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

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Screening for Autism Spectrum Disorder

Case Study Part I It’s a busy morning in the NICU, and you, a second-year pediatric resident, think longingly of the lunch you won’t be able to have as you quickly sign out your patients. You hurry over to your community clinic, arriving a few minutes late. Your first patient for the afternoon is a baby you have been following since birth. You first met the family in the newborn nursery and have enjoyed seeing little Matthew learn to roll over, sit, cruise, and walk. Matthew is now 18 months old and is coming in for a routine health care maintenance visit. As you enter the room, you smile at Matthew and ask his mother and father how he’s doing. “Great,” they reply. “He loves to explore our apartment and laughs like crazy when we play peek-a-boo. We have started taking him to the park, and he enjoys playing with blocks.” You do a physical exam on Matthew and note that he has said very few words during the assessment. His eye contact is variable. When you ask about his language, Matthew’s parents indicate that, although they have noticed he’s not saying as many words as they would have anticipated at his age, they attribute this to his being raised in a bilingual household. They indicate he only has a couple of words. You spend a few more moments engaging Matthew in play before going back to the conference room to present to the attending. Although Matthew is a quiet and sweet boy, you remain concerned about his language and variable eye contact. Given his age, Matthew should have an ASD-specific screening as well as a general developmental screening as part of his 18-month checkup. After discussing Matthew’s case with your preceptor, you go back to the family. You discuss the importance of screening with Matthew’s parents. You explain to Matthew’s parents that screeners are not used to diagnose, but can provide important information regarding milestones that Matthew should be reaching. You give Matthew’s parents the screening tool to complete. Your next patient is Claudia, a 2-year-old girl who has just moved to the area from another state. This is Claudia’s first visit to the clinic. As you introduce yourself to Claudia, you notice that she stares at the door. You complete a physical exam and look over Claudia’s immunization record. You ask Claudia’s dad about preschool, and he replies that since Claudia does not speak yet, the family decided not to place her in preschool. You attempt to engage Claudia with toys, but Claudia appears more interested in the buttons on her sweater. You go back to your preceptor and describe Claudia’s concerning behavior and lack of words. You and your preceptor agree that these may be signs of ASD. After explaining the routine of screening for ASD at the 18-month and 2-year-old visits, you give the screening tool to Claudia’s dad for completion.

Case Authors • • • •

Rebecca J. Scharf, MD, Children’s Hospital at Montefiore, Albert Einstein College of Medicine Jan Harold Sia, MD, Yale University School of Medicine Demetra Pappas, MD, Children’s Hospital Boston, Harvard Medical School Maris Rosenberg, MD, Children’s Hospital at Montefiore, Albert Einstein College of Medicine

Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

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Screening for Autism Spectrum Disorder

Case Study Part II Matthew’s parents complete the questionnaire and give it back to the nurse. The nurse scores the M-CHAT and determines that he has three failed items. You discuss Matthew with your preceptor, and together you decide to refer to an audiologist and call Matthew’s parents for a follow-up interview. Claudia’s dad is unsure of the answers to several questions as mom typically cares for Claudia during the day. He asks to speak with you. Upon scoring the M-CHAT, you note that Claudia failed at least four critical items on the screening tool, as well as at least six other items. You explain to Claudia’s dad that some of his responses about Claudia’s behavior raised concerns about Claudia’s development.

Case Authors • • • •

Rebecca J. Scharf, MD, Children’s Hospital at Montefiore, Albert Einstein College of Medicine Jan Harold Sia, MD, Yale University School of Medicine Demetra Pappas, MD, Children’s Hospital Boston, Harvard Medical School Maris Rosenberg, MD, Children’s Hospital at Montefiore, Albert Einstein College of Medicine

Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

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Screening for Autism Spectrum Disorder

Case Study Part III – Epilogue - Epilogue Matthew’s Matthew’s parents parents return return the the next next week week for for aa follow-up follow-up appointment appointment to to discuss discuss the the results results of of the the screening screening tool, tool, and and you you conduct conduct the the follow-up follow-up interview. interview. On On the the follow-up follow-up interview, interview, Matthew Matthew passes passes all all the the items. items. You You discuss discuss Matthew’s Matthew’s development development with with his his parents parents and and ask ask them them ifif they they have have any any concerns. concerns. They They state state that that they they do do not not at at this this time. time. You You provide provide ideas ideas for for engaging engaging Matthew Matthew in in creative creative play, play, as as well well as as facilitating facilitating speech speech and and language language development, development, and and you you make make another another health health care-maintenance care-maintenance appointment appointment for for Matthew Matthew during during which which you you will will continue continue to to follow follow his his development development progress. progress. Per Per the the AAP AAP recommendations, recommendations, Matthew Matthew should should have have another another ASD-specific ASD-specific screen screen at at 24 24 months months or or earlier earlier ifif the the parents parents or or physician physician have have concerns. concerns. Claudia Claudia and and her her parents parents also also return return the the next next week week so so you you can can obtain obtain further further history history and and complete complete the the M-CHAT M-CHAT follow-up follow-up interview interview with with her her mom mom and and dad. dad. You You were were concerned concerned by by Claudia’s Claudia’s results results on on the the M-CHAT M-CHAT screener, screener, and and you you would would like like to to use use the the follow-up follow-up interview interview to to identify identify the the areas areas of of greatest greatest need need and and where where to to focus focus your your energies. energies. Claudia’s Claudia’s parents’ parents’ responses responses note note continued continued concerns concerns regarding regarding Claudia’s Claudia’s communication communication and and social social skills. skills. For For instance, instance, Claudia Claudia takes takes interest interest in in children, children, but but typically typically does does not not respond respond to to the the presence presence of of others. others. She She does does not not engage engage in in pretend pretend play play and and does does not not play play properly properly with with toys, toys, preferring preferring to to bang bang them them on on the the floor. floor. Although Although she she uses uses her her finger finger to to point, point, she she cries cries and and whines whines when when she she wants wants something something and and does does not not use use gestures gestures or or pointing pointing in in order order to to work work to to gain gain attention attention from from others. others. Claudia Claudia also also does does not not imitate imitate others. others. She She occasionally occasionally responds responds to to her her name, name, but but does does not not respond respond when when she she is is focused focused on on aa preferred preferred activity. activity. She She also also has has been been noted noted to to stare stare at at nothing nothing and and wander. wander. Given Given the the presence presence of of continued continued concerns, concerns, you you speak speak in in depth depth with with Claudia’s Claudia’s parents parents regarding regarding the the possible possible diagnosis autism spectrum disorder based screening measures. note, although some of Claudia’s diagnosis of of an autism spectrum disorder based on on thethe screening measures. Of Of note, although some of Claudia’s initially initially reported behaviors of concern are resolved on the M-CHAT follow-up interview, and Claudia’s dad is unsure reported behaviors of concern are resolved on the M-CHAT follow-up interview, and Claudia’s dad is unsure of someof some of Claudia’s behaviors, there remain enough concerning behaviors to warrant referral for further evaluation. of Claudia’s behaviors, there remain enough concerning behaviors to warrant referral for further evaluation. You You address address the the need need for for aa formal formal evaluation evaluation to to clearly clearly delineate delineate Claudia’s Claudia’s symptoms. symptoms. Claudia’s Claudia’s parents parents are are in in agreement agreement with with the the concerns, concerns, but but also also wonder wonder how how these these results results are are accurate accurate based based on on such such aa short short time time for for observation. observation. You You refer refer Claudia Claudia for for aa hearing hearing evaluation evaluation and and an an assessment assessment by by an an early early intervention intervention specialist. specialist. You You also also refer refer her her for for aa complete complete evaluation evaluation by by aa developmental developmental specialist. specialist. You You schedule schedule aa follow-up follow-up visit visit with with Claudia Claudia and and her her parents parents in in two two months months to to continue continue to to follow follow her her progress progress and and to to ensure ensure that that assessments assessments and and services services are are underway. underway.

