First Signs of Autism

J was screened at 18 months by an early intervention agency. Her receptive and expressive language skills were placed at a 6-9  month level. 2 months later another screening was done and she was referred for Early Childhood Special Education services. At 23 months J was given an educational autism assessment. The sections of the assessment included the following:

• Modified Checklist for Autism in Toddlers (M-CHAT) - helps to identify children with characteristics of autism
• Childhood Autism Rating Scale (CARS) - rates behaviors that typically manifest in autism. Consists of 15 subscales including: Relating to people; Imitation; Emotional Response; Body Use; Adaptation to Change; Visual Response; Listening Response; Taste/Smell/Touch Response and Use; Fear or Nervousness; Verbal Communication; Nonverbal Communication; Activity Level; Level and Consistency of Intellectual Response; and General Impressions. The subscale scores are combined to give an overall rating.
• Early Coping Inventory - observation instrument to assess coping related behaviors for everyday living. Provides information about the following: level of coping effectiveness; coping style; and specific coping strengths and vulnerabilities. Divides 48 items into 3 categories: Sensorimotor Organization; Reactive Behavior; and Self-Initiated Behavior.
• Observations
• State Criteria for Autism - includes: Qualitative impairment of reciprocal social interactions (2 or more out of 8); Qualitative impairment in communication (1 or more out of 8); and Restricted, repetitive or stereotyped patterns of behavior, interests and activities (1 or more out of 7)
• Developmental Interview

M-CHAT
J did not pass the M-CHAT. Concerns included: not taking an interest in other children; not using index finger to point; not imitating; and difficulty following a point.

CARS
For CARS, J's scores were as follows:

1. Relating to people (2.0) - avoids looking people in the eye and gets mad if encouraged to relate to someone
2. Imitation (3.0) - rarely imitates sounds or words despite prodding from an adult
3. Emotional Response (2.0) - occasionally displays emotional responses
4. Body Use (1.0) - shows typical coordination
5. Object Use (3.0) - shows little interest in toys and gets preoccupied with repetitively touching certain parts of toys
6. Adaptation to Change (3.0) - tries to continue same activity when an adult tries to change tasks
7. Visual Response (2.0) - avoids looking people in the eye
8. Listening Response (3.0) - covers ears to certain sounds and sometimes ignores sounds the first time they are made
9. Taste, Smell, and Touch Response and Use (2.0) - tastes inedible objects
10. Fear or Nervousness (2.0) - not enough fear
11. Verbal Communication (4.0) - absence of meaningful speech
12. Nonverbal Communication (2.5) - difficulty pointing or gesturing to indicate wants or needs and unable to pick up on facial expressions
13. Activity Level (3.0) - very active and endless energy
14. Level and Consistency of Intellectual Response (1.0)
15. General Impressions (2.0) - symptoms of autism are present

Overall CARS score is 35.5 which falls in the moderate range of autism.

Early Coping Inventory
J scored 3.4 in Sensorimotor Organization; 2.8 in Reactive Behavior; and 3.1 in Self-Initiated Behavior. Adaptive Behavior Index was 3.1, which means her behavior is situationally effective.
Her most adaptive behaviors include:

• demonstrates coordinated movements
• tolerates being in a variety of positions
• energy level that is forceful and vigorous
• accepts warmth and support from familiar persons
• reacts to different types of touch by caregiver
• accepts help when necessary
• demonstrates happy disposition
• demonstrates persistence during activities

Least adaptive behaviors include:

• difficulty maintaining visual attention to people and objects
• difficulty reacting to feelings and moods of others
• difficulty adjusting to irrelevant sounds
• difficulty engaging in reciprocal social interactions
• difficulty with actively participating in situations
• difficulty changing behavior to solve problems or achieve goals

State Criteria for Autism
Qualitative impairment of reciprocal social interactions

• limited use of facial expressions toward others
• prefers isolated or solitary activities
• difficulty relating to people

Qualitative impairment in communication

• not using finger to point or request
• absence or delay of spoken language
• inability to initiate or maintain conversation
• lack of spontaneous imitations and lack of varied imaginative play
• limited understanding of nonverbal communication skills (gestures, facial expressions, voicetone)
• using others' hand or body as a tool

Restricted, repetitive or stereotyped patterns of behavior, interests and activities

• lack of true imaginative play vs. reenactment
• over-reaction or under-reaction to sensory stimuli
• intense focused preoccupation with a limited range, interest or conversation topics

Based on the results of the educational autism assessment J was referred for special education services through the school district.