Our SLP chat tonight, Monday, Dec. 10th, 2001, will be hosted by Dr. Patricia Prelock who will the address the topic of Understanding Autism Spectrum Disorders. Patricia Prelock, Ph.D, CCC-SLP, is an ASHA Fellow and Professor in the Department of Communication Sciences at the University of Vermont. She is the Project Director for the Vermont Rural Autism Project, which prepares SLPs and early childhood providers to serve children with autism and their families. Dr. Prelock is also the Interdisciplinary Training Director for Vermont's Interdisciplinary Leadership Education for Health Professionals Program and project director of Vermont's State Improvement Grant initiative to increase the number and quality of school-based SLPs. She teaches graduate courses in collaboration, autism, and interdisciplinary leadership and research. Her research interests include evaluating the efficacy of alternative models of service delivery and supervision, nature and treatment of autism, as well as describing the influences of complexity and processing mode on children's linguistic productions. Recently, she was appointed Associate Editor for Language Speech Hearing Services in Schools. References for Autism Spectrum Disorders have been provided by Dr. Prelock and can be found at the bottom of this chat transcript. <Robin> Welcome, We are chatting tonight with Dr. Patricia Prelock about understanding Autism Spectrum Disorders. <Anonymous2819> Hi. My name is Karin. I am a SLP. I work in early intervention in southern CA. I am working with a lot of children with Autism so I was interested in this chat tonight. <Adrienne> Thanks for coming Dr. Prelock!! <Robin> great that you could join us Karin! We are so very pleased that Dr. Prelock could join us tonight! <Patty Prelock> Hello! I look forward to chatting with you. <Robin> Dr. Prelock, could you start by giving us some general info about autism? <Patty Prelock> I would be happy to. As you may know autism is a developmental disorder characterized by 3 specific areas of impairment-social interaction, communication & behavior. <Robin> How is autism diagnosed? <Patty Prelock> I described it as a developmental disorder because we still diagnosis it clinically. It is usually diagnosed by a physician with experience with this population <Adrienne> How do you distinguish interaction, communication and behavior? <Adrienne> aren't they going to be related? <Patty Prelock> Good question Adrienne. There is specific criteria in the DSM-IV that outline each of these behaviors. This is the manual used to make a diagnosis. <Adrienne> can you test them individually? <Patty Prelock> You're right Adrience, they are interrelated. For example, a child who has a communication impairment will be challenged in their social interactions <Patty Prelock> You also can certainly assess the behaviors individually, and there are tools that look at that, but in making a diagnosis we usually look at the interactions. <Adrienne> is it possible to be diagnosed with a "severe" comm impairment and a "moderate" social interactions impairment... or some such combination? <Patty Prelock> Yes, Adrienne, you can have different degrees of impairment, but what is important is that all aspects of the core deficits have to be present. <Adrienne> ok <Anonymous50> What assessment tool would you recommend to assess the language of a toddler or preschooler with dx of autism? <Adrienne> Cool. Thanks! I didn't mean to hog the floor... 50 had a question about a specific tool you would use? <Patty Prelock> An assessment tool I would use first in supporting and understanding the diagnosis is the ADOS <Patty Prelock> The ADOS is the current gold standard for assessment. It has 4 modules and can be used to assess young children through adults. <Patty Prelock> This tool was designed by Catherine Lord & colleagues and looks carefully at social interaction, communication and play. <Erika-URI> I have a question... <Patty Prelock> Yes, Erika <Erika-URI> Is it possible that adolescents or adults with some form of autism could have appropriate interactions via a chat function like this? <Erika-URI> I am not sure if I asked that effectively <Patty Prelock> Yes Erika, it is possible that chats can occur for individuals with autism. In fact there are on-line opportunities for individuals with autism to talk with one another <Erika-URI> Including normal discourse, appropriate turn taking etc. <Erika-URI> even if they have problems with that in a face to face encounter? <Patty Prelock> It is different for each individual. For some writing may be easier because they do not have to read the facial expressions or interpret the prosody of their conversational partner <Erika-URI> oh wow <Erika-URI> ok <Adrienne> good point <Adrienne> I always thought it was harder because