Autism is common disorder of childhood affecting 1 in 500 children

Often unrecognized and undiagnosed until or after late pre school age Appropriate tools for routine developmental screening and screening specifically for autism very limited

Autistic disorder is a pervasive development disorder defined behaviorally as a syndrome consisting of :

Abnormal development of social skills (withdrawal, lack of interest in peers) Limitations in the use of interactive language (speech as well as non verbal communication), and Sensorimotor deficits (inconsistent responses to environmental stimuli)

Early identification and early intervention during the toddler and preschool years

improves outcome for most young
children with autism

CHECKLIST FOR AUTISM IN TODDLER (CHAT)
SECTION A: Ask parent 1. Does your child enjoy being swung, bounced on your knee, etc? 2. Does tour child take an interest in other children? 3. Does your child like climbing on things, such as up stairs? 4. Does your child enjoy playing peek-a-boo/hide-and-seek? 5. Does your child ever PRETEND, for example, to make a cup of tea using a toy cup and teapot, or pretend other things?a 6. Does your child ever use his/her index finger to point, to ASK for something? 7. Does your child ever use his/her index finger to point, to indicate INTEREST in something? 8. Can your child play properly with small toys (e.g. cars or blocks) without just mouthing, fiddling or dropping them? 9. Does your child ever bring objects over to you (parent) to SHOW you something? YES NO

YES YES YES YES

NO NO NO NO

YES YES YES YES

NO NO NO NO

…..Chat in toddler
SECTION B: GP or HV observation i. During the appointment, has the child made eye contact with you? ii. Get child’s attention, then point across the room at an interesting object and say “Oh look! There’s a [name of toy]!” Watch child’s face. Does the child look across to see what you are pointing at? iii. Get the child’s attention, then give child a miniature to cup and teapot and say ”Can you make a cup of tea?” Does the child pretend to pour out tea, drink it, etc?b iv. Say to the child ”Where’s the light?” or “Show me the light.” Does the child POINT with his/her index finger at the light? v. Can the child build a tower of bricks? (If so, how many?) (Number of bricks:---------)

YES YES

NO NO*

YES YES

NO# NO+

YES

NO

Baron-Cohen et all., (1992), British Journal of Psychiatry Vol 161, p. 842)

KEY and NON - KEY ITEMS
Section A CHAT key items
A5 : Pretend play A7 : Protodeclarative pointing
A1 : Rough and tumble play A2 : Social interest A3 : Motor development A4 : Social play A6 : Protoimperative pointing A8 : Functional play A9 : Showing

CHAT non key items

Section B CHAT key items
Bii : Following a point Biii : Pretending Biv : Producing a point Bi : Eye contact Bv : Tower of bricks

CHAT non key items

RISK ASSIGNMENT
High risk for autism group Fail A5, A7, Bii, Biii, Biv Medium risk for autism group Fail A7, Biv (but not in maximum risk group) Low risk for autism group Not in other two risk group

Who should use the CHAT and when

The CHAT is designed to be administered by primary healthcare workers or clinician in children’s services
As a screening tool, it is convenient to administer at the eighteen-month development check-up

What happens if a child fails the CHAT

Those child who failed this CHAT were rescreened about one month later with the same questioner A second CHAT is advisable so as to check that a “fail” on a key item occurs for valid reasons Any child failing the CHAT a second time should however be referred to a specialist clinic for diagnosis

ASSESSMENT
The purpose of assessment is to confirm the diagnosis; seek an underlying cause; assess strengths and weaknesses in the child and associated developmental and mental health impairments (comorbodities); assess family needs; and identify the resources to meet the needs
The use of DSM-IV and any of the several autism-specific diagnostic inventories substantially increases diagnostic reliability

DIFFERENTIAL DIAGNOSIS
Other pervasive development disorders - Rett’s syndrome - Childhood disintegrative disorders - Asperger’s disorders Disorders of infancy, childhood, and adolescence - Selective mutism - Stereotypic movement disorder Schizophrenia with childhood onset Mental retardation or general learning disability Language disorder

MANAGEMENT

The general goals of treatment for autistic patients are to improve language and social skills, decrease problem behaviors, support parents and families in their adjustment to and education of autistic children, and foster independence
No drug or other treatment cures autism, and many patients do not require medication. However, psychotropic drugs that target specific symptoms may help substantially

CONCLUSION

When an autistic disorder is suspected, referral should be made for further developmental evaluation and cognitive testing Although there is currently no cure for autism, early diagnosis and intervention can significantly enhance functioning in later life