Developmental Milestones
& Early Signs of Autism
How to use the Modified Checklist for
Autism in Toddlers and Talk with Families
Cindy Carroll, M.A., CCC-SLP
Speech and Language Pathologist
ASD Coach and Consultant
Supervisor of ASD Diagnostic Clinic
Community M.J. Murdock Grant
TODAY 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?
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 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 SignsAct 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)
Family Outcomes
Intervention
Referral
Developmental surveillance/screening
Developmental Awareness
Why Is Developmental Screening
Important?
We an improve identified developmental
delays from 30% (surveillance) to 70-80%
with developmental screening
Learn the Signs. Act Early.
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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 Materials
• On the CDC website, you can download:
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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” Booklet
Early Learning Providers must
incorporate what’s known about
typical 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 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
a Predictable Path –
T/F?
Development follows the
same path for every
child – T/F?
Children with Autism have
uneven developmental profiles
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?
1. Medical Home
2. Under 3 – refer to EI
3. Over 3 – Refer to Local SD
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 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
Reciprocity
• 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 –
responding and initiating
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 Blocks
Theory of
Mind
Symbolic
Play
Expressive
Language
Joint
Attention
Restricted, Repetitive and
Stereotypical Patterns of Behavior
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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
–Screening at;
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9 months
18 months
24 months
30 months
• 18, 24 and 30 months
autism specific screen
The Modified Checklist for Autism in
Toddlers (M-CHAT)
FOCUSED Level 1 SCREENING
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User friendly to assess the risk for autism spectrum
disorders and detect as many cases of ASD as possible
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High False Positive Rate – Tool not a rule
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Developed for but not limited to; physicians, teachers,
therapists, paraprofessionals, psychologists, early
interventionists, childcare providers, nurses, etc.
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Developed for toddlers 16-30 months
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Drills down to Joint Attention Skills (Improved from the
CHAT)
Robins, Fein, & Barton, 1999
THE SCREEINING IS
CONSIDERED FAILED IF
2 OR MORE CRITICAL
ITEMS OR/ ANY 3
ITEMS ARE FAILED.
MCHAT Follow-up interview
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 810 months of age)
WHAT I LOOK FOR
Set 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
concern?
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
Talking about Concerns
http://www.autismspeaks.org/whatautism/learn-signs/talking-parentsabout-autism-action-kit
I’m sorry but…….
It’s not about YOU!
Start with positives
Use a respectful tone
Read your audience
Validate and relax
Remember it is a process
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 Conversation
Listen FIRST
Share positives
Be supportive, never judgmental
Avoid jargon, labels, and
terminology
Give time to process… pause..
breath
At the end of the
conversation
Outline next steps
Give resources
Ask what you can do to
help?
End on a supportive note
HOW DO WE REFER?
Where can I refer parents?
WithinReach
Call center
http://withinreachwa.org/
ParentHelp123.org – now in Spanish!
The Birth-to-Three
center in your area
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