you can't see facial expressions <Adrienne> but maybe not for people with autism <Patty Prelock> I wanted to go back to a question Adrienne asked about language assessment for autism <Patty Prelock> Once we have a diagnosis of autism, for verbal children, we may need to look more carefully at their semantic and pragmatic language <Patty Prelock> Although we have formal tests to do that, it seems more appropriate to engage in more authentic assessment <Adrienne> As a beginning clinician, I am wondering how confident I can be in administering an "authentic" assessment that requires more subjective evaluation <Patty Prelock> Another good question Adrienne. I think you need to have a clear understanding of typical development first. <Patty Prelock> For young children, you want to be able to examine their communicative function and means <Patty Prelock> Then you need to consider that children with autism may respond in unconventional ways <Patty Prelock> The best thing to do is watch, interview those who know the child best (like their families), and create opportunities for them to show what they know. <Patty Prelock> Confidence in this type of assessment comes with experience, and even those of us who have lots of experience, we struggle with how much and what kind of infomration we need. <Adrienne> Thanks for the encouragement :~) <Adrienne> Do you find answers you get in a parent interview accurate or biased? <Adrienne> Does unconventional necessarily mean delayed or disordered? <Patty Prelock> Unconventional means that the individual may be communicating in a way that is different than expected. <Patty Prelock> I tend not to use disordered since I think children with autism have strengths and challenges that are different than what we might usually see <Adrienne> So you aren't looking for a delay as much as a difference? <Patty Prelock> I think it is just different and where authentic assessment comes in is that we can determine how the unconventional behaviors interfere with learning & successful interaction <Adrienne> got it, thanks <Patty Prelock> In terms of delay, some children may show a delay in certain aspects of behavior, even communication, but not in others <Patty Prelock> For example, verbal children with autism may have good language form but not use <Robin> what is the earliest age that autism can be diagnosed? <Patty Prelock> To respond to Robin's question about age of diagnosis, it is usually by 3 years <Patty Prelock> However, there are current studies that are looking at early diagnosis, as young as 12 months <Anonymous50> I am seeing a lot more 2 yr. olds with the dx in my work setting. <Patty Prelock> 50, I bet you are. More and more practitioners are working toward early diagnosis so that early intervention can begin <Anonymous50> How are the studies assessing 12 month olds? <Patty Prelock> There are a couple of ways. Most often, retrospective video analysis is done where families share videos of the first year of life, first birthday parties, etc. <Patty Prelock> And reseachers are viewing videos of children who eventually receive a diagnosis of autism by 3 <Patty Prelock> These researchers then look for 'red flags' that were demonstrated at early ages in compairson to control groups. <Adrienne> what are some "red flags"? <Erika-URI> one of my profs talked about the birthday video study. <Patty Prelock> Other studies are doing screenings or assessments at 18 months check ups and following children to see what the best discriminators are for a diagnosis <Patty Prelock> Some red flags are failing to develop a point, not orienting to name, failure to develop symbolic play, lack of joint attention <Anonymous5011> And what have they found in terms of discriminators for dx? <Patty Prelock> Lord (1995) defined some early discriminators that were similar to the red flags <Patty Prelock> Absence of point, hand leading and unusual finger and hand mannerisms were discriminators at age 3 <Patty Prelock> Lack of joint attention and poor attention to voice, esp. neutral voice were discriminators at 2 <Anonymous5119> I have run across pediatricians that label children 3-5 yrs. old autistic when I feel they are globally delayed, and showing autistic characteristics, but not necessarily autistic. Any feedback ? <Patty Prelock> Diagnosis is particularly difficult when children have signicant cognitive delays as well <Anonymous83> I'm interested too in what anonymous 5119 is questioning. <Patty Prelock> One of the reasons I like a test like the ADOS and the ADR-I (which is the interview format for diagnosis) <Patty Prelock> Is that this tool does a good job discriminating children with a variety of disabilities <Patty Prelock> To have a diagnosis of autism, the core deficits of impaired communication, social interaction and behavior