Early Detection of Autism Spectrum Disorder

November 17, 2016

Autism Spectrum Disorder (ASD) is a complex neurological condition, which affects an individual’s communication skills, social interactions, and cognitive functioning. In the U.S., only 20% of people with ASD are diagnosed before age 3, with most diagnoses not occurring until age 4-5.

According to the Autism Society of the United States, early intervention (beginning before age 3) can reduce the cost of care over a person’s lifetime by 67%. All states have early intervention programs. In Florida, the Early Steps program serves families of infants and toddlers with developmental disabilities and delays up until a child’s third birthday. Because early intervention services end at age 3 in most states, early diagnosis is necessary to access those services and achieve better outcomes.

Parents are often encouraged by well-meaning friends, relatives, and even physicians, to take a “wait and see” approach when it comes to communication disorders, with the rationale that the child is just a late talker and will grow out of it. While some children really are just late talkers, it is not normal for a child not to talk until age 3 or 4, and the opportunity for early intervention is lost, in the event something more significant than being a late talker is going on.

Below are some milestones to be aware of. If your child has not met these milestones, that it is a red flag for Autism Spectrum Disorder and/or a language delay.

By your child’s first birthday, s/he should be:

  • Babbling (strings of consonants and vowels)
  • Pointing to things (both to ask for them and just to show them to you)
  • Following your point
  • Responding to his/her name

 

By your child’s second birthday, s/he should be:

  • Using at least 50 words spontaneously (without you saying the word first)
  • Beginning to meaningfully combine two words and not just using memorized phrases like “thank you” or “here ya go”

 

The loss of words in a child 18 months or older is an additional red flag for ASD.

Some of the social behaviors that are absent or delayed in children with ASD can go unrecognized if you’re unsure of what to look for. Autism Navigator is a great resource to view side-by-side videos of young children at risk for ASD and typically developing peers. The ASD Video Glossary on this site can be especially helpful in figuring out if what you see your child doing is a sign of ASD or typical behavior.

A diagnosis of Autism Spectrum Disorder is hard for any parent to hear, but children are not helped by taking a “wait and see” approach. If you suspect that your child has any kind of developmental delay, you should contact your state’s early intervention program as early as possible to give your child the chance at the best possible outcomes.

hanen-program-logoSharon Ascher, M.A., CCC-SLP

Speech-Language Pathologist

Certified to Provide: More Than Words® – The Hanen Program® for Parents of Children with Autism Spectrum Disorder or Social Communication Difficulties


How Many Words Does Your Child Say?

April 9, 2015

When you take your toddler to a well-child check-up at the pediatrician s/he will certainly ask you how many words your child says. The developmental milestone that they are looking at is your child’s spontaneous use of words. These are words your child says not in imitation. If your child points to a dog and says “dog,” that is spontaneous. If you ask your child, “What’s that?” and he says “ball,” that is spontaneous. If your child repeats a word s/he overhears or says a word when you tell him or her to say it, then it’s imitated.

The most accurate way to keep a count of your child’s spontaneous words is to maintain a written list and add to it every time you hear a new word. The chart below can be printed and used to track your child’s early word acquisition. If your child reaches 50 words that s/he uses spontaneously before his or her second birthday, you can stop counting. Children should have a minimum of 50 words in their vocabulary by their second birthday. If your child does not have 50 words by age 2, you should seek a speech-language evaluation from a speech-language pathologist or a developmental evaluation through your state’s early intervention program.

Toddler Word Chart

 


Simple, but Effective, Communication Strategy

March 24, 2015

This simple strategy is easy to implement at home. At snack time, get down on your child’s level and offer two choices. Hold them about shoulder-width apart and far enough away so that your child cannot grab. Once s/he points to or reaches for the desired object, hold that one up by your face and say the name of it. Pause expectantly, giving your child the opportunity to imitate. After about 5 seconds (you can count in your head), say the name again and pause. Do this once more and then hand the item over whether or not your child has imitated. If your child does imitate (or attempt to imitate) the word, be sure to praise the effort.