Case Authors • • • •

Rebecca J. Scharf, MD, Children’s Hospital at Montefiore, Albert Einstein College of Medicine Jan Harold Sia, MD, Yale University School of Medicine Demetra Pappas, MD, Children’s Hospital Boston, Harvard Medical School Maris Rosenberg, MD, Children’s Hospital at Montefiore, Albert Einstein College of Medicine

Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

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Screening for Autism Spectrum Disorder

Handout I: AAP Screening Guidelines

©

FIGURE 1 Surveillance and screening algorithm: ASDs.

1196

AMERICAN ACADEMY OF PEDIATRICS

Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

Reproduced with permission from Pediatrics Vol. 120, Pages 1096-1097, copyright ©2007 by the AAP

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Screening for Autism Spectrum Disorder Surveillance and Screening Algorithm: Autism Spectrum Disorders (ASDs) 1a - Developmental concerns, including those about social skill deficits, should be included as one of several health topics addressed at each pediatric preventive care visit through the first 5 years of life. (Go to step 2)

1a: Pediatric Patient at Preventive Care Visit

2: Perform Surveillance Score 1 for Each Risk Factor: - Sibling with ASD - Parental Concern - Other Caregiver Concern - Pediatrician Concern

1b:

E xtra Visit for A utism R elated C oncern, A SD R isk Factor, or O ther D evelopm ental/ B ehavioral C oncern

1b – At the parents’ request, or when a concern is identified in a previous visit, a child may be scheduled for a “problem-targeted” clinic visit because of concerns about ASD. Parent concerns may be based on observed behaviors, social or language deficits, issues raised by other caregivers, or heightened anxiety produced by ASD coverage in the media. (Go to step 2)

2 - Developmental surveillance is a flexible, longitudinal, continuous, and cumulative process whereby health care professionals identify children who may have developmental problems. There are 5 components of developmental surveillance: eliciting and attending to the parents’ concerns about their child’s development, documenting and maintaining a developmental history, making accurate observations of the child, identifying the risk and protective factors, and maintaining an accurate record and documenting the process and findings. The concerns of parents, other caregivers, and pediatricians all should be included in determining whether surveillance suggests that the child may be at risk of an ASD. In addition, younger siblings of children with an ASD should also be considered at risk, because they are 10 times more likely to develop symptoms of an ASD than children without a sibling with an ASD. Scoring risk factors will help determine the next steps. (Go to step 3)

For more information on developmental surveillance, see “Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening” (Pediatrics 2006;118:405-420).

3 - Scoring risk factors: 3: What is the Score?

• • •

4: Is this an 18- or 24-Month Visit?

5a: Evaluate SocialCommunication Skills

3a –

If the child does not have a sibling with an ASD and there are no concerns from the parents, other caregivers, or pediatrician: Score=0 (Go to step 4)

3a: Is the Patient at Least 18-Months Old?

If the child has only 1 risk factor, either a sibling with ASD or the concern of a parent, caregiver, or pediatrician: Score=1 (Go to step 3a)



If the child’s age is <18 months, Go to step 5a



If the child’s age is ≥18 months, Go to step 5b

If the child has 2 or more risk factors: Score=2+ (Go to step 8)

4 – In the absence of established risk factors and parental/provider concerns (score=0), a level-1 ASD-specific tool should be administered at the 18- and 24-month visits. (Go to step 5c) If this is not an 18- or 24-month visit, (Go to step 7b). Note: In the AAP policy, “Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening”, a general developmental screen is recommended at the 9-, 18-, and 24-or 30-month visits and an ASD screening is recommended at the 18-month visit. This clinical report also recommends an ASD screening at the 24-month visit to identify children who may regress after 18 months of age.

5a - If the child’s age is <18 months, the pediatrician should use a tool that specifically addresses the clinical characteristics of ASDs, such as those that target socialcommunication skills. (Go to step 6a)

5b: Administer ASDSpecific Screening Tool

5b - If the child’s age is ≥18 months, the pediatrician should use an ASD-specific screening tool. (Go to step 6a)

5c: Administer ASDSpecific Screening Tool

5c – For all children ages 18 or 24 months (regardless of risk factors), the pediatrician should use an ASDspecific screening tool. (Go to step 6b)

AAP-recommended strategies for using ASD screening tools: “Autism: Caring for Children with Autism Spectrum Disorders: A Resource Toolkit for Clinicians” (in press)* 6a: A re th e R e su lts P o sitive o r C o n c e rn in g?