must be primary. <Patty Prelock> Children with global developmental delays should look a little different, particularly in the early red flags like pointing, joint attnetion, etc. <Robin> Dr. Prelock, could you give us the full name of these tests? <Patty Prelock> Yes, the ADOS is the Autism Diagnostic Observation Schedule-Generic, Lord et al., 1999, published by Western Psychological Services <Patty Prelock> The ADI-R is the Autism Diagnostic Interview-Revised, also designed by Lord and colleagues <Patty Prelock> You cannot get the ADI-R without being trained <Patty Prelock> There are also other tools that many people use, including the CARS-Childhood Autism Rating Scale <Patty Prelock> Gilliam also has developed the Gilliam Autism Rating Scale <Patty Prelock> And there is the Autism Behavior Checklist--many of these involve interviews and/or observations <Anonymous5011> Thank you. It's been interesting, but I must cont. studying. Good night. <Patty Prelock> Good luck on your exams 5011 <Anonymous5011> Thanks!! <Adrienne> I know it's almost time to go, but I wanted to know how the "spectrum" comes into play <Adrienne> what is the spectrum of? <Patty Prelock> The spectrum is used to describe the range of pervasive developmental disorders <Patty Prelock> In the DSM-IV (Diagnostic & Statistical Manual of Psychiatric Disorders), they use the term Pervasive Development Disorders (PDD) <Adrienne> ok, it is a range of levels of functioning? <Adrienne> I guess I'm trying to understand what the range encompasses <Patty Prelock> For me, the spectrum suggests the variability we see in degree of symptoms and level of involvement <Adrienne> ok <Patty Prelock> Level of involvement can be related to any of the core deficits-communication, social, behavior and it relates to cognitive level as well <Patty Prelock> Also, there are 5 'disorders' described under PDD--Classic Autism, Retts, Asperger, Childhood Disintegrative Disorder and PDD Not otherwise specified <Adrienne> I see <Anonymous83> how can I measure cognitive capabilities (short -term memory retrieval, attention, etc) in children with autistic behaviour? <Anonymous83> with no verbal skills I mean <Patty Prelock> I recommend assessing attention and memory for learning in real contexts--looking to see when the child is able or not able to sustain their focus and recall information <Patty Prelock> For those with limited to no verbal skills, I would like through observation the child's ability to sustain focus, remain alert, respond, nonverbally to cues, etc. <Anonymous83> you say Dr. Prelock, something like a qualitative asessment? Just observing the child? <Patty Prelock> Generally, my thoughts are to define the particular goal(s) you have for a child and then select the intervention that is most likely to meet that goal and not the other way around <Patty Prelock> 83, yes a qualitative assessment would be more reasonable and give you more information for a child with autism <Anonymous83> thank you Dr Prelock <Patty Prelock> Also, when you observe, you should have a framework to guide your observations--knowing what is imortant to be a successful learner in a particular environment. You are welcome 83! <Anonymous50> Any thoughts on differing intervention approaches (in home vs.clinic based) for toddlers? <Patty Prelock> Continuing with 50's question, it is critical to have involvement at home and school-it needs to be a collaborative effort and should interface all environments <Anonymous50> Thank you <Robin> Thank you , Dr. Prelock, for taking time out of your busy schedule to join us! Dr. Prelock is quite busy writing a book about autism! <Patty Prelock> I enjoyed chatting with all of you--the questions were great--and the time flew by for me <Adrienne> You were so informative Dr. Prelock! Thank you!! <Robin> It did go by fast! <Erika-URI> yes thank you <Patty Prelock> Good luck to all of you who are taking exams and happy holidays! <Robin> Dr. Prelock has given us resources and references which we will be adding to the transcript <Robin> Thank you again Dr. Prelock!!!!! And thanks to all of you who have joined us! <Anonymous83> Good luck for you and happy holidays to you Dr prelock. Thank you very much <Patty Prelock> You are very welcome--Goodnight! <Robin> good night! NATIONAL ORGANIZATIONS AND WEBSITES: Aspen of America, Inc. www.asperger.org 904-745-6741 P.O. Box 2577 Jacksonville, FL 32203-2577 Aspergers Association of New England www.autism.com/ari.dan.html 617-964-6860 c/o NWW Box 242 Newton, MA Autism National Committee www.autocom.org 610-649-9139 610-649-0974 (fax) 635 Ardmore Avenue Ardmore, PA 19003 Autism Network International www.students.uiuc.edu PO Box 448 Syracuse, NY 13210-0448 Autism Research Institute www.autism.com/ari/ 619-281-7165 619-563-6840 (fax) 4182 Adams