Apple
Boy
Banana

Benefits of using this strategy:

  1. By offering a choice, your child has to intentionally communicate a want or need. This is an early step on the way to talking.
  2. By getting down on your child’s level, you get his/her attention and make it easier to watch your face.
  3. Children tend to look at the object they want, so bringing it up by your face while you say its name encourages eye contact and allows your child to watch your mouth as you form the word, so s/he can see how it is said.
  4. By pausing expectantly and waiting, rather than saying, “Say ___,” you are giving your child the opportunity to imitate without any pressure. This is important because many children with delayed language will shut down when pressure is put on them to speak. Please be sure not to tell your child to say the desired word.
  5. By saying the word 3 times, you ensure that s/he has heard the word 3 times in the immediate context of the item, which helps with understanding the meaning of the word.
  6. By giving the item to your child after the third time you have said it, you reduce everyone’s frustration. You, as the parent, do not have all day to wait for your child to say a word before giving a snack. By limiting yourself to saying the word 3 times, you get to move on. Your child also gets to practice being patient.
  7. When this strategy is used consistently, many children get tired of waiting for you to say the word three times, and learn to imitate after the first or second time.

Modifications:

  1. If your child points specifically to what s/he wants, you can skip the step about offering a choice, as your child has already used intentional communication to indicate a want/need. Go straight to holding the desired item up by your face.
  2. Once you’re comfortable with this strategy at snack time, try it out during other routines. (Green shirt or red shirt; play trains or blocks; milk or water)

 


Bubbles Aren’t Just for Blowing Anymore

February 10, 2014

In one of my previous posts, “Bubbles, bubbles, bubbles!” I listed several speech and language skills that could be targeted while blowing bubbles with a young child. In this post, I have a few more skills that can be addressed while blowing bubbles.

Encourage your child to pop the bubbles in different ways:

  • Poking the bubbles with the index finger will encourage an isolated point, a fine motor skill. Once the skill is achieved, the child can more effectively point to indicate wants and needs and engage in joint attention.
  • Pinching the bubbles between the thumb and index fingers will encourage the use of a neat pincer grasp, another fine motor skill. Young children need this skill in order to efficiently pick up small objects and will one day use it to hold a pencil correctly for writing.
  • Stomping the bubbles while standing up encourages use of the gross motor muscles.
  • Clapping the bubbles between the two hands encourages the child to bring his hands together at the midline of the body, which requires the two sides of the brain to work together.

You can use these motor activities when playing with bubbles and integrate some additional cognitive and language skills.

  • Motor imitation – Have your child copy your action: poking like a bumblebee, pinching like a crab, stomping like an elephant, or clapping like a seal.
  • Following directions – Give your child a verbal direction without modeling the action to be done.
  • Imitating 2-word phrases – As you and your child pop the bubbles in a variety of ways, use 2-word phrases to describe what you are doing, and encourage your child to repeat them. “Pinch bubble,” or “Clap bubbles.”
  • Using verbs – You perform the action and have your child narrate what you are doing. “You poked the bubble,” or “You stomped on the bubble.”
  • Engaging in pretend play – Your child can act out how one of the animals listed above would pop the bubbles or he can think of an original one to act out.

Bubbles

In my previous bubbles post, I discouraged the use of a bubble machine because the key to the activity was the interaction between the adult and the child in requesting bubbles. However, for this set of activities, I think the use of a bubble machine is fine, since the goal is not requesting. The adult and child still need to be interacting for it to be effective, but a bubble machine could free up the adult’s hands for some good clean bubble popping fun.


Red Flags in Speech and Language Development

July 23, 2013

When I was approached by Lauren’s Hope, a medical ID jewelry company, to write a guest post about red flags in speech and language development, I jumped at the chance to share this important information.

Small_Red

It can be difficult to know whether or not your child’s speech and language development is on track, whether it’s your first child, and you’re just not sure what “normal” is, or it’s your second or third child and he just doesn’t seem to talk as much as your first child did at a particular age. It’s important to note that there’s a great deal of variation in what is considered normal or typical when it comes to speech and language development. Here are some answers to common questions about communication development.