6a – When the result of the screening is negative, Go to step 7a When the result of the screening is positive, Go to step 8

6b: A re th e R e s u lts P o s itiv e o r C o n c e rn in g ?

6b – When the result of the ASD screening (at 18and 24-month visits) is negative, Go to step 7b When the result of the ASD screening (at 18- and 24month visits) is positive, Go to step 8

7a – If the child demonstrates risk but has a negative screening result, information about ASDs should be provided to parents. The pediatrician should schedule an extra visit within 1 month to address any residual ASD concerns or additional developmental/ behavioral concerns after a negative screening result. The child will then re-enter the algorithm at 1b. A “wait-and-see” approach is discouraged. If the only risk factor is a sibling with an ASD, the pediatrician should maintain a higher index of suspicion and address ASD symptoms at each preventive care visit, but an early follow-up within 1 month is not necessary unless a parental concern subsequently arises.

7a: 1. Provide Parental Education 2. Schedule Extra Visit Within 1 Month 3. Re-enter Algorithm at 1b

8: 1. Provide Parental Education 2. Simultaneously Refer for: a. Comprehensive ASD Evaluation b. Early Intervention/Early Childhood Education Services c. Audiologic Evaluation 3. Schedule Follow-up Visit 4. Re-enter Algorithm at 1b

7b – If this is not an 18- or 24-month visit, or when the result of the ASD screening is negative, the pediatrician can inform the parents and schedule the next routine preventive visit. The child will then re-enter the algorithm at 1a. 7b: 1. Schedule Next Preventive Visit 2. Re-enter Algorithm at 1a

8 – If the screening result is positive for possible ASD in step 6a or 6b, the pediatrician should provide peer reviewed and/or consensus-developed ASD materials. Because a positive screening result does not determine a diagnosis of ASD, the child should be referred for a comprehensive ASD evaluation, to early intervention/early childhood education services (depending on child’s age), and an audiologic evaluation. A categorical diagnosis is not needed to access intervention services. These programs often provide evaluations and other services even before a medical evaluation is complete. A referral to intervention services or school also is indicated when other developmental/behavioral concerns exist, even though the ASD screening result is negative. The child should be scheduled for a follow-up visit and will then re-enter the algorithm at 1b. All communication between the referral sources and the pediatrician should be coordinated.

AAP information for parents about ASDs includes: “Is Your One-Year-Old Communicating with You?*” and “Understanding Autism Spectrum Disorders.*”

*Available at www.aap.org

FIGURE 1 Continued

Reproduced with permission from Pediatrics Vol. 120, Pages 1096-1097, copyright ©2007 by the AAP PEDIATRICS Volume 120, Number 5, November 2007

Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

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18–48 mo

9–24 mo

Pervasive Developmental Disorders Screening Test-II, Primary Care Screener (PDDST-II, PCS)

Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP) Infant-Toddler Checklist Screener is administered by trained examiners

Parentcompleted questionnaire

Parentcompleted questionnaire

20 min

5–10 min

24 items

12 activities that look at play, imitation, communication

10–15 min

5–10 min

10 min

5 min

Time to Complete

22 items

23 items

37 items

Section A: 9 yes/no parent questions Section B: 5 clinician observations

Items

Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

24–36 mo

Broadband screener used to detect communication delays including in children with ASD

16–30 mo

Modified Checklist for Autism in Toddlers (M-CHAT)

Screening Tool for Autism in 2-Year Olds (STAT)

Parentcompleted questionnaire

4–11 yr

Childhood Autism Spectrum Test (CAST)

Interview or questionnaire + observations

18–24 mo+

Checklist for Autism in Toddlers (CHAT)

Format

Ages

Screener

not applicable

English, Chinese, German, Slovenian, Spanish

English, Spanish

Arabic, Bangla, Chinese, Dutch, French, German, Greek, Gujarti, Icelandic, Japanese, Kannada, Kurdish, Portuguese, Sinhala, Somalian, Spanish, Tamil, Turkish, Vietnamese, Urdu

English, Dutch, French, Greek, Persian, Slovak, Slovenian, Spanish, Swedish

English, Dutch, Greek, Persian, Spanish, Swedish

Available Languages

Handout II: Screening Tools Chart

Screening for Autism Spectrum Disorders

http://kc.vanderbilt.edu/triad/ training/page.aspx?id=821

http://firstwords.fsu.edu/pdf/ checklist.pdf

http://firstwords. fsu.edu/pdf/ Checklist_Scoring_ Cutoffs.pdf

www.firstsigns. org/downloads/ Downloads_ archive/m-chat_ scoring.PDF

http://autismresearchcentre. com/arc_tests http://www. firstsigns.org/screening/tools/ rec.htm

Available for purchase at: http://www. pearsonassessments.com/ haiweb/cultures/en-us/ productdetail.htm?pid=0761635-106&Community=CA_ Ed_AI_Early

www.autismresearchcentre.com/ tests/cast_test.asp

www.ny2aap.org/ CHATscoring.pdf

Scoring Templates and Instructions

http://autismresearchcentre. com/arc_tests

http://autismresearchcentre. com/arc_tests

Information and Free Downloadable Templates

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Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

Suggested Citation: Scharf RJ. Sia JH, Pappas D. Rosenberg M. Screening Tools Chart. Developed for the Autism Case Training A DevelopmentBehavioral Pediatrics Curriculum. 2011.

PDDST-II Pervasive Developmental Disorders Screening Test-II (PDDST-II). American Speech-Language-Hearing Association website. http://www.asha.org/SLP/ assessment/Pervasive-Developmental-Disorders-Screening-Test-II-(PDDST-II).htm.

Robins DL. M-CHAT Information. http://www2.gsu.edu/~psydlr/Diana_L._Robins,_Ph.D..html

Robins D, Fein D, Barton M, Green JA. The Modified-Checklist for Autism in Toddlers (M-CHAT): an initial investigation in the autism and pervasive developmental disorders. J Autism Dev Disord. 2001;31:131-44.

Dumont-Mathieu T, Fein D. Screening for autism in young children: the Modified Checklist for Autism in Toddlers (M-CHAT) Ment Retar Dev Disabil Res Rev. 2005;11:253-62.