Avenue San Diego, CA 92116 Autism Services Center www.autocyt.com/aane 800-328-8476 304-525-8014 304-525-8026 (fax) The Pritchard Center 605 Ninth Street, PO Box 507 Huntington, WV 25710 Autism Society of America www.autism.org 800-328-8476 301-657-0881 301-657-0869 (fax) 7910 Woodmont Avenue, Ste. 300 Bethesda, MD 20814-3015 Center for the Study of Autism www.autism.org P.O. Box 4538 Salem, OR 97302 Cure Autism Now (CAN) www.canfoundation.org CAN@primenet.com 888-8-AUTISM 323-549-0500 323-549-0547 (fax) 5225 Wilshire Boulevard, Ste. 226 Los Angeles, CA 90036 Indiana Resource Center for Autism www.isdd.indiana.edu/~irca 812-855-6508 812-855-9630 (fax) 812-855-9396 (TT) Indiana University 2853 E 10th St. Bloomington, IN 47408-2601 More Advanced Individuals with Autism 219-662-1311 219-662-0638 (fax) P. O. Box 524 Crown Point, IN 46307 Asperger's Syndrome & PDD (MAAP) www.netnitco.net/users/chart.maap.html Chart@netnitco.net National Alliance for Autism Research www.naar.org Naar@naar.org 888-777-NAAR 609-430-9160 609-430-9163 (fax) 414 Wall Street, Research Park Princeton, NJ 08540 On-line Asperger's Syndrome Information& Support (OASIS) www.udel.edu/bkirby/asperger bkirby@udel.edu Yale Child Study Center www.info.med.yale.edu/childstdy/autism kathy.coenig@yale.edu 203-785-2513 203-737-4197 (fax) P.O.Box 207900 230 So. Frontage Rd. New Haven, CT 06520 EARLY DIAGNOSIS AND ASSESSMENT: American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th edition) (text revision). Washington, DC: American Psychiatric Association. Baird, G., Charman, T., Baron-Cohen, S., Cox, A., Swettenham, J., Wheelright, S., Drew, A., & Kemal, L. (2000). A screening instrument for autism at 18 months of age: A six-year follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 694-702. Baranek, G. T. (1999). Autism during infancy: A retrospective video analysis of sensory-motor and social behaviors at 9-12 months of age. Journal of Autism and Developmental Disorders, 29, 213-224. Baron-Cohen, S., Allen, J. & Gillberg, C. (1992). Can autism be detected at 18 months? The needle, the haystack, and the CHAT. British Journal of Psychiatry, 161, 839-843. Baron-Cohen, S., Cox, A., Baird, G., Swettenham, J., Nightingale, N., Morgan, K., Drew, A., & Charman, T. (1996). Psychological markers in the detection of autism in infancy in a large population. British Journal of Psychiatry, 168, 138-163. Lord, C. (1997). Diagnostic instruments in autism spectrum disorder. In D. J. Cohen & F. R. Volkmar (Eds.), Handbook of autism and pervasive developmental disorders (pp. 460-483). NY: John Wiley & Sons, Inc. Lord, C. (1995). Follow-up of two-year-olds referred for possible autism. Journal of Child Psychology and Psychiatry, 36, 1365-1382. Lord, C. & Risi, S. (2000). Early diagnosis in children with autism spectrum disorders. Advocate, 33, 23-26. Osterling, J. & Dawson, G. (1994). Early recognition of children with autism: A study of first birthday home videotapes. Journal of Autism and Developmental Disorders, 24, 247-258. Volkmar, F. R., Klin, A. & Cohen, D. J. (1997). Diagnosis and classification of autism and related conditions: Consensus and issues. In D. J. Cohen & F. R. Volkmar (Eds.), Handbook of autism and pervasive developmental disorders (pp. 5-40). NY: John Wiley & Sons, Inc. CONSIDERATIONS FOR INTERVENTION: Freeman, B. J. (1997). Guidelines for evaluating intervention programs for children with autism. Journal of Autism and Developmental Disorders, 27, 641-650. Gresham, F. M., Beebe-Frankenberger, M. E., & MacMillan, D. L. (1999). A selective review of treatments for children with autism: Description and methodological considerations. School Psychology Review, 28, 559-575. Heflin, L. J. & Simpson, R. L. (1998). Interventions for children and youth with autism: Prudent choices in a world of exaggerated claims and empty promises. Part I: Intervention and treatment option review. Focus on Autism and Other Developmental Disabilities, 13, 194-211. National Research Council (2001). Educating children with autism. Committee on Educational Interventions for Children with Autism. Division of Behavioral and Social Sciences and Education. Washington, DC: National Academy Press. Prizant, B. M. & Rubin, E. (1999). Contemporary issues in interventions for autism spectrum disorders: A commentary. Journal of the Association for Persons with Severe Handicaps, 24, 199-208. Prizant, B. M. & Wetherby, A. M. (1998). Understanding the continuum of discrete-trial traditional behavioral to social-pragmatic developmental approaches in communication enhancement for young children with autism/PDD. Seminars in Speech and Language, 19, 329-352. Rogers, S. J. (1998). Empirically supported comprehensive treatments for young children with autism. Journal of Clinical Child Psychology, 27, 168-179. |