Read More

laurens hope


Language development? There’s An App For That.

July 8, 2013

At the end of a recent speech and language therapy session, I was allowing a preschool-age child to use my Android tablet as a reinforcer for having worked hard throughout the session. I opened an app that I recently added for my daughter to use and suddenly had a great idea. The app, PBS Kids Photo Factory, can be used to target location concepts, facial body parts, and size words.

Here are the steps to follow once you’ve downloaded the app:

  1. Tap the camera button in the app.
  2. Select “Take Photo” to take a picture of your child using your phone or tablet’s camera.
  3. Once you’re satisfied with the photo, tap the checkmark.
  4. Tap decorate, and select a show your child enjoys.
  5. Choose one of the characters by tapping it.

To target the comprehension of location concepts and facial body parts, you can have your child move the character around her face to different spots you tell her. Examples include:

  • Put Elmo next to you.
  • Put Elmo under your nose.
  • Put Elmo on top of your head.
  • Put Elmo between your eyes.
  • Put Elmo below your chin.
  • Turn Elmo upside down.

For the expressive use of these concepts, the adult can move the character around and ask the child, “Where is Elmo now?”

Elmo between the eyes

The characters can be made smaller or larger by either pinching or stretching them. Then, they can be used to work on size words. To target receptive language, you could give commands like, “Make Super Why bigger,” or, “Make Clifford smaller.” For expressive language work, the adult would change the size and ask the child, “Did Caillou get bigger or smaller?”

The one caveat is that your child cannot just be left alone with the device and expected to learn these concepts. As always, it’s the interaction with another person that counts. The device is merely a fun tool.

This activity is appropriate for older toddlers and preschoolers, as well as elementary-age children with language delays.

This app is available for iPod Touch, iPhone, Android phone, Android Tablet, and Kindle tablet.

What other apps do you know that can be used this way? Leave a comment to tell us!


Car Talk

June 4, 2013

With the summer upon us, many families will be traveling, yielding potentially many hours in a car or on a plane during which you will need to occupy your child. Below are a few ideas for entertaining your child, and at the same time, fostering his language development.

Play category games. These games help your child to better organize the meanings of words and how words relate to each other in his mind. They are also helpful for working on turn taking. Here are some ideas of categories in which you can take turns naming members.

  • colors
  • vehicles
  • foods
  • fruits
  • vegetables
  • clothes
  • Disney characters
  • super heroes
  • things with wheels (You can talk about how this is not necessarily the same as vehicles. Boats are vehicles without wheels. Suitcases can have wheels but aren’t vehicles.)

You can make the games slightly more complex by adding an extra feature to the category.

  • foods that are green
  • Disney characters that aren’t people
  • vehicles that don’t go on land

For kids who are a little older, you can make the task harder by making it an alphabet game. Take turns naming category members beginning with each letter of the alphabet. For example, if the category were foods, the first person could say “apple,” the second person could say “bagel,” and so on.

For preschoolers on up, you can take turns trying to come up with as many words as you can think of that start with a particular letter. For young children who aren’t yet reading and spelling, this requires the use of phonics (letter-sound associations) and phonological skills. For example, if the letter is M, your child has to recognize that M says /m/ and then think of words that begin with that sound. If your child is in speech therapy and is working on saying a particular sound correctly, this can be a great carryover activity.

There are also plenty of free printable games available on the web that are perfect for the car. Travel bingo and backseat scavenger hunts, in which your child looks out the window to find specific things, utilize attention and memory skills. This vehicle graphing activity is an easy way to work on early math skills. Once the graph is completed, you can talk about quantity concepts like more, less, most, and least.

As you can see, none of these games require you to bring a lot of extra stuff on your trip, but they can help fill what seem like endless hours in the car. What games do you and your family like to play in the car? Leave a comment to let us know!

backseat kid