M_CHAT Robins D, Fein D. Barton M. Modified Checklist for Autism in Toddlers. MCHAT. http://autismresearchcentre.com/arc_tests.

Scott FJ, Baron-Cohen S, Bolton P, Brayne C. The CAST (Childhood Asperger Syndrone Test): preliminary development of mainstream primary-school age children. Autism. 2002;6-9-31.

CAST Childhood Autism Spectrum Test (CAST). Autism Research Centre website. http://autismresearchcentre.com/arc_tests March 12, 2013.

Baird G. Charman T. Baron-Cohen S. A screening instrument for autism at 18 months of age: a 6 year follow-up study. J A Psychiatry.2000;39:694-702.

CHAT Checklist for Autism in Toddlers (CHAT). Autism Research Centre website. http://autismresearchcentre.com/arc_tests. March 12, 2013.

Schonwald A. Developmental Screening Tool Kit for Primary Care Providers. 2006-2007. www.developmentalscreening.org.

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Overall Johnson CP, Myers SM, Council on Children with Disabilities. American Academy of Pediatrics. Identification and Evaluation Autism Spectrum Disorders. Pediatrics. 2007;120(5);1183-215.

Screening Tools Chart References

Screening for Autism Spectrum Disorders

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Screening for Autism Spectrum Disorder

Handout III: Blank M-CHAT Form

© 1999 Diana Robins, Deborah Fein, & Marianne Barton

Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

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Screening for Autism Spectrum Disorder

Please fill out the following about how your child usually is. Please try to answer every question. If the behavior is rare (e.g., you've seen it once or twice), please answer as if the child does not do it.

Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

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Screening for Autism Spectrum Disorder

Handout IV: M-CHAT for Matthew

Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

:30

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Screening for Autism Spectrum Disorder

Handout V: M-CHAT Form for Claudia

Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

:30

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Screening for Autism Spectrum Disorder

Handout VI: M-CHAT Scoring Instructions

Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

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Screening for Autism Spectrum Disorder

Handout VII: M-CHAT Follow-Up Interview

Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

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Screening for Autism Spectrum Disorder

Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

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Screening for Autism Spectrum Disorder 1. You reported that ____________ does not enjoy being swung, bounced on your knee, etc. Is this still true? NO

YES

Then s/he does enjoy being bounced or swung?

YES

NO When you swing or bounce him/her, how does s/he react?

PASS

Laughs or smiles?

Yes

No

Requests more by holding out his/her arms?

Yes

No

Talks or babbles?

Yes

No

Other (Describe): ____________________________________ ___________________________________________________

If NO to all

If YES to any specific examples

FAIL

PASS

If other is clearly a positive response

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

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Screening for Autism Spectrum Disorder 2. You reported that ____________ does not take interest in other children. (Critical) Is this still true? NO

YES

Then your child does take an interest in other children?

YES

NO When you are at the playground or supermarket, does your child usually respond to the presence of another child?

Is he/she interested in children who are not his/her brother or sister?

YES

NO

PASS

YES

NO

How does your child respond? (Ask all)

Plays with the other child?

Yes

No

Aggressive behavior?

Yes

No

Talks to the other child? Vocalizes?

Looks at the other child? Smiles at the other child ?

Yes Yes Yes Yes

No NO to all

No

FAIL

No No

If YES to any:

Does s/he (fill in responses given heree.g. plays, talks, smiles, looks, or vocalizes) more than half of the time?

NO

FAIL

YES

PASS

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

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Screening for Autism Spectrum Disorder 3. You reported that ____________ does not like climbing on things, such as up stairs. Is this still true? NO

YES

Then s/he does like climbing on things?

Then s/he does not like climbing on things?

YES

NO

PASS Does he/she enjoy climbing on... ...stairs?

Yes

No

...furniture?

Yes

No

...chairs? ...playground equipment?

Yes Yes

If YES to any

If NO to all

PASS

FAIL

No No

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

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Screening for Autism Spectrum Disorder 4. You reported that ____________ does not enjoy playing peek-a-boo / hide-and-seek. Is this still true? NO

YES

Then your child does enjoy playing peek-a-boo or hide and seek?

YES

NO YES

PASS

Does your child like any games that involve a back-and-forth exchange with another person?

NO Examples

________________________________ ________________________________

________________________________

What does s/he do if you try to play a game like peeka-boo or pat-a-cake (or example given) with him/her?

Smiles/laughs?

Yes

No

Refuses to play?

Yes

No

Requests more verbally?

Yes

No

Not interested in those games? Yes

No

Vocalizes pleasure?

Requests more nonverbally?

Yes Yes

If YES only to example(s) from above

PASS

No No

Cries?

Leaves situation if parent initiates Yes

If YES to examples from both

Pass response

Yes

What is more typical?

No No

If YES only to example(s) from above

Fail response

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

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Screening for Autism Spectrum Disorder 5. You reported that ____________ does not ever pretend, for example, to talk on the phone or take care of dolls, or pretend other things. Is this still true? NO

YES

Then your child does pretend play?

YES

NO YES

Can you give me an example?

Does he/she ever play make believe?

NO

If parent gives any examples listed, it is a pass.

If NO, ask examples individually

Push a car on a pretend road?_____ Does he/she put a toy pot on stove or stir imaginary food?_____ Pretend to vacuum or mow lawn?_____ Feed self with a toy spoon or empty cup?_____

Pretend to be a robot, an airplane, a ballerina, or any other favorite character?_____ Put an action figure or doll into a toy car or truck?_____ Pretend to talk on the telephone?______

Feed a doll with real or imaginary food?_____

If parent gave any example listed

If parent did not give any example listed

PASS

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

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Screening for Autism Spectrum Disorder 6. You reported that ____________ does not use his/her pointer finger to point, to ask for something. Is this still true? NO

YES

Then your child does use his/her pointer finger in order to ask for something?

YES

NO

If there is something your child wants this is out of reach, such as a cookie up on a counter, how does he/she get it?

PASS

Points?_____

Reaches for the object with the whole hand?_____ Leads the parent to the object?_____

Tries to get the object for him/herself?_____ Asks for it?_____

If responds with any of the above:

If you said “Show me,” would he/she point at it?

