Listen, Screen & Recognize the Red Flags for

Autism Spectrum Disorders

Presented By
Lori Kalash, Ed. D. Project Director for Great Plains
Autism Spectrum Disorder Treatment Program
(GPAST) and Great Plains Interdisciplinary Clinic
Project (GPIC)
What is autism?

3
Pervasive Developmental
Disorders
Autism
Asperger’s Syndrome
PDD-NOS
Rett’s Syndrome
Childhood Disintegrative Disorder
5
ACT EARLY – KNOW THE SIGNS
http://www.cdc.gov/ncbddd/actearly/pdf/parents_pdfs/TrackChildsDevMilestonesEng.pdf
 SOCIAL DEVELOPMENT: 0-7 MONTHS
Typical Red Flags
 Develops Social Smile  Few facial expressions
 More expressive with face &  Doesn’t cuddle
body  Shows limited interest in
 Imitates some movements watching others
and expressions
4-7 months
 Shows interest in watching
people’s faces
 Smiles often while playing
with you
 Relate to parent with joy
 Interested in mirror images
SOCIAL DEVELOPMENT: 6-12 MONTHS
Typical Red Flags
Stranger Anxiety Doesn’t distinguish
Exchange back-and- caregiver from others
forth facial expressions Doesn’t look where you
Joint Attention point
Social games – peek-a- Not interested in social
boo, patty cake, other games
Object permanence Flat emotion/affect
with people
SOCIAL DEVELOPMENT: 12-24 MONTHS
Typical Red Flags
Use mother as secure No distress separating
base from caregiver
Separation distress Strange attachment to
Independence hard objects (rather
Knows people by than stuffed animals)
Doesn’t seem to notice
pointing when named
Simple pretend you or others in the
play/imitation room
Seems to tune others
out and plays alone
SOCIAL DEVELOPMENT: 24 – 36 MONTHS
Typical Red Flags
Parallel Play: plays by Solitary Play
peers Little interest in peers
Associative Play: some No Showing, Giving of
exchange: sharing, turn- toys
taking May be more interested
Cooperative Play: play
in household objects
together cooperate with than toys
common goal May not imitate others
Imaginative Play
through play
(creative, pretending)
SOCIAL DEVELOPMENT: 3+ YEARS
Typical Red Flags
Creative Imaginative Prefers to play alone
Play Tunes others out
Recognizes emotions in Difficulty reading body
others language and emotions
Interest in others Lack of social
Understand social rules reciprocity (interest in
and routines others,
Socially motivated concern/recognition of
Can take turns in games others)
 COMMUNICATION: 0-7 MONTHS
Typical Red Flags
3 Months Unusually Quiet
Cooing No attention to voices
4 Months
Laughs
Turns to voice
Follows and reacts to
bright colors
5 Months
Razzing
 COMMUNICATION: 6-12 MONTHS
Typical Red Flags
6 Months  No imitation of sounds
 Babbling  Only screeches
 Cries when unhappy  No back and forth
8 Months
 Dada/mama nonspecifically
9 Months
 Exchanges back-and-forth
sounds
 Gesture games
10 Months
 Understands no
 Mama/dada specifically
COMMUNICATION: 12-24 MONTHS
 Typical  Red Flags
 12 Months  Any regression of skills
 One step command with a gesture  Appears deaf
 Turns toward person when name  No babbling
is called  No Words by 15 Months
 13 Months
 Immature jargoning
 15 Months
 One step command without a
gesture
 Uses and understands at least
three words
 18 Months
 Knows people by pointing when
named
 Points to body parts
 Mature jargoning
 COMMUNICATION: 24 – 36 MONTHS
Typical Red Flags
24 Months Any regression
Puts two words together No compensation with
Uses and understands at gestures or sign
least 50 words
Pronouns
inappropriately
Two step commands
34 Months
States first name
 COMMUNICATION: 3+ YEARS
Typical Red Flags
36 Months
 Uses thoughts and actions
together in both speech
and play
 Uses pronouns
appropriately
Older children
 Gradually understand
pragmatics (figures of
speech, myth, symbolism,
jokes)
 May say words okay but
has a difficult time using
language functionally
 Ex. Can say the ABCs,
numbers, or words to TV
jingles but can't ask for
things he wants
 Laughs for no clear reason
 Uses words or phrases
that are inappropriate for
the situation
 Takes things literally
 OTHER DEVELOPMENT
Fine/Gross Motor Red Flags
Cognitive skills Narrow or Restricted
Sensory interests
Nonfunctional
Does well with routine
adherence to routines
or rituals
Inflexible thinking
Fascination with parts
of objects
(nonfunctional)
OTHER DEVELOPMENT
Fine/Gross Motor Red Flags
Cognitive skills May have delays in
Sensory learning if they have
poor imitation skills
Sensory difficulties
 Doesn't seem to have any
fear
 Doesn't seem to feel pain

 Oversensitive to noise,

texture
Eating/Gastrointestinal
 Screening & Early Intervention
Well-visits to child’s pediatrician is the best time for
developmental screenings and for early identification
or concerns regarding autism. Without identification
through screening, a child may not receive the early &
intensive interventions he or she needs.
Early and appropriate intervention can be the key to
greater independence, increased participation in the
wider community, and ultimately, a more productive
and fulfilling life as an adult.
Identification is essential for intervention.
http://www.firstsigns.org/screening/index.htm
See handout on Normal Developmental Milestones
A.L.A.R.M
Autism is prevalent
Approximately 1 in 110 according to ADDM network
study released in December 2009. (Autism and
Developmental Disabilities Monitoring/Center for
Disease Control)
Developmental disorders have subtle signs and may be
easily missed.
A.L.A.R.M
Listen to parents
Early signs of autism are often present before 18 months
Parents usually DO have concerns that something is
wrong
Parents generally DO give accurate and quality
information
When parents do not spontaneously raise concerns, ask
if they have any
A.L.A.R.M
Act early
Make screening and surveillance an important part of
medical practice. AAP recommends routine screening
for ASD in all children at 18 and 24 months.
Know the subtle differences between typical and
atypical development
Learn to recognize red flags
Use validated screening tools
Early and appropriate intervention
M-CHAT/CAST
First level screeners (free for educational and clinical
purposes at firstsigns.org)
False positives
Interview to clarify answers
Screening recommended at 18 and 24 months for all
children. (MCHAT)
Screening advised at elementary level for all children
(CAST)
A.L.A.R.M
Refer
to Early Intervention or school programs (Do not wait
for diagnosis)
To an autism specialist, or team of specialists,
immediately for definitive diagnosis
To audiology to rule out a hearing impairment
To local community resources for help and family
support.
A.L.A.R.M
Monitor
Other conditions know to be associated with autism
(seizures, GI, sleep, behavior)
Educate parents and provide them with up-to-date
information
Advocate for families with other agencies
Watch for additional or late signs of autism and/or
other developmental disorders
Basic Screening Guidelines

http://www.firstsigns.org/screening/guidelines.htm
Practice parameter: Screening and diagnosis of
autism. Neurology 2000, 55: 468-79.
Questions
Lori.Kalash@minotstateu.edu