PASS

YES

NO

FAIL ©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

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Screening for Autism Spectrum Disorder 7. You reported that ____________ does not use his/her pointer finger to point, to indicate interest in something, (Critical) Is this still true? NO

YES

Then your child does use his/her pointer finger in order to point to indicate interest in something?

YES

NO

PASS

Does your child ever want you to see something interesting such as... YES

...an airplane in the sky?

Yes

No

...a bug on the ground?

Yes

No

...a truck on the road?

...an animal in the yard?

NO

Is this to indicate interest, not to get help?

NO

YES

Yes

No No

NO

How does your child draw your attention to it? Would he/she point with his/her pointer finger?

YES

Yes

FAIL

PASS

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

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Screening for Autism Spectrum Disorder 8. You reported that ____________ does not play properly with small toys (e.g. cars or blocks) without just mouthing, fiddling, or dropping them. Is this still true? NO

YES

Then your child does know how to play properly with small toys?

YES

NO

Can you give me an example?

How does he/she play with toys?

PASS

FAIL

Stacks blocks?_____

Puts toys in mouth?_____

Plays with cars/trucks?_____

Doesn’t play with toys?_____

Does simple puzzles?_____

Throws toys?_____

Plays with a shape sorter?_____

Swallows pieces?_____

Stacks rings on a stick?_____

Lines toys up?_____

Nests cups inside each other?_____

If YES only to example(s) from above

PASS

Carries one toy around the house?_____ Stares at toys?_____

If YES to examples from both

Pass response

What is more typical?

If YES only to example(s) from above

Fail response

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

35

Screening for Autism Spectrum Disorder 9. You reported that ____________ does not bring objects over to you (parent) to show you something. (Critical) Is this still true? NO

YES

Then your child does bring objects over to show you?

YES

NO

PASS

Does your child sometimes bring you:

A picture or toy just to show you?_____ A drawing he/she has done?_____ A flower he/she has picked?_____

A bug he/she has found in the grass?_____ If YES to any:

YES

NO

Is this just to show you, not to get help?

YES

NO

FAIL

PASS

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

36

Screening for Autism Spectrum Disorder 10. You reported that ____________ does not look you in the eye for more than a second or two. Is this still true? NO

YES

Then your child does look you in the eyes for more than a second or two?

YES

NO Does s/he look you in the eyes when s/he needs something?_____

PASS

When playing with you?_____ During feeding?_____

During diaper changes?_____

When you are reading him/her a story?_____

YES only to one

Does your child look you in the eyes every day?

On a day when you are together all day, does he/she look you in the eyes at least 5 times?

YES

YES to two or more

NO to all

PASS

FAIL

NO

FAIL YES

NO

PASS

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

37

Screening for Autism Spectrum Disorder 11. You reported that ____________ sometimes seems oversensitive to noise. Is this still true? NO

YES

Then your child does not seem oversensitive to noise?

Does your child have a negative reaction to the sound of: (ask as needed)... A washing machine?_____ Babies crying?_____

NO, he/she does not

YES, he/she does

Babies squealing or screeching?_____ Vacuum cleaner?_____ Sirens?_____ Traffic?_____

PASS If YES to two or more, continue:

Doors slamming?_____ Loud music?_____

Telephone/doorbell ringing?

Noisy places such as the supermarket or

How does your child react to (list noise that child does not like?

restaurant?_____

Other (describe): _____________________ ____________________________________

PASS

FAIL

Calmly covers ears?_____ Expresses displeasure verbally?_____

If YES only to example(s) from above

PASS

Pass response

If YES only to one

Screams?_____ Cries?_____

PASS

Covers ears while upset?___

If YES to examples from both

What is more typical?

If YES only to example(s) from above

Fail response

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

38

Screening for Autism Spectrum Disorder 12. You reported that ____________ does not smile in response to your face or your smile. Is this still true? NO

YES

Then your child does smile in response to your face or your smile?

YES

NO

PASS

What ____________ smile? How makes does he/she play with toys? Ask specifically about below examples if parent does not give any:

PASS

FAIL

Smiles when parent smiles?_____

Always smiling?_____

Smiles when parent returns?_____

Smiles randomly or at nothing in particular?_____

Smiles when parent enters room?_____

If YES only to example(s) from above

Smiles at favorite toy or activity?_____

If YES to examples from both

PASS

If YES only to example(s) from above

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

39

Screening for Autism Spectrum Disorder 13. You reported that ____________ does not usually imitate you. (Critical) Is this still true? NO

YES

Then your child does imitate you?

YES

NO

Does your child copy you if you:...

PASS

If YES to two or more

Stick out your tongue?

Yes

No

Wave good bye?

Yes

No

Make a funny sound?

Clap your hands?

Put your fingers to your lips to signal “Shhh”? Blow a kiss?

Yes Yes Yes Yes

No No No No

If YES to one or none

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

40

Screening for Autism Spectrum Disorder 14. You reported that ____________ does not respond to his/her name when you call. (Critical) Is this still true? NO

YES

Then your child does respond to his/her name?

If he/she is not doing anything particularly fun or absorbing, would he/she usually respond to his/her name being called?

YES

NO

NO

YES

PASS

PASS What does he/she do when you call his/her name? If parent does not spontaneously respond, ask below examples:

PASS

FAIL

Looks up?_____

No response?_____

Stops what he/she is doing?_____

Parent needs to be in child’s face?_____

Talks or babbles?_____

If YES only to example(s) from above

PASS

Seems to hear but ignores parent?_____ Responds only if touched?_____

If YES to examples from both

Pass response

What is more typical?

If YES only to example(s) from above

Fail response

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

41

Screening for Autism Spectrum Disorder 15. You reported that if you point at a toy across the room, ____________ does not look at it. (Critical) Is this still true? NO

YES

Then your child does look at objects that you point to?

YES

NO

PASS

If you point at something, what does your child typically do? If parent does not spontaneously respond, ask below examples:

PASS

FAIL

Looks at object?_____

Ignores parent?_____

Looks and comments on object?_____

Looks at parent’s finger?_____

Points to it?_____

Looks around room randomly?_____

Looks if parent points and says “look”?_____

If YES only to example(s) from above

PASS

If YES to examples from both

Pass response

What is more typical?

If YES only to example(s) from above

Fail response

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

42

Screening for Autism Spectrum Disorder 16. You reported that your child does not walk. Is this still true? NO

YES

Then s/he does enjoy being bounced or swung?

YES

NO

PASS

FAIL

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

43

Screening for Autism Spectrum Disorder 17. You reported that ____________ does not look at things you are looking at. Is this still true? NO

YES

Then your child does look at things you are looking at?

YES

NO

PASS

What does s/he do when you are looking at something? If parent does not spontaneously respond, ask below examples:

PASS

FAIL

Looks at object you are looking at?_____

Ignores?_____

Points to object?_____

Looks around to see what you are looking at?____

If YES only to example(s) from above

PASS

Looks at parent’s face?_____

If YES to examples from both

Pass response

What is more typical?

If YES only to example(s) from above

Fail response

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

44

Screening for Autism Spectrum Disorder 18. You reported that ____________ makes unusual finger movements near his/her face. Is this still true? NO

YES

Then s/he does not make any unusual finger movements?

NO

YES

PASS

Please descibe these movements If parent does not spontaneously respond, ask below examples:

PASS

FAIL

Looks at hands?_____

Moves fingers when playing peek-a-boo?_____

Wiggles his/her fingers near his/her eyes?_____ Holds hands up close to eyes?_____

Holds hands off to the side of his/her eyes?____ Flaps hands near face?_____

Other (describe): _________________________

_______________________________________

If YES to any fail response

Does this happen more than twice a week?

PASS

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

NO

YES

FAIL 45

Screening for Autism Spectrum Disorder 19. You reported that ____________ does not try to attract your attention to his/her own activity. Is this still true? NO

YES

Then s/he does try to attract your attention to his/her own activity?

YES

NO (Ask each item)

PASS

Does he/she.... Say “Look!” or “Watch me!”?_____

Bring a toy or activity to show you (parent)?_____

Look expectantly to get praise or comment?_____

Keep looking to see if you’re (parent) looking?_____

If YES to any or sometimes two or more

If YES to none or sometimes to one or fewer

PASS

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

46

Screening for Autism Spectrum Disorder 20. Have you wondered if your child is deaf?

NO

YES

Then you haven’t wondered if he/she is deaf?

NO

YES, I have

PASS

What led you to wonder that? __________________ __________________________________________ __________________________________________ Did he/she frequently ignore sounds?_____ Did he/she often ignore people?_____

If NO to second and third questions

If YES to either second or third questions

PASS

FAIL

Ask all parents: Has your child’s hearing been tested? If YES, what were the results? Note results: _____ Hearing impaired _____ Hearing in normal range - If hearing is impaired > PASS - If parents report that they wondered about their child’s hearing only as part of a routine checkup > PASS - Regardless of hearing test results, if child ignores sounds or people > FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

47

Screening for Autism Spectrum Disorder 21. You reported that ____________ does not understand what people say. Is this still true? NO

YES

Then he/she does understand what people say?

YES

NO When the situation gives him/her a clue, can he/she follow a command? For example, when you are dressed to go out and you tell him/her to get his/her shoes...

PASS

If NO or sometimes

YES

If it is dinnertime and food is on the table, and you tell the child to sit down, will he/he come sit at the table?

NO

YES

When the situation does not give any clues, can he/ she follow a command (e.g., “show me your shoe” without any gestures)? Use other examples as needed: “Bring me the book”; “Bring me my keys”.

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

NO

YES

FAIL

PASS 48

Screening for Autism Spectrum Disorder 22. You reported that ____________ sometimes stares at nothing or wanders with no purpose. Is this still true? NO

YES

Then your child does not stare at nothing or wander with no purpose?

Can you give me some examples of this behavior? _________________________________________ _________________________________________

NO

YES

_________________________________________

PASS

(If not stated above) Does your child often stare off into space?

NO Note (only if parent asks): these behaviors need to last for at least a couple of minutes.

YES

(If not stated above) Does he/she like to walk around the edges of the room instead of settling down with an activeity?

YES to either example NO to both examples Does he/she do this behavior (fill in behavior parent

indicated) often - at least several times per week?_____ Does he/she walk in circles (not in play to make self dizzy) often - at least several times per week?_____

YES to either

PASS

NO to both

YES

PASS

NO

FAIL

Does he/she do this only when tired?

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

49

Screening for Autism Spectrum Disorder 23. You reported that ____________ does not usually look at your face to check your reaction when faced with something unfamiliar and a little scary. Is this still true? NO

YES

Then he/she does look at your face to check your reaction when faced with something scary?

If your child hears an unfamiliar or scary noise, will he/she look at you before deciding how to respond?

YES

NO

NO

YES

PASS Does your child look at you when someone new approaches?

NO

YES

PASS

What does your child do when faced with something unfamiliar and a little scary?

Sometimes or probably looks at parent’s reaction?_____

PASS

Probably does not look at parent’s reaction?_____

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

50

Screening for Autism Spectrum Disorder

Handout VIII: M-CHAT Follow-Up Interview for Matthew:30 5. You reported that ____________ does not ever pretend, for example, to talk on the phone or take care of dolls, or pretend other things. Is this still true? NO

YES

Then your child does pretend play?

YES

NO YES

Can you give me an example?

Does he/she ever play make believe?

NO

If parent gives any examples listed, it is a pass.

If NO, ask examples individually

Push a car on a pretend road?_____ Does he/she put a toy pot on stove or stir imaginary food?_____ Pretend to vacuum or mow lawn?_____ Feed self with a toy spoon or empty cup?_____

Pretend to be a robot, an airplane, a ballerina, or any other favorite character?_____ Put an action figure or doll into a toy car or truck?_____ Pretend to talk on the telephone?______

Feed a doll with real or imaginary food?_____

If parent gave any example listed

If parent did not give any example listed

PASS

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

51

Screening for Autism Spectrum Disorder 10. You reported that ____________ does not look you in the eye for more than a second or two. Is this still true? NO

YES

Then your child does look you in the eyes for more than a second or two?

YES

NO Does s/he look you in the eyes when s/he needs something?_____

PASS

When playing with you?_____ During feeding?_____

During diaper changes?_____

When you are reading him/her a story?_____

YES only to one

Does your child look you in the eyes every day?

On a day when you are together all day, does he/she look you in the eyes at least 5 times?

YES

YES to two or more

NO to all

PASS

FAIL

NO

FAIL YES

NO

PASS

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

52

Screening for Autism Spectrum Disorder 23. You reported that ____________ does not usually look at your face to check your reaction when faced with something unfamiliar and a little scary. Is this still true? NO

YES

Then he/she does look at your face to check your reaction when faced with something scary?

If your child hears an unfamiliar or scary noise, will he/she look at you before deciding how to respond?

YES

NO

NO

YES

PASS Does your child look at you when someone new approaches?

NO

YES

PASS

What does your child do when faced with something unfamiliar and a little scary?

Sometimes or probably looks at parent’s reaction?_____

PASS

Probably does not look at parent’s reaction?_____

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

53

Screening for Autism Spectrum Disorder

Handout IX: M-CHAT Follow-Up Interview for Claudia

:30

2. You reported that ____________ does not take interest in other children. (Critical) Is this still true? NO

YES

Then your child does take an interest in other children?

YES

NO When you are at the playground or supermarket, does your child usually respond to the presence of another child?

Is he/she interested in children who are not his/her brother or sister?

YES

NO

PASS

YES

NO

How does your child respond? (Ask all)

Plays with the other child?

Yes

No

Aggressive behavior?

Yes

No

Talks to the other child? Vocalizes? Looks at the other child?

Smiles at the other child ?

Yes Yes Yes Yes

No NO to all

No

FAIL

No No

If YES to any:

Does s/he (fill in responses given heree.g. plays, talks, smiles, looks, or vocalizes) more than half of the time?

Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

NO

FAIL

YES

PASS 54

Screening for Autism Spectrum Disorder 5. You reported that ____________ does not ever pretend, for example, to talk on the phone or take care of dolls, or pretend other things. Is this still true? NO

YES

Then your child does pretend play?

YES

NO YES

Can you give me an example?

Does he/she ever play make believe?

NO

If parent gives any examples listed, it is a pass.

If NO, ask examples individually

Push a car on a pretend road?_____ Does he/she put a toy pot on stove or stir imaginary food?_____ Pretend to vacuum or mow lawn?_____ Feed self with a toy spoon or empty cup?_____

Pretend to be a robot, an airplane, a ballerina, or any other favorite character?_____ Put an action figure or doll into a toy car or truck?_____ Pretend to talk on the telephone?______

Feed a doll with real or imaginary food?_____

If parent gave any example listed

If parent did not give any example listed

PASS

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

55

Screening for Autism Spectrum Disorder 6. You reported that ____________ does not use his/her pointer finger to point, to ask for something. Is this still true? NO

YES

Then your child does use his/her pointer finger in order to ask for something?

YES

NO

If there is something your child wants this is out of reach, such as a cookie up on a counter, how does he/she get it?

PASS

Points?_____

Reaches for the object with the whole hand?_____ Leads the parent to the object?_____

Tries to get the object for him/herself?_____ Asks for it?_____

If responds with any of the above:

If you said “Show me,” would he/she point at it?

PASS

YES

NO

FAIL ©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

56

Screening for Autism Spectrum Disorder 7. You reported that ____________ does not use his/her pointer finger to point, to indicate interest in something, (Critical) Is this still true? NO

YES

Then your child does use his/her pointer finger in order to point to indicate interest in something?

YES

NO

PASS

Does your child ever want you to see something interesting such as... YES

...an airplane in the sky?

Yes

No

...a bug on the ground?

Yes

No

...a truck on the road? ...an animal in the yard?

NO

Is this to indicate interest, not to get help?

NO

YES

Yes

No No

NO

How does your child draw your attention to it? Would he/she point with his/her pointer finger?

YES

Yes

FAIL

PASS

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

57

Screening for Autism Spectrum Disorder 8. You reported that ____________ does not play properly with small toys (e.g. cars or blocks) without just mouthing, fiddling, or dropping them. Is this still true? NO

YES

Then your child does know how to play properly with small toys?

YES

NO

Can you give me an example?

How does he/she play with toys?

PASS

FAIL

Stacks blocks?_____

Puts toys in mouth?_____

Plays with cars/trucks?_____

Doesn’t play with toys?_____

Does simple puzzles?_____

Throws toys?_____

Plays with a shape sorter?_____

Swallows pieces?_____

Stacks rings on a stick?_____

Lines toys up?_____

Nests cups inside each other?_____

If YES only to example(s) from above

PASS

Carries one toy around the house?_____ Stares at toys?_____

If YES to examples from both

Pass response

What is more typical?

If YES only to example(s) from above

Fail response

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

58

Screening for Autism Spectrum Disorder 9. You reported that ____________ does not bring objects over to you (parent) to show you something. (Critical) Is this still true? NO

YES

Then your child does bring objects over to show you?

YES

NO

PASS

Does your child sometimes bring you:

A picture or toy just to show you?_____

A drawing he/she has done?_____ A flower he/she has picked?_____

A bug he/she has found in the grass?_____

If YES to any:

YES

NO

Is this just to show you, not to get help?

YES

NO

FAIL

PASS

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

59

Screening for Autism Spectrum Disorder 10. You reported that ____________ does not look you in the eye for more than a second or two. Is this still true? NO

YES

Then your child does look you in the eyes for more than a second or two?

YES

NO Does s/he look you in the eyes when s/he needs something?_____

PASS

When playing with you?_____ During feeding?_____

During diaper changes?_____

When you are reading him/her a story?_____

YES only to one

Does your child look you in the eyes every day?

On a day when you are together all day, does he/she look you in the eyes at least 5 times?

YES

YES to two or more

NO to all

PASS

FAIL

NO

FAIL YES

NO

PASS

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

60

Screening for Autism Spectrum Disorder 13. You reported that ____________ does not usually imitate you. (Critical) Is this still true? NO

YES

Then your child does imitate you?

YES

NO

Does your child copy you if you:...

PASS

If YES to two or more

Stick out your tongue?

Yes

No

Wave good bye?

Yes

No

Make a funny sound? Clap your hands?

Put your fingers to your lips to signal “Shhh”? Blow a kiss?

Yes Yes Yes Yes

No No No No

If YES to one or none

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

61

Screening for Autism Spectrum Disorder 14. You reported that ____________ does not respond to his/her name when you call. (Critical) Is this still true? NO

YES

Then your child does respond to his/her name?

If he/she is not doing anything particularly fun or absorbing, would he/she usually respond to his/her name being called?

YES

NO

NO

YES

PASS

PASS What does he/she do when you call his/her name? If parent does not spontaneously respond, ask below examples:

PASS

FAIL

Looks up?_____

No response?_____

Stops what he/she is doing?_____

Parent needs to be in child’s face?_____

Talks or babbles?_____

If YES only to example(s) from above

PASS

Seems to hear but ignores parent?_____ Responds only if touched?_____

If YES to examples from both

Pass response

What is more typical?

If YES only to example(s) from above

Fail response

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

62

Screening for Autism Spectrum Disorder 20. Have you wondered if your child is deaf?

NO

YES

Then you haven’t wondered if he/she is deaf?

NO

YES, I have

PASS

What led you to wonder that? __________________ __________________________________________ __________________________________________ Did he/she frequently ignore sounds?_____ Did he/she often ignore people?_____

If NO to second and third questions

If YES to either second or third questions

PASS

FAIL

Ask all parents: Has your child’s hearing been tested? If YES, what were the results? Note results: _____ Hearing impaired _____ Hearing in normal range - If hearing is impaired > PASS - If parents report that they wondered about their child’s hearing only as part of a routine checkup > PASS - Regardless of hearing test results, if child ignores sounds or people > FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

63

Screening for Autism Spectrum Disorder 21. You reported that ____________ does not understand what people say. Is this still true? NO

YES

Then he/she does understand what people say?

YES

NO When the situation gives him/her a clue, can he/she follow a command? For example, when you are dressed to go out and you tell him/her to get his/her shoes...

PASS

If NO or sometimes

YES

If it is dinnertime and food is on the table, and you tell the child to sit down, will he/he come sit at the table?

NO

YES

When the situation does not give any clues, can he/ she follow a command (e.g., “show me your shoe” without any gestures)? Use other examples as needed: “Bring me the book”; “Bring me my keys”.

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

NO

YES

FAIL

PASS 64

Screening for Autism Spectrum Disorder 22. You reported that ____________ sometimes stares at nothing or wanders with no purpose. Is this still true? NO

YES

Then your child does not stare at nothing or wander with no purpose?

Can you give me some examples of this behavior? _________________________________________ _________________________________________

NO

YES

_________________________________________

PASS

(If not stated above) Does your child often stare off into space?

NO Note (only if parent asks): these behaviors need to last for at least a couple of minutes.

YES

(If not stated above) Does he/she like to walk around the edges of the room instead of settling down with an activeity?

YES to either example NO to both examples Does he/she do this behavior (fill in behavior parent

indicated) often - at least several times per week?_____ Does he/she walk in circles (not in play to make self dizzy) often - at least several times per week?_____

YES to either

PASS

NO to both

YES

PASS

NO

FAIL

Does he/she do this only when tired?

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

65

Screening for Autism Spectrum Disorder

23. You reported that ____________ does not usually look at your face to check your reaction when faced with something unfamiliar and a little scary. Is this still true? NO

YES

Then he/she does look at your face to check your reaction when faced with something scary?

If your child hears an unfamiliar or scary noise, will he/she look at you before deciding how to respond?

YES

NO

NO

YES

PASS Does your child look at you when someone new approaches?

NO

YES

PASS

What does your child do when faced with something unfamiliar and a little scary?

Sometimes or probably looks at parent’s reaction?_____

PASS

Probably does not look at parent’s reaction?_____

FAIL

©1999 Robins, Fein, & Barton Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum

66

Screening for Autism Spectrum Disorder

References Baron-Cohen S, Cox A, Baird G, et al. Psychological markers in the detection of autism in infancy in a large population. Br J Psychiatry. 1996,168(2):158-63. Council for Children with Disabilities, Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening. Pediatrics. 2006,118(4):1808-9. Dosreis S, Weiner CL. Autism spectrum disorder screening and management practices among general pediatric providers. J Dev Behav Pediatr. 2006;27(2):S88-94. Drotar D, Stancin T, Dworkin PH, Sices L, Wood S. Selecting developmental surveillance and screening tools. Pediatr Rev. 2008;29(10):E52-8. Gray LA, Msall ER, Msall ME. Communicating about autism: decreasing fears and stresses through parentprofessional partnerships. Infants Young Child. 2008;21(4):256-71. Johnson CP, Myers SM, Council on Children with Disabilities. Identification and evaluation of children with autism spectrum disorders. Pediatrics. 2007;120:1183-215. Kleinman JM Robins DL, Ventola PE, et al. The Modified Checklist for Autism in Toddlers: a follow-up study investigating the early detection of autism spectrum disorders. J Autism Dev Disord. 2008;38(5):827-39. Mayes, SD, Calhoun SL, Murray MJ, et al. Comparison of scores on the Checklist for Autism Spectrum Disorder, Childhood Autism Rating Scale, and Gilliam Asperger’s Disorder Scale for children with low functioning autism, high functioning autism, Asperger’s disorder, ADHD, and typical development. J Autism Dev Disord. 2009;39:1682-93. Ozonoff S, Goodlin-Jones B. Solomon M. Evidence-based assessment of autism spectrum disorders in children and adolescents. J Clin Child Adolesc Psychol. 2005;34(3):523-40. Sices L, Feudtner C, McLaughlin J, Drotar D, Williams M. How do primary care physicians identify young children with developmental delays? A national survey. J Dev Behav Pediatr.2003;24(6);409-17. Zwaigenbaum L, Bryson S, Lord C, et al. Clinical assessment and management of toddlers with suspected autism spectrum disorder: insights from studies of high-risk infants. Pediatrics. 2009;123(5):1383-91.

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Screening for Autism Spectrum Disorder Handouts

Screening for Autism Spectrum Disorder Case Worksheet for Learners Case Goal Early identification of autism spectrum disorder (ASD) and referral